Salzburg

From Munich, Kay and I caught the train for Salzburg. If this isn’t the most beautiful city I’ve ever seen, it’s in the top 3, and at the moment I can’t recall the other 2. It has the same fairytale quality of some of the German burgs, but it is nestled in the Alps and has peaks right in the town. There is the Hohensalzburg Fortress towering over the city:

Kay and I took the funicular partway up; it’s a good thing they have one because there was no way I was going to make it to the top on these aged knees. Kay and I had a drink at an outside bar at the fortress, and the view was spectacular.

Our hotel is in the old city, and the whole area is great for strolling. Plenty of Mozart-themed and Sound of Music memorabilia everywhere for them what likes that kind of thing. I’ve never really gotten classical music; I don’t dislike it, but the idea of sitting quietly in a concert hall and just listening to an orchestra play doesn’t appeal to me. They used to schlep us down to Severance Hall in Cleveland once a year to listen to what I’m told is one of the best symphony orchestras in the world. Their efforts to civilize me didn’t take. I have to admit that songs from The Sound of Music keep running through my head; when I get back to the hotel, I’ll have to ask the concierge if I can borrow a small hammer to beat against my head until “The Hills Are Alive” stops playing.

Speaking of mass media, if you are an English-only guy like me, it’s pretty slim pickings on TV back in the room in Deutschland und Austria. It can be a hoot to watch the Simpsons or Richard Burton and Liz Taylor in Cleopatra dubbed in German, and if you have seen the show/movie before, it’s not so hard to follow. My favorite so far was hearing the original Star Trek opening monologue in German. I offer it below courtesy of YouTube:

One thing they do very well here is coffee. Kay and I went to a little cafe for breakfast, and I got something called an Einspänner, which is a shot of espresso topped with whipped cream. The waiter gave me the option of having a chocolate truffle nestled in the whipped cream, but that seemed like overkill. Wikipedia tells me that the name “Einspänner” “refers to a one-horse carriage, with the cream topping serving to insulate the coffee and keep it warm for the driver.” Not sure I get it, but the coffee was good; so were the bacon and eggs.

Back at the hotel, they have a free pool and sauna. The etiquette is a bit complicated if you are not familiar. In Japan, it was pretty straightforward. The hotel provided an outfit to wear down to the hot tub; I’m reliably informed that it’s only an onsen if the water comes from a hot spring. I’m not sure what the Japanese call a hot tub with water that just comes from the city pipes. These days, the vast majority of Japanese onsen/hot tubs are single sex. You strip down and sit on a little plastic stool in a small cubicle and wash thoroughly, then you can enter the pool.

It’s a little different in Germanic countries. For one thing, the saunas are shared by men and women. You have to wear a suit in the pool for reasons that are not clear to me. It took me a while to figure it out, but you enter the sauna area, shed your duds, shower up, and enter the sauna au naturel. In the hall or on the way to the sauna, you wrap up in a towel. It’s pretty complicated. Also, the second night, I went into the sauna, and it wasn’t hot. I needed help from the concierge, but how was I to know that going to the lobby as God made me was a faux pas? Apparently ordering a drink at the adjacent lobby bar only made things worse.

Once I explained, the Salzburg police were surprisingly understanding. They agreed there would be no legal complications, provided I left the country tomorrow and never come back. So after breakfast, Kay and I depart for France. Stay tuned.

Addendum to Salzburg: Striding Through Germany and Austria: Castles, Cobblestones, and the Curious Case of Crutches

Kay and I have been wandering around German cities for almost two weeks now, and one thing keeps catching my eye. It isn’t the castles, the cobblestones, or even the bakery windows that somehow fill themselves with pretzels and pastries each morning—it’s the crutches. You see people everywhere, men and women, young and old, swinging along on a pair of aluminum forearm crutches; trekking poles are also common with both young and old. At first I thought there must be an epidemic of sprained ankles or long waits for hip replacement. Germans do love to hike, after all. When Kay and I were riding the cable car up Mount Wank (OK, I warned you about the sniggering), I could see folks bounding up the mountainside like goats. But the more I watched, the more I realized: it isn’t that they’re falling apart—it’s that they use crutches differently than we do back in the States.

In Europe, crutches with a cuff around the forearm are standard issue. In Germany, if you sprain a knee, break an ankle, or tweak a hip, the doctor sends you home with a pair of wrist crutches. They’re light, balanced, and easy to use. Back in America, the moment you hear “crutches,” you picture the underarm specials, the ones everybody learned to walk with in high school after they landed badly after a layup. Those are the American default—big, clunky things you squeeze into your armpits until your ribs feel bruised and your hands are throbbing.

