2 Years to the Day!

Another Memorial Day Weekend, and some time to think and write, and return to an old medium, where I can reflect and where my thoughts don't pop up on the screens of "friends" from the Facebook universe…. not that I don't like Facebook, but it doesn't usually encourage me to the kind of introspection that I like to treat myself to, and share, on an irregular basis.

I guess the first question is how many of my old friends are still on LJ? And how many have moved on to Facebook or other social media sites?

I owe, whoever's still there, an update, and, with the understanding that I may be largely talking to myself, at least I'll have the chance to summarize what's happening.

Sort of working my way backwards…. Yesterday, Lin and I, in her new Tesla P85D, went to the Keck School of Medicine of U.S.C. Annual Luncheon at the California Club on Flower Street in downtown Los Angeles. The Tesla is a wonderful stealth vehicle that is both a luxury limousine and a dragster, and you can guess what aspect of its personality appeals to which of its occupants. We arrived safely and were shepherded to the same table as 3 other classmates (about 72 didn't show up, some with very good reasons, as we're just about all octogenarians, or nearly so, and too many have hung up their stethoscopes forever. Passed on, in a better place, decomposing… depends just how existential you want to be. I miss them. Like old army buddies, I guess, as we were in many of the same trenches together. Ed Bloom, almost retired ENT who still works part time at Kaiser, Joe DeFrancisco who retired from OB/Gyn 19 years ago, and Willa O'Day, a retired pediatrician who remains very active in fund raising and in a fraternal organization that is tied to the Catholic Church, and myself, were the class representatives, and there was the recounting of who we were in touch with, and how they were doing, and the roll of the missing. It's funny how much I now appreciate the socializing that I had so little appreciation of in my younger years. Phil Manning, 94, looking like he was in his 70's, our former teacher, introduced the speaker, a third year student, who gave a speech that was not particularly memorable, but our medical school dean, Carmen P., a Harvard man, and a fund raiser extraordinaire, brought me to near tears by thanking the doctors present on behalf of the patient they served, many of whom had no idea what sacrifices and considerations had been extended. The Trojan Band marched in and played "Conquest," and "Fight On!" and I thought about my undergraduate days at the Coliseum booing those rich kids, and cheering on the Bruins, never imagining that USC would offer me a very safe harbor and a future doing what I love, while UCLA thought there were better candidates for their medical school. So I raised my right hand in the Winston Churchill "V for Victory," that USC has adopted as their own, and applauded my alma mater. The salmon was healthy and wonderful The chocolate, peanut butter cream dessert was… wonderful! My diet, again, was held in check for another day, and we 4, were the last to leave, vowing to come back next year.
  • Current Music
    The sound of breakfast plates clacking away in the kitchen

4 Hours 10 Minutes to Zero Hour

We're celebrating Memorial Day weekend with the Bjurstens in Corte Madera. Peter, my son-in-law, has always had a special interest in the B-17, and we've visited one together at the Chino Air Museum. My fantasies were always more in the direction of fighter planes, the Spitfire, in particular. A month or so ago, while perusing the AAA magazine, Lin showed me an advertisement for the Collings Foundation, and their Wings of Freedom Tour. It seems that a private foundation that maintains flying aircraft of historical interest was coming to Livermore, 55 minutes away, to offer B-17, B-24 and P-51 rides. The price for the B-17 was $425 of which $300 is a deductible charitable contribution. 22 years ago, or so, Lin had surprised me with a Spitfire flight, out of Aspen, CO, with Bill Greenwood's Spitfire TR9, which is the highpoint of my fantasies, actualized. Knowing Peter's love of history and the B-17, I purchased a copy of "Mission to Berlin," by Robert F. Dorr for him and one for me and I'm 2/3 finished and enjoying every moment. I called Becky and told her about the flight, and she thought it would be a great birthday surprise. I will join Peter in the flight, hoping they have a ladder or a winch to haul me on board. I've assured Becky that it should be safe, and compared 4 Wright Cyclones holding the plane in the air to the one Rolls Royce Merlin that powered the Spitfire. The Flying Fortress will fly on 2 engines, and if the Spitfire loses its single engine, it becomes a very ungainly glider. It will be a surprise for Peter, as only Becky, Lin and I know where we're headed. We'll have our books along and our cameras.

This is the plane as captured on YouTube and linked to the Collings Foundation website. Hope it's a "piece of cake."

Seat 15A Swallowed My Passport!

