March 2008

Translating Truth

Translating Truth, Multiple Authors ★★★★
This book is a discussion about theories of translation of the Scripture into the vernacular and is written by a group of most venerable scholars, most of whom were involved in the ESV translation, including JI Packer, Wayne Grudem, Leland Ryken, Jack Collins, Vern Poythress, and Bruce Winter. My interest in this book stemmed from multiple comments about the use of essentially literal vs. dynamic equivalent translation techniques. The book was quite effective at persuading me about the value of essentially literal translation techniques. I realize that there was a time when missionaries paid obeisance to dynamic equivalence, claiming that their audience would not understand various words such as “sheep” or “justification”. In the process, the gospel is dumbed down. Indubitably, many passages in Hebrew and Greek have double meanings, and perhaps both meanings are correct. Perhaps the original language is simply uninterpretable or challenging to understand; in those situations, the translator should not attempt to force on the reader a single interpretation. The book was quite readable, although I’m sure I would have understood it better with a better knowledge of Hebrew and Greek. Oh well.


Global warming has struck the far corners of the earth, including the humble little hamlet of Puyallup, Washington. On the sixth day of spring, while the rhododendrons were contemplating the blooming process, a horrific snowstorm smote our kleine Dorf, and the evidence of snow was found in both our front and back yard. Unglaublich! It’s spring! I’m busy polishing up my bicycle, getting ready for a season of centuries and road miles. The snow has dampened my bicycle spirits. It’s awful, coming out to your car in the morning, and having to scrape off snow…

Even Katze found the snow intriguing…

So, the thoughts go to politics. Perhaps my feelings are best portrayed by the bumper sticker…

Unfortunately, it doesn’t mention the Republican Party bimbo, McSomebody. It’s tough being a Ron Paul advocate, seeing that the Amerikan Kingship is going to be some liar, cheat, and fool. Maybe the army will take over. Or, perhaps Mexico will invade. This week, we learned that Chelsea’s mama evaded gunfire in her visit to Bosnia, only to have the news clips show the opposite. We also learned that Obama’s book about daddy failed to mention some important fact, like, that he was a womanizer that ran out on mama, and was an uncontrolled drunk that killed others and then himself while on the bottle. Voll wie eine Haubitze!  Sinnloss betrunken! Sturtzbesoffen! Sag es, wie du willst. Obama seems a little confused about daddy. He and Chelsea’s mama would make a great pair.
So, I haven’t done any major bike rides, and ski adventures were thwarted for various reasons. I also suggested to my surgical group a moderately high possibility that I would be gone if my work style could not substantially change. We’ll see. I’ve done a few large cases in the last few weeks, including one done last evening with Dr. King, taking out a 4 kg 26 cm mass from some lady who thought that she was just putting on a little weight…

I am trying to separate the bowel from the tumor and had to resect about 20 cm of the ileum (small bowel) along with the tumor. In the pan, tumors all look the same…

Well, enough for grossing out my fan club.
Next month, you’ll get a report of Betsy and my trip to Deutschland/Österreich. I’ve updated my Über mich page, as well as added a few music and book reviews.

The Climb

The Climb – Tragic Ambitions on Everest, by Anatoli Boukreev and G. Weston DeWalt ★★★★★
Having just read “Into Thin Air” by Jon Krakauer, I felt it necessary to get another viewpoint of the 1996 Everest Tragedy. Krakauer certainly had a smoother writing style, though Boukreev remains the more believable author. Both detail the facts as they saw them that led to the death of six climbers on Everest in one day, though Boukrrev gives a far more plausible explanation as to the mistakes, and errors in judgment that occurred not only among the guides but also among the clients in several expedition groups competing with each other for the summit of Everest. Errors in supply tactics, preparation of the client climbers, organization of Sherpas and other personnel, and overestimation of ones’ own energy and endurance were skillfully laid out by Boukreev but totally glossed over by Krakauer. Both books will hold you spellbound until the end–such an event needs no elaborate journalism to portray the hopes, the folly, and the extreme conditions that all faced attempting to claim the distinction of having climbed the tallest mountain in the world. As for me, I’ll stay a little lower down on terra firma. If you had to choose between the two books, this would be the preferred.

