End of Year Ramblings

December 31st, 2011

The year is over. We are still alive in spite of Obama. Life goes on. The end of the year gives us pause to reflect on where we’ve been and where we’re heading for the year to come.

2011 has been a good year. My surgical practice has slowed down a bit, and I am giving Obama just a little less support than in years past. I have not done as many bicycle rides as I wished. Betsy and I have been able to spend more time together, and that has been most enjoyable. One particular highlight of the year has been our trip to Europe, having Betsy meet Katja und Hannes for the first time, and getting to see Italy. It’s always a treat to touch base with Onkel Herbert. Russ Anderson has been very special this year in providing a real friend to go bicycling with. The elaboration of those trips last year can be found on the various blog posts in feuchtblog.net.

Betsy and I are thinking about next year. I will be going to about four surgical conferences, including the Miami Breast conference with Betsy and Society of Surgical Oncology meeting with Dr. Tate in Orlando, both in March. I’d like to go to the American Society of Breast Surgeons meeting in Phoenix in late April. Betsy and I also plan to go to the American College of Surgeons meeting in Chicago in October.  We anticipate a trip to Germany and Switzerland in early June, hopefully where I could do some bicycle riding with Russ and Carsten (and maybe Peter?), as well as seeing Katja and Hannes, Herbert, Hille (Herbert’s sister), Marike (student in Bonn whom we met in Cameroon, Udo Middelmann in Switzerland (Francis Schaeffer’s son-in-law) and our good friends Mike (and Carolyn) who is doing a year teaching Sabbatical in Lausanne, Switzerland. That might be a little too packed of an agenda, but… In November, Betsy and I are seriously planning a trip to Egypt, Jordan and Israel. We’ll do the tour sort of thing. I’ve never been to the Holy Land, but have always wished to go. If you are interested, come along with. We will be going with the Rev. Dr. John (http://www.biblicalisraeltours.com/), who I found after a long internet search.

I continue to ride my bike. Yesterday was enjoyable in taking Patrick for his first long bicycle ride. He did about 8 miles. Not bad for an 8 yo kid on a 20 inch bicycle. It got rather cold at the end, the sun going down about 15 minutes before the end of our ride. Typically, I’ll ride the trainer. It’s one of my bicycles hooked up to a virtual reality trainer (Tacx). I’ll usually have iTunes going. This last year, I’ve been working through the series on Romans by Martyn Lloyd-Jones while training. I am now down to about 97 more 50 minute sermons out of 353 sermons. That’s a lot of sermons on Romans, and tends to be repetitive. You’ll get a review on that series once I’m done with it.

While sitting at my computer, I listen to music. My iTunes has a total of 721 gBytes of music and lectures, etc. One may wonder what I do with so much music. Well, I listen to it. It’s mostly classical, a total of 359 gBytes, or 175 days of constant listening. Making a smart playlist, I started working through everything a little over a year ago. I’m now down to 94 days, or 196 gBytes of classical music left. Right now, I’m listening to a little known piano concerto by Mendelssohn, which is actually quite good and doesn’t deserve obscurity — a trait true of much of classical music.

I continue to read every moment possible. Currently I am working through Gregg Allison’s Historical Theology, and am about 1/2 way through. I am reading Crime and Punishment by Dostoyevski on the Kindle. I have a massive lineup of books remaining on my shelves and in the Kindle store that I must read. I’ll need to quit medicine just to get my reading done. For time with Betsy, we’ll usually watch things like Teaching Company series together, and are currently working on a series about Oceanography. We are becoming adept at speaking about the pelagic vs. neridic realms of the ocean, knowing the difference between plankton and nekton, etc., etc., as well as understanding the various forces that make the ocean a wonderful world. For a lighter note, Betsy and I will watch movies. We have just started the films of Clint Eastwood, a total of about 40 that we’ll be seeing. Reviews for those films will have to wait! We still don’t have television, and I refuse to pay for cable. When we must watch something, we’ll watch it over the internet if it’s available.

I will be turning 58 in 2012. I’m not sure how much longer I will want to continue practicing medicine. It’s a serious love-hate relationship. I love the practice of surgery, but it’s everything else that one needs to put up with. Government has taken complete control of medicine, and turned it into an uncaring prohibitively expensive beast. Desperately needed tort reform is now a long-gone wish. As one pundit commented, “America is no longer governed by the rule of law, but by the rule of lawyers”. Such a statement could not be closer to the truth. Political processes are always preempted by court decisions. Democratic or Republic behavior no longer exists in the USA. We are governed by the tyranny of the courts. It wouldn’t be so bad if lawyers were behaved. Unfortunately, lawyers have devolved into a subhuman species. It’s hard to know what to compare them to, but the cyclops  is most fitting. Cyclops have only one eye, are monsters seeking to destroy anything alive that is not one of their own, will act even more intentionally and violently when their one eye is put out, a threat to anything else in existence. That’s the good part about what I have to say about lawyers. Don’t get me going on their bad side.

Those of us that work in the public realm have occasions from time to time with lawyers. Much of this we are not allowed to openly discuss for privacy concerns, and so will discretely tailor my statements. Physicians are advised to avoid a jury trial as much as possible, as juries tend to ignore the facts and are easily swayed by emotion. There is no rule of law in the courtroom. The selection of juries has become a joke. It used to be a trial by your peers or neighbors. Now, it is a trial before the a highly selected group of individuals based on the bias of the judge, people who would rather be anywhere than setting on a jury or people who are so worthless in society they have nothing better in life to do. The instructions to the jury often counter the constitution, which is why I will not set on a jury. I’ve written more on this elsewhere. The prevailing consensus among Joe Public is that justice no longer exists, and that is for the most part true. Why do we do everything to avoid the courts? If our neighbor sues us for using the wrong type of fertilizer that gives him asthma attacks, the costs in court will be prohibitive, it will be unbearable stress, and a flip of the coin will determine which way the judge may lean, even after hours of defending your case. It’s too easy to create a case, as you have little to loose in the process. Lawyers will determine the case based on their merit, which means, if it is possible for the lawyer to make a good profit off of a case. In the end, the plaintiff and defendant lawyers win, and the plaintiff and defendant loose. I’ve seen so many people destroy their lives by taking someone else to court, get lost in a long court trial, and even if they win the trial, much of the money ends up squandered or in the hands of the lawyers. Nobody but the lawyers win. We were taught well as kids to never sue, and for the most part, that remains true. There are three prongs to the solution. 1. Go back to the European court process where the looser pays all court costs. 2. Use Biblical law, which truly punishes offenses to others and demands restitution or death penalty in serious cases. There is no prison term in Biblical law. If you are a violent murderer, you die. If you stole, you repay. If your debt is too great, you become an indentured servant (slave) for 7 years to the person you owe to. Bankruptcy would not be tolerated, and Donald Trump would be picking cotton for the next 30 years. 3. Return to a Christian society that thinks in a Judeo-Christian fashion and holds Christian morality as the highest of all possible goods. Unfortunately, this isn’t going to happen, even if every non-Christian were immediately terminated. So, we tolerate matters, try to keep our nose clean by living morally, and if one must suffer for doing good, they will get their blessing and reward in the end. It is good that for a Christian, this short life is not the totality of existence.

So, I wish you all a happy New Year.  Keep looking up, and keep  your stick on the ice.

Never Loose Hope

December 30th, 2011

It has been uncommon for me to write commentaries of late, in part because there seems to be minimal feedback from the internet community. In my earlier years of web blogging, I used iWeb and it facilitated readers adding comments for feedback. I would never wish to go to a social networking type style, such as with FaceBook, in that it tends to breed short, abrupt thought processes that do not have premises, reasoning, and conclusions demonstrated. It is meaningless prattle. No, even if I love you, I’m not interested in your kid graduating from pre-school, or where you went out to eat last night, that is, unless these events have a significant meaning in your life, and you offer explanation as to how these events were significant life-events.

Hope. It is one of the three Christian virtues. Faith, hope, and love. Just as we don’t wish to ever cause another person to loose love or faith (in Christ), we never wish to cause a person to loose hope. But, hope in what? I am on rare occasion accused of causing my patients to loose hope. Generally, I try to tell the patient the exact truth. If I don’t, they’ll get it over the internet. I feel that integrity is a foremost virtue for a physician. I have heard many doctors argue otherwise. Dr. Lauren Pancratz argues vehemently that if a lie (deviation from the whole truth) contributes to the betterment of a patient, then we should lie to our patient. I disagree entirely. Truth must be presented graciously and skillfully, but it must be presented all the same.

I see many patients that come from other doctors, mostly medical oncologists, who were never told the significance of their cancer. For many medical oncologists, hope  in “the system” must be preserved. Perhaps much of this is self-serving. I find that only 5% of patients do not wish to know the truth of their condition. Most patients welcome it, often are relieved and are happy that they can better understand their condition and make long-term plans with better knowledge of their condition.

There is a balance that physicians struggle with. If there is a reasonable expectation that the health care system can significantly improve their condition, then I will strive to be positive, even if the short term outcome is expected to be dismal. In one sense, there is always hope, but that hope depends on the objectives of the physician/patient encounter. If the expectation is to prolong life no matter how miserable that life might be, the treatment options are going to be different than if the objective is to simply offer comfort measures. Both contain hope that the therapy will work, but the outcome expectations are different. Thus, in a real sense, hope is never lost.

The source for hope is my greatest concern. Patients usually do well or do poorly in spite of me. Health care professionals have less control of a situation than they would like to believe. To trust that the health care profession will provide health is a mis-direction of one’s trust. It is always a pleasure when a patient comes to me, realizing that only God can give them hope, and trust in Him is of greatest value. It is a pity that so many devout Christians have a seriously displaced hope, trusting entirely in the physician, and not seeing that even the best physicians have feet of clay. Balance is important. To ignore the physicians that God provides is unwise. To expect that physicians always know best is also unwise. Many Christians run to Hookey-Pookey medicine (Chiropractors/Naturopaths) feeling that they are more “natural” or “christian” than mainline medical practice — that is also highly unwise.

We don’t want our patients to loose hope. We wish for them to have the correct source for their hope. We wish them to have realistic expectations. We wish them never to give up. We wish them to be able to change expectations when the facts suggest it. Mostly we wish them to maintain the three Christian virtues, faith, hope and love, up to the very last breath that they take.

Tea

August 14th, 2011

I have given up most of my coffee consumption and turned to tea. At first, I used tea bags, and had about 10-15 different varieties. I was always in amazement when Dr. Liao would decline having tea, as he commented that he just didn’t like the taste of the tea that I brewed up. So, I asked him to bring me back some good chinese tea on his next trip to China. He did, and brought me a box that had eight different flavors.

Since then, I’ve slowly evolved into using only tea leaves. You can see my tea cabinet. Only a portion of the teas I brew are visible, and some are actually just using old containers.

I brew the tea in a white ceramic pot or cast iron pot, kept warm over a tea candle apparatus.

I use a Finum strainer for the tea. These are very nice, since you can remove the tea leaves after the appropriate infusion time, and can reinfuse the leaves quite easily. The lid also serves as a convenient base to prevent tea from getting on the counter.

At the office, I use a larger ceramic pot, with a hot water pot to boil the water.

Learning how to properly brew tea takes practice, experience, but a good book also gives one an idea as to techniques for making the perfect pot of tea. The book below also discusses the various types of tea, their origin and their differences. Generally, there are Chinese vs. Indian teas. Africa does produce some teas like Rooibos, which I’ve found to be quite distasteful. The Chinese/Indian teas vary from black, Oolong, green, flavored (like Jasmine), mixed (like Earl Grey), or moldy (like Pu-Erh). Pu-Erh tea is actually quite interesting, in that the 2-5 infusions are all quite good. The tea smells like a barnyard, but the taste is very nice.

The Tea Enthusiast’s Handbook, by M. Heiss and R. Heiss ???

This book is a good introductory summary for the tea lover. Happy brewing!!!

Alaska 01-07AUG2011

August 14th, 2011


Alaska 01-07AUG2011

This trip had several objectives. The first was to meet with Dr. Lattin and give a breast cancer update talk at his hospital. The second was to achieve a brief rest and relaxation while meeting friends, including not only the Lattins whom we met in Bangladesh, but also the Bankers, who attended Resurrection Presbyterian church with us in the past. We spent 3 nights in Anchorage, followed by three nights in Soldotna with the Lattins.

The first day in Anchorage was to simply settle in. We drove downtown, and shopped for moose hats and other Alaska paraphernalia. Betsy fell in love with the moose.

The second day, we drove up to Wasilla, and then out towards Tok. The mountains were stupendous. In the evening, we met with Jeff and Ellen Banker, and went out to eat. The seafood was incredible! The beer was quite good also.

The third day was mostly resting. I met with Jeff again, still recovering from hand surgery, and ran up to the top of Flattop Mountain. The most distinctive feature of Flattop Mountain is its flat top.

The fourth day, we checked out of our hotel and headed down to Soldotna. The drive is quite beautiful, with the seashore on one side, and immense mountains on the other side.

The fifth day, I gave my cancer talk. Later, we went out to dinner, and then drove to the beach in Kenai. We were able to see Mt. Iliamna and Mt. Redoubt.

The sixth day was a walk for life for Betsy and Anna, and a fishing trip for Jason, Nathan and myself. We drove down to Homer, and took off on a chartered boat out into Cook Inlet.

We spent much time with the kids.

Joshua

Noelle

Esther

I let Nathan run around with the camera for a bit, and noted that he wasn’t taking care to compose his shots. To illustrate the importance of adequate view in a photo, I took a photo of him. Included are photos Nathan took of the parents.

Nathan

Dad according to Nathan

Mom, according to Nathan

It was sad for Betsy and I to leave Alaska. It was more enjoyable than our last visit, and suggested returns, especially with friends. I also noted that the roads typically had quite wide shoulders and thus makes it quite conducive to cycle touring. All we need to worry about are moose and bear.

Special thanks to the Bankers and Lattins for making this trip quite special.

Thoughts on Blogging

July 11th, 2011

It was almost two years ago that I was forced to move to this new blog site. Before then, I was using the Apple proprietary program iWeb, and it allowed for some capabilities that I have not been able to recreate through WordPress. Yet, WordPress doesn’t crash resulting in the loss of data. The older site is still up, though I am unable to add further entries to that site or revise the pages.

This blog site has had a different character, in that I spend much more time reviewing books, music, and movies, and less time talking about political, religious or medical issues. Perhaps that was a mistake. I found that political topics tended to generate the most interest. To date, I have written 225 blogs and gotten 101 responses. Many of those responses were from my brother Dennis, whose comments I always appreciate. I have published all of the responses to date, except for one dude, unknown to me, who wrote a quite vitriolic comment regarding my “naivete” for believing in creationism and rejecting evolution as a valid hypothesis for origins of the world as we know it. I would have approved his comments, except that they were quite foul mouthed, and failed to reflect any substantive thought process. Please understand that I often do not agree with comments that come back to me, but I still post them. I have occasionally had friends personally e-mail me regarding articles on the website. I assume that these comments were intended to be kept private, and so have not posted them. I will often have friends mention that they’ve read a certain posted blog, but not comment. I do the same for others blogs, but realize that it leaves the blog author slightly uncertain as to the number and identity of the population that you’re writing for.

I have rejected the thought of developing a presence in the social networking work of Facebook, Twitter, or other similar sites. I continually receive messages to have certain people “connect” with me on Linked In, a network that truly confuses me as to its utility. If I wished to connect with you, I would find your e-mail address, and e-mail you. Why do I need Linked In? The standard social networks like Facebook create a larger issue, in that they encourage brevity of thought and absence of connectedness in ones’ thinking. Those networks are the ultimate in encouraging mindless prattle that occurs between two or more people. One is demanded to express themselves in short brief statements that fail any sort of real development of thought. Worse, Facebook best facilitates emotional expressions rather than discussions on important issues. For these reasons, I have not been on Facebook for years, and will never go on under the current environment of Facebook.

I have learned that one must not manifest diarrhea of the mind on a website. Since these are public forums, care needs to be exercised as to what is said. It is not that I would mutter extremist or revolutionary views, since that is not my cup of tea. Simply watching how the press destroys various politicians for fairly tame statements suggests that political correctness rules the social interactions among members of our society. Casting aside political correctness, I will try never to offend anybody.

I anticipate that this website will probably contain more personal interest articles, and discussions as to what is transpiring in the lives of me and Betsy. I also wish to start using Lightroom to create photographic presentations. This might take some experimenting in order to get it into WordPress. I welcome comments and suggestions as to where to go from here. Or, just drop me a line and say “hi”.

Ken F. von Puyallup, WA

 

 

Selkirk Loop

June 8th, 2011

The Selkirk Loop Bicycle Ride 02-06JUNE2011

Russ A. and I had been planning this loop for quite a while. We had other loops in mind, such as going to Glacier National Park, but realized that the snow conditions were not permissive of a ride anywhere we wished. There is a website that promotes this loop (www.selkirkloop.org), so we decided that this would be  perfect choice. We drove to the start of the loop in Newport, Washington in a driving rain, hoping that the weather would clear. We stayed in a cheap motel and took off the next morning. Here is a map of the loop, and then our Garmin statistics…

03JUNE – Newport, WA to Bonners Ferry, Idaho, riding time 4:21, 101 km, 295 m ascent, 3755 calories – mostly cloudy weather, no rain; stayed in a hotel in Bonners Ferry

04JUNE- Bonners Ferry to Gray Creek, B.C., riding time 6:29, 125.5 km, 949 m ascent, 4872 calories – perfect weather, stayed in our tent at an RV park at Gray Creek, on Lake Kootenay

05JUNE- Gray Creek to Salmo, B.C., riding time 4:56, 88.54 km, 848 m ascent, 4098 calories  - again, perfect weather. Hard climb noted out of Nelson.

06JUNE- Salmo, B.C., to Newport, WA, riding time 7:33, 147 km, 623 m ascent, 5864 calories, we took the LeClerc Road variant, which was very flat, along the Pend Oreille River. The weather was perfect, but we drove back to Tacoma that evening, noting a very hard rain on the drive from Newport to Spokane, WA.

Total stats: 23:19 hours riding time, 462 km (287 miles), 2715 meters elevation gain (8907 ft), 18,689 calories burned off. We essentially accomplished the loop we wished, though it took us a little less time than anticipated. The only significant plan alteration was that we hoped to go to Kaslo and New Denver on the extended upper loop, but the weather did not look like it was going to stay perfect long enough for us to enjoy an entirely dry trip, and thus gave reason for doing the standard Selkirk Loop rather than a variant. Besides, we needed an excuse to return. Also, Russ had an injury to his thigh on the second day of riding, which suggested that it be best that we not push matters too hard.

In all, it was a delightful ride, and I had a wonderful time with Russ, and am already planning our next touring trip. It would be helpful if we knew what to expect in towns, and maps like the Adventure Cycle Association would be nice to have for all towns. Some towns on the map were essentially ghost towns, others had stores and motels and other provisions, and it was impossible to know what to expect along the route. This made it harder to plan for stops. Here are some photos of the trip…

Russ with the Selkirks in the background

Me on my loaded Co-Motion bicycle

Lake Kooteney in British Columbia

Lake Kooteney scene

The Glass House - built out of embalmers bottles

Lake Kooteney

On the Ferry crossing Lake Kooteney

West Arm of Lake Kooteney looking at the town of Nelson

Our hotel in Salmo, B.C.

Russ humping up a long steep hill out of Salmo

Russ and I in Metaline Falls

Last day - along the Pend D'Oreille River

So, we’re back. Tired, but, it was a wonderful trip.

Synology

May 27th, 2011


Synology DS1511+ with 5 Western Digital 2 tbyte Black Caviar hard drives and DX510 Expansion module with 5 Western Digital 2 tbyte Black Caviar hard drives ?????
This is my new system of memory. It came at the recommendation of Jason L. Not being a techno-guru, I had some concern regarding configuration problems and setup, yet it worked immediately after assembling all the hard drives and putting the thing together. I made one small mistake in that I tried to make both the main unit and the expansion module into one volume, which simply won’t work. I have it running in RAID 5 configuration, so that each module consists of 20 tbytes of memory, but I functionally am working with 14 tbyte (giving me at total of 28 tbyte), and if any single hard drive goes out, I can simply swap it out and have no data loss. Now, I need to cat5 wire our house, so that I might leave this system elsewhere in the house. Not that it matters, since the system has no fans, runs completely cool, and makes no noise.
I have all my movies and music and photography stored on this system, with volume left over. My only frustration so far has nothing to do with Synology, but with Apple iTunes, which will not allow me to make the Synology as my main location for iTunes playing on a remote computer.

United Bicycle Institute

March 27th, 2011


United Bicycle Institute- Ashland, Oregon 21-25MAR2011
Back to school! This time, it was bicycle repair school. The drive was 7 hours each way. I had heard about the UBI from the General during the Adventure Cycling Association Introduction to Touring class, and wanted to learn more about bicycle repair. This introduction was very well done, the instructors not only very knowledgeable, but very patient and superb at teaching. It was a most enjoyable week of not only getting away from work, but of actually learning something useful.
I drove down to Ashland from Puyallup on Sunday. I stayed about 3 km from the Institute at Cedarwood Inn, an inexpensive but nice motel. Monday was focused on wheels. We first learned how to change a tire, and the different types of tires. We learned about taking the hub apart, removing the gears, re-packing the bearings, and getting everything back together. A short discussion on truing wheels was made, but little hands on.

Nathan (instructor) tells a joke and Dan looses control!


Bryce works on his mountain bike


Tuesday was pedals, cranksets and bottom brackets. I completely disassembled my bottom bracket and put it back together. We also learned about removing, inspecting and changing chains.

Tom was my bench partner


Matt (instructor) helps Jose


Dan the Canadian, not laughing this time


Wednesday was derailleur day, starting with the rear derailleur, and then the front. Oddly, the front derailleur is more touchy to tune up than the rear derailleur. In the evening, I went for a bicycle ride. I went up route 66 headed for Klamath Falls, but got only about 14 km before the weather became a little concerning, and it started to get dark.

Route 66


More Route 66


Lake on Route 66
Gnarly trees on Route 66- Mirkwood
Thursday was brake day. We had to completely dis-assemble caliper brakes, and then re-install them on the bicycle correctly. The instructors were a bit fussy about doing things correctly, since a bad setting for brakes could have serious consequences on the road. The weather was horrible today, with a mixture of rain and snow, so no thought of riding was possible.