The events of April 12, 2013 ~ 2 PM, PDT

It happened most innocently enough. I was lying nearly flat on the wonderful business class seat. The contents of my trouser pockets were pressing into me and I emptied my wallet, credit card case, the Crystal Symphony key case and photo case into the little blue drawstring bag that ANA supplies to hold their toothbrush and toothpaste, eye cover and sleep promoting tea, or aroma… Lin’s and my passport were safe in my left breast pocket with my glasses and pen. I had slept for at least three hours and I was feeling a bit restless. I turned to my left from the horizontal position of this seat and I felt something begin to slide. Before I could arrest the slippage, I heard a two part thunk, as something left the pocket and slipped out into some space between the window seat and the fuselage’s internal plastic covering. I reached into the pocket and Lin’s passport was still there. Mine was gone.

The potential destination of the passport had to be between the fuselage and the chair, or between the various components of the chair’s left arm, the left side of the seat cushion, or the mechanical and electrical devices that permit the chair to go from vertica to horizontal. The spaces within that arm rest and the seat were just wide enough to permit the fairly dense passport to slip through, and its weight to carry the little book down into the recesses of the mechanism. Fingers could not slip into the space, and the penlights of the two lovely ANA flight attendants could not adequately illuminate the tiny space.

The attendants tore out seat cushions exposing the horizontal surface of my seat, but the vertical surfaces could not be moved. The passport had disappeared into thin air, its path marked only by the thump of its coming to rest against the bottom of the seat or the cabin floor.

There is a gentleman sleeping in Seat 16C, and no one in 16A, the window seat directly behind mine. When he wakes up, or we land, we still have the possibility of reaching under 15A from behind and retrieving the passport. If that fails, I am about to learn what happens to someone who takes off with a passport and lands without one. I have visions of “The Man Without A Country,” destined to travel forever aboard a ship and never to be permitted ashore, or taken into custody by Immigration, particularly since I have a Santa Ana address and connections at Clinica La Amistad, as well as a funky Castilian accent. Even my attempts at Hebrew reveal a sinister Ashkenazic accent, linking me to an Eastern European shtetl ancestral origin. The beard, the subscription to The Nation, an NPR supporter…. A believer in the Single Payer Health Care dream of Liberals…. A history of odd bumper stickers…. The charges are piling up.

What will immigration say when I say, “I don’t have my passport.” They will say, “You lost your passport?!!!” I will say, “No, I know where my passport is. It’s just not accessible until the plane is scrapped, or the seat is removed.” Then, I will be taken away and grilled. They can’t waterboard me… Can they? I have nothing to confess to except not safeguarding my passport, but who would suspect a business class seat of being the agent of my undoing. I can’t say it with a smirk, or even a smile, although I can see the humor before the consequences arrive.

It’s 3:15 PM, PDT, less than 3 hours.

It’s 4:33 PM, PDT, on Friday, April 12th. 8:33 AM, on Saturday, April 13th in Japan. We’ve just had a filet mignon, sake, miso, and a cheese plate. The gentleman in 16C enjoyed his dinner and our lovely flight attendant, Kimiko Ozaki, found my passport, apparently quite easily just under my seat, toward the back-left side. The passport is safely back in the left breast pocket and I will be ever vigilant. We’ve just passed over the Golden Gate Bridge, so Becky, we’re right over your house. Cheney, Woolfowitz, the FBI and the CIA have totally lost interest in this tubby, old nephrologist who is just bringing home some tee shirts, and purses, and tea cups, and a lot of wonderful memories. No extraordinary rendition, no visit to the security apparatus of a police state. The ANA staff and flight was a pleasure. Just don’t take one left turn, too many!

Book Review: "Life's Too Short to Cry: The Compelling Memoir of a Battle of Britain Ace", Wing Comm

Life's Too Short to Cry: The Compelling Memoir of a Battle of Britain AceLife's Too Short to Cry: The Compelling Memoir of a Battle of Britain Ace by Tim Vigors

My rating: 4 of 5 stars

View all my reviews

The biographical entry in Wikipedia appears to barely brush the surface of a most interesting life.
I would love to know more about him and his career. I note that he was married four times and flew a Spitfire, placing him very close to my heart.

Farewell to an Indomitable Spirit

He died on December 18, 2012, following a liver-kidney transplant several months ago. This was his second kidney transplant, the first, coming from his mother, was done in 1976, and functioned successfully until April 2010, when he was started on hemodialysis.
He was gainfully employed until very recently, despite 3 times weekly hemodialysis, which was done in the early evening, to allow him to continue working. The transplanted kidney worked for 34 years. He had been born with congenital abnormalities that caused urinary tract infections in very early childhood, and corrective urologic surgery was needed, but still a transplant was required, when he was 7 years of age.