Stockhausen: Stimmung

Stockhausen: Stimmung, Sing Circle with Gregory Rose ★★★★
During a recent operating room conversation with Herr Doktor Peters, an anesthesiologist, and expert in classical music, he wondered whether I had any Stockhausen. I didn’t. So, now I do. Karl Heinz Stockhausen was among the Avant-Garde experimental composers in the 60’s and 70’s. This is a wonderful example of that creative output. It definitely will generate many comments. Most will note that it is not music. Of course, then, we lapse into the lengthy discussion of defining music. Let’s not go there. Needless to say, this is a cohesive collection of vocal sounds that seem to have some pattern or flow to them, and not much else. I guess if I was truly into late 20th-century music, I might have a better understanding of this work. But, having listened to this work about 4-5 times now, I find it quite valuable to play in the operating room as background “music”. Once you’ve listened to this recording, you’ll know why music is in quotes.  You may soon hear more in Kritik about Stockhausen.

Haydn: String Quartets

Haydn: String Quartets, Aeolian String Quartet   ★★★★★
A set consisting of 22 CDs, it is worth every minute of listening time. These quartets are performed with great soul and vibrant feeling. Though one might expect classical era quartets to be soporific, these are everything but that, manifesting the profound genius of Haydn. I have other performances of the Haydn string quartets, which are quite enjoyable in their own right, but remain limp when compared to the performances on these discs. The recording technique itself is quite brilliant and forward, quite like you were in the room with these performers. A special treat with this series in the last CD, which is Op 51 Die Sieben Letzte Worter unser Erlöser Am Kreuz, well performed, but intermixed with poetry readings by Peter Pears. I heard this performance many years ago on plastic, wondering where it would ever show up again since I didn’t remember the performers. The mixture of Pears and the Op 51 quartet is especially effective… I’m not sure if Haydn actually wrote it that way, though I wouldn’t be surprised. All in all, these recordings should be in every respectable classical collection.