Rich helps Tom


Matt shows us how to really wash a bicycle


The framebuilding shop with Robert (student) on right


Friday entailed pulling off the handlebars, headset, and removing the stem from the bike. This was fairly straight forward. We learned the correct method of washing and oiling a bicycle. After getting a tour of the frame building shop, we were handed certificates of completion and “graduated”. There was no test, since the true measure of success was in how well the bicycle worked.Bryce needed a lift up to Portland which provided me a delightful companion to keep me awake on the road, and then I was able to get home by 2300 Friday night.
To Matt, Rich, and Nathan I say “Thank You”. To everybody else who enjoys riding bicycles, this is a class very much worth taking. It’s fun. Matt, Rich and Nate are delightful characters that add a tremendous enthusiasm to not only cycle repair, but to cycle riding in general. A class like this could someday save your life, if you are out and away, with a broken bicycle. It has my highest recommendation.

The workbench


Our class - from top left clockwise - Michael, Bryce, George, Ryan, Jordan, Rico, me, Bridget, Don, Tom, Rebecca and Dan.

San Antonio SSO Meeting

March 12th, 2011


The Society of Surgical Oncology Meeting in San Antonio, 01-06MARCH2011
Dr. Tate is pictured in the photograph trying to remember the Alamo. We remembered it for several minutes, then paused to enjoy a cigar while sitting on park benches just across from the Alamo. We inquired of the status of PeeWee’s bicycle in the basement of the Alamo, and learned that the Alamo actually has two small basements, large enough to hold a bicycle. You can’t believe everything that you see in the movies. The meetings were long and arduous, but we were able to get 34 CME credits for this venture. The conference literally went from dawn until dusk, and so we did not have a lot of time to spend reflecting on the Alamo, but we did get around a little bit. The conference was at the large conference facility just next to the river walk. We’d go down to the river to eat our lunch.


You can see that we were dressed up to the hilt. This is sort of a snobby conference, as most surgical meetings usually occur in more casual attire. The pathologists were having their meeting next door to us, where I was able to encounter one of the Puyallup pathologists. Notice his more casual attire.

We were able to see the San Antonio imitation of the Seattle Space Needle.

It was one of the better conferences that I’ve gone to as of late. Most notably, it was announced that we must stop doing so many axillary dissections, and that while it would have been malpractice a week before to not complete an axillary dissection when the sentinel lymph node was grossly positive, we are now committing malpractice to do the same. The Surgical Oncology gods have spoken and we must obey. NCCN guidelines will be slow to correct the new change in practice recommendations, but we will be patient. So, I return to Puyallup full of vim and vigor, and will be plagiarizing one of the talks I heard in presenting to the other surgeons and oncology doctors the new revelations from the randomized trials.
p.s. too much academia becomes hard to endure…

The magical god?

February 28th, 2011

Brother Dennis wrote an article for the American Scientific Affiliation several years ago arguing against “magic” in the works of God in creation. Though this article is directed toward “magic” in creation, Dennis would consider any act of God in His created world that acts outside of the natural law that God formed when He created the world to be outside of His nature. Thus, Dennis would propose that all miracles of Scripture would have a physical, natural law explanation, such as the turning of water into wine, the raising of the axe head, or even the ascension of Christ, which Dennis explained probably happened by a flying saucer picking up Christ and escorting Him off into the Heavens (where, I don’t know, perhaps somewhere close to Betelgeuse). In order to discuss Dennis’s article, I have enclosed a copy of it for non-ASA members and can be found at the end of this blog following my discussion.
First, Dennis presupposes that the concept of God working miracles as supposed by most Christians is that God has a larger magic wand than the pagans, and thus is more effective. Included in this supposed concept is the assumption that God acts without constrain and is fickle in His actions. Most devout evangelical Christians would not agree with this summary of their concept of God and miracles, feeling that God does offer restraints on Himself, but those restraints are a product of God’s own ontology or nature, and is not dependent on external law, either law coming from God’s declaration or man’s development.
Even the pagans understood the difference between miracles and magic, so perhaps it would serve the reader to elaborate those differences.
1. Magic generally is a means whereby man might constrain if not force the god’s to cater to man’s desire or will. In contrary, a miracle is a request of “the gods” to consider the desire or bidding of man. Miracles may occur at the internal behest or desire of the god himself, acting according to his own nature or in his own best interest.
2. Magic requires learning the right incantations, or going through the proper forms in order to compel the supernatural forces or gods to follow the magicians’ bidding. The only requirement of a miracle (when requested by man) is the right sincerity in man’s interaction with the god.
3. Magic tends toward relatively few themes, including seeking after health, life, or erotic love, or perhaps the curse (or breaking/blocking of the curse) on another person. Miracles tend toward a diversity of interests, and generally performed for public display in order to manifest a lesson from the gods.
4. Magic demands clandestine, secret techniques, often learned after years or through occult means and held by a relatively few initiates. The technique of miracles is quite open, and limited to prayer or open request of the god to act on the person’s behalf.
5. Magic exalts the magician alone. Miracles mandatorily exalt the god alone.
6. Magic requires the innate force of the magician to accomplish its effect. Miracles function best with the utter helplessness of the requestor.
It is true that there are common themes with both magic and miracles that may cause the unobservant to miss the difference. Both magic and miracles violate natural laws in their undisturbed course. Both may also utilize natural laws to accomplish their effect, but in both cases, the roll of natural physical law will never be either 0% or 100%, but somewhere in between. Thus, God may have parted the Reed Sea with an east wind, yet the timing remains inexplicable outside of God interacting with nature, and the precise details such as the ground being entirely dry could not be explained by simple natural phenomenon. Both magic and miracles believe in a spiritual world that interacts and affects the natural world in such a manner that influences the desire or will of the god.
Dennis continues his discussion by supposing that God would never ever violate His own physical laws, yet Dennis makes a serious mistake in this analysis. First, he supposes faithfulness by God as discussed in Scripture to include restrains on His physical actions in the world. Dennis mistakes God’s faithfulness to His own nature, which acts as the restrain on His actions. Dennis confuses God’s promise to never violate His moral law, by supposing that God really meant that He would not violate the physical “laws” of the universe. This is patently absurd, in that God’s own existence violates physical “law”, and thus any action of God and the physical universe must entail a transgression of physical law. If one believed that God, who exists outside of physical law, would never violate physical “laws”, then that person would be forced to be a functional deist by restraining God to the initial events and then being impotent to affect the “wound-up watch”. Dennis’s discussion laboring over God’s covenant faithfulness remains irrelevant to presuming that God acting outside the system denotes an absence of faithfulness. It also reflects the notion that the “laws” of science are as immutable as God’s word. Though God’s word remains immutable over the centuries, I typically need to buy a new science textbook on any topic every ten years to remain up to date, and every fifty years to grasp the entire change in paradigmatic structure of the current science.
Dennis would tend toward a theistic evolution similar to what is offered by Francis Collins. Though Collins is quite well known as head of the NIH as a most prominent scientist and also a professing Christian, Collins (like Dennis) has sold God down the drain by placing theology in a subservient roll to science. In theistic evolution, you remain with a quandary. You have two choices. First, God may have created the world in a fashion that He occasionally needed to stick His finger into the system to betray His natural laws, such as with the formation of an organized DNA for the first primitive living organism, and later with the transformation of the last “pre-human” into man. Or, secondly, He may have created a system from the initial first billionth of a second of the big band, where the universe possessed a personality, that is, an anthropic principle built into the system. I find neither explanation as satisfactory, and thus am left with a God who was and is and always will be active in the creation, maintenance, and outcome of His universe, and yet who exists above the “laws” of the universe.
Dennis’s greatest mistake is in trying to be both a scientist and a theologian, of whom he is neither, but rather a theological dilettante with training in electrical engineering and an insatiable curiosity about the world. His theological discussion shows many mistakes, such as his definition of h?se? as being “faithfulness” when it implies “lovingkindness”. Such mistakes are excusable except for when somebody is attempting a scholarly defense against prevailing notions. Dennis insists on nomenclatural exactitude, yet fails even in his definition of the word “magic”. His final plea is in the importance of making careful distinctions. Dennis fails to persuade me that the prevailing distinctions of mainline evangelicals are necessarily wrong. Worse, he fails to offer any substantial proof that it is pagan to believe in miracles performed by a God or His agents that generate events that cannot be explained by the natural laws of the system. Perhaps Dennis’s notion of science is the most pagan of all in being a closed system that restricts God from interacting with the system according to His divine will?

____________________________________
Does God Wave a Magic Wand?
By Dennis L. Feucht
One of the great unfulfilled tasks before the people of God, and in particular those of ASA orientation, is to help recover among God’s people a biblical view of how the Creator interacts with the creation. I continue to encounter Christians whose view of God’s activity in creation is essentially that of the gods of paganism, who were capricious and wielded power in an incoherent and inconsistent manner, effecting their desires much like decadent ancient Greeks might. The difference is that the Christian God has a bigger magic wand.
This pagan view of God is manifested in church meetings by those who advance the argument that “God can do anything” and therefore does. The tacit assumption underlying the motivation for this line of thought is that God is also not constrained – not even self-constrained – in how he operates. The magic-wand notion of God’s ways appears when events in scripture are given little description. Eschatology is a favorite playground for such imagining, as are miracles. Events for which we can give no rational, scientific explanation are tacitly assumed to not have any underlying rationality at all. A terminal cancer remits without explanation; God has waved his magic wand. Moses’s rod becomes a snake before Pharaoh; God’s magic wand is now in Moses’s hand. The farther the event is from explanation, the stronger the magic-wand approach becomes. The resurrection of the dead and the creation acts in Genesis 1 – do they not call for some kind of magic wand in God’s hand? Each day of creation, he emits his abracadabra and it is so. God waves his wand and “poof”; the dead are brought back to life. Not only do we not know the underlying rational structure of these events, by the pagan view of God, there are none.
While as Christians we do not deny that both scripture and life have their inexplicable events, it is how one regards them beyond our present ignorance that is critical here. Are they indeed irrational events arbitrarily brought about by God in much the same way that the ancient gods of the pagans would order events in their respective regions of nature? Magic-wand Christians will affirm that all events fit into God’s larger plan, but how they fit into his ongoing activity of upholding the universe remains to be better examined.
Consistency and predictability were not important to the pagan view of how the gods behaved. They were fickle and difficult to appease. This is perhaps the largest difference between paganism and the biblical view of the Yahwist God. In the pagan view, there is little thyme or reason to the events of nature. What purposiveness the gods might have in on the order of people who have not yet discovered the importance of setting goals. Paganism, consistently appreciated by the intelligent mind, is the grounds of atheism, of seeing reality accidentally, as “just one darn thing after another”. In this view, there is no underlying rational structure to history because the forces of history – the gods – are not rational in their behavior.
In contrast to this (and for me, one of the best evidences for the extraordinary nature – indeed, the truth – of scripture) is the existence in history of a thread of humanity set apart from this vast sea of paganism with a radically different view of reality. The Hebrews, as scripture tells us over and over, understood Yahweh as having some characteristics antithetically opposed to those attributed by paganism to the gods. One of the most featured of these characteristics – indeed, the one that stands out above the others to me – is that of God’s faithfulness. “The Rock, his work is perfect, for all his ways are justice. A God of faithfulness and without iniquity, just and upright is he.” Deut. 32:4 (ESV) The Psalms dwell extensively on this one distinctive characteristic. Its consequences for God’s ancient people were explored and appreciated. Fellowship with God was based on the legal covenant, giving a stable and dependable form to the relationship between Israel and Yahweh. The sitz im leben (sic) of it was God’s consistency and predictability in keeping his obligations of the covenant. If you want to know how Yahweh will behave, look at the covenantal agreement. The Hebrew word sedeq, found often in pre-Christian scripture and often translated “righteousness” was this faithfulness in keeping the covenantal obligations. As Gerhard Kittel wrote (Theological Dictionary of the New Testament, 2109, 110, 115): “There is no firmer guarantee of legal security, peace, or personal loyalty than the covenant… It means legitimate order as opposed to caprice, uncertainty, and animosity.” Or as Leon Morris put it (The Apostolic Preaching of the Cross, pp. 232, 233):
The Old Testament consistently thinks of a God who works by the method of law. … Among the heathen the deity was thought of as above all law, with nothing but the dictates of his own desires to limit him. Accordingly, his behavior was completely unpredictable, and while he made demands on his worshippers for obedience and service, there were few if any ethical implications of this service and none of a logically necessary kind. Far otherwise was it with the God of the Hebrews. The Old Testament does not conceive of anything outside Him which cold direct His actions and we must be on our guard against the thought of a law which was over Him. But Yahweh was thought of as essentially righteous in His nature, as incorporating the law of righteousness within His essential Being. Accordingly He works by a method which may be called law -
It was millenia later, in a Christian setting, that the wider consequences of this understanding of God’s ways were applied, though instinctively at first, to the creation itself. Those who dwelt deeply upon the nature of God in scripture would inevitably generalize in their understanding how this same God would act relative to his own creation. The characteristics of faithfulness in God’s upholding of creation gave it a certain knowability of a repeatable and predictable kind that could be relied upon. The theater-prop world of pagan neoplatonism in medieval religion – a world of appearances, lacking an underlying rational structure – were swept away by early men of God in science, who dared defy the pagan gods with the alternative belief that if a God with the characteristics of Yahweh created the universe, then those same characteristics should be manifested in his creative behavior. A Being consistent in relating to Israel must also be consistent in upholding the created order. Yahweh’s hesed, his covenant-faithfulness, should apply to the physical world. And they found that it did. It is the history of the scientific enterprise.
The rest of that story has been well told, of how this faith relating God’s faithfulness to nature has been abundantly rewarded in a growing understanding of nature that has turned it from being capricious and fearful to humanity to instead becoming the servant of humanity, and increasingly under the subjection of those who have participated in this faith, whether explicitly or instinctively. (Hebrews 2:5 – 8 refers to this subjection of the creation to man, and to the archetypal “son of man”, but in its quoting of Psalms 8:4-6 leaves no doubt that the everyday physical world is included in this subjection regarding the future world in Hebrews). Today, much of science has degraded to the status of an instinctive participation, while often denying the underlying foundation for it in the hesed of the Creator. Nevertheless, God distributes his blessings through technology, a human activity that relies upon the faithful patterns of the Creator that have been discovered in the creation, even to those who deny him as the source of this hesed manifested in nature through science. (Eph. 4:8; Psalms 68:18).
This view of science and of the creation is often not shared by other Christians. It is inconceivable to some of my non-scientific Christian friends that God might behave in all of his activities with an underlying rationality and consistency – a covenant-faithfulness – that might conceivably be discovered and understood in the ongoing subjugation of the creation to humanity in the future. Wider access to space-time might allow the information content of the dead to be acquired. In the future, life will eventually be understood, conceivably to the point of the engineering of new, improved human hardware. And “booting up” the dead on instantiations of this hardware, though still science fiction in our sober understanding, is not inconceivable. A physicist of Baptist roots, Frank Tipler of Tulane U., has written a book, The Physics of Immortality, (Doubleday, 1994) that offers some plausibility arguments based on such means in the hands of a redeemed humanity functioning as his servants under the earthly rule of Christ to effect the equally wild-sounding scenarios of scriptural eschatology.
As engineers who follow in the scientific tradition in which the creation doctrine of the early scientists is embedded, the task of mitigating the latent pagan creation doctrine of a magic-wielding god and its pervasive influence upon our fellows in Christ is ours to effect. We, and our fellow Christians in science, if anyone, are both positioned and motivated to such a task. Babylon casts a shadow through the millenia upon civilization, and it reaches even into the innermost thought processes of fellow Christians today. Where to start? Any Bible-reading church eventually comes upon the many texts of scripture extolling the covenant-faithfulness of god. These texts provide opportunities in Bible classes or lectures to make explicit some of the wider implications of these characteristics of the biblical God. While most Christians will not deny that God is rational, they do not carry through this assertion to his actions in processes that he brings into being in a way that is consistent with his other processes, might turn on some new lights or at least point to the light switch. Then, the next step is to clarify that science, properly so-called, is the human effort to understand God’s ways in creation.
Error is often a result of failure to make necessary distinctions. In avoiding scientism, it is too easy for many Christians to fall into a pagan creationist view of God instead. Hopefully, scripture itself, expounded upon in these ways, will bring new thinking and save some from an essentially magical conception of God and creation.

Trip to Belize — 05-11FEB2011

February 16th, 2011

Saturday 05FEB.   Betsy woke up at 2am and I an hour later in order to catch a 6am plane to Houston and then on to Belize. The flight went well, and the only real abuse was in customs in Belize. It was actually the worst we have ever been treated in going through customs, and even Bangladesh and re-entry into the US were never so bad, with them insisting on looking through our bags and then charging us customs on “suspicious” items, as well as taking away several blocks of cheese that we had with us. We ultimately met Dennis and Jonny and drove in darkness to their home.

Sunday 06FEB.   Day of rest, Dennis gave us a tour of the “colony”. It is impressive to see somebody surviving without public electricity or water. There was a relative drought, and so we had to be careful about water usage.

Monday 07FEB. Today, we rode into Belmopan, which is the capitol of Belize, in order for Jonny to renew his visa. We then toured San Ignacio, which is the largest town close to Dennis and Dottie’s house.

Tuesday 08FEB. It rained, and so plans were changed. Betsy went visiting with Dottie to various neighbors and I stayed home. Betsy and I later had coffee with the Schiemanns, a Geman couple living on Dennis’ land.

Wednesday 09FEB. Dottie toom us to 5 Sisters rezort and waterfall. It was south of Dennis and Dottie’s home and on the way to Caracol. The waterfalls demanded a short hike. Afterwards we went to Blancaneux resort, owned by Francis Ford Coppola and had lunch. This was a truly impressive resort… One that Betsy and I wouldn’t mind returning to some day.

Thursday 10FEB. Today, Dennis drove us to Spanish Lookout, an area of Belize owned by the Mennonites and in appearance like Iowa, though with palm trees. The Mennonites, in trying to escape the world, brought the world with them. Dennis needed to stop at a few hardware stores. Ralf Schiemann was with us, and was able to give me instruction in the German language. I enjoyed him.

Friday 11FEB. This day was a leisurely trip back home, with our plane leaving Belize City at 12:30 and arrival back in Seattle at 8 pm.

So, what did we accomplish? These are NOT in order of importance or significance!

1. We were able to get the slide scanner working for Dottie.

2. We had a wonderful time with Jonny.

3. We had a wonderful time with Dennis and Dottie.

4. We learned a lot about Belize culture and land.

5. We had multiple lectures from Dennis regarding “what’s going on” in the world, as well as theology/history lectures on the virtues of British Israelism.

6. Betsy and I had a nice break together.

7. We explored the possibility of buying land in Belize.

8. We got to meet many wonderful Belizeans, both immigrants as well as native Mayans.

We appreciate all that Dennis and Dotie did to make our trip a comfortable success, and recommend considering making Belize a possible vacation destination. When we return, we’d like to explore more of Belize, perhaps staying on the coast for several days to do some scuba diving, and definitely try to see Corazol, the large Mayan temple at the end the road Dennis and Dottie live on, and much farther south.

Genesis vs. evolution

November 14th, 2010

I recently posted a blog regarding my stand on the first chapters of Genesis, attesting that there is not sufficient information in the Scriptures to lead absolutely in favor of old earth versus young earth creation. Not being a Hebrew scholar, or expert linguist, or having formal extensive training in religious studies, my comments have to reflect ultimately my synthesis of the writings of others. I am a scientist, and thus may take liberties to look critically at scientific data, feeling myself to be a competent judge of the scientific literature. This combination of scientific training and religious readings allows me to draw certain conclusions about the nature of creation.

Linguistic and philological studies do not demand that the word “day” hold to a literal 24-hour period, although the context of Genesis 1 strongly suggests a 24-hour period. Day is very often used in both the old and new testament to refer to more than a 24-hour period. The “day of the Lord” refers in the prophetic writings to an epoch or a dispensation. Stylistic and textual studies suggest that the order of creation is not necessarily as stated in Gen 1. There are those that argue that the order is merely poetic, which I object to, as it is written as a historic account of creation. Yet, the converse argument is also not true, in that quite often in the historical writings of Scripture, strict chronology is not always followed. The Gospels are excellent examples of that, and numerous examples exist in Joshua through Chronicles of historical inversions, usually done intentionally to emphasize an effect or theme. The beauty of Gen 1 is that is a perfect merger of poetics and history, being perfect poetry, and yet perfect history, as defined by a Hebrew mindset.

Neither a pro-scientific nor anti-scientific viewpoint should be forced on Gen 1. One should not seek to merge the Genesis data into the prevailing scientific models. Science may used to substantiate the statements of Genesis but not necessarily to aid in the interpretation of Genesis. As an example, the big bang gives strong credence for a creation ex nihilo yet should not be used to force an interpretation of Genesis. As an anti-science example, it is hard to imagine that plants were created, and day and night were occurring before the creation of the sun, moon and the stars. Young earth-literal 24-hour day explanations fail miserably to offer an explanation for the order of creation. Most young-earth creationists end up being terrible scientists, Henry Morris possibly being one of the worst. It would have been better had he simply offered the absence of explanation rather than to write many scientifically weak volumes that have caused more to leave the young-earth camp than to join it.

To demand a rigid scientifically plausible explanation for creation does injustice to the Scriptures. Too many of the miracles defy a scientific explanation. How might I explain the sun standing still for Joshua? Or, the virgin birth and resurrection of Christ? How might I explain something so simple as the turning of water into wine, or the unlimited cask of oil in Elijah’s time? Those events all go contrary to even our most imaginative forms of quantum mechanics. It is clear that God doesn’t feel limited by the physical laws of the universe, and there is no reason to expect that He was held bound in the creative events of the universe.