He was short in stature, undoubtedly because of the early onset of kidney disease. The strain on his mother and his family were enormous, but they were there for him, and somehow, despite this enormous challenge, he received his education and assumed a very responsible position in a financial corporation. He was married and had an extremely supportive wife and son. His wife accompanied him to his dialysis treatments.

The anemia that accompanies renal disease required transfusions. Somewhere, along the way, before Hepatitis C could be detected in blood, he received a contaminated transfusion. The disease was diagnosed years ago, but therapy requiring interferon would have caused rejection of the transplant, and in consultation with gastrointestinal specialists, a decision was made not to treat the hepatitis with the hope of arresting the progress of cirrhosis, at the loss of the kidney.

So he continued to work and to enjoy his family. By 2010, he was having episodes of confusion due to ammonia accumulation related to his liver disease. This was treatable, and even as the transplanted kidney failed and he started dialysis, he continued to work. He was a fighter…. an indomitable spirit.

On dialysis with kidney failure, he suffered encephalopathy from liver failure, controllable by diet and by unpleasant medication that caused a therapeutic diarrhea, that interfered with his life… his ability to work. He didn't always take all of his medications the way the doctor ordered, but bright as he was, he controlled the diarrhea and the encephalopathy, and he continued to work.

He needed a transplant of a kidney and a liver. Our hospital, with a superb kidney transplant program, could only offer him a kidney, and that wasn't enough. So off he went to UCLA, and then to UC San Francisco, and off to UC San Diego. Records and phone calls, and still he worked.

Finally, Cedars-Sinai put him on the list. Then there was staying on the list, and working your way to the top of the list, the MELD score. There were the ups and downs of chemistry changes, lab values going up and down, and intervening events that landed him in a hospital ER, and threatened his hold on the number one spot on the liver-kidney transplant list. There was a moment during an alumni event that I recorded previously that will give me a belly laugh whenever I think of it. We got over the obstacle and finally he got his liver-kidney transplant, but things did not go well, or smoothly.

Many of the events following the second transplant occurred at CSMC or at his new dialysis unit, closer to his home, where he was attended by another nephrologist. His course was complicated and the last week or two, he was at Cedars. He underwent a laparotomy, and as his wife describes to me, "They found a recurrence of his hepatitis and said they could do nothing more for him. He went onto hospice, but he continued to want to live."

Well, that was the man I knew and respected. It wasn't easy to be his doctor, but it was an honor to try to help this great little fighter, and a special kindness to me that I wasn't there when his battle finally ended.

I extend my respect to his memory and honor his existential battle. I admire the constant support of his wife, son, mother and all of his family, who understood the events that made him such a determined fighter, if, often, a challenge in their lives, but one they willingly assumed. Sometimes its the patient who are the heroes and heroines. Often, it is their loved ones.

I assure you that I will never forget him. He died on the same day my oldest daughter was born, December 18. that day will never pass without his memory surfacing in my thoughts.

A Rant on Free Offers and Internet Frustration

This was psychotherapy….. It really is a great espresso maker. Letter sent off today, before I visit the hospital. No, the regular hospital. Not the psychiatric hospital.

December 21, 2012

The Nespresso Year End Promotion
24-01 44th Road, 12th Floor
Long Island City, NY 11101


The Nespresso CitiZ & Milk is a beautifully designed and manufactured Espresso Maker which we first bought as a present for our daughter and loved, and then bought our own via Sur la Table, by the internet, and then I have spent the last 3 hours inputting information and revising that information to respond to error messages, appearing on 2 different computers. I have copied receipts, phoned for the receipts, changed formats from Excel to .jpg and then phoned in to your support, where I received the following message, “..We are experienced more than the usual delay….etc.” 30 minutes later, a most polite lady guided me through the process that I had just performed, using the serial number without spaces and with spaces, and then submitting. The internet site then erased all of my input and I started again! And again. And again.

Now I’m writing to you, because I love the design and appearance of your espresso maker, and I love the espresso it makes, and the froth, and its speed. And I love Nestle Crunch Bars…. A bit too much!

I don’t love your website! Stuff happens. I have a good sense of humor. I’m laughing as I scratch out this desperate note. I’m a nephrologist and I have had a long career, and need lots of espresso to keep myself going. My wife loves bargains. $100 worth of coffee credit, looked to her, like a great bargain, but she doesn’t enjoy reading instruction manuals, and she has no real facility with the internet and computers so I’m delegated to those chores.

Even with the very poor state of reimbursement for the medical services I render to Medicaid patients and indigent patients, my time is still worth $100/hr to the government and to the insurance company. I figure that should a $100 reward ever reach my wife, I will be about $200 behind in the time spent. I’m writing this because it is therapeutic to express one’s frustrations and not take them out on the family dog or the unfortunate motorist who commits some minor infraction in front of me.