The Lexus and the Olive Tree

The Lexus and the Olive Tree, by Thomas Friedman ★
Initially, I was going to give this book a few more stars, until Tom grew a touch weary to me. For a journalist, Tommy boy remains a putative total expert on international economics, national economics, international relations, and is single-handedly more responsible for world peace than any other journalist alive. He alone understands. So, what’s so good about this book? Mr. Friedman is a great storyteller. He’s a journalist. It is delightful to learn that other countries behave in ways that are different than in Amerika, but, don’t worry, globalism will solve that. This book was moderately enjoyable to read since Friedman is excellent at generating thought while reading this book, I was constantly awash of comments to write. Only a few will make this Kritik. Maybe the best criticism is that I have another best seller of T. F., “The World is Flat” sitting next to me, which I don’t think I’ll waste my time reading… I have a reasonable feel as to Tom’s thinking and really don’t need any more of it. At first, you begin to feel that Tom is a right-wing Republican. He advocates government non-intervention in the markets and the absence of trade barriers or restrictions. He advocates for morality as the principle fuel that drives a market, and the absence of integrity as the prime extinguisher of globalization, thus, the term golden strait-jacket. So, you then learn that Friedman went through an evolution in learning to get to the truth, and this evolution came only through seeing such as the poor in Rwanda, which informed him that freshman Republicans had no clue at all about the world. Only Tom knows. Friedman fails to suggest whether he has reached an apogee of learning, or, perhaps, that he may have to unlearn certain things. Friedman need not travel in order to learn what his enlightened self now knows – the ride in Disneyland called “It’s a small small world” would have taught him everything he needed to know. His experience in Rwanda taught him the mistake of the second amendment ( right to bear arms) and the necessity of the government’s forced distribution of wealth. The only conservative notion, he doesn’t take shots at is abortion, which makes me quite surprised. Throughout the book, he makes quite asinine statements, such as the fact that Amerika has a huge bankruptcy rate is a good thing since it represents a system that tolerates mistakes (but no mention as to where that lost money came from?). He suggests that Europe, notably Germany and France are somewhat inferior to the US in market integrity (book written before the fall of Enron and bank failures of 2008, or the massive loss of value of the American dollar over the Euro). He supports market integrity without accepting that the individual integrity of a country’s citizens is perhaps the most valuable asset a country could ever have — personal integrity has no place in Friedman’s thesis. Globalism has it’s problems, and Friedman enumerates them but concludes that globalism alone will save the world, especially poor, renegade countries. They need to speed up and make a flying leap onto the express ICE train flying by them. They need to accept that an intangible but totally irrational market, deeply controlled by hunches and propaganda, will influence their well-being significantly. Oddly, part of the reason I enjoy visiting Europe is that things are slower, and people thus think better. There is no greater joy than taking a long stroll with Onkel Herbert to the Biergarten and then solving all the world’s problems. Sadly, things will slow down, but in a totally cataclysmic way, especially for the USA, which, like Friedman, lusts for maintaining Amerikan world hegemony, at least in terms of markets. Friedman views the past as simply sentimentality (what’s old is mold, what’s new is true). Rather, I challenge that the book of Revelation talks quite plainly about globalization since it has always existed in one form or another…
After this I saw another angel coming down from heaven, having great authority, and the earth was made bright with his glory.  And he called out with a mighty voice,
“Fallen, fallen is Babylon the great!…
For all nations have drunk
the wine of the passion of her sexual immorality,
and the kings of the earth have committed immorality with her,
and the merchants of the earth have grown rich from the power of her luxurious living.” …
And the kings of the earth, who committed sexual immorality and lived in luxury with her, will weep and wail over her when they see the smoke of her burning.
They will stand far off, in fear of her torment, and say,
“Alas! Alas! You great city,
you mighty city, Babylon!
For in a single hour your judgment has come.”
And the merchants of the earth weep and mourn for her, since no one buys their cargo anymore, cargo of gold, silver, jewels, pearls, fine linen, purple cloth, silk, scarlet cloth, all kinds of scented wood, all kinds of articles of ivory, all kinds of articles of costly wood, bronze, iron and marble, cinnamon, spice, incense, myrrh, frankincense, wine, oil, fine flour, wheat, cattle and sheep, horses and chariots, and slaves, that is, human souls….
The merchants of these wares, who gained wealth from her, will stand far off, in fear of her torment, weeping and mourning aloud,
“Alas, alas, for the great city
that was clothed in fine linen,
in purple and scarlet,
adorned with gold,
with jewels, and with pearls!
For in a single hour all this wealth has been laid waste.”
And all shipmasters and seafaring men, sailors and all whose trade is on the sea, stood far off and cried out as they saw the smoke of her burning,
“What city was like the great city?”
And they threw dust on their heads as they wept and mourned, crying out,
“Alas, alas, for the great city
where all who had ships at sea
grew rich by her wealth!
For in a single hour she has been laid waste.   (excerpts of Rev 18 ESV)
Nobody would have thought that the Galilean fisherman John would see the world so clearly as to predict global economic collapse, using Babylon as representative of world politics and commerce. So, we await the continued journey of Tommy Boy, and what new revelations will strike him in his visits to the ends of the earth. I’ll use others of lesser status, such as fishermen and tentmakers, to help define my Weltanschaaung.