An evolutionist theology of creation has no credence, since evolution itself has no credence as a science. Evolution is a pseudo-science so poorly conceived and inadequately substantiated as to not deserve mention, let alone serve as a framework for modeling our theology of creation. Yet, many Christians have argued in depth for what is now called theistic evolution. This includes Francis Collins (see his website, www.biologos.org), Bruce Dembski, and sadly, some conservative theologians, including Bruce Waltke and Tim Keller. In arguing against a creationist model, Biologos specifically states “Because BioLogos includes belief in a creator, it is sometimes thought to be a version of Old Earth Creationism. However, because BioLogos does not require that God miraculously intervened in the process of evolution in the sense of working outside the laws of nature, and because BioLogos also claims that biological evolution is the way by which God created the world, it is not a form of Old Earth Creationism.” The first statement, that does not require to God to work outside of the laws of nature (thus suggesting that He usually always works within the laws of nature), is totally nonsensical and a clear return to Hume’s Scottish rationalism. Isn’t the entirety of Scripture the account of God intervening in the world outside of nature? He created the laws of nature, often works with them, but not necessarily. The parting of the Reed Sea and all the miracles of the Exodus narrative, the miracles and resurrection of Christ, the salvation of a dupe like me, are all miracles outside of natural laws. Perhaps Collins could tell me how Christ naturally turned water into wine (revised, of course, to make beer!). Collins offers a seriously weak argument for the possibility of miracles, which fails to be convincing. His second statement on the insistence for biological evolution does injustice to both science and Scripture. Quite honestly, I believe that Collins sold his soul to the devil in order to achieve political ascendency. How could he ever achieve and remain head of the NIH if he were a “creationist”? The theistic evolution camp develops a serious theological problem, in that if it were true, then Paul is sorely mistaken and Romans should be stricken from Scripture. He would have had to attest that at the time of Adam and Eve in the garden, there were a plethora of humans, sub-humans, humanoids, human apes, etc. and that Adam (& Eve???) stood as the federal head of whoever. If one held to theistic evolution, one would be forced to burn all the existent theology texts, and start over. I don’t think theology should be so dependent on a weak scientific theory!

Collins draws a distinction between three theories of creation.

1.Theistic evolution—all events of Scripture including creation are bound by natural laws. This forces God to be subservient to natural law rather than the God to which natural laws serve.

2.Intelligent design—this is not actually a theory of evolution, since it takes no stance other than to argue against a purely random evolutionary scheme.

3.Creationism—this has two camps, including the young earthers (7 24-hr day creationism) vs. old earthers (longer than 7 days for creation).

My stance is against theistic evolution, but refuses to commit to either a young vs. old earth camp. You might call me a generic creationist. Both types of creationism are possible, do not seem to do violence to Scripture, and do not force a reinterpretation of the corpus of theology as we know it. There are reasonable arguments for both creationist camps, and I’m not sure arguments among the two creationist camps are where the true battle is raging. Together, we must combat other insidious, rationalistic forms of atheism or deism, disguised as Biblical and theological truth.

Bruce Waltke, who resigned from professorship at Reformed Theological Seminary because of his stance on evolution, has been a focus for defining the nature of the theistic evolution discussion. Because I am currently reading his book An Old Testament Theology, I find it necessary to interject a few thoughts regarding his comments.

1. In a footnote on the word “day” as found in Gen 1, Waltke admits that it more probably refers to a 24-hr period just from linguistic constructs, yet he later shows how the textual usage of the word “day” in in Gen 1 & 2 could not possibly mean a 24 hr period. Doesn’t make sense to me. I’m no scholar of Hebrew or textual criticism, and have to beg an inability to resolve this tension in the first chapters of Genesis.

2. Towards the end of the Cosmos chapter, Waltke admits there that he has been mostly influenced by a) BB Warfield, who stated a belief in evolution, and b) Francis Collins’ book The Language of God. I find it to be terribly disappointing to think that Collins has influenced the thinking of Waltke.

In order to sort out the science vs. Scripture dilemma, one needs to take a closer look at science. Science can be categorized into two parts.

1. Observation of God’s world, and development of new methods of observation. This we are encouraged to do in Scriptures. It is God’s world, and we are to delight in it, and the Creator who made it. Our senses are not entirely to be trusted, but our ability of observe the world in different ways often (not always) brings resolution when there are conflicting observations.

2. Interpretation of the observable data. Data demands a framework for its interpretation. By abandoning a biblical framework or Weltanschauung of Scripture, science becomes its own god.  This creates a problem when we fail (like Collins) to see what we have done, in that Collins tries to merge a secular atheistic interpretation of scientific observation onto Scriptures.

Waltke in his text spends much time talking about a parallel ancient near east myth of creation, which has many close resemblances to the biblical creation story, but clearly far more vulgar and fantastic. He proposes that the biblical creation was written as a rebuttal of the Marduk mythology. There are several problems with this.

1. It is not characteristic of Scripture to BEGIN any writing or major thesis as a rebuttal or defense. Scripture needs no defense. God is a big boy, and doesn’t ever come out fighting to defend Himself. How else could I say it? It is too atypical to suppose that the creation account is a DEFENSE (!!!!) against ancient religions?

2. I am deeply puzzled why Waltke could not have given the simplest explanation of the Marduk account, that is, that the Marduk account is a perversion and degeneration of the creation story passed down from Adam to Moses, and probably corrected by God in an inspiratory fashion to Moses.

3. Theistic evolution can be likened to recruiting the Marduk myth to enhance the meaning of the creation story, that is, to use another god (science in its second meaning above) to offer us further insights into the creation story. If evolutionary theory wasn’t such a pathetic replacement of the creation story, I might be tempted.

Science in its first meaning is legitimate, and observations can influence exactly how we see Scripture. The Scriptures speak of the four corners of the earth, and we know only from our reasonably un-interpreted observations of the planet earth that there aren’t four corners, so we do utilize to some extent how we see the world and how we read Scripture. I do not stand strongly in favor of either a young earth or old earth creation, because I say we simply have insufficient information from either Scripture or our observation of the world to decide between the two. Maintaining a “neutral” scientific stance allows only the statement that we don’t know exactly how and by what mechanism God created the world and all that is in it, but simply that He did it. We can’t state a precise time period or order, but just that God was active in creating all that we know of the universe, including all of the laws of physics, matter, energy, anti-matter and anti-energy, and everything else.

Perhaps the best old-young earth merger is the possibility that the seven days of creation are seven 24-hour periods separated by lengthy segments of time, and that the days do not necessarily reflect a perfect chronological order. The gaps between days would explain the saltatory effects of the fossils, i.e., that the fossils don’t show a steady progression, but demonstrate spurts and jumps with large gaps, suggesting miraculous creative activity, interspersed by lengthy periods of creative inactivity. Even here, I’m reluctant to offer this as my absolute stance, since the exact progression and timing of creation will not be known outside of further revelation and clarification by God himself. It is possible that your comments will help persuade me one way or the other!

Im Vaterland mit Fahrrad

September 2nd, 2010

It was time to go to Germany, and discover the world of bicycle riding in Europe. Dr. Peter Tate was to meet me in Berlin with his bicycle, and I was bringing my Novara Element with the intention of leaving the bicycle with Onkel Herbert. Daughter Diane was able to get away from work and go with us, and she seemed content to take care of herself when Peter and I were out riding. Our plan was for a Blitzreise, spending three days in Berlin, three days in Leipzig with Herr Doktor Kretschmar, and three days in Krefeld with der berühmte Herr Doktor Feucht. Diane left us after Berlin to go see a friend in Frankfurt, and we met again in Krefeld. The trip included much learning about how to survive with a bicycle. It was especially the case with learning how to travel on public transportation with a bicycle, like riding the Bahn. Once arriving in Berlin, the first order of attention was to assembling the bicycle, and then to going out to get some Döner. We were able to take Peter on a walk around Berlin in order to show him the main sites, like the Bandenburger Tor.

21 AUG 20 km ride around Berlin– riding a bicycle around Berlin was easier than expected. Bicycles need to observe the same rules as cars, though they usually have special bicycle paths for bicycles. The rest of the day was spent taking a long walk with all three of us together and Diane as Stadtführerin.

22 AUG 108 km ride to Potsdam from Berlin, with bypass to see Sans Soucci and to loop around several lakes in the Potsdam area. This was a long ride, and the weather was perfect. On this trip, we learned how confusing it could be to try to find your way around, and we often went in circles. Streets are not often clearly marked, and they frequently change name for no good reason. To make matters worse, I was depending on a gps card for my Garmin Edge that would give me streets in Europe. The gps unit refused to accept the card, and so was left without a reasonable means of orientation and poor maps. I couldn’t have been more upset. Needless to say, the ride was awesome, and the palaces around Sans Soucci were overwhelming in their size and grandeur.

24 AUG Dresden. 4:30, 81 km3500 cal, 120 m– Peter and I arrived in Leipzig on 23AUG, and was picked up at the Hauptbahnhof by Dr. Kretschmar, whom I met last year while in Cameroon. He arranged for us to stay at a Ferienwohnhausrun by one of his friends. We were able to meet his parents and to have supper with them. The home-made sauerkraut was awesome. They also took us on a quick tour of Leipzig. On 24 AUG, Karsten, Peter and I were able to take off on our bicycles to the Elberadweg. We drove about 1 hour to our planned start, and off we went. The route was unbelieveably well cared for, and many people were on the road. It was fascinating to see a very large number of quite elderly people out riding their bicycles. We passed through the towns of Meißen, where the famous porcelain comes from, Dresden, and on. As we rode up stream, the canyon walls got steeper, and more impressive. There were multiple castles and elegant palaces along the way…. Nothing like one would ever see in the US. We then stayed in a very large Herberge, which looked like an old castle with a Turm, and nestled on the side of the canyon wall.

Peter and Carsten

Meißen

Peter in Dresden

Frauenkirche

Semper Oper

Our hostel was the upper right white “castle”

25 AUG. Konigstein to Neuhirschstein 90.6 km 5:17  3593 cal, 215 m ascent– the next day, we first rode 10 km up the Elbe to Konigstein, making a fairly steep climb up to the largest fortress (Festungen) in all of Europe. It was overwhelming. The trip back along the Elbe attempted further variations in order to see different things. At the end of the trip, it was very sad for me to have to say goodbye to Carsten, as I really appreciated seeing him and family again. I’ll definitely want to see him again in Cameroon, as well as spend time with him again in Deutschland.

Königstein

Königstein

Summer palace in Dresden

End of the ride in Hirschstein

26-27 AUG — we took the Bahn from Leipzig to Krefeld, and then rode our bicycles from the Krefeld Hauptbahnhof to Herbert’s Haus. The next day, Diane, Peter and I rode the regional transport to Düsseldof. We also spent much time looking for a bicycle box in order to sent Peter’s bibcyle back to the US on the airplane with him. We finally found a box for him at the Rückenwind bicycle shop.

28 AUG Krefeld to Ossenberg and back.   5:42,  100.7 km     3673 cal, 127 m ascent. Today, Peter and I took off on our bicycles to ride up the Rhein. The bicycle path was reasonably well marked, but the road was not in nearly as good of shape as the route along the Elbe. Also, since we were in the  Ruhrgebiet, we saw a huge number of very large factories. At the end, the weather got us, and we were caught in a squall. Peter wanted to stop for a beer, but I just wanted a warm shower and dry clothes.

It’s been hard saying goodbye again to so many friends. Carsten, Herbert, Katja and Hannes and Peter. Having left a bicycle with panniers at Herberts Haus, I now have no excuse not to return to Deutschland for another ride. I’ll either do the upper Rhein, the Schwarzwald, or perhaps something over in the Franken/Spessart area, heading to Prague. Hopefully, the next trip might be a little longer, and focused on just one region, to prevent spending a lot of time just getting from one place to another.

Telling God how He did it

August 15th, 2010

Brother Dennis opened up some thought processes when he made some comments regarding a book that I reviewed by Dempski called The End of Christianity. In particular, he comments on God sticking His fingers into the process of Creation/Evolution by saying “This is a key issue between intelligent-design theorists and evolutionary creationists. Why God should have to tinker with the creation after he establishes the laws of the universe along with initial conditions is unclear. Has he not gotten it right from the start?”.

Simultaneous with Dennis’ comments, I receive an e-mail from NH, a physician and Christian thinker whom I respect dearly. His note is as follows…

“I would commend to you a careful reading of these two items:

http://www.modernreformation.org/default.php?page=articledisplay&var1=ArtRead&var2=1137&var3=issuedisplay&var4=IssRead&var5=112

in which 8 geologists appeal to the PCA to accept the “old earth view.”  It is a pitiful piece when looked at from a theological perspective, and actually quite poor from a scientific perspective (the analogies in particular are often invalid). Hopefully when you read it you will anticipate the arguments made in this point-by-point rebuttal by another geologist:

http://www.reasonablehope.com/node/117

Both the links are worth reading, the second article being a rebuttal of the first. You may determine for yourself the strength of his rebuttal, though I consider it as standard classical argument of young-earthers.  Clearly, NH is a 7-literal day creationist. I am very reluctant to trash either Dennis’ or NH’s comments, yet offer a slightly different approach.  The first difficulty is in creating a discussion. The 7-day creationist (if you wish, young-earth folk) consider their stand as a litmus-test of orthodoxy, and any disagreement is considered either an inability of believe the Scriptures or inability to hold Scripture as the infallible word of God. The old-earthers look at disdain at young-earthers as somewhat scientifically naive and guilty of the sins that possesses many medieval theologians that fought against Kepler and Galileo. Neither side is right.

I proffer several foundational statements.

1. The word “day” in Genesis 1-3 does not necessarily denote 24 hour spans. This argument is ably developed by both Hebrew scholars and biblical scholars that look at the use of the word “day” throughout Scripture.

2. The genre of Genesis 1-3 is neither strictly poetic nor strictly literal-historical. Those who develop the construct of Genesis 1 as simply being an apologetic against the Egyptian gods are wrong, though an apologetic is implied by the structure of how Moses constructs Gen. 1. Nor does it utilize language and terms that suggest an accurate detailed historical approach to creation.

3. The implication that God commands events to happen in each of the days of creation suggest a divine interference on a “daily” basis. Dennis’ comments, of which I’ve heard many times before, suggests that there is a “anthropomorphism” in the very substance of the atomic structure of the universe, that demanded that this is the sort of universe only that could have come out of the “big bang”. This seems to lean dangerously to Deism, if not Animism, whereby Nature itself is offered the source of personality, and that the universe, once wound up, can take care of itself.

Thus, there remain a few questions of relevance…

1. What is the level of involvement of God in the process of creation/evolution? At what stage, or, at what time in history, did God decide to cease active interventional work in the universe outside of the laws of nature, and thus work through the “laws of the universe” in his actions in the world, including his miracles as described in Scripture? This is simply an unanswerable question. Scriptures give us no clues, and science could never answer such questions.

2. Is it morally deceptive of God to create things that are aged? To what extent would he have done that? In my opinion, it is neither right nor proper to ask such questions.

3. Do the questions of creation/evolution really need to recruit discussions of a universal flood? Are these not ultimately separate questions?

4. Can we ultimately claim an exegetical basis for establishing the genre-type of Gen 1-3? I bring this up, because young earthers wail long and hard about the abandonment of a strictly literal interpretation of the Scripture. Yet, John Gerstner, in Wrongly Dividing the Word of Truth, waxes long and hard against dispensationalists who force literal interpretations when the genre doesn’t permit a literal interpretation.

My own personal stance leaves me neither a strictly young nor old earth creationist. I feel that we assume too much when we attempt to engage in the creation argument. I feel that discussions have not allowed for a plastic middle position, and focused on how far from that middle one needs to go before one falls off the edge. It could happen both ways. I feel that Dempski falls off the edge, when he removes God from the much of the processes of creation. Morris from the Creation Research Institute falls off the other edge by pushing his agenda so hard he simply does poor science. It would be better for Morris to simply be a fideist than an apologist. Yet, I also accept that much of science will eventually be proven wrong, that our standard tools such as carbon dating will be replaced, and that new paradigms will replace old. Like Hugh Ross, and others of the conservative old-earth school, I see how we may use science as an apologetic for a Christian worldview, even though the science may evolve with time. As an example, the red-shift observation in the stars led to the “big-bang” theory, which is entirely consistent with Christian thinking that there was a time when the universe was not, and then came instantly (almost) into being. The intelligent design argument wonderfully argues against a laissez-faire universe explained entirely by random events. God clearly interfered with natural processes at all stages throughout the development of this world, though we will never know the balance of interference/natural process nor the speed/acceleration by which he had natural processes occur. To me, the arguments sit around trying to tell God how He did things. I’m sure He’s not so amused at our undertakings.

Since we are on the topic of God interfering with nature, there is one more thing that bothers me. I just wish to know why Jesus didn’t turn the water into beer rather than wine.

Bangladesh 2010

July 4th, 2010

07JUN2010 I’m currently sitting in the airport at Muscat, Oman. It is a very nice airport, and thankfully, all have been very helpful to me. I discovered only a few days before leaving that CheapOAir changed my reservations such that I was left with a 28 hour layover in Muscat, the thing that I dreaded most, being stuck in an airport for lengthy periods of time. There was no way that I could correct matters, though there was a glimmer of hope yesterday with Lufthansa suggested that I could be bumped for a day, which would have left me a 4 hour rather than 28 hour layover. Oh well. The trip started in Seattle. The checkout person was German, so we did the entire exchange auf Deutsch. I was pleased to discover that I was also able to fare quite well in the Frankfurt Flughafen, my German ever so slowly improving, though mostly in interpretation, and not in ability to communicate. I’ve been able to read two large books so far in my travel, well as study some German and Bengali. I sadly discovered that I left my light yellow rain jacket on the last airplane, but won’t discover until this evening whether it showed up in lost and found. The airport is quite fascinating, and am surprised at the amount of liquor that could be found here, even though it is a strict Muslim country. I’ll probably pick up some frankincense on my way back from Bangladesh. I wish that Betsy was with me. I miss her, even though she seems to be constantly anxious about any sort of imaginable trivia. I’ve seen only a few spooks so far, and most people seem to be dressed in Indian western dress. I am quite surprised at the prevalence of Western culture, and especially English, in remote parts of the world, such as here in Oman.  Watching Muslim and Hindu families come by, seeing people interact and converse, it amazes me that cultural differences are over-emphasized, and how similar the characteristics of all humankind tend to be.

08JUN2010 Finally in BD. Babil got me at the airport, and we went for lunch at a local Bangladeshi restaurant. I’m eating with my hands again! You don’t use a spoon and fork in BD but pick up your food with your hands. It was wonderful to see old friends here in Chabagong, including Steve K, Steve W., Jason & Anna, John Tripura, Poromil, Uttam, Sujan, and the Collins. They make the trip worth it! Please forgive me if I left your name out…

20JUN2010 A 12 day interlude is now noted. I have been quite busy at the hospital, and enjoying my interactions. Like before, I have spent much of my free time in either talking with friends (of whom are both Americans and Bangladeshis), and reading. A number of books have already been devoured. Several books will not be reported in my website for the sake of Christian charity. Dr. Lattin has also loaned my some old copies of First Things.  I find First Things quite fascinating with a mixture of feelings. About a 1/3 of the articles are delightful and of interest to me. They utilize English at its best, a subject which leaves me rather jealous, because, try as I may, I find it impossible to write well. Every time I re-read what I write, I find grammatical errors, confusing statements, inappropriate use of words, self-manufactured words, and other stupidities. Brother Dennis only points out the most glaring examples. Yet, while reading First Things, I am able to obtain a vicarious joy in the best use of the English language, and the thoughtfulness of the articles. I am less inclined to delight in First Things because of its replete Romish Catholicism, as well as its slightly too liberal stretch of “co-belligerency” to Rome, Eastern Orthodoxy, Judaism, etc. Yet, Neuhaus is a first class writer, and often strikes a cord of agreement with me that I am able to appreciate.  My time is also spent in reflection on life in general. I miss Betsy tremendously. I do not feel complete without her. I’ve reflected much on the nature of missions, especially missions in a Muslim realm. Modern Western sympathies for Muslim culture and religion seem to lack an appreciation of the working of Muslims when found as the predominant cultural or religious group in a community. This has been seen by me both in BD as well as in Cameroon. It is a religion of slavery, joylessness, oppression. It offers minimal respect for women, disguising the depersonalization and subjugation of the female population all in the name of modesty. Yet, devout Muslim men seem to be the most lustful of all of God’s creatures, and the presence of a Burqua doesn’t quench their lusts. Generalizations tend to betray the large amount of quite decent living and courteous Muslim people that I’ve encountered, who have been most helpful in my travels. Like last time in BD, probably the hardest thing to endure is the persistent beggarliness of all Bangladeshis. It’s hard not to respond to that, though agreements with the mission to not give more than meager gifts to the natives must be observed. A typical BD native seems to view the missionary Christian as the equivalent of “wealth”, and I remain perplexed as to how to personally respond. I sometimes feel that my presence in BD is perhaps more a problem than good for the gospel.

27JUN2010 I have just finished my last day of call, and will be wrapping things up this week. Call kept me up both nights, the first to do a D&C, and then next night to answer questions about a patient who decided to go into the dying mode. It is monsoon season, and rain occurs unlike anything in the Northwest. It will rain torrentially for about twenty minutes, and then it will be sunny. Rains occur about 2-3 times a day. I tried going out once in a downpour, with an umbrella, and found that I was soaked from head to toe, as the rain falls horizontally with a small wind. You’re always given a minute or so premonition of coming rain, as the wind begins to blow. You don’t see dark storm clouds, just a wind. I’ve now met with all my friends on the hospital compound, and feel like I’ve been able to spend quality time with them. I haven’t taken enough photographs, and will need to spend one last day running around with my camera. Nurul (his name sounds more like Noodle as the Bengalis do a different sort of “r”) will be taking me up to Chittagong. Meanwhile, only one thing is on the mind of most Bangladeshis—the World Cup in soccer. Oddly, the nation cheers for only two teams, Argentina and Brazil. It will be tragic when both of those teams loose.