Would you please note that your site requires some tuning and that you have a fan who still likes your products, if not your internet page.

Sincerely yours,
  • Current Music
    The Generals (Unabridged) Part 2 - Thomas E. Ricks
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A Dinner with Lin and Sylvia

Lin, my wife, has done incredibly well over the years despite her multiple sclerosis. Much of this is the slow progression of the disease process, but an awful lot of that is her positive attitude. She simply does not focus on the limitations, but concentrates on what is not limited, and keeping her ability to walk and her strength maximized. In this vein, for greater than a year, she has been regularly going to a gym, with an exercise program that has built up her strength in a very positive way. Her trainer, Sylvia, has become her friend. Actually, anyone who Lin interacts with for any length of time, including lines at the bank or the super market, is likely to become a friend. When Sylvia got married last summer, we were invited, but we were in Chicago with our grandsons. So last night, we got together with Sylvia at our favorite Vietnamese restaurant, Long Hai, in Tustin. Her husband, who aspires to be an occupational therapist, was out for a football watching evening with his buddies, but Sylvia had committed to this dinner.

Over egg rolls, spring rolls, crab wontons, bun, teriyaki salmon and orange chicken, I got to know a very interesting young lady who had attended college with a major in religious studies, wanting to be a missionary, but especially, wanting to travel. She worked as an au pair in New Zealand and Fiji, her last job being with an Italian furniture manufacturer and his Iraqi wife, caring for their 2 year old. Our conversation ranged from the challenge to pay for an education to be an occupational therapist, to the limitations of being raised in a society where entitlements go unrecognized, and where one's station limits the development of empathy. Sylvia is empathic. It was a lovely evening, and I did not greatly miss the Titans vs Jets game, or even the PBS Evening News. Sometimes, its nice to be social. I must remember that.

Oh, and Lin (and I) loved to recount how we had met and fallen in love. On second thought, perhaps the very best part of the evening was the action that I toss in so casually at the end. The retelling of a love story that remains so fresh and so vibrant. Isn't love what makes the world go round, and the antidote to existential anxiety?

Newtown, Connecticut and Tucson, Aurora and Oak Creek - Gun Violence

So sad to see the president speaking from Newton, CT in an effort to console the grieving loved ones of those slain in the insane shooting of school children and their teachers, on a pre-Christmas Friday, by a madman, whose mother had a fascination for guns, and an apparent denial or a functional paralysis in coping with the mental illness of her son. I looked at a few pictures of innocent children, of brave school teachers, and I'm sad that the majority of our society that opposes gun violence, has been powerless to confront the NRA and those in its pay, and under its influence. We need leadership, and I hope that President Obama rises to the leadership challenge that this tragedy demands.

The President acknowledges that this is the fourth time that he has come to an area to console the victimized families. "Are we prepared to say that we are powerless in the face of such carnage...."

It was more sermon than plan. Hopefully, the plan will come later. It better!
  • Current Mood

Congressman Raul Ruiz, M.D., Democrat, Bruin

He defeated the incumbent, Mary Bono, in a bigger upset than the Bruins delivered last Saturday. I wrote him the following message:

I can't tell you how thrilled I am to see that you, a Democrat, a Physician, a Latino, a Bruin (and a Harvard Graduate..... maybe you couldn't get into UCLA's medical school, as I couldn't in 1958, but you chose a considerably more prestigious alternative, than I {USC, Class of 1962}) are now Congressman Raul Ruiz, congressman elect. I once dreamed of running against "Bomber Bob" Dornan, in Garden Grove, a seat now held by Loretta Sanchez.

This message is just to tell you how much hope and inspiration you infused into this old warrior. I'm Orange County's longest serving nephrologist, and I've focused on the Hispanic community since 1967, when I was deferred from the Viet Nam War to start dialysis in Orange County. I was a Eugene McCarthy Liberal in John Birch country, an early advocate for Single Payer Health Care and PNHP, and even managed to make it as far as the Board of Directors of the Orange County Medical Association. I searched and searched for a bilingual nephrologist coming out of the Mexican community for a partnership and would still welcome the opportunity to pass my practice along to someone with the sensitivities to care for the people that I serve. I volunteer at Share Ourselves Clinic (Costa Mesa), Clinica La Amistad de San Jose (Orange) and Lestonnac Free Clinic (Orange), where my Chicago secondary school Castillian Spanish draws peels of friendly laughter.

I'd love to meet you sometime, and I have no hidden agenda or favors to ask. I'm simply proud to have you as a professional colleague, a fellow alumnus, and a Latino physician Democrat! Buena suerte y felicidades!