Complete Book of Road Cycling Skills

Complete Book of Road Cycling Skills, by Ed Pavelka and the editors of Bicycling Magazine  ★★★★
Okay, I’m torturing you with a review of yet another bicycling book, also written in part by Ed Pavelka, but with a different focus, looking a road biking in general, rather than simply talking about long-distance riding. The book is divided into 8 parts, which I will not review, but each focuses on some aspects of bicycling, such as training, riding in traffic, medical problems with bicycling, etc. Each chapter was mostly 3-4 pages long, and thus easy to read in short spurts. All in all, an excellent book for somebody just starting out in the road biking world.

Wagner: Tristan und Isolde

Wagner, Tristan und Isolde, Bayreuther Festspiele mit Daniel Barenboim, 1983 production, Tristan René Kollo, Isolde Johanna Meier  ★★★★★
First of all, if you are not an inveterate Wagner fan, don’t waste your time on T&I. You will go crazy. If you bleed Wagner, then this is a must. The production was superb, with excellent props and design, and Kollo was the most stupendous Tristan I have ever seen. Having seen a more recent production of T&I using a modern staged genre and Isolde as Janet Eaglen, I longed for a more traditional approach. While Eaglen had a perfectly splendid voice, her morbid obesity did not fit the bill for an Isolde, who is supposed to be young and sexually irresistible–Janet was uncomfortable to watch because of her massive overweight. But, back to this production. I typically perfect many conductors over Barenboim.  Yet, Barenboim remains first-rate, it is just that Karajan, Solti, Fürtwangler, and others do a more convincing overture and direction of general orchestration. This production gets 5 stars for its absolutely unbeatable love scene in Act 2 between Tristan and Isolde, and for the entire third act, so sublimely performed, up to the knock-out Liebestod by Meier.  All in all, this is my preferred dvd version of the opera.

Another Day in the Life of Kenneth A. F.

What does one write when one’s life lacks significant events. True, as you can see in the Kritik section, I’ve been cross-country skiing, I’ve been appreciating the arts, I’ve been busy. Most of life’s best moments are not earth-shattering.  I’ve gotten back into the grand scheme of things, which is probably not good for my health, in that I’ve been quite busy at work, especially doing almost entirely Surgical Oncology and some large challenging tumors, but that makes me tick. It’s everything else, including the agony of sorting out politics with the hospital and other doctors, all of whom, myself included, possess too large of egos for their own good.

It is true that I’ve been doing a moderately large volume of breast cancer surgery. A week ago, I resected a right-sided poorly differentiated retroperitoneal liposarcoma, including right colon, kidney, ovary, and some liver, taking me about 2 hours, without any help save for the surgical tech on the case. I simply could not get a partner, nurse assistant, or anybody else to help. Fortunately, the patient is doing well. She weighed about 105 lbs before surgery and weighed 84 lbs. afterward. It was about a 20 lb. tumor. Today, I had the help of one of my partners, doing a left retroperitoneal liposarcoma. I was able to save the kidney, but took the left colon, distal pancreas, spleen, and greater curve of the stomach, besides the tumor itself, about 10-15 lbs worth of blubber. This took about 1-1/2 hours, with only about 300 ml blood loss.

You can see the spleen on the top, the colon below, but the pancreas behind all that yellow fat that’s tumor. The photo of afterward shows a void…

I’m trying to show the cut edge of the pancreas, which I stapled across, and then sewed over with 3-0 silk Lembert sutures.
These tumors typically would have had to go up to Seattle in years past, and usually be managed much more poorly than I would do on one of my worst days. Using one of my partners, I’ve been able to do a number of laparoscopically assisted transhiatal esophagectomies, all in under three hours, with the patients all doing well. Strangely, as you get older and better at surgery and make better judgments, you also burn out easier and get exhausted earlier in the day. Then, you have to face the hospital, which treats you a little less than dog excrement, which is great for helping you maintain humility, but terrible for you acquiring any sense of self-worth or pride in your accomplishments. It leaves me progressively closer to just wanting to through in the towel…but…I love surgery and doctoring. There must be an alternative in this profession.
I’ve spent time tackling large volume books, which will not turn over book reviews quickly, the current being Tremper and Longman’s “Introduction to the Old Testament”. I am slugging my way through Thomas Friedman’s “The Lexus and the Olive Tree”, and should have a review of that out by the end of the month.  Other books that I’m working through are not reportable, including