02JULY2010 I’m now sitting in the airport in Chittagong. It’s the first time in ages that I’ve been able to access fast internet (and free, also!!!!). A few Taka and the airport assistant was able to shuttle me through to the head of the line, and get me through without a problem. The airport scanner was broken, and so they quickly let me through when I told them that I was a daktar (doctor). The ride to the airport was with Nurul, who drove quite decently, and we arrived in generous time to catch the plane. Although Cameroon roads were the worst I’ve ever encountered, Bangladeshi roads are not exactly super-highways, and more than once, we almost hit a dog, rickshaw, and oncoming bus. I can’t believe that more accidents don’t happen in this country. Later… I’m now in the airport in Muscat, Oman, waiting for my Papa John’s pizza to cook. I happened to be the only white person on the plane from Chittagong to here, and it’s nice to see a few English speaking people around. Bangladeshi behavior is close to hilarious. They are very pushy in line, always trying to get ahead of anybody else. Once the plane hit ground, almost immediately, about half the passengers popped their seatbelts and were standing to fetch their overhead items. Strange. Papa Johns was quite good, not greasy, close to what one would eat at home. I ordered the super Papas, since they didn’t have the Arabian Always special. I presume it was halal. The checkout lady was in black dress, not a full burqua, but had absolutely no personality; no smile, no regard for people, nothing.

Papa Johns in Muscat, Oman

Flowers of Bangladesh

Selling Jackfruit in Chabagong

John and Nimmi with hospital schematic

In the market with Sujan

I now think about the trip summary. I feel that it was a valuable trip, especially being able to meet old friends, and acquire new friends in Malumghat. I was able to give Steve K. free time to work on the design of the new hospital with the architect. I especially enjoyed meeting John M. and his wife Nimmi, who live in North Carolina, though they come from Chennai (formerly Madras) India. What did I forget? 1. Insect repellent. The last four days, the bedbugs came out, and I was covered head to toe. Interestingly, at the same time, I read recently that an Abercrombie and Finch was closed in New York City because of bedbugs. Go figure. 2. Flashlight (headlamp) – the lights go out way too frequently, and I have to ride a very bumpy road on my bike at night to get to the hospital when on call. 3. Voltage converter/adapters- the only thing that wouldn’t work was my beard trimmer, but sticking a three prong plug into the outlets provided tended to put a terrible strain on the plug. It would have been better to have an adapter.

I am considering a return in late January/early February 2011 with Betsy. If we go, I think I will try the oriental route, and maybe stay several days in Bangkok. Jason noted that the town was quite interesting, and fairly modern, worth a visit. We’ll see how the Lord leads.

So, as soon as we arrived home, Betsy and I went out to purchase a new vehicle. Diane needed our RAV4, and we sold it to her since we were considering a pickup. We ended up with a Toyota Tacoma.

Life Update 19APR10

April 19th, 2010

Cannon Beach
It’s been over three months since I’ve posted about events in Betsy’s and my life. A lot has gone by, like, Easter! I had out the Österlamm that Herbert gave me about 6 years ago.

So, here is a quick catchup, mostly with photos…

1. Deutsch Unterricht– I restarted Saturday AM German class. Between reading the Magazine Deutsch Perfekt and going to German class at the Tacoma German Language School, I’ve been able to keep from totally loosing my language skills. Here are some photos of the class, as well as the teacher, Yvonne. She is from Dresden, Germany, and is unbelievably patient with us old farts.

2. Oregon Coast– in early February, Betsy and I took a trip to the Oregon Coast. The lead photo was from Cannon Beach. The Oregon Coast is one of the most beautiful coasts in the world.

3. Cycling & trainer– Betsky now has a new bicycle, named Meggie II, after her first bicycle. We took a brief 10 mile ride recently…

Betsy also let me get a Tacx Virtual Reality Trainer. These are quite nice at being able to cycle train in bad weather or when you only have an hour to spend on a bicycle and need a hard workout. It works by connecting a computer to a gizmo that your back bicycle wheel sets in. When you are going “uphill”, the wheel offers resistance in proportion to the steepness of the hill, and when going downhill, it may actually spin your tire for you. It is close to reality.

You can see that it really chews up your training tire. Meanwhile, you watch a video screen, which you set to a number of rides that you may wish to experience, throughout Europe. As you pedal faster, the scene moves faster, quite comparable to reality.

The screen will also show your power output (in watts), cadence (how fast you’re pedaling), heartrate, bicycle speed, time, and distance. This allows you to monitor closely how well you are improving on your endurance. Here is Jonathan on the bicycle trainer…

4. Bicycle Tour 15-18APRIL2010. This trip was to celebrate tax day, April 15. Russ A. and I drove to Chelan, WA, and took off from there. Our first stop was 52 miles later in Twisp, WA. The road either followed the Columbia River, or tributaries, leaving us at a resort town just east of the North Cascades pass.

The next day went from Twisp to Coulee Dam, a 85+ mile ride, with fully loaded touring bikes, and about 7000 feet elevation gain. Here was our first challenge, that of crossing Loup Loup Pass. We were concerned about the weather since it had snowed on the pass just a week before. It was quite cold, but we were working so hard to cross the pass that we were over-heated anyway.

We then ended up in Omak. We met a kindly elderly gentleman on the street to enquire about our options, and he suggested that we NOT go the way we had planned, but instead take an alternative route that was marked on the map as gravel road, yet in reality was fully paved. He also suggested that there were minimal hills. The route indeed was far less hilly than our planned route, but was persistent in multiple sections of 6-7% grade uphill, and a lengthy 8-9% grade section at the beginning and end of the new route. We were quite pleased to have done this alternative route, since it took us by some absolutely spectacular scenery, like Omak Lake.

We eventually ended up at nightfall quite exhausted but looking at the Grand Coulee Dam. We stayed in a motel that faced the dam.

The next day was 61 miles and another 5000 feet of climbing. From the photo below, the intuition would remark at how flat the terrain was, yet, on a bicycle, it was quite rolling hills, with lots of 6% grade climbing. We were still moderately tired from the previous day, which made it harder to do even simple hills.

Our last memorable scene was from the Columbia plateau, getting ready to descend down to the Columbia River. In the distance, you could see Lake Chelan and the town of Chelan. It was a 8-12% grade descent for about 5 miles. Awesome! I’d sure hate to come up that hill on a loaded touring bike!

5. Future– so much has gone by. A niece, Laura, won a beauty pageant.

Laura, we are so proud of you. It takes not only beauty but true talent and skill to get to Teen Colleyville.  Thankfully, you didn’t have to have uncles dying in the car and brothers spazzing out on you to get into your contest, like in Little Miss Sunshine. We had old friends from many moons ago, Aaron and Anita visit us. They remain quite special. I especially appreciate being able to do outdoor things with Aaron. We plan on seeing Jonny off to Belize for the summer, and perhaps longer, to visit and study with Uncle Dennis. Dennis has been doing well, as is attested by this recent photograph…

Once he gets out of jail and quits playing with poisonwood, he’ll be back to his old self, I’m sure. Dennis is not really in jail; he is just showing us the miracles of Photoshop. I’d really like to visit Dennis some day. Belize is looking increasingly appealing, especially with our Destroyer-in-Chief Obaminator as el Presidente ruining all that we count as precious in our country. He will go down with Woodrow Wilson and FDR as the worst presidents ever of the USA.

I hope to do a few more cycle tours this summer. I also plan on spending the month of June in Bangladesh, and will be in Germany for the last 2 weeks of August, if all works well. More blogs will follow. I haven’t had many book or movie reviews since I’m listening to 2 lengthy Brahms compendiums, which I wish to review together, watching a lengthy tv series with Betsky, and reading a very large and ponderous book. So, more blogs will be in the works in the future. Meanwhile, please stay in touch.

Surgery and the Airline Industry

April 19th, 2010

I’ve written about this before, but the topic doesn’t go away and I’m growing weary of it. Hospital regulatory agencies in our state, and in most states, are being instructed the the way in which the airline industry has become safe was through the use of certain regulations and imposed rituals. Especially being pushed on the medical community are the use of checklists, similar to what are used before and after a flight to assure that all procedures are carried out correctly. Our state is now instituting a checklist standard with 100% compliance by hospitals in our state, and celebrated by meeting at the old Boeing plant in Seattle, Washington with an author of a favorite book detailing the use of airline safety procedures in the health care industry.

I’m all for airline standards, but not in the “pick and choose” standard that is being shoved down our throats. There are too many other airline industry differences that are simply ignored, at the patient’s peril. I’ve discussed many of them in the previous post. Let’s re-hash a few of them.

1. Airline personnel work hours. The airline industry, as well as the government, has strict standards on the amount of fly that a pilot can do, or work that a repairman can do, before exhaustion leads to inefficiency as well as mistakes. Nobody would ever dream of climbing on an airplane, where the pilot has been up the last 24 hours, and is now exhausted. I have personally called for reform in this area with deaf ears listening. It is hard to imagine that a truck driver is our state is forbidden from driving his truck for greater than 8 hours straight, and yet physicians frequently work for 48-96 hours straight with nary a comment from the state about the dangers that this is imposing. I’ve asked both the medical society as well as state legislators to consider this problem, and it is swept under the rug. Yet, if there are any actions that could be taken to eliminate errors in medicine, this is certainly the most important. Even airline pilots, on long flights, have replacement pilots in the plane to prevent the pilot from having to fly for over 8 hours.

There are 2 main stresses on an airline flight, that of taking off, and that of landing. True, decisions may need to be made in the air, but the main stresses are the start and end of the flight. In medicine, the initial patient consult, the care during a moment of extreme instability, or the trip to the operating room, may be likened unto the takeoff and landing stresses. The period that physicians spend on call sitting by their beepers could be likened to the time in the air. It is similar, since the physician is still being called, and must make consequential decisions. Many of those decisions are made when awakened from sleep, and more often than not, a night on call will rarely give more than an hour of straight sleep in a night. Yet, we not only have to make significant decisions during the night, but must show up at work and consult on new patients or operate the next day. Would anybody feel comfortable flying on an airplane where the pilot had no sleep in the last 24 hours? Thankfully, most patients have no clue how much sleep their surgeon had in the last 24 hours! Comparable to the airline industry, it would be like saying that the only legitimate work-time for the pilot was the time on takeoff and landing, and then who cares how much time is spent in the air, since flight time is low stress.

2. Co-pilots. It used to be that almost all surgical cases had two doctors in the room. For smaller cases, it was the surgeon and a family doctor, and for larger cases, it was two surgeons. Nowadays, it is almost impossible to get two surgeons both in the room at the same time. It is economically unfeasible, and we’ve been forced to adapt. This has mostly been to the greater risk of the patient. Two surgeons on a case always goes quicker and better than one surgeon alone. It could be compared to the airline industry deciding that a co-pilot is too expensive to maintain, and thus eliminating that position. Maybe it’s time to return to the co-pilot in surgery practice?

3. Retirement – My pilot friends tell me that the airline industry bumped up the age of mandatory retirement from age 60 to age 65. Frightening! Pilots need to go through more rigorous pyschomotor testing to assure that they have good reflex timing as they age. Why aren’t they doing this for doctors, especially those who do procedures on people? We are required to take ever expanding CME classes and tests to prove our mental competence, though it is dubious that either accomplish their intended task. At the same time, we are required to take courses in things we never intend to see or would not manage even if we encountered such a situation, since courses of themselves are absolutely no replacement for real-life experiences. I recently took a mandated pediatric trauma on-line course in order to maintain my ability to serve our hospital. I felt like I was in the military–dotting all my “i”s and crossing all my “t”s, yet realizing that I had not acquired any true competence at pediatric trauma. We don’t have simulators that can exactly match what a flight simulator can do for a pilot. There are no surgery simulators that will spray blood in your face and give you AIDS if you screw up.

At this time, I have no recommendations for the medical profession, but pray that it soon die the same death that all it’s patients will eventually experience. Physicians are unwilling to defend their profession from external abuse, but complain bitterly about the loss of their profession. Medicine – R.I.P.

Checklists

April 19th, 2010

Below is an article that I wrote several years ago, that is now more true today than when I wrote it. At the time, we had a flamingly incompetent Chief of Staff (called Dr. Bigshot, since he remains very prominent in politics at our hospital) and the staff of our hospital was all given an article by Dr. Guwande from the New Yorker regarding the virtues of checklists in saving lives. My apologies for not being able to give you the exact reference for this article, as I threw it in the wastebin. I have no problems with checklists. I have a serious problem with assuming that checklists are what saved the airline industry, and that people would be saved if only we used checklists. So, I re-post my article. The next post carries on with the same theme, now written contemporarily. BYW, Dennis, I found most of my grammatical errors, but feel free to inform me of others.

Several years ago, tort reform became the cry of the medical profession. We felt that our profession was being destroyed by a litigious culture which was strongly supported by a government that seemed to thrive off of a healthy legal industry. We lost that battle. In return, the law industry laid claim that the health care industry was careless and did not attend properly to quality control or error reduction. In turn, we responded with multiple programs. There were state and national programs that were initiated, such as the 100,000 lives campaign (I await eagerly the 250 million lives campaign). Even in Pierce County, our medical society invited various quality control pundits to speak to us. The rallying cry was to become like the airline industry. After all, did not the airline industry take an intensely complex system, and produce methodological algorithms (such as checklists) to eliminate human error? As I learned in flight surgery school, the number one cause for airline fatalities was a loss of situational awareness on the part of the pilot. Checklists helped to reduce routine operational error, thus, decreasing the one aspect of fatal error.

The article by Atal Guwande in the New Yorker further fosters this idea that if only the health care industry model itself after the airline industry, then error reduction would significantly fall, and lives would be saved. I certainly agree with Dr. Guwande that checklists can serve some useful purposes in our profession. Yet, I also see certain problems with what he proposes. The first problem discusses differences between the airline industry and medicine, that disallow the airline model. The second details the evidence that Dr. Guwande himself provides claiming that checklists can solve many of our woes.

First, what are the differences between medicine and the airline industry? There are a number of issues that I can list.

1. We can?t control the circumstances. In the airline industry, if bad weather hits, the airlines shut down. We can?t do that. We “fly” in any circumstances. If a patient arrives in immediate need for surgery when the operating rooms are already filled and the patient already has multiple system organ failure, we aren?t allowed to “stop all flights (surgeries)” and wait, in order to get control of the situation.

2. We don?t aim for 100% survival. Ultimately, all of our patients will die, which is 0% survival. Unlike airplanes, we have a poor means of predicting personal survivability. We can quote population statistics, which do not apply to a given individual. Checklists or not, eventually everybody will die on us. In fact, we have very poor means of measuring when we are actually successful in medicine, as it is not necessarily survivability at low cost without complications.

3. We cannot set the circumstances for surgeons or health care personnel like we can with pilots and flight attendants, airline mechanics, etc.. I would love to have the same working circumstances as a surgeon as a pilot usually lives. There are strict controls of working hours, and time that a pilot is allowed in the cockpit. We have no such controls. Yet we know that human error is our biggest source of health care error, just like situational awareness is the biggest problem in the airline industry. Establishing mandatory retirement ages, mandatory work-hours, mandatory spontaneous drug testing would kill the industry. I have operated countless times high on antihistamines in the symptomatic treatment of seasonal URI?s, yet such drugs would have grounded me in the airline industry. Are we willing to have our health care personnel subjected to such demanding regulation as the airline industry has done? Why not? The object is to eliminate human error, and such airline regulations would accomplish that.

4. Human systems back-up cannot compare. A pilot has not only a second backup (the copilot) always at his side, but also the capabilities of autopilot. Generally, we virtually never have a second physician (with the same expertise) simultaneously participating on a case. Auto-doctors remain to be invented.

5. Which leads to brutally serious question…why have auto-doctors not been invented yet? Autopilots work because one can “figure out” most the systems issues and expected problems in the operation of an aircraft. The “machinery” (the human body) that we work with is infinitely more complex than the machinery (the airplane) that the airline industry works with, and the expected problems vastly greater. While Dr. Guwande tends to disparage the “art” of medicine, heralding the virtues of scientific medicine, it remains without question that the complexities of medicine demand both intuitive as well as methodological decisions, and the intuitive decisions cannot be check-listed. An equivalent comparison would be to devise an airplane that is so complex, the ground support personnel never really understand how the airplane works, or exactly what the proper procedures are to repair. The pilot could never be sure whether pushing the joystick to the right would move the appropriate wings or flaps in the proper direction, and would be told that any control panel action would have only an 80% or less response rate, as well as a highly unpredictable nature of whether all the monitors or gauges on the control panel were ever monitoring the correct information. Yet, we live with this all the time in medicine.

6. The economics are different. If the airline industry is asked to institute an industry-wide change, they would raise rates to passengers to pay for that. We cannot do that any more in the health care industry. In fact, our pay would either remain stagnant or cut, in spite of elimination of error.

7. Training and retraining. We call retraining CME, yet CME only remotely pertains to our practice of medicine. A flight-simulator has never been invented for the health care industry, probably for reasons explained in #5. Our expertise comes solely from experience, coupled with the maintenance of an innovative mindset. When we increase physician educational demands and demonstration of competence through increased testing, the net result is not increased competence among physicians, but a decreased number of physicians, who drop out rather than re-test. This doesn?t mean that we can?t learn from the airline industry. It only means that we need to be very cautious in selecting what methodological algorithms we acquire from the airline industry, and then be highly selective in exactly which circumstances or activities would be well served by these algorithms. It is possible that some systems in medicine would actually be harmed by blindly applying the airline industry methodology of error prevention.

What about Dr. Guwande?s claims that checklists can significantly reduce error in medical care? Dr. Guwande discusses his thesis with unbridled enthusiasm. In a most unscientific manner, he fails to discuss multiple variables that should have been examined, especially since his thesis of the virtues of checklists are now being mandated throughout hospital systems in the USA. Which variables did Dr. Guwande follow? Survival? Costs? Turnover rates of health care personnel? Patient and family satisfaction? Days of hospitalization? His studies of checklists were limited to highly specific and controlled circumstances, such as the management of central lines. This is a relatively non-complex system compared to many systems seen in medicine. Does he propose that all operational systems will be helped by check-listing? Does he have evidence for that? Newly enacted checklists tend to eventually breed familiarity, that in turn lead to loss of effectiveness. Dr. Guwande has only short-term follow-up of his check-list system, so it is not surprising to see short-term improvements. What do you suppose we will see after ten years of checklisting and familiarity itself leads to error? I suspect it will lead to even more detailed check-lists, probably orchestrated by a computer program, rather than a human, such as the nurses that Dr. Guwande used in his catheter study. This in turn will not only drive up the costs of medical care, but also the depersonalization of medical care.

Outside of checklists, the failure to communicate has been identified as the other great sources of medical error. There is a great amount of truth to this, and check-lists certainly serve the function of forcing a brief episode of communication among the team, many of whom often don?t even know each other?s name, let alone the most rudimentary facts about the other people on the team in the room. But, we don?t dare tread on that. We must remain scientifically impersonal. Yet, when I work with a team that has known me for years, typically, minimal communication ever occurs about the patient or medical care we are rendering, save for occasional teaching points for the team (we do talk about other things!). We know how each other does things, and we expect things to be done that way. This is true for nurses and techs in the OR or recovery room, as well as experienced nurses on the wards. Sadly, regimented communication cannot fix the problem of operational harmony, something that only time and experience with each other as a team can fix. Which is why “teams” are probably more important than check-lists. Another communication issue, handwriting, was fixed thirty some years ago with computer-order entry, quite the norm in Chicago, IL where I trained, but still unknown in these parts.

Dr. Bigshot comments that resistance to checklists is an “ego” issue. I doubt it. True, there are ego issues when one has a nurse policing the doctor. Not even the airline industry has stooped that low, having a stewardess tell the pilot to push the rudder right rather than left when the airplane is going down. But that is exactly what is happening in medicine. You can escape hierarchical disorientation by being independent, which is exactly what Dr. Bigshot has done. Hospital bound doctors like surgeons and intensivists don?t have that luxury. Is it ego-istic to ask questions pertaining to the efficacy of checklists? I don?t think so. Many of us could have easily gone into research rather than clinical medicine. Our training teaches us to ask questions, look for alternative solutions, explore the unthinkable, to agonize over a solution that doesn?t exist in a textbook, journal article, or on a check-list. Yesteryear, that made you a good physician. Now-days, it makes you a non-team-player, radical, disruptive, or perhaps, worst of all, egoistic.

We will turn to checklists. We will love them with religious devotion. The Joint demands it. We will comply. Yet, it feels like we are driving just another stake into our coffin. R.I.P.

Speling-fore mi bwuder

January 26th, 2010

Deer Denis;

I weally twy to katch awl mi speling mysteaks. I weally doo. Butt i m knot a superman lik Obama. I doen’t haf a telle-prompter lik himm. So i meak misteaks. I awso gouf oup mi grammer wonce in a whil and doen’t katch it. Sowwy.

Bwoder kin

Church

January 17th, 2010

I am prompted to write an article on the church, owing to a number of comments made to me, and internet articles that I’ve read recently, that reflects what seems to be a new thinking regarding the role and form of a local church. Because this new thinking has some serious implications as to the nature of what we may see of church in America in the future, I felt it relevant to jot down my reflections of church.

A person that I knew from early on in life became a local celebrity in Portland for her authorship of a article about her problems with church (click here to read). Though the title is “How to Survive Church”, it would be more appropriately titled “How to survive in spite of church”). In this article, Becky P. describes her problems with her childhood church, and subsequent churches that she has attended. Her final solution was essentially to not take church so seriously. She states in conclusion

I’ve also learned what not to expect from church. In the past, my whole life–family, friendships, social activities, vacations, even employment–revolved around church. As a result, church crises impacted every aspect of my life, and leaving a church meant losing my entire support system. Church is still an important part of my life, but it’s no longer the center of every friendship or endeavor. I interact more with the world around me and pursue relationships outside of, as well as within, my church. Most important, I’ve learned not to put too much stock in human institutions or leaders, who will inevitably let me down. Psalm 118:8 reminds me, “It is better to take refuge in the LORD than to trust in man.”

I had always wanted to give Becky feedback, since I feel that her conclusions are not only quite dangerous, but just the opposite of what Christ wishes for us to experience with the church, and what I’ve been able to experience the last 16 years. Over the past few years, I’ve learned that

  • church is my high-point of the week
  • church is the most relevant activity that I do
  • church as a formal structure is far more delightful than as an informal structure
  • church is where my worship is at its highest and where I am closest to God
  • church is where I best see myself for who I really am and God for who He really is
  • I survive because of church and not in spite of church

In essence, I am offering a 180° counterpoint to Becky P. Perhaps I should begin with Scripture references to orient and set a reference of how I view church.