Why the difference? Some of it is practical. Forearm crutches are easier on the body in the long run. They don’t pinch nerves in the armpits, and they let people walk more naturally. Germans also walk more in general, and since driving isn’t the automatic solution for every errand, it makes sense to equip people with crutches suited for the sidewalk and subway as much as the living room. Add in that their insurance covers them without much fuss, and it isn’t surprising you see them so often.

But if you look behind the scenes, there are plenty of reasons the U.S. establishment hasn’t changed its ways. Years of American medical training have built habits around axillary crutches (Those are the armpit versions), and clinics stick with what they know—plus, these are cheaper and easier to supply in bulk for all those short-term, post-injury needs. Insurance coverage follows the same groove: pay for what’s common, fast, and familiar. Then there’s the question of perception—forearm crutches in the U.S. still carry an air of permanence, almost like wearing a sign that says, “This isn’t just a sprained ankle; this is a long haul,” so most folks avoid them for short-term injuries. Meanwhile, ergonomic research keeps piling up, showing forearm crutches are less likely to cause nerve compression and encourage a better posture—yet, inertia wins the day, and the armpit-crushing models continue their reign.

There’s probably a whole grab bag of reasons American medical folks keep handing out underarm crutches, and it goes well beyond old habits and plain old stubbornness. Some of it is simple caution—nobody wants a patient tripping over themselves on a pair of “fancy” new crutches. Underarm models may be rough on the ribs, but they’re familiar, easy to size, and just about anybody can use them right out of the box. Picture an ER nurse trying to send a wobbly retiree home after hip surgery; she’s not risking the hospital’s reputation (or her own sanity) by introducing gear that might require a training video, a lesson in posture, and a note from legal.

Then there’s the supply closet—a land of bargains and bulk deals. Hospital buyers have buying protocols and insurance red tape to navigate, and nobody’s eager to file paperwork for another “non-standard device.” Add in the fact that medical supply reps can barely get the lighting fixed, let alone convince anyone to rethink mobility for the masses.

And, of course, there’s what everybody expects. Americans see TV sprains and schoolyard tumbles propped up on underarm crutches, so that’s what feels “normal.” So, even though the sidewalks of Munich and Salzburg are bustling with people cruising on forearm crutches and trekking sticks, in the States we keep on limping along, armpits pinched, waiting for the future to finally catch up.

So, “safer” and “easier”? Maybe for day-one users who just want something familiar. But over the long haul, the European approach probably has the edge—especially if you value wrists and dignity over sore pits and bruises. Sometimes, making life better just means letting go of the ordinary, even if it takes a little extra balance. The supposed “safety” and ease of underarm crutches is really in the eye of the beholder—or, more likely, the inventory manager. Sure, they’re the familiar option, and most people can stumble out to the car without an instructional manual. Clinical studies actually show forearm crutches give more freedom and less risk of nerve damage. They demand a tad more coordination, maybe, but the payoff is real comfort—no bruised ribs, no awkward shuffle, and no posture that makes you look like a marionette with a pulled string.

Part of the problem is something I noticed when I started working as a school psychologist in the early 80s. Here in the US, we generally have public money for acute problems. If a kid gets to 8th grade and is reading at a 2nd grade level, the whole special education/IEP process kicks in, and we have meetings, and elaborate educational plans are drawn up. But lots of this could be avoided with the proverbial ounce of prevention. We could provide social skills groups, lunch clubs, and routine check-ins with the guidance counselor or school psychologist for all children and adolescents. It does happen, but not often. Many years ago I was involved in a case in which a high school-aged student with Down syndrome was being bullied. I was working with a lawyer named Michael Chamberlain who came up with a genius plan. He approached the captain of the football team and asked if he would take the student under his wing. The football captain spoke to his teammates and our young friend became part of the football group. He sat with them at lunch, and attended all the games, sitting with the team on the bench, and they even got him his own version of a letter jacket. The young man’s mood improved greatly, and the bullying stopped cold; nobody wanted to mess with a kids who was tight with the team’s middle linebacker. But it occurred to me, what about all the intellectually impaired students who were not lucky enough to have an educational lawyer? You guessed it, shit out of luck. We do a good job with crises; things like primary prevention and harm reduction, not so much. Same with orthopedics, it seems.

So, if you see a German strolling past you effortlessly with crutches or a set of trekking poles, don’t assume that they fell down the stairs earlier in the week. It’s just another example of how culture, healthcare, and habit shape the little details of life we usually take for granted. Even something as simple as how you hobble down the street can tell a story about where you come from.