Both are wonderful repetition for developing German fluency, though I would learn German better by just spending a few months over there like daughter Diane is currently doing.
Toward the end of the month, I hopefully will have done my first Century (100-mile bike ride), assuming that weather permits. You’ll get a report on that.
Meanwhile, I just learned that one of my very very best friends was recently stabbed with a knife in the operating room used on a patient dripping with Hepatitis C. How terrible can a person feel about his best friend? Suddenly, he is at an enormous risk of acquiring Hep C from the patient. Why can’t lawyers or politicians or administrators experience terrible, life-threatening events like this on a daily basis? Maybe they wouldn’t be so hard on docs. Each event like this makes me seriously reflect on the craziness of our profession…  We have had authority removed from us doctors, which was given over to hospital administrators and clipboard nurses. Decisions must now be made by the team. We cannot reprimand a hospital employee for messing up. It is our fault, always. Patient rights have assumed such a high priority, that it restricts any ability of a physician to protect himself. Just try to check if somebody is HIV positive without first asking their permission. If they refuse to grant you permission, you are not released from any obligations or responsibilities in their care. Like my dear friend, a re-think of our entire role in medicine is occurring. I have no idea where I will end up.
And to my very best friend, have a nice time in Paris with your wife and kids. I’ll pray that you do not actually get Hep C, and that your time in Paris will inspire you to new and higher ventures.

Cross-Country Ski Trip on Huckleberry Creek Trail

Did this with Jonny, starting at 0900 and getting out at 1300, about 10-12 miles each way for a total of 20-24 miles. The road to the trailhead was closed, so we had to have an additional 2 miles additional skiing on the snowed-over road in order to reach the normal starting point. The weather was cool and snowing most of the time, leaving us wet powder, which made it remarkably easy to negotiate on skis. We had to break trail the entire distance and never saw another single person, until we met somebody at the trailhead on our return, going up alone with her two dogs. I tried to use the Magellan GPS to figure out our ending location and distance, but the unit was inoperable, only to learn after skiing out, that I put in one of the batteries wrong. Also, I forgot my camera, thus no photographs. Though we were in view of Mt. Rainier, and probably just inside the park, weather conditions did not allow for distant viewing. At the trailhead, we were even barraged by a rather fierce hailstorm.
I had done this trail partially last year with Dr. Cull, but only making about a third the distance. I would like to return to the trail in order to attempt a complete ascent to Grand Park, hopefully on a clear day to see Mt. Rainier,  or possibly to even camp out in Grand Park. Interestingly, this trail took us quite close to Lake Eleanor, located within the Park. Jonny and I hiked into Lake Eleanor from Sunrise many years ago when Jonny was quite young, and in minimalist style, i.e., without a tent. All that we could remember from the trip is how we were eaten up by mosquitos, and achieved almost no sleep that night. On the way out today, in the snow, Jonny and I encountered several mosquitos! What a wonderful memory.
I defied all sensibility on this trip. I had no snow shovel or rescue equipment. I forgot a map and compass. I depended on a non-functional GPS unit. In fact, I carried absolutely no safety equipment. We forgot the cell phone and had no signaling devices. This was part of the reason I decided to call it quits a touch early. Stupidity needs not to be multiplied. Firsts on this trip included a backpack thermos filled with hot chocolate. Great idea!  Second, I actually sustained blisters on both metatarsal heads, which is unusual for me when skiing.  At home, I applied Blisto-Ban, which works awesomely. Immediately after application, I had virtually no blister discomfort even while walking around. They are worth their expense. Unfortunately, REI does not carry Blisto-Ban.