One thing I have asked of the Lord, that will I seek after, that I may dwell in the house of the Lord all the days of my life, to gaze upon the beauty of the Lord, and to inquire in his temple. Psalm 27:4

How lovely is your dwelling place, O Lord of Hosts. My soul longs, yes, faints for the courts of the Lord; my heart and flesh sing for joy to the living God… Blessed are those who dwell in your house, ever singing your praise… For a day in your courts is better than a thousand elsewhere. i would rather be a doorkeeper in the house of my God that dwell in the tents of wickedness. From Psalm 84

I was glad when they said to me “Let us go to the house of the Lord” Psalm 122:1

A few relevant theological & historical points need to be made.

  • Unlike dispensationalists and other new-church thinkers, I consider the Old and New Testaments to be one book, describing one set of behaviors, by a single God with a single similar character and expectations in the Old and New Testaments.We can thus consider any model of “church” or temple worship in the Old Testament as reflective of the similar form of worship we should be offering corporately at this time.
  • I cannot find ever in early church history where church was modeled as house micro-churches. Because of structural limitations, churches were not huge, but Christians always, I repeat, always, built churches or larger structures when the law and absence of persecution permitted it. In the apostolic age before the fall of the temple, worship still continued for Christians in the temple!
  • Throughout church history, God always worked through the greater visible church, and not through autonomous individuals. This is not to say that he did not use individuals, or that these individuals never went against the belief structure, but that these individuals always functioned as though part of the greater church.

Biblical and historical references have gone by the wayside in an age where the church and post-modernism have become dear friends, so that many people are rethinking and speaking out or writing about new concepts of church. The so-called cell-group as a during-the-week extension of church has been turned into “church” itself. Hypocrisy and ill-sought gain of many clergy have led many to disavow many of any possibility of clergy in their life. Therapeutic models of church have been found to have the same efficacy as voodoo medicine, and unhealed people conclude that church no longer has a purpose. Entertainment and seeker models of church have worn themselves thin, as electronic and television churches provide an ample replacement, in the convenience of ones’ own home, sipping coffee and eating donuts in a lounge chair while receiving the weekly heavenly instructions and motivations for life. Some will expect church to be a quasi-paradise where theology is all non-controversial and people get along with such contentment for each other that one would think they were at an LSD party —only to discover the truth of Luther (simul justis et peccator), that all Christians are hypocrites and sinners, oftentimes worse than one would encounter on the street, and thus justifying an exit from fellowship with all but a few chosen believers in the comfort of ones’ own home, or at the local coffeehouse or breakfast restaurant.

And so church goes by the wayside. Church has been found wanting, and Christians who desire true worship have found that they must create that environment for themselves. They may still attend church, mostly out of guilt of needing to follow Biblical instructions to not forsake the assembly of other Christians, yet their true worship is found in the loneliness of their private time, one-on-one, tete a tete, with God. If a given church fails to meet ones’ needs, or if it proves either controversial or too impersonal, then one can simply pack their bags and go church-shopping for a fellowship that most satisfies an individuals’ personality. The smorgasbord of churches are huge. There are mega-churches and tiny 2-3 family fellowships struggling for existence. There are young-upstart-meet in a local school building churches, middle age churches, and dying or dwindling churches. There are churches of entertainment, churches with almost no structure to the liturgy, high churches with a rigid structure and formality, pastor as big screen television church, pastor as gee-I’m everybodies friend church, pastor as layperson struggling to survive church. Churches could be oriented around football and sports, movies and entertainment, drama and music; you can find special interests group churches, politically oriented churches, environmental churches, god-save-America-gee-I-love-my-country churches, commie-pinko-freak churches, social justice “feed the poor” churches, and even wife-swapping churches. All of these churches are filled with members that consider themselves not only Christians, but evangelical and with a higher plane of spirituality than the hoi polloi of this world. Yet all of them are doing everything but what a church should do, so it’s no wonder that church itself is driving many sincere folk away.

What then should church be? I could do no better than to quote J.G. Machen, the last paragraph of his seminal book Christianity and Liberalism. He states…

Is there no refuge from strife? Is there no place of refreshing where a man can prepare for the battle of life? Is there no place where two or three can gather in Jesus’ name, to forget for the moment all those things that divide nation from nation and race from race, to forget human pride, to forget the passions of war, to forget the puzzling problems of industrial strife, and to unite in overflowing gratitude at the foot of the Cross? If there be such a place then that is the house of God and that the gate of heaven. And from under the threshold of that house will go forth a river that will revive the weary world.

Scripture establishes the nature and order of a church. Berkhof in his Systematic Theology describes the marks of a church in particular, being 1) the true preaching of the Word, 2) the right administration of the sacraments, 3) the faithful exercise of discipline. We will deal briefly with each of these issues. Regarding true preaching of the Word, this discriminates against heretical churches such as the Mormon church of Jehovah’s Witness, where a false gospel is being offered, or a false Christ. Preaching is the cornerstone of a church service, and about which all revolves. It is here that we offer respect to Scriptures as being alone our motivation, our driving influence, and God speaking directly to us. In the modern church, the message is more often conveyed in other portions of the service, such as the music, the drama, or the personal worship/fellowship time, yet the administration of Gods’ Word is the entire pivotal portion of a service. Too often, a preacher will read a Scripture passage, yet the sermon will be on everything but an attempt to expound the meaning of that Scripture to us. Those are false preachers, preaching of themselves, rather than solely of Jesus Christ and Him crucified. The administration of the sacraments have taken an enormous hit in recent times, since “new-think” tells us that the sacraments are devoid of meaning or significance. In regard to the sacraments, I am referring to baptism, the eucharist (communion) and marriage, and not the extended sacraments of Rome. While the Roman Catholic Church has turned the Sacraments into something too much, almost magic, the Protestants have progressively devalued the sacraments into an optional, ritualistic activity symbolic of corrupt institutionalized denominations. They have de-sacralized the sacraments by allowing the administration of the sacraments in a casual fashion by laity and clergy alike, so that you could be baptized by your favorite person, rather than a minister of the church, or have a communion session in a coffee shop with friends. My scriptural basis for the sacraments is found in the orderliness of ecclesiastical practice as described in the NT, noted throughout Paul’s and Peter’s epistles, as well as the even stronger example of the OT, where professional clergy were strictly described. It is a grave error to consider that the OT does NOT provide instruction regarding our liturgy and administration of our sacraments. Finally, the church administers discipline for the growth of the body of believers. Ecclesiastical discipline has been truly been demoted in both the Catholic and Protestant churches, now that you have a supermarket of churches all competing for your attendance and possible donations. To remove oneself from the possibility of discipline would be to remove oneself from anything that you could legitimately call church.

Before I end my statement on church, I will note that church models have been everything that described in Scripture. The growth of mega-churches leaves one wondering why they even waste calling themselves “church”, save that a church can impose God’s wrath as a threat for encouraging financial giving or tithing. The pastor of many churches nowadays serves more as an administrator than a godly messenger conveying and opening Scripture up to the congregation. It is no wonder than church services leave most people feeling empty, something that must be made up with the smaller cell-group meetings or an individuals’ quiet time. It is no wonder that church has taken such a serious hit in recent years.

The church has weathered many storms, and it will weather the current onslaught or accused irrelevancy. I bring to mind a great Anglican priest and song writer, Samuel Stone, who grew up in south London as a pugilist (boxer) until his conversion. He went into the ministry, working with the roughest and meanest folk in London. It was said that he once even boxed a disorderly parishioner, knocking them out, but later apologizing for that. He wrote the following song as a glorification of the institution that we have now so bitterly devalued.  Stone was a high-churchman. He was not speaking of the fad of do-it-yourself church-ism. He was referring to the grand visible institution of the church of which he was a very dear part of.

The Church’s one foundation
is Jesus Christ her Lord;
she is his new creation,
by water and the word:
from heaven he came and sought her
to be his holy bride;
with his own blood he bought her,
and for her life he died.

Elect from every nation,
yet one o’er all the earth,
her charter of salvation,
one Lord, one faith, one birth;
one holy Name she blesses,
partakes one holy food,
and to one hope she presses,
with every grace endued.

It is in the third and fourth verse that Stone speaks of a heresy going on in the Anglican church in South Africa during the 1860′s. The church has taken many beatings, and will receive many more until the Lord returns, yet Christ’s body will continue to the end.

Though with a scornful wonder
men see her sore oppressed,
by schisms rent asunder,
by heresies distressed;
yet saints their watch are keeping,
their cry goes up, “How long?”
and soon the night of weeping
shall be the morn of song.

Mid toil and tribulation,
and tumult of her war
she waits the consummation
of peace for evermore;
till with the vision glorious
her longing eyes are blessed,
and the great Church victorious
shall be the Church at rest.

The last verse concludes with the proper view of church. It is mystical, yet ordinary. It is an exercise of living with Saints before the face of God. It is an entirely imperfect experience on earth, but reflective of an entirely perfect experience in the life to come. For those who choose to remove themselves from church, to devalue church, or to redefine church as anything less than this description of the church given by Samuel Stone will be all the worse off, and to be pitied indeed.

Yet she on earth hath union
with God, the Three in one,
and mystic sweet communion
with those whose rest is won.
O happy ones and holy!
Lord, give us grace that we
like them, the meek and lowly,
on high may dwell with thee.

I conclude with a plead for individuals to return to a grander image of the church, and for the church to return to a grander image of itself. Our frustration with church should manifest itself by correcting our vision of what a church is, and then encouraging the church leaders to do the same. It is to seek for a church that has a high view of itself, and to be involved. It is not to expect the church to be therapeutic or non-hypocritical, but to be reflective of our own sinful state, a place where together with other sinners we can worship and pray and glorify the God of heaven. May God grant us the view of the church of JG Machen or Samuel Stone, and we will realize that we survive not in spite of the church, but rather because of the church.

The Source of All Problems with Health Care

January 13th, 2010

Please see my prior recent blog on healthcare. On the left sidebar, click on the “Feuchtblog” category or “medicine” tag, and that will take you right to this article and the prior one.

Many people have asked me about my views on ObamaCare, and what I would offer as a reasonable fix to the healthcare “crisis” in our country. I have no hope that our wonderful government will be able to fix the mess of healthcare. This is why I support the Obama health care plan. If it goes through in its entirety, it will destroy medicine. Then, we could start over. Maybe. Unfortunately, too many conservatives blame the government for the health care problems of the USA, while the liberals wish to give the government everything. Neither makes sense, because neither side takes the time to ask what is really wrong with American medicine. My final answer is that everything is wrong. There is no party or group that doesn’t stand innocent of our mess. Specifically, finger pointing must include all parties, including government, the lawyers, big Pharma and the health care industry, physicians, hospitals, insurers and third party payors, and patients themselves. I will be very brief in how each party is making a mess out of medicine.

1) Government. Government would love to control medicine. It is intrinsic in government to have control of the people, whether that government be a democracy or a totalitarian regime. Our constitution was established to restrict the power of government. Now that our constitution has become a “living” document, it may be interpreted and changed at will, usually to the effect of offering the government more power, and us less. I cannot think of a single government in the world and throughout history that I would trust my body and my life to, yet, that is essentially what we are asked to consider with the health care plan of St. Obama, the patron saint of the infirm. Medical ethics will become what is good for the masses, rather than what is good for the individual, since government will always seek global, rather than individual solutions. Decisions will be made that are most politically correct, and not what is most morally correct, or what maintains the highest dignity and honor to the individual. It has been argued that health care delivered by government would be less expensive and more efficient, yet, I cannot bring to mind any federal agency that delivers efficient services without graft and corruption. A simple look at pure government health care systems, the Veterans Administration and military medicine show highly inefficient and expensive systems with shoddy health care delivered in a haphazard fashion, always at the whim of an incompetent and fickle congress. One only need to pause at the countless ways in which the government has made physicians lives currently unbearable, including ever increasing and expanding agencies to regulate and control health care. Need I mention JCAHO and the totally ridiculous demands them make on hospitals, or Medicare and its “fraud” provisions on honest and hard working physicians. To the feds I say, no thanks.

2) Legal. Many conservatives have argued hard for legal reform, feeling that it is the legal system in most part which has destroyed American medicine. Arguments have returned from our legal colleagues of the necessity of our system to safeguard and protect a vulnerable public from increasingly greedy and immoral physicians. In fact, conservatives refuse to look at the breadth of the source of problems of our current health care debacle, and lawyers refuse to accept that we need more protection from increasingly greedy and immoral lawyers than that of physicians. Estimates that suggest that the current legal climate drive up the costs of medicine by 40-50% or more, are off by about 1000%. There is no longer any bang for the buck; the health care consumer has discovered that it is cheaper to fly to India for major heart surgery, and yet receive reasonably equivalent safety in their health care. The lawyers have not protected us, but instead, have stifled creativity, autonomy of physician-patient relations, and made health care unaffordable. Every drug that I purchase, and every medical device that I use, has a cost that tends to be 10x-1000x more expensive than non-medical or veterinary equivalents. Malpractice has driven up the cost of practice of countless physicians who have chosen to switch trades, retire, or sell their soul to an employment situation rather than endure unsustainable malpractice premiums, regardless of whether they have ever been sued. Lawsuits themselves have no correspondence with the personal competence of a physician or hospital. I see quite competent physicians occasionally being sued because they choose to manage riskier cases, and incompetent physicians that have never been sued. Somehow, lawyers don’t connect. When a surgeon goes to trial, they usually try to avoid a jury trial, only in that they know that a jury will be another form of wanton injustice, since juries will always sympathize with the party that can generate the most tears, rather than the party that claims the moral high ground. The practice of our trade lacks absolute control-biological systems, being overwhelmingly complex, can have only partially predictable behaviors. Since physicians can only know limited facts of any given medical case, there always remains the possibility of things going wrong, outside of our control, regardless of how careful we happen to be. The legal system simply cannot correct that. Efforts to build in increased safeguards in hospitals have only served to sweep problems under the rug, and no serious study has ever shown a hospital to be safer with the use  of recently enacted safeguards over those hospitals that do not exercise those safeguards. The driving factor for all this madness is the accusation of the legal system that health care needs to clean up their act. The legal system remains clueless about the true nature of medicine, and will only make healthcare problems worse rather than better with their well-intentioned efforts.

3) Big Pharma and the health care industry – There was an epoch in American history where physicians and health care industry was not permitted to advertise. Physicians felt that advertising would degrade their profession with distraction for economic gain from medicine. Indeed, for the most part, this has happened. With the combination of appeal directly to the public, and government regulations that supposedly protect the public but more importantly protect the mega-health care industry from competition, and protect markets, it is not surprising that big Pharma has erupted into a multi-billion dollar industry. We see how this has led to major corruption, such as the Martha Stewart shady investments in Erbitux, a drug that cost well over a billion dollars to develop and bring to market. Big Pharma naturally has a lot to loose, should a drug like Erbitux suddenly be discovered to have untoward unforseen side-effects, or if it proves to be less effective than originally believed, or less useful than other drugs on the market. Naturally, such pressures would be overwhelming for a large corporation, and easy fudging of the numbers (many ways to do that!!!) tends to protect great investments. In the end, we are all hurt. Are we much better off with Erbitux? Perhaps a little bit, as it is a useful drug in many circumstances, such as in head and neck cancer. Yet, patients truly are not living too much longer with as compared to without the drug. Big Pharma continues to appeal to the general public. You can see elderly people dancing across the tv screen in a proverbial retirement paradise, all thanks to Viagra or Flomax or Arimidex, or etc., etc.. The message is conveyed that the drugs bring a fulfilled life, happiness and joy, peace and prosperity. This advertising is an overt lie, and the advertisers know that. I do not wish to indulge into Big Pharmas’ cozy relationship with Big Government, and their desire to overwhelmingly protect themselves rather than the patient. Notice how little they protest the FDA or the legal climate in the US, even though those two factors so steeply drive up the costs of new medicines. I don’t believe Big Pharma really cares at all about you and me.

4) Physicians – I wish I could say that physicians were not a part of the problem, yet we are as much of the problem as anybody else, but for differing reasons. First, physicians have not stood up to their oaths of morality. The Hippocratic Oath is no longer used anywhere in the US, but entirely replaced by Oaths, sadly, including the Christian Medical and Dental Society Oaths, which focus more on population and societal ills, as a focus on the patient themselves. Physicians are not politicians–we have in our care only one patient at a time, and our morality evolves around that patient. We were historically bound to patients by covenants. The legal binding now is a contract, which in turn diminishes our profession into an occupation similar to that of a garbageman or plumber. Our major Medical societies have rolled over dead when reprimanded by government, rather than standing up for what is right. I refer specifically to government forcing rulings on various drugs, forcing the AMA to remove their restrictions on physician advertising, and forcing the health care community to accept and comply in the murder of unborn children. Now,we are even complying with the murder of the elderly. We have lost our morality, allowed medicine to be turned into a business rather than a high profession, allowed government and Insurance companies to intervene between us and the patient, and then we scratch our heads wondering what went wrong. We did it all to ourselves.

5) Insurers and Third party payors – In the eyes of some people, it is the health care insurors who receive all of the blame. Certainly, Michael Moores’ movie Sicko seems to cast much of the blame for America’s health care woes on the Capitalist pigs that govern the major insurance companies. This might be the only theme in Sicko that Moore has partially correct. Contrary to Moore, it is the act of third-party indemnification, whether that third party be a “capitalist” insurance company, or a government, that creates serious problems. First, it places a fourth player in the game of the covenant between doctors-patient-God, as defined by the Hippocratic Oath. It removes much decision making from the patient, and gives it to the insurance company or to the physician. The patient assumes minimal responsibility on an economic basis for the health care decisions that they make, especially if the funding for the patients’ health care came from an employer insurance policy, to which they paid nothing (save for lower wages). In reality, health care insurance no longer functions as an insurance plan, except for those plans that are high deductible or catastrophic. The contracts that and insuror makes with the patient loose their legitimacy when a patient demands high expense procedures, such as transplants or major cancer therapy, and insurors often are forced to comply regardless of the contract. In some states, there is no “pre-existing” clause, so that patients may obtain insurance whenever they wish, without penalties. Insurance companies have sought for survival, but usually at the expense of higher premiums to all, rather than fighting public and government insanity in court.

6) Patients – I love most of my patients, and so I must be quite careful about what I say about them. All the same, in our state, it was over 50% of my patients that voted against tort reform, even though they deny that in the exam room. It is many of my patients that demand free or almost free care. Co-pays are greeted with disdain. It is many patients that expect me to be available 24 hours a day, 7 days a week, 365-366 days a year, and never make a mistake or error in judgement. It is many of my patients that live a life of wanton self-abuse, and then are angry at me that I can’t miraculously fix them in a day or two. It is many patients who lie to me, abuse me, take advantage of me, expect perfection of me, and have no qualms at suing should an opportunity arise. Ultimately, it is the greater than 50% of patients who allow government to get away with murder, vote in idiots such as Obama and Reid and Pelosi, and demand free health care for all. It is the same patients who are so severely protesting ObamaCare, but who refuse to admit the serious problems in the current system, especially with Medicare. I am grateful to God that a good number of my patients see the problems that exist in health care, though they remain powerless to enact a change.

So, I return to my original statement. I hope that ObamaCare succeeds, since it will destroy medicine. Maybe afterwards, a better system could resurrect. Maybe not. Ultimately, our trust is in God, and not doctors. As I grow older as a physician, I realize how powerless I am to add time onto a patients’ life. It still seems to remain entirely in Gods’ hands. Too heavy of reliance on physicians seems to do as much harm as too little reliance on them. But for now, I simply do not foresee any viable fixes to the healthcare crisis, unless the entire system, from the patient to the government corrects. I doubt that that will happen. To attempt a fix of only one aspect of the health care problem will only make the entire health care crisis worse. I don’t wait with hopeful expectation for a solution.

Changes in Medicine

January 12th, 2010

In Feuchtblog, I will be publishing several articles regarding healthcare and medicine. This article, as well as several to follow, will be short reflections of mine regarding the status of medicine in our country.

Following my heart procedure and then subsequent Sabbatical, I’ve had time to think about medicine and what is different about my profession from when I began as a private surgeon in 1992. The opportunity of being away from medicine for a year has been especially helpful in delineating what seems to bother me about the “New” Medicine.

1. The feminization/effeminization of medicine: The percentage of physicians that are female have sharply increased, so that in many medical schools in this country, there are now a majority of females. This is especially true in surgery, where the shift toward female doctors have taken a sharp upward turn. As a female, different expectations are held toward the profession. It is often the activity that conflicts, rather than supports family life. The female psyche of being more a nurturing person changes the approach to the patient. Oddly, this feminizing effect on medicine has affected even males. They are no longer supposed to be aggressive. They must be gentle and never lose their temper or raise their voice. They must now approach their patient as an advocate, friend, sympathizer, rather than as the authority and aggressor against their illness. As we have seen the effeminization of male movie stars, who previously were masculine and tough, Clint Eastwood types, but are now boyish girly men, male doctors have had a tendency to become girly men in the ways mentioned above.

2. The foreign-ication of medicine: I will be the first to comment on my absence of objection for foreign doctors. I believe that foreign physicians stimulate thought and provide wonderful new perspectives to American medicine. My favorite doctor of all time ever, Dr. Das Gupta remains a role model and mentor, though he was born outside of the USA. Yet, I can’t help but think that there is a problem when greater than 50% of our physicians are foreign medical graduates, and not necessarily assimilating into the American cultural belief systems. Besides religion, they differ in such drastic things as how they view the nature of science, medicine, and life itself. Many come here, assuming that wealth and lifestyle will be an automatic given, and often end up frustrated or disappointed when that doesn’t happen.

3. The accelerated gentrification of physicians: we see both an effect on the older physician, and a response that older physicians are giving to their profession in this gentrification. First, modern technology demands rapidly changing practice patterns in order to keep up on the latest-greatest. This often results in ping-ponging of management, that is, certain techniques or management methods are forbidden, then encouraged, and then later forbidden again. Otherwise, newer technologies or treatment plans come in that are often demanded by the patient, but offer no distinct advantage, are far more expensive, but take seemingly forever to discover the errors in their thinking. We see physicians retiring early, or, as soon as possible. They simply don’t wish to put up with the arrogance of younger doctors and competing technologies that seem to be more hot air than distinct helps to the physician or patient. We also see a loss of respect for the older physician. They tend to be out-dated, not with it, hopelessly lost in the past. It takes years to make the best physician judgements, yet these older physicians are no longer respected. A most functional medical community would allow the older physicians to slow down, and work with younger physicians to help them develop skills. This is not happening, and an increasing generational gap happens between younger and older doctors. In times past, the older doctors were able to hone their practice to allow for their decreased ability to be as physically agile or supple as the younger doc. It is more difficult to stay up at night, to have great physical strain in caring for sick patients, yet, there is no reprieve for the aging physician. Thus, for an aging physician, it only makes sense to get out asap.

4. Economic and legal dis-incentivation of physicians– The cost of medicine continues to rise. Prices on medical commodities continue to inflate at standard or accelerated rates, rent and employee costs continue to rise, taxes fail to go down, all of this eating away at physician profitability. Meanwhile, reimbursements continue to fall. When one subtracts costs from reimbursements, you get a number that is essentially your profit. If you divide that profit by the hours that you work, you get an essential pay rate. Currently, when accounting for inflation, I made more as an apprentice typographer than I am currently earning as a physician. Ultimately, physicians will deem the effort not worth it, and consider an employed situation, volunteering, or switching professions. Worst of all, many physicians will remain in their trade, while playing other trades such as gambling with the stock market or real estate investments in order to make a reasonable income commensurate with ones’ education and overall “sweat factor” to get where one is. Remember, most physicians started as quite competitive throughout high school, college, and even competed seriously in medical school, if one desired a more challenging specialty. Residency could be quite variable, but usually seriously limited ones’ lifestyle in years past. As an example, I spent essentially 16 years in “school” past high school to get to a point of being able to earn a living, and all the while accrued hefty school loans. Meanwhile, friends who started to work after high school were able to establish families, purchase homes, and become quite established. Others, who enlisted in the military or worked government jobs immediately after high school were 4 years from retirement by the time I was able to earn my first dime. I don’t pull out too many Kleenex when people complain about doctors’ earnings. But, what about legal dis-incentivation? It is not infrequent nowadays to see articles in surgical journals lamenting that certain surgeries are safer at high volume centers, and even though one may examine their own track records and see competitive  morbidity and mortality rates, the pressure is still extreme to transfer those patients on. When deciding to tackle a more complicated case, the reimbursement is no higher than a simpler case, yet the amount of time spent could be quadruple to ten-fold. At the same time, one is not legally protected for medical “heroics”, but could always be faulted for assuming care of certain patients. Thus, there is every reason to stick with simple cases, and transfer off more complicated, high risk cases. This does a terrible service to many patients, where travel away from families and known surroundings and a known medical community makes life more difficult, and often increases the risks to the patient. I have often seen where patients go off to these “centers of excellence” only to receive vastly inferior care to what would have been provided back home in a smaller hospital. The legal climate offers me no incentive to attempt to retain these patients.

5. The rise of public medical pseudo-professionalism with de-professionalization of physicians–Patient empowerment is a good and a bad thing. It is good when a patient comes to a true specialist and then gets a more complete picture of their current illness or situation. It can be bad when patients determine that they are more knowledgeable than the physician. I wish to add one caveat here. Patients always know themselves best, so that a decision for or against a medication or a surgical procedure is something that they need to choose in their own mind, and it is not good for a physician to force a treatment plan on a patient against the patients’ better sense, no matter how wrong it may seem to the physician. Contrary, when a patient attempts to force the hand of a physician for a treatment that the physician feels to be wrong, you could expect only trouble if the physician gives in. Much public pseudo-professionism is a result of a combination of the internet and big Pharma direct patient marketing. Another way in which pseudo-professionalism manifests itself is with the “2nd opinion”. In the past, a second opinion was often required by an insurance company. Now, many websites encourage seeking a second opinion. The problem with the second opinion is that a patient will never be able to adequately and critically choose between two doctors without a large amount of personal health care experience. Rarely is second opinion thinking correct. I have had patients turn me down because their second opinion physician gave them a kinder hug at the end of the session, or had a slicker office, or had better name recognition from advertising. When I discover that I’ve just wasted an hour or more with a highly anxious patient who just saw me as a second opinion and now is even more anxious in needing to decide between physicians, I will ask them for what criteria they would be using to determine who would be the best physician for them–typically, their answer betrays the other physician promising false security or over-rated expectations of what is physically or humanly possible. Therefore, I refuse to see second opinions, and will immediately cut off a second opinion visit unless the patient swears that they intend to stay under my service. I am not an entertainment committee to amuse the curiosity of needy patients. They can watch a medical soap on television for that.  Meanwhile, while patients become the “professionals”, physicians are rapidly loosing their concept of “professionalism”. I already railed about physician advertising, the loss of a true moral creed for physicians, and increasing dishonesty with physicians. Since the advent of the 80 hour residency workweek, personal time and comfort has taken a strong priority over the care of the patient. I was taught that one always sacrificed personal time when a patient needed your care. Residency meant almost never planning an event, since your primary responsibility was for your patients, and not the movie or restaurant you would be attending that evening. It was considered immoral to be an employed physician, as that meant confused loyalties. All of that is gone, and physicians have become nothing more than highly intensively trained plumbers or electricians. We are no longer professionals, but sophisticated and highly educated blue-collar workers. In return, we no longer have the right to expect to be treated like professionals.

Concomitant with these changes among health care professionals and patients, are changes that are occurring throughout our society, which influence medicine and the attitude of physicians.

1. Loss of personal integrity. I am called by the chart reviewer and asked to up-grade a person’s admission for no reason other than increased reimbursement by Medicare, and Medicare would allow it. The whole idea seemed quite dishonest to me, or at least encouraged serious inconsistencies, that would leave us physicians always wondering from moment to moment whether we were being “honest” rather than violating some crazy medicare rule. Physicians no longer desire integrity as a supreme quality. Efficiency and profitability come first.

2. De-personalization of others. While walking home one day recently, I passed a number of people, and would usually smile at them and either nod my head or say hello to them. The typical response was for the passerby to walk on, head slightly turned away from me, and not even acknowledge the presence of another person. De-personalization has affected medicine in many similar ways, so that people have become more and more fragmented, consisting of lungs and livers and intestines. This attitude has been true of the past, but distinctively truer now, and more obvious on the wards.

So, where does that leave me? In a sense, I dread being back in the bathtub of medicine, since the water now has become quite filthy. The next feuchtblog will talk about who is responsible for breaking medicine. I might eventually write a blog about my thoughts regarding what could be done to fix the healthcare crisis that we are in.

Dar Essalam

January 9th, 2010

Mike and Anne S. were good friends from first moving to Puyallup. Mike was a doctor at Good Samaritan Hospital, but retired in order to do medical work in Morocco. Since then, cousin Dee and her husband Abdellah started a Moroccan restaurant in Wilsonville just south of Portland. So, it was decided that Mike and I would run down to Portland with our wives to have Moroccan food. I’ve reported on this restaurant in prior blogs on the .Mac site. Now, we were taking two friends in love with Morocco with us.

Mike & Anne

Mike and Anne

Dar Essalam Group

Mike, Anne, Ken, and Betsy

We came dressed in Moroccan and Cameroonian outfits. Dee and Abdellah were again most hospitable, and the restaurant was packed to the brim, so both Abdellah and Dee as well as their two sons were working quite feverishly.

Carter and Zack

Zack and Carter

Abdallah and Ken

Abdallah and Ken

Dee in the restaurant kitchen

Dee working feverishly in the kitchen

My siblings also showed up…

Brother Gaylon

Gaylon

Gloria and friend

Gloria and friend

Lewis & Carol

Lewis & Carol

Once again, the food was absolutely stupendous. I had no idea that Moroccan food could be so good. It is certainly much better than French cuisine, and most Amerikan food. But then, I’m told that Cousin Dee is probably the best Moroccan chef in the entire world, including Morocco. If you live in the Northwest, and haven’t gone to their restaurant, it is totally worth taking the drive. You’ll find directions at their website (click here). This truly is a 5-star restaurant for quality of food and ambiance.

End of the Sabbatical

January 2nd, 2010

The year 2009 is now gone, but I am thankful for all the events of the year. In summary, I started by spending 5 weeks in Germany, mostly going to language school at the Goethe Institut in Düsseldorf, but also spending time with Herbert and with Katja and Hannes.  On return home, Betsy and my time was spent preparing for Bangladesh, and we spent 10 weeks there working at Malumghat Christian Hospital. After returning home, I had a wonderful summer, riding my new bicycle and doing some simpler hikes. Another attempt with Jonny and Russ A. to hike the entire Wonderland trail  met in retreat because of rain, but we did some wonderful bicycling around Crater Lake instead. Betsy and I then headed out to Northern Cameroon, working at l’Hopital de Meskine. On coming home just before Thanksgiving, I decided to return to work 3 weeks early so that I wouldn’t spend time at home getting on Betsy’s nerves. At New Year’s beginning, we were blessed with the visit of Alex V., who is now my son-in-law. We could not have been more blessed, and Betsy and I both regard him as a perfect person for our Rachel, and we are most proud to have him in the family. See the separate blog covering the wedding.

The only crisis during the year was the iWeb crash. Should you wish to refer to my previous adventures, reviews or blogs, you will need to go back to my old site on .mac. This current site has a great advantage, in that, as I learn XHTML and .css, I’ll be able to have much more freedom in modifying the site to my pleasure. Also, there is less of a chance for a serious crash. You will have the ability to RSS this website, in that you can tell your mail program to receive RSS feeds from http://feuchtblog.net . I will not be sending out notices every time the webpage is updated, and will update this site a bit more often. Please feel free to write comments, especially if you disagree with me. Unlike a few of my commie pinkie freak relatives/friends/fiends who refuse to publish certain comments from me that don’t exactly jive with their Weltanschauungen, I will not block your entries unless your writing is overtly offensive or obscene. Therefore, remember that comments do not necessarily reflect my point of view. If you are too timid to make a blog comment, then drop me an e-mail.

Nota Bene

You have not heard from me in website-communication since late September 2009. Since then, I have reviewed 20 plus books, multiple movies and pieces of music, and have posted the Cameroon adventures. You are welcome to go back a bit to review those blogs. Everything (except for one or two entries) are entirely new and have not been published on the old site. I have not quite mastered the art of xhtml mark-up, and so photos don’t always fit in correctly. Those will be corrected over time.

Alex and Rachel’s Wedding

January 2nd, 2010

Alex proposed to our daughter Rachel after our visit to Sioux Center, Iowa this summer. They decided to have a winter wedding. Betsy had the preponderance of responsibility for organizing the wedding, and she did marvelously. We are most delighted to have Alex as a son-in-law as he and his family are very pleasant and entirely delightful to be around. I did not attempt to obtain a massive number of traditional photos, but did get some of the action shots that the wedding photographer may not necessarily have taken. Here they are…

Preparing Rachel's hair for the wedding

A surprised Alex coming in before the wedding

Preparing the decorations inside the church

The reception dinner area

Sir Patrick - grandson

Alex calm as a cucumber

Alex and Dad before the ceremony

The Groomsmen

The brides area

Sister Sarah with Rachel

Carol making the Cake

The cake - strong work, Carol

Photo time before the Wedding

Hannah the Flower Girl

Just Made Man and Wife

Alex & Rachel VanV.

Pastor Rob makes sure everybody leaves in order

Newlyweds

Reception frolics

Alex Cuts the Cake

The limo waits

Full speed to the hotel, please!!!!

And they disappear into the night...

The Sabbatical Begins

December 31st, 2009

The two Iowa girls made it home, letting us have Christmas together complete as a family. The above photo shows Jonathan, Sarah, Rachel and Diane. It was wonderful having all four children together. The only distress was an extra visitor (Schmutzie die Wutzie)-actually, she’s a cat, something we didn’t really expect, and Katze has not been very happy about her new feline roommate. The girls have gone back home, but they left the cat. That’s ok. We still love the Iowa kids.

 

Meanwhile, my practice has slowed down so that I have had time free to get packing. Not having made many 5 week trips out of the country, it is a little difficult to determine exactly what to bring. So, minor indecisiveness prevails while I decide on my favorite things to bring. As I write this, I notice that the temperature in Düsseldorf is -8°C, meaning that is absolutely freezing. No way I’m going to ride a bicycle and come home with frostbite. I’ll stick to walking and public transportation in Germany, for now.

 

Getting travel issues straightened out with my other trips to Bangladesh have been made much easier through the agency of Samaritan’s Purse. They will essentially be the organization that sends me off. They also have done this before, and so they have been superb at helping neophytes like Betsy and me organize the trips.

 

Snow. Yes, this year is experiencing global cooling. Next year, it may return to global warming. But, we had a moderate amount of snow, that sits in patches by the side of the road. It snowed just before Christmas, giving us a wonderful Weiße Weihnacht. Here are a few photos…

 

 

 

Of course, Christmas was celebrated as usual…

 

 

I was able to do a home visit to one of my patients who is now in his last days, on whom I performed a major cancer operation. I had learned that he had an absolutely incredible story of escape with his family from Eastern Germany during the cold war. We then discovered that he was my student teacher in German class in high school. I was so excited about that, that I decided to help him write his autobiography. Using my typographical skills, we slowly got his story together, which included scanned photos from many aspects of his life. I would encourage you to read the story, which can be found in Die Veröffentlichen as Meine Geschichte (My Story). Helmut has a strong love for the Lord, which takes some of the sorrow out of the soon-passing of a dear patient but also dear friend.

 

Exercise continues. After the accident on the trainer, I have my bicycle repaired, and am pushing the training each day. I finally figured out how to use the Garmin 705 in training mode, as I was having a problem with it making a wireless connection with the rear sensor that would tell me speed, distance, and cadence. Together with a heart monitor, I am totally in the know on my rides that go nowhere. The Garmin is actually a slave-driver

since it forces me to maintain a steady speed and cadence, and usually shows me that my cadence is too slow. Cadence is your pedaling speed, and you like to keep it between 70-90, but I usually go 60-70. Well, I have the winter to work on that.

 

While pedaling away, I’ve managed to work my way through Heidegger,  Wittgenstein, the Frankfurt School including Habermas, Quine, Hayek, Popper, Kuhn, the Structuralists Saussure and Levi-Strauss. There are only a few lectures left to go, covering to deconstructionists, Rohrty, MacEntyre, and Nozick. So, what has this availed me? The designers of this series have left out various schools of thought, such as the existentialists, for reasons that elude me. Truth has taken a hard hit, and nobody, save for perhaps MacEntyre, even believes in a notion of truth. Many of the lectures, including those about Habermas, Quine, Popper, Kuhn, & Rawls deal only with the nature of social interactions and language in forming a constructive society. Democracy has rightfully taken a serious hit, as these philosophers abandon the polar opposites of both socialism (esp. Hayek), and democracy in its raw form. In addition, Wittgenstein essentially destroyed the possibility of language (based on commonly accepted philosophical pre-suppositions), yet the structuralists and late 20th century philosophers don’t wish to abandon the possibility of communication, as least until they’ve spoken their mind. Popper and Kuhn, while seemingly restoring a philosophy of science, have essentially destroyed the possibility of science demonstrating ultimate truth, since the paradigms of research determine the interpretation of outcomes. Yet, we still do science since there is utility in it. Bottom line—it seems to me like the pragmatists have won; philosophers have despaired of philosophizing, and are no longer asking questions of ontology, morality, or epistemology, but simply ascertaining how to produce a functional society at peace with itself. In essence, they have become nothing but political scientists and sociologists. Francis Schaeffer again proves right, when he spoke of personal peace and prosperity being the summum bonum of the late twentieth century, rather than truth or morality. Enough philosophizing.

 

Many continue to ask about my plans for the Sabbatical. Here is a rough outline…

02JAN-07FEB Deutschland, esp. Düsseldorf, where I will be spending four weeks in language school. Betsy didn’t want to go. I think she suspects Germans to all be closet Nazis or jack-booted Prussian militarists, myself included. During that time, I’ll be spending time with Onkel Herbert, visiting a childhood friend and her husband (Heinz und Debbie Fuchs) in the Stuttgart area, hopefully getting up to Bremen and Hamburg, and then going with Herbert to Würzberg to visit Katya (Herbert’s, and soon to be, my friend) and eventually on to Praha (Prague).

 

February - cross-country skiing, and maybe some downhill skiing. I’ll be spending a lot of time organizing for Bangladesh.

 

02-07 March - Phoenix, to go to the Society of Surgical Oncology meetings. Betsy I plan on spending time with Dr. Peter T. and also delighting ourselves in one of the most fascinating characters of the twentieth-21st centuries, Peter Megyesi, who is Betsy’s brother. Peter and his wife Linda live in Scottsdale, and are always enjoyable to visit, with never a dull moment. I’m not sure how Linda puts up with Petie, but they seem to remain madly in love.

 

15MAR-15MAY Bangladesh. I’m ready. Betsy’s psyching up. Pray for us!

 

Summer - will be spent in the Pacific Northwest. One does not leave the PNW in summer, as it is paradise here. Plans are to hike the 93 mile (150 km) Wonderland trail around Rainier with Jonny (again), do the entire loop of Crater Lake on bicycle with Luc A and father while camping out with Aaron H., doing the Seattle to Portland (STP) on bicycle in one day, only 203 miles (327 km) of fairly flat terrain. I also am considering a touring ride across the state of Washington with the Cascade Bicycle Club.

 

September-December - to Africa. Too far away to think seriously about, except to pencil in the days that we will be away.

 

While in Düsseldorf, I will try to make a blog page every week with the events of the week. I will NOT be announcing the publication of the page, in part to not burden you with unnecessary junk mail. Please stay in touch and drop comments as appropriate.

 

Final Days in Cameroon

November 23rd, 2009

08NOV2009 The photo below shows  the Lutheran church in town, one week ago. It is a much smaller church that the one in Meskine that we usually attend. We did appreciate the service quite a bit, though it was a touch more formal than the other church.

Yesterday I took a bicycle ride from the hospital up to the mountains. This was done with Carsten and Scott. We took off at 6 am, rode for two hours, and went nearly 20 miles. It was over dirt road, and so mountain bikes were imperative.

I think the natives were more puzzled about us than we were about them. You can see their standard home structure, with a cluster of Boukarous and mud walls enclosing the village.

The Meskine missionaries invited a priest from the Anglican church to come give meetings for four days.  He was heavily influenced by the teaching of the Toronto Blessing, which is an form of Pentecostalism. There were many “words from the Lord” and talk about healings. Some basic doctrines of the faith, such as the doctrines of Christology, were brought into question. My feeling was that though the missionaries wished for “revival”, a revival of emotions without revival of the primacy of God’s word is doomed to failure, frustration, and a worse end than if nothing at all occurred. You are left momentarily with the haunting notion that maybe there is a form of Christian faith, a technique or belief structure, that will magically transform you into somebody that can heal on command, read minds, and hear God directly. Unfortunately, there is no magic, but there are the Scriptures, with God speaking about as plainly as imaginable. So, our doubts about missing a “higher blessing” are relieved by knowing that attendance to God’s word alone gives the highest blessing.

That evening everybody went out to dinner, and we had sauerkraut. It wasn’t the best sauerkraut that I’ve ever had.

Today, we attended the main church in Meskine, partially skipping out of the healings and words from the Lord. It is quite a dramatic event, and so I include a short portion of video. The natives here are excellent musicians, and Betsy and I both enjoyed native African beats with Christian songs.

MVI_2014

There is general singing, mostly in Fulfulde, but also in French. Then, various sub-groups will get up to sing in their particular dialect. When it came to the time for us Western folk to sing, it was just Carsten’s family and Betsy and I, so we had Betsy sing “Amazing Grace” as a solo. It was well received. Sermons and more singing occurred. The entire service lasts 2.5-3 hours. As you can see, the worship is quite animated, and there is more body movement than in Western churches (except for the Pentecostals, of course!).

13NOV09 Time is quickly coming to an end. Having felt light-headed soon after arrival in Cameroon, I solved matters by cutting my blood pressure medicine in half. I am already on the lowest dose possible, so now I am just about taking naturopathic doses the last 4 weeks. I measured my blood pressure during the stress of a busy surgical day, and it was 100/60. I am beginning to draw further conclusions as to the probable cause and treatment of my hypertension. I just wonder what my weight and cholesterol levels are doing. We are preparing for a trip to Roumsiki with the Kretzschmar family this weekend. It is a small resort town located on the Cameroun/Nigerian border. There are supposed to be some interesting volcanic formations, and it is known as one of the more beautiful parts of the country. Though it is only 80 miles at most away, it will take us about 4-5 hours to get there, since the road is anything but ideal. More on that later.

I showed up at the operating room this morning, and the techs invited me into their own room for brunch. They were sitting around a bowl of what they called “soup”, and sticks of French bread, which they would break off, dunk in the soup, and then eat. It was quite spicy, and tasted great. I suddenly realized what had occurred at the Lord’s supper, as I joined into the common pot.

The brunch was served with Cameroon tea, which was quite sweet, and tasted just like lal cha from Bangladesh. That will be one of my more memorable experiences, and it really touched me that the techs would honor me like what they did, inviting me to join with them.

17NOV09 We have just returned with the Kretzschmars from Roumsiki, one of the few resort towns of Cameroon.

It actually was very nice. We stayed at a resort that is maintained by a Swiss man and a native Cameroonian lady. The resort has the comforts of a typical Western hotel, including a swimming pool.

The area is known for its volcanic granite rock formations, that are seen throughout the horizon.

We took a hike one day down into the valley enclosed by these formations, and actually entered Nigeria. The path, though steep, is heavily traveled by donkeys bearing large loads of goods from Nigeria, as well as ladies carrying massive volumes on their heads.

The donkeys are essentially the Cameroonian equivalent of large transport trucks. We were also able to step foot into Nigeria. Here is Betsy and I in Nigeria.

The next day, Carsten and I tried to climb Roum, which is the mountain around which the town is made. He did okay, but I was slipping too much from poor shoes, and decided to opt out of the very last few hundred feet. This the mountain to which the Kapsiki speaking people escaped to from the Muslim terrorists-I mean, invaders. You can see caves where they hid out.

We later went to visit a house of an animist. Each of his many wives has their own home, while he has the biggest, close to where the goats are kept.

Afterwards, we realized that Betsy was having a high temperature, and quickly realized that she was having a bout of malaria, so got her going on Co-Artem.

The ride home was a little difficult with sick Betsy and sick children, since, if you look at a map, it looks like a major thoroughfare, but in actuality, it is dirt road of the worst possible condition.

Diane, if you are reading right now, look closely, as it’s not a cow nor a horse, but a donkey.

19NOV09

Over the last few days in Meskine, the morning temperature has dropped as low as 73ºF, and many people, nationals and ex-pats alike, are wearing heavy jackets and wool hats. Babies are bundled in extra sets of thick clothing. It has become very cold for people accustomed to living in 110ºF weather.

Last night, I did prayer rounds with Martin, one of the evangelists at the hospital. 6/8 people we prayed for were Christian. It is amazing how many Christians are in this mostly Muslim area. The missionaries and many of the native Christians will make rounds on every hospital patient each Tuesday evening, and that has been an interesting way for me to see the patients in a totally different light from that as a physician. It is especially delightful to be able to spend time with the Natives. My pre-conceived conception of them as being a tad bit primitive, living in mud huts, etc., is entirely wrong, and I am amazed at their wit, intelligence, and awareness of world events. Most people have cell phones. Most Natives speak at least two languages, many as much as 4-5 languages fluently. It is not loin-cloth jungle savages barely commanding what lays a few yards beyond their existence.

23NOV09 We are finally home, with a moderate case of jet-lag. Yet, we are thankful to see family, and to touch base with our home and surroundings, while sustaining good health. I now have a laundry list of chores to do before I go back to work on 07DEC. Before then, I’ll probably publish some reflections on the past year, which will go unannounced by e-mail. So, stay in touch.

Crazy Days in Cameroon

November 4th, 2009

21OCT2009 – Please also read “First Days in Cameroon”. I tried publishing blog updates from Cameroon, and it would not go through, so, the trip to Cameroon will be a series of several blogs. The above photo shows Sadjo and Carsten in the OR. Sadjo is Muslim, though a most friendly person, and most intelligent. He was one of the first employees at the hospital, brought in when he was a young man, and trying to earn a living as a tailor. He now spends most of his time sewing people.

Today, I did a oophorectomy/hysterectomy on the Pyles cat. This was performed in the quiet of their back porch, using Ketamine as the anesthesia, and Kalabasoo helping with the surgery. It was a bit floundering, but the cat seemed to survive our ordeal. At 1700, Carsten dropped by for our first bicycle ride. He rode out into the fields surrounding Meskine, noting that cotton and Millet were the main crops. Both seemed to be doing well. There are mountains surrounding Meskine, and several have large monkey populations. Our hope is to have a little more time to ride further. Since it gets dark at 1800, we were limited to about 20 km ride today. You must use mountain bikes, since the roads are dirt, and are not in terribly good shape.

I am still doing a lot of operating, and fortunately, able to give Carsten a break more often. This has been good for him. We have also been discussing ways to help Meskine get back into general orthopedics, like bringing the SIGN-nail to Meskine. This is an intramedullary nail that you run down the middle of a long bone in order to stabilize a fracture. They are then able to return to function much quicker. Carsten has been absolutely delightful to be around, and we have been able to work well together. I think that I need to learn better German in order to communicate with him and my other German relatives and friends.

On 23OCT, I did a D&C, today a cystolithotomy (removing a stone from the urinary bladder), as well as herniae repair and abscess drainage. The types of surgery seem to be rapidly expanding. It has been an enjoyable experience in the OR. I am still frustrated by the inability to perfectly communicate with Carsten, but fortunately, he is moderately patient. Simple things are easy, but when trying to describe precise details of an operation or procedure, I don’t have the vocabulary in either French or German to adequately communicate.

27OCT, no changes. It rained yesterday, and the temperature fell to 80ºF. It was the first night here where we slept without the air conditioner running. I’m working feverishly on my French, so that I may communicate a little better.

30OCT, our time seems to be winding down. This AM, I went to the hospital 15 minute prayer service, opening with the songs “How Great Thou Art”, and “To God be the Glory”, in French of course. It was interesting to see how joyful the Africans were, in that they could not even sit down to sing these songs. They tend to be far more animated than Western folk. I compare that to the woeful sound of the call to prayer heard 4-5 times/day over loudspeakers in the village mosque next to the hospital grounds. Islam is such a sad religion compared to Christianity. Later, Scott Pyles and I went to do a reading to a young Muslim man showing some interest in the faith. This is similar to a reading that Betsy went to a week ago, where a missionary will go to a Muslim house, and will have bible stories, that they will read. In this instance, it was a bible story of the tabernacle in the wilderness, written in Arabic script, but using the Fulani language. All in all, it was a very pleasant experience.

The bottom photo shows some of the students of the person we went to read to. They learn to read and write by writing the Koran out on a large wooden board, which they are displaying. Once they have one page memorized, they erase the board, and put on the next page. This person lived in a one room house, inside a large compound of about a city block, housing several hundred people, including 90 some children, many barnyard animals and goats. His wife had just had a child, and the tradition is for the wife to stay with her mother for forty days after the first child, in order to learn how to raise the child.

Diane, it’s not a cow! It’s a goat!

Though missionaries may be chided for trying to “sell” religion, I would remind the dear reader that coercion or force is never used by the Christians like the Muslims, as many Muslims would readily convert if the societal pressure and intimidation was not so great. Also, the missionaries are almost always the first to form languages for remote peoples, and to teach them how to read and write. Contrary to M. Mead who would love to “preserve” ancient cultures, those ancient cultures all desperately wish to move into the 20th century like the rest of mankind, and Islam, unlike Christianity, is doing absolutely nothing to assist in mankind trying to improve their lot. I show a child trying to learn the Koran. Though many children might recite the Koran in Arabic, they have no clue as to what it says or means, as they do not understand Arabic. It would be like Christians insisting that one recite the Scriptures in Latin in order to find favor with God. Fortunately, our God is multi-lingual.

03NOV09 Today, I turned into a Urologist. We had a patient whom was thought to have a vesico-vaginal fistula. We could not find the fistula by instilling blue dye in her bladder, but noted serious urinary incontinence. So, we happened to have some bladder suspension kits, and I had seen it done several times, and went ahead and did it. In spite of that, we still noted a small amount of urine persistently coming into the bladder. So, I suggested we wake her up, do an IVP, and assess the problem. That would be true in the US or Europe, but not here. We proceeded to open her bladder, searched hopelessly for a fistula, but noted that there was absolutely no urine coming out of the left ureter. Again, I suggested a work-up. Sadjo suggested otherwise. We opened her up,  and found a markedly dilated left ureter, and much scarring surrounding the most distal ureter. So, our decision was to simply re-implant the left ureter into the bladder. This we did in a standard fashion, Sadjo paying close attention, since he will not only repeat the surgery someday, but probably do it better next time. It’s quite incredible working with these guys. As mentioned above, Sadjo was nothing but an ambitious young tailor, hired on for the hospital 17 years ago, fluent in Fulfulde, French, English, Arabic, and some German, now in his mid-forties, owning a large cattle ranch, working evening in the tailor business, as well as pursuing his love for surgery. He and Barbar are a total joy to work with.

The weather is cooler now. It was only 85ºF last night, which now seems cool to us. This time of year, winds from the north commence, causing a red dust to fill the atmosphere. The surrounding mountains no longer appear crisp, but a blurry red. This causes the temperature to cool down, but also leaves dust everywhere. I now remain a touch more congested, and am constantly sneezing from the irritation of the dust.

Just a little mention of all those who have made our stay memorable.

Sadjo and Barbar are the two main techs. Sadjo is Muslim, Barbar Christian, and totally opposite personalities, Sadjo being quiet and thoughtful, Barbar expressive and impulsive, alway saying “Ah cha cha”.

Tijani and Walko, quiet workers, Tijani’s uncle is chief of the village, and Walko is a tech that does much of the minor things in the operating room, as well as much of the anesthesia.

Saido,Roger and Falkamo also do anesthesia. It is usually spinal (rachidienne) or ketamine. All are absolutely superb. They can also do general intubation, but the OR is not well set up for that.

Vadera and Wome also do a lot of the minor activities like wound debridements and rapproachments (wound closures).

So now I turn to the missionaries that we have met. We loved all of them. Each one has become special to us in their own way. So, let’s start with Scott and Lee. They, along with Danny and Frances, started this place. It was their vision and hard work that led to the founding of Hopital de Meskine, and it continually shows. Scott is responsible for the main leadership, and possesses an uncanny sense of wit and humor about him. He is always able to break a tense situation with a word or comment that leaves a smile on others. Lee is amazingly hard working, and keeps everything in the surgery end of things running well.

So now I turn to the missionaries that we have met. We loved all of them. Each one has become special to us in their own way. So, let’s start with Scott and Lee. They, along with Danny and Frances, started this place. It was their vision and hard work that led to the founding of Hopital de Meskine, and it continually shows. Scott is responsible for the main leadership, and possesses an uncanny sense of wit and humor about him. He is always able to break a tense situation with a word or comment that leaves a smile on others. Lee is amazingly hard working, and keeps everything in the surgery end of things running well.

David and Patsy have been most special. David runs the informatics side of things, and keeps communications going. They are more quiet workers, but always possess a gentle loving spirit. Their hospitality will always be remembered. One day, Betsy was commenting on her bad back, and the next day, David dropped by a special chair that was very comfortable on her back. That really touched us, just the caring for little things in another person’s life.

Andrew and Kari have had two young adopted children to care for and so we have not had the opportunity to get to know them nearly as well as the other missionaries. They are also a bit newer, and so are working on learning the languages and becoming effective on the mission.

Carsten, Annette, and their children Rabea, Lucas, and Aaron (here, shown with Betsy and Marike in Roumsiki) have become quite well known to us. I have spoken more about Carsten in other places, since I have been working with him in surgery, but their entire family remains special. Carsten and Annette grew up in the former DDR in Leipzig. He and Annette are both very musically enclined, and he happens to like Bach, which makes them very much true friends. I truly hope to visit them in August in Leipzig, if the Lord wills.

Carsten and Annette have a young German girl named Marike (here shown with Rabea) from Baden-Württemberg helping out with teaching the children, and also working in the hospital, since she would like to eventually go into Medicine. She has been very special to us, since she has been able to help us better converse with Carsten and Annette, since she is fluent in German, French, and English. Her maturity and love for the Lord has been especially noticed by us.

Me with Josephine, Melissa with Aisha, Sarah, Kari and Ruth. Josephine is a general practitioner from the Netherlands, Melissa a short-termer from Louisiana, and Sarah a PA from Michigan. I’ve not had much of a chance to interact with Josephine, but have really appreciated getting to know her. She very sweet, is fluent in Dutch, German, English, French, as well as Fulfulde, and also a superb, caring doctor. I don’t know how she does it. Sarah has been wonderful to have. She is a real take-charge person, very industrious, and very capable in the tasks she has at the hospital. She rarely makes bad decisions, and has been a joy to work with. Kari is a physical therapist, whom I haven’t had the ability to get to know well. I appreciate her sweet temperament, as well as her loving demeanor around natives and patients. We had just gotten to know Ruth, who is working mostly in Chad, and quite fluent in Arabic.

First Days in Cameroon

October 17th, 2009

Betsy and I left home on 26SEPT. Dr. King took us to the airport, and we flew out on Air France to Paris, with an eight hour stopover and then on to N’dJemena, Chad. Adama picked us up at the airport, and drove us to the guest house, that had not quite prepared for our arrival. We made do, and was able leave by road to Meskine the next day, driven by Adama. The roads had multiple large potholes, yet Adama still drove at roughly 60-80 mph, the exact speed not known since the speedometer constantly read “0”.  One of our four boxes had not arrived, though we were assured that it would be in in several days, and promptly delivered to us. On 30SEPT, I started working in the OR. It is much different than in Bangladesh, in that the surgeon does very little ward care, but spends most of his time in the OR suite, or seeing consults. It will take me a few days to get used to things. The workers all speak a little English, and I spent much of my time speaking German with the other Surgeon, Carsten, who is from Leipzig.

02OCT, our final box arrived, missing only a few items, such as clorox wipes, which we can survive without. Surgery has been busy, with a few very odd cases. One was a 12 yo boy, gored by a bull, coming in several days later (how many, we don’t know), and his only injury was a complete division of his common bile duct. We did a Roux-en-Y reconstruction, but he died later that night. There are too many other cases to talk about, and I’m sure you’re not interested, so, we’ll let it slide.

10OCT, we had a fairly busy week at the hospital, but able to relax on the weekend. All is going well. I haven’t taken too many photographs, and I am not getting out of the compound too often. The US State Dept. informed us of a cholera epidemic in town, though we will still to go in to eat tonight. It is a bit harder than Bangladesh to acclimatize to the heat, and I’m not sure exactly why. Otherwise, save for a bout of travelers’ diarrhea which resolved quickly in both Betsy and myself, all is going well.  A few days later, we spent with Carsten and Annette on the river flowing through Moroua. This river is now just a stream, but will fill its banks at some times of the year, and in a month, will be completely dry.

The main church in Meskine has about 100 adult members, and though church starts at 8 o’clock and lasts until 10:30 AM, most people arrive between 8 and 9 am, filtering in slowly, and sitting with their own people group. The various groups are then invited sequentially to sing a song for the remainder of the folk, including a time for us white people, who usually sing in French some hymn.

Notice, the Christmas decorations remain, like in Bangladesh. Our house is quite nice, and here are some photos.

Yes. The bed has mosquito netting. No mosquito bites at night. The main crop in this area is Millet, which looks a bit like corn.

Firewood also is in huge demand, as they prefer firewood over natural gas, even though firewood is more expensive than gas!  Getting photos in the community has been a serious problem, because, unlike Bangladesh where everybody fought to have you take their photo, the natives will turn and run if you get out your camera. Both situations below witnessed this happen…

Here is the whole missionary group at Annette’s birthday party, with real ice cream made from powdered milk!!!! …

We’re having a good time, and feeling like we are contributing a bit to the entire effort. More to follow…

P.S. Aren’t you glad I didn’t include any political discussion. Though we’ve stayed in touch with American and World news, and watched the Stalk Market (sic!) and price of gold fluctuate, it seems a touch removed from us, where our patients simply are wondering if they will have food for the next day. We have much to be thankful for, in spite of our national distresses. The next few years are going to be time to re-think the real battles that face us, and hopefully they are not simply battles for peace, security, and prosperity, as the end result will probably be the opposite of what we seek. Fortunately, Betsy and I have had time to read and think (see Bookblog) and talk, and it has helped in keeping us on track together about our goals for the coming few years, as I return to work.

Obama Cares

August 27th, 2009

My best friend kindly rebuked me for my absence of propriety in discussing issues sensitive to race. He is correct. But, it is a hard balance. Any political commentary against the reigning Führer is deemed to be racial, as evidenced by Jimmy Carters‘ comment about Wilson’s inappropriate (though true) epithet in the joint (congress).

As Pat Buchanan said regarding Carter’s comment, “Carter’s contribution to the national debate represents a truly rare blend of malevolence, ignorance and moral arrogance.” (click here for reference)…  Unfortunately race is being used as a witch-hunt accusation against anybody who seems to be strongly opinionated in a non-liberal fashion. Similar accusations happened recently with sexual orientation. I can’t wait until we get a cross-dressing gay/lesbian for president—my comments will then be delivered in an unrestrained though personally detrimental fashion.

ObamaCare!!!!. . . I would really like to obtain a Medizinmann outfit like Obama is wearing as pictured above. Maybe I’ll be able to purchase one while in Cameroon. I think that my patients would love that. We must not act judgmentally against those who hate the AMA/Big Pharma/Medical Industrial complex. After all, there is a dominant role for  the chiropractic, naturopathic, transcendental meditation, Christian Science practitioner, Voodoo, alternative medicine, Medizinmann health care provider within general medical practice. Just ask my brother Dennis!

We reflect back on the Obamaphilia the nation experienced a half year ago. School children sang in solemn reverential worship about Obama. People displayed their ecstasy over Obama now being able to rescue their bank accounts, put food on the table, clothe them and give them comfortable shelter, regardless of their ability or desire to work for those things. He was even likened to a saint that we could pray to.

He may not have come through yet with providing those material items of sustenance, yet, like God in heaven, he watches over our very thoughts, and will hold us accountable if we rise in rebellion against him. Thus, we are no longer policed just for our actions, but also what we might perhaps, perchance, vielleicht, peut-être, possibly, could have been thinking.

In terms of commenting on the virtues and failures of ObamaCare, I believe that I have said more than enough.  So, now I’ll tell you what I really think of Obama. He is a corrupt, dishonest racial bigot hell-bent on an agenda that is polar opposites of the beliefs and philosophies of the founding fathers of America. He is a traitor to the state that has doubtful constitutional credentials to serve as our president, speaks with forked-tongue, smooth and slick, yet working toward philosophic ends that when embraced by other nations has always led to their inevitable ruin. Though he shows signs of intelligence, he lacks any sort of true wisdom to adequately guide a nation, and instead will dupe the masses with his worm-wooded tongue. In spite of that, the masses voted him into office, and they deserve what they will get, so I wish Obama total success with two to four or more terms in office as president. The only regret is for those who wish to maintain honest quiet lives with a separate morality from our Obamination-in-chief, like my children and grand-children. So, to our new national anthem, needing just a few substitutions of words….

The Mickey Mouse Club March

Enough of that! The last month was quite event-filled.  Most of it was filled with bicycling and reading. I attempted to backpack the Wonderland Trail for a second time, with Jon and Russ, but was heavily rained out the first night. We drove home, dried out, and headed down to Crater Lake for two fantastic rides. The weather has remained quite desultory, with rain constantly threatening, but with weather breaks leaving us wishing that we were in the mountains.

Other events… Alex, Rachel’s fiancé, came to visit. I was able to take him around Mt. Rainier. It was nice having him here, and I am very proud to be able to call him a son-in-law. The wedding is on 02JAN10.

I learned to do Panorama shots, using a tripod, and then stitching together various panned shots using photoshop. Here is a view of Rainier that I did on top of the first Burroughs Mountain Summit…

This photo can be blown up to a huge photo, since it is about 7 photographs put together, with 12 megaPx definition, taken on a tripod, so it is a sharp image even at huge magnifications.

With Diane’s help, we also mastered the art of making Pico de Gallo. Here is the top secret recipe…

1 scotch bonnet pepper

2-3 Jalapeno peppers

1-2 Serrano peppers

1 Green pepper

8 cloves garlic

Clean them all out, wash out the seeds, and chop them VERY fine in a food processor. Add…

1-large Walla Walla sweet onion

1 large bunch of fresh Cilantro, with the stems removed

This time, chop them moderately fine in the food processor. Then, remove all the ingredients from the food processor, and add the juice of two fresh limes, and two tbsp. of salt. Finally, take 12 Roma tomatoes, wash out the juicy innerds, chop by hand modestly fine, and fold into the pepper concoction. This makes a great Pico de Gallo, that is not too spicy. Please do not give away this recipe to anybody, as it is TOP SECRET!!!!! It is the mixture of the various types of peppers with lots of lime juice that creates a pleasant taste. But, beware when cleaning the peppers, as they are highly toxic!

Liam was baptized, our fourth grandchild. That was a wonderful experience, and Pastor Scott did a nice job of officiating the event. That same day in the evening, Resurrection Presbyterian church became a real church, loosing its mission status. Thus, we elected elders and had Pastor Scott appointed as the official minister. I feel very good about both the choice of elders, and David Scott’s ability to serve as a pastor. Scott seems to have grown in pastoral skills by leaps and bounds since we first met several years ago, and we have deeply appreciated his ministry in Puyallup.

As you can see, we had the kids over for ice cream afterwards. They also got to experience our new deck, built since the old deck was rotting out, and actually becoming dangerous. We found a carpenter with a good price, and so was able to follow up on a project that I started 10 years ago. It seemed like forever to finish this deck. Here are some photos, though it is not quite finished, including getting a roof on the gazebo…

I was able to do one last bicycle ride with Russ. We rode from the top of Chinook Pass down 27+ miles, and then back. Later, we stopped at our favorite ice cream stop, Wapiti Woolies, famous, since they make the cap that every great contemporary climber from the US has worn in the Himalaya expeditions, including Ed Viesturs… They have photos from a smorgasboard of the hall of fame of American climbers on their wall, showing themselves on the Summit of Everest or Annapurna or where-ever in Wapiti Woolie hats…

The last photo is Russ on the right with Bob, who owns Wapiti Woolies.

Meanwhile, we need to pack for Cameroon. We leave on the 26th of September, and will be in Cameroon for two months. I must learn French. I prefer to talk German as my second language. French has too many silly grammar rules. French used to be the language of the self-acclaimed intellectual snobs in college. I took Russian instead. I tried to talk Russian with a German accent. My Russian teacher always needed to correct me. Except for the articles, German seems the closest of any foreign language to English. I’ve finished Part I of French in Action, which is the most entertaining language program I know, but I still feel most comfortable sitting down and listening to a German podcast or reading Der Spiegel on-line. German just kind of clicks in my brain, even though I don’t understand all of what is being said. I’ve also just finished a book written by a missionary surgeon in Nepal titled “Don’t Let the Goats Eat the Loquat Trees”. It was an enjoyable read, and certainly seemed to reflect what I’ve seen in Bangladesh more than any other book that I’ve read so far. You can see the full review in the books section.

Unless the internet connection in Cameroon is fantastic, you will probably not see any more posts on this site until we return to the US, which is thanksgiving time. Expect to see a lengthy post at that time. Remember to keep us in your thoughts and prayers as we serve in Cameroon, and e-mail us if you think of it. We fly into N’Djamena, Chad, and the travel to the Maroua, Cameroon area, where we will be staying.

Obama Will Save Us

August 5th, 2009

I’ve written often regarding the new health care system under our national clown – Obama. Whether or not the health care agenda of Obama goes through remains to be seen. Yet, it really doesn’t matter, since any failure of the democratic agenda only means that it will take just several more years for all the facets of his plan to settle into place. The greatest disappointment was receiving an e-mail from Dr. Lunzy Britt, who I know quite well, who as the director of the American College of Surgeons Board of Regents, informed us that our college is siding with the Obama agenda. I presume that skin color may be playing a small role, since both the Lunz and Barack originate from a race with innately darker skin than the pilgrims that settled this land. We wait with baited breath. The American College of Surgeons has almost no private practice surgeons in its leadership, and so increasingly don’t speak for the surgeon in the trenches. Maybe it’s time to drop out of the ACS?

Schöne Sommerszeit

July 27th, 2009

This summer has been awesomely beautiful, permitting a delightful ability to ride my bike, go backpacking, or just sit outside enjoying the sun. It’s been truly marvelous. Since my last post, I’ve been able to do the STP in one day, backpack Eagle Creek, and then do the Seattle Century. I’ve had time to spend with family, and get some reading in, as well as listening to music. It’s also been a time when I am able to do other sundry projects, such as to write test questions for PAACS, and study French in preparation for our trip to Cameroon. I prefer to learn German, and find that I am understanding German speech much more, especially on news channels, where the language is more clearly spoken, and less idiomatic than you would find in movies.

 

We are also blessed with our fourth grandchild, Liam Isaac. He was born on 22JUL09, healthy and cute. His photo is above. The other children seem to appreciate their new brother, as well as Oma.

Sammy had a birthday two days later…

He loved the cake, but would not eat my favorite food…

… sauerkraut mit Wurst und Senf.  Yum. I always shop for German-made sauerkraut, as the stuff made over here tastes terrible. It might explain why so many Amerikans don’t like sauerkraut.

 

I brought my Lungi on the Eagle Creek backpack trip, and found out that it is perfect for wearing around camp in the evening. Yet, when I sent Hannes und Herbert Lungis, they developed a wonderful new use for them, that I must show you…

 

I love Herbert!!!!! There is something about him that tells me that we are of the same blood.

 

Before sending out this Blog today, I was able to do the Sunrise ride. I’ve blogged this before, but it has now become just another fun ride, though probably the most beautiful ride in the world. Photos fail. It is 10 miles (16 km) of 6-12% grade uphill, unrelenting, averaging about 8% for a total 3000 ft elevation gain. In truthfulness, the last time I did it, I stopped several times to rest, but not this time. This time, I couldn’t keep up the speed of Russ A., but he stopped to clean rocks off the road. Luc A. started about 5-10 miles before our start, and he arrived on top at about the same time as us. He is totally awesome power on a bike. Jonny just ordered a new bike but couldn’t pick it up, so rode my Touring bike, which is too heavy of bike to just be running up to Sunrise. At the same time, the RAMROD was occurring (Ride Around Mt. Rainier in One Day), a 150 mile 10,000 foot elevation gain circuit around Mt. Rainier. I would never formally do the RAMROD, though would like to just try it in a self-supported fashion. Today would have been a terrible day for the RAMROD, as the ending temperatures in Enumclaw were 96°F (35.5?), which is just too hot to ride. Fortunately, we were at 6200 ft elevation on top of Sunrise. Here is what we looked like on top. The photo from left to right shows Luc, me, Russ, and Jon.

The ride down was totally exhilarating, though I’d never ever wish to miss the ride up.

You may review my many adventures and other activities during the last month at BikeBlog, BookBlog, Hike-Ski Blog, MovieBlog, and MusicBlog.  Stay in touch and keep your stick on the ice.

  1. I lift up my eyes to the hills.
  2. From where does my help come?
  3. My help comes from the Lord,
  4. who made heaven and earth.

 

4-7JUN Trail Skills College, Dee

June 8th, 2009

I needed to take a trip to Portland since I had just purchased a new Apple computer, and had it delivered to Gaylon. Lew seemed to be tied up, and Karen and Steve were in town, but too busy to get together. Delores had invited us to her restaurant in Wilsonville, so, we decided to go. Delores is a cousin, and she married a Moroccan man, whose mom taught Delores how to cook Moroccan. She had asked us many times to come down, but now I finally had the opportunity. This was an absolute feast. I had no clue that mid-eastern food could taste so good, but Dee made it especially well. She gave us a sampling of many items, from appetizers, to her lentil soup, to the main meal (I had lamb with a raisin sauce), and then dessert. It was absolutely unbelievably good. Dee gets 10 stars for incredible cooking. Most of the food was very nutritiously cooked, such as the vegetarian couscous, which tasted like no couscous that I have ever eaten before, but also very spicy, using similar spices to that of Bangladesh. All in all, it was a most sumptuous feast. Thank you, Delores and Abdellah!

I spent the night at Gaylon’s, hooking up an old Airport, and also connecting a hard drive to his Mac Mini. The next day was off to trail college. I was a little doubtful, almost wondering if I should skip out and head home. I slept out in my tent, and relaxed for several days. The first day, we went out to a portion of the Pacific Crest Trail, and studied trail maintenance, including how to provide trail rain runoff, so that the trail doesn’t become a highway of a grand mudpuddle. We also learned about how to condition a trail, using McLeod’s and Pulaskis. It was a rainy day, we were all soaked and muddy at the end of the day. The next day was lectures in the morning, and then we went up onto a recently built trail. At first, it looked fairly good, until we began to realize that there were multiple design mistakes. We talked about designing a proper trail, using proper construction techniques to maintain a solid trail base, so that the trail would manage rain water without becoming a mud puddle, and spent time actually punching out a hypothetical new trail. It was a blast. I will forever have a much greater appreciation for trails, and will never look on a trail the same way ever again, knowing how badly a trail could thoughtlessly be constructed.

 

Why I won’t leave the Northwest

June 1st, 2009

I went on a bicycle ride today from home up to the Carbon River entrance of Mt. Rainier National Park, and this was what I saw along the way. The Carbon River entrance remains closed owing to previous rains washing out the road, but the ride to the entrance and back was 72 miles (116 km) and moderately steep uphill most the way, allowing me to burn off over 5000 calories in the 5 hours that it took me to do the ride. Here’s proof…

Yes, I am still using the Trionfo, as my Steelman bicycle is not quite done yet. I did visit my bicycle dealer, with Tacoma bike, a super cool guy named Mike Brown. I bought him a lungi, and here we are together in his bike shop.

The mail came today, and I had a box from Hannes und Katja aus Würzburg. When I visited them this February, they knew that I desperately wanted a Universität Würzburg t-shirt, as I collect university t-shirts.

What an awesome gift! As you realize, not only is it (the U of W) an ancient university by American standards (founded in 1402), but it has had significant Nobel prize winners, including Röntgen, who discovered X-Rays here. Well, I’ll soon be sending Hannes and Herbert (sorry Katja, only men wear lungis) their own personal lungis from Bangladesh. Unfortunately, I won’t be there to teach them how to tie the lungi. Oh well… it’s an excuse to visit Germany again.

 

But!!!!!! I’m omitting the most important event of the last week!!!! Yes!!! Betsy and I flew back to Iowa so that I could visit Rachel & Diane, and Rachel’s boyfriend (not yet engaged). it was a wonderful time, and I really liked Alex from the very beginning, as not only a wise and prudent young man, but also a strong Christian man.

We will be praying that the Lord be in that relationship. Meanwhile, we also went boating in Lake Obijobi.

We also got to meet Alex’s family, as well as his new dog, Bentley.

I’m sure you will be hearing more about this in my next blogs, but, we’ll leave it at this for now.

 

Apnara amader bondhu

May 20th, 2009

It was not easy for me to decide exactly how to do the reports on the trip to Bangladesh. It was impossible to publish a webpage update while in Bangladesh, unlike while I was in Germany. Thus, I created a large Bangladesh report in the “Travel” section. Here, I offer overall assessment and reflections on the trip. First, you may be wondering about the title. It means, you all are our friends. After such a long episode of silence and absence of correspondence, many of you felt that we had abandoned you as friends. That is simply not true. There was a combination of 1) poor internet connections, 2) mac incompatibility, 3) inability to download appropriate programs to connect my mac, owing to large program size and slow internet connections, and 4) suspicion that the Bangladeshi government was keeping an eye on correspondence. It was not that we felt that we might say something that offends our Bengali friends, but only that we wished to avoid even a remote suggestion of wrong-saying or wrong-doing. Thus, our silence.

 

So, reflections on our trip. Many of you have written to us, acknowledging the sacrifice that we have made to serve the Bangladeshi people. I guess that Betsy and I don’t really view it as a sacrifice. What were our motives? I hope they were genuine, in having a love for the people we served. I certainly have a much deeper compassion for reaching out as a Christian to the Bangladeshi people and other unfortunates in this world. Perhaps there was also this curiosity, or spirit of adventure. Perhaps Betsy and I were “absolving sins”. I hope not. I leave with two thoughts. 1) I have the most extreme respect for Memorial Christian Hospital, and their ability to not only provide medical care to the mostly Muslim community that we served, but that they were also able to deliver the message of salvation only through Christ, in a consistent and honest fashion. 2) I have acquired the utmost respect for the long-termers, who faithfully work year after year, mostly unthanked, mostly unregarded, yet they serve without grumbling or complaining, delivering medical care and spiritual hope with joy and gladness. For this reason, I have listed a few people in the trip section that have especially been an influence to me.

But, what about Bangladesh? My biggest surprise was the number of people in this country. When you look on a map of our area of stay in Bangladesh, you see only two cities, Chittagong and Cox’s Bazar. Yet, except for a few rice paddies and rivers, it is almost wall-to-wall people between those two towns, with many large villages between. And, Chittagong has a population of about 4-5 million, Cox’s Bazar of a million. Dhakha itself is roughly 15 million people. The country has about 160 million people, in a state the size of Wisconsin. It is the equivalent of moving everybody east of the Mississippi into the state of Illinois. If you look on a map, you will not even see the town of Chabigong where our hospital sets, yet the 30 mile radius around the hospital has approximately 6 million people. Except for the Chittagong hills, which are not terribly high, it is essentially flatland, and a giant vacuum for typhoons. In spite of the crowdedness, they grow 95% of their food, and unfortunately, also grow a poor quality of tobacco, and poor quality rubber (the rubber starts out okay, but poor standardization of processing ruins the quality of the product).

 

There are four main religious groups in Bangladesh, being Muslim (approx. 90%), Hindu/Buddhist (10%), Animists mostly found in the Chittagong Hills (?%),  and Christian (less than 1%). Buddhists are mostly located in the strip of land south of where we are. Hindus live sporadically throughout the country, but tend to stick to their own sections of town, living together. Wealthier Hindus will also own land in India, owing to a serious lack of trust of Hindus for their more dominant Muslim neighbors. Muslims seem to dominate the scene. Many mornings, they will wake us up at 5 am with prayers roaring over the loudspeakers (their god is now slightly deaf), or late at night on Thursday. They tend to be reasonably pleasant folk as a whole, and we have found many of the Muslims to be quite enjoyable.

 

But, we also see the problems of the Muslim religion. It is definitely a man’s religion, and the wives are often treated no better than dogs. Besides an obliteration of their personality through the Burkha, they are expected at all times to remain at home, while their husband socializes at the local tea shop or town square. We have seen many instances of husbands dumping their wife when they fail to deliver a desired boy child. Joy seems to be totally absent from their religion.  It’s hard to not imagine that religion maybe plays some role in the prevailing morals of this country. When one ventures to the wealthier Muslim countries, one doesn’t see the situation any better. Indonesia, Saudi Arabia, United Arab Emirates and many others have no freedom of religion, and Muslim converts are usually put immediately to death. The situation is only slightly better in Bangladesh. We get many patients in our hospital from Saudi Arabia. Bengali workers will go to the Middle East with the lure of money. It is not uncommon for serious injuries to occur to these migrant workers, since the Bengalis are given the worst and most dangerous jobs. If they have any life left in them at all after an injury, they are usually thrown on the next airplane back to Bangladesh. If you think that the Saudis have any value for human life, think twice. The appeal of their religion remains a mystery to me. Muslim is the only religion that teaches their children to hate at birth. The more religious the Muslim is, the greater the scowl you get from them on the streets. Yet, even the most radical bitter Muslim will soften after a time in our hospital, seeing that we truly care for them, and have no intention of shoving religion down their throat. The less religious will often return a smile once they realize that you are looking upon them as a person and not just as a “Muslim”. It is certain that unloving Christians have done more harm than good.

 

Again I am NOT saying that all or that even the majority of Muslims are mean and nasty, because we have become friends with many kindly Muslims, such as the Mayor of CB, though they often tend to go unnoticed sitting quietly on the side.

 

Hindus tend to not exhibit the passivity that would be expected from their religion. They can be violent, when they are in the majority. Sadly, we have seen this behavior even in Christian countries. All in all, there seems to be a common behavior of man, in spite of their religion. This confirms the Christian doctrine of the total depravity of man. Man cannot escape their “mannishness” through religion. It is sad to see that as the west escapes from its Christian base, we are reverted more and more to the prevailing behavior and moral base of the rest of the world.

 

The tribal people are hated by all, especially the Muslims, which leads to the tribals having a very poor image of the religion that dominates the country. This leads to serious unnecessary oppression of the tribal people by the Muslims, increasing the hate factor between the two peoples. I find the tribal people to be the most friendly folk, and there are many tribals at the hospital that we’ve gotten to interact with.

 

I suspect that there will be a day when white ex-pats will be asked to leave the country of Bangladesh. That day is possibly soon, as economic jealousies and racial tensions as well as Muslim fundamentalism intensifies in the country. I pray that the Christian Nationals in the country have the fortitude to stand for Christ, even when it means persecution or death.

 

What have we accomplished personally by the trip? I was able to catch up a little on my reading, going through 33 books on the trip. We (Betsy and I) had our first real experience with third world medical missions. We had much time together in devotions, and in really thinking about our plans for the future. It was a great time to escape our culture and see the world through the eyes of a non-European. It was a time that we hope to repeat. We will probably keep our trips a little bit shorter, but hopefully, will be able to do at least one trip somewhere each year. And, hopefully, that will mean returning to Malumghat more times in the years to come. We have new friends on the complete other side of the globe, that are more dear than most of our acquaintance (friends) at home. I’m not sure we will ever be the same, once we return home.

 

Coming home has had minor challenges. It’s called foggy brain syndrome (jet lag). I’ve never been hit worse with it. It has disoriented cay and night for me and Betsy to the extreme degree, so that we are getting barely nothing done. We’ll have to try to figure out a solution.

 

I should be posting additional thoughts and reflections on our trip in blogs to come. This whirlwind trip left us with many questions and thoughts that we will need to explore in the coming months. Our next medical mission in coming up in late September through November, and hopefully, a restful summer will provide more time to meditate and prepare ourselves for the work ahead.

 

For a blow by blow account of our trip to Bangladesh, please turn to the section on “TravelBlog”. I have tried to be discrete in my discussions, and to not leave anybody out. Considering the technical difficulties that I had, I may have inadvertently said something too strongly or offensively, or failed to mention somebody. Please graciously drop me an e-mail if you feel that have noted a website problem, and I’ll do my best to immediately correct the issue.  Note that I have divided the Bangladesh account into three sections to allow for easier editing and downloading.

 

I will be giving slide shows of various other aspects of this trip, such as the work at the hospital. I would normally include it on the webpage, except that it would be photo heavy and quite laborious to download. Also, I am using iWeb, which is acting up on me, and behaving unbearably slow. It took me about 36 frustrating hours to accomplish what usually takes me about two in making up this website. I’ve figured out pretty much what I’ve been doing wrong, and will be re-designing this site for more speed. In the meantime, it is forcing me to do a smart move, which is to reorganize my website with “blog” style for all my entries. This will allow you to comment on particular book reviews, trips, etc. You should see this organization on my next post.

 

Phoenix SSO

March 9th, 2009


I’ve often commented about the Northwest being a Paradise in summer. Actually, I was slightly inaccurate about that comment. It is also a paradise in winter. True, it rains all winter. But… it can be paradise if one enjoys skiing. Both downhill and cross-country skiing appeal to me, though I definitely enjoy cross-country skiing more than downhill. So, I got to experience my first downhill night skiing this year. It was a blast. I was with somebody who was definitely a much better skier than myself, but it was still very delightful. The photograph of this precious event was not so helpful at showing that we really had a blast.

Cross-country skiing has many varieties in the Northwest. One day, Jonny and I was able to go at a fairly fast clip on groomed trails. The next,  Jonny and I did true cross-country skiing, plowing our way through steep slopes, in the woods, powder up to our hips, which made it extremely difficult since we were on fairly steep slopes attempting to go up. It would have been easier with Mountaineering cross-country skis, with skins attached. (If you don’t know what I’m talking about, don’t worry!).

 

The snow hasn’t been particularly plentiful in the mountains. That is a little surprising, since, as I write this piece, it is snowing for the fifth time this year outside. This is unusually strange, since I’ve never seen it snow more than twice in a year. Surely this is global warming! Either that, or God intends to make a total fool of Algore.

 

I was able to make it down to Portland. During that visit, I discovered that a new Bengali language text was out on the market. The problem is that it didn’t have a CD, which is not available yet from the publisher. It looks a lot better than the only other real text out there, which is totally useless, the Teach-Yourself-Bengali text by Wm. Radice. I am completely frustrated with the language teaching modalities used in Radice’s text. I’ll have to wait for Bangladesh in order to re-commence my studies. Meanwhile, I was also able to see my youngest brother Gaylon. We went out to a “German” restaurant (Gustav’s), and I noted that there was about nothing on the menu that was similar to what I had in Deutschland. So, I endured, enjoyed a good beer, and left it at that. I ate much better in Germany for a fraction of the cost. The photo shows Gaylon in his pad.

 

So, off to Phoenix. The first two days were spent with brother-in-law Petie Megyesi. He is a wonderful cook, his wife is an even better baker, and they have the most loving dog named Bubba that would eat your leg off if you ever came near to him.

Petie runs a business that makes on-hold messages for the telephone. If you need some 1st class stuff done up for your office telephone system, give him a call (1-800-678-9971). I then went to the Society of Surgical Oncology meetings. It was nice meeting my old friend Dr. Peter T.

There was nothing new at the meeting. I didn’t learn much. In the old days, we fought cancer by looking at very large metabolic charts that hung on the wall, and devised means of blockage of various metabolic enzymes. Now, we have very large charts that hang on the wall with lots of regulatory substances, all named with three letters, like ras, raf, fos, kit, etc., etc., and now we are devising blockade for them. Then, we do a few limited bench studies, herald the drug as a “promising” new treatment for cancer, after which we run countless expensive clinical trials to find out that the drug gives a possible 1% survival benefit, which is definitely statistically significant, even though the effect lasts for only 3 weeks – 9 months. I had to contain my excitement. There were a few good talks. I wish they would spend their time funding sole basic research, especially looking at embryology, the genetics of development, and the mechanisms of differentiation, de-differentiation, and phenotype expression. It’s not so glamorous of research, but it would be challenging to convince the Feds to pour billions of dollars into this sort of research, though, I suspect that it is here where the ultimate cure for cancer will be found, and not in the endless search for another metabolic or regulatory pathway to blockade.

 

Final preparations have commenced in earnest for our trip to Bangladesh. Our bags are slowly getting packed, unpacked, and repacked, very indecisive about exactly what may be needed for 2 months in Bangladesh. Betsy also has several outfits for Bangladesh, as you can see in the introductory photo. When we return from BD, I will make up a packing list for future ventures! We have our visas, and Samaritan’s Purse has been exceptionally helpful for Betsy and myself. Meanwhile, I’d like to remind all you dear readers that I cherish all of our e-mails, even though I don’t respond to every single one of them. We will try to stay in touch, and even update our “Feuchtblog” once in a while, though I’m not sure how good the internet will be in BD for such a task. I WILL NOT be sending out notices of blog updates which in BD, so please check the webpage from time to time if you are interested.

 

Apnar nam kenneth

February 11th, 2009

I now have to prepare for Bangladesh. Part of preparation is getting a feel for the language. Bengali is the most deprived language in the world. I’ve only been able to find one instruction book in Bengali, with a limited CD that gives you a rough impression as to what the words sound like. No major language instruction company offers any help. Berlitz? No Bengali. Rosetta Stone? You can take Welsh, spoken by 750K people total in the world, or Irish, where only half the population of Ireland speaks Irish, and then, mostly as a second language. Then, there is Bengali, the 6th most common language in the world. Nothing. Nichts. Nada. Nichivo. So, I slave away. Countless pages of Sanskrit later….

 

A return to semi-reality has just occurred. I was able to touch base with the office and surgery center, as well as do lunch with Dr. Liao. I ran over to the hospital to talk with The Lord High Grand Inquisitor. It was a rather cold event. I’m troubled by the statements that I’m a valuable character in the MultiCare system, and yet do not get the impression that I’m particularly wanted. They realize that I am the character able to bring major abdominal cases as well as breast cases to the hospital. Otherwise, the cases will be totally lost to elsewhere. It was sort of like a “wake-up” for me. Several movie wake-ups come to mind. The first is in the next-to-last scene of Conan the Barbarian (the best movie of all time) when Conan wakes up to the siren voice of Thulsa Doom. The second is deep in the earth when Puddleglum wakes up to the sweet talk and enchantment of the witch, in the movie, The Silver Chair. Somehow, I don’t have a good feeling about things to come. Then, I get the Surgical News, and always enjoy reading the occasional articles by Dr. Cossman, who is a vascular surgeon in Los Angeles. He seems to hit home every time. The article this month speaks of the death of private practice general surgery, and he is absolutely on the mark. I have included an exerpt in the Veröffentlichungen. Please read it in whole to get a good feel of what I’m going through. So, I remain uncertain as to what to do for the future. With the Franciscans, I will need to throw out any chance of doing any more thoracic or gynecological work, and I’d have to work with surgeons that I don’t trust. That doesn’t turn over well with me. I’d consider moving to Portland but the job market there is a zoo like it is in Tacoma. There is the thought of either figuring out a way of staying in Missions work until retirement, or doing nothing but locum tenens. Please pray for me that the Lord will guide Betsy and me in making proper decisions.

 

So, national news continues. A chimpanzee attacks a lady and nearly kills her. We now learn that apes can be quite vicious. Why didn’t Margaret Meade tell us that? If you accept the simple schoolbook -what you’ve learned in college- teaching on evolution, then we are the random product of a fairly violent species. No wonder I don’t feel safe in Harlem, or Washington D.C..

 

The Pope has now made several declarations that have ruffled many feathers. The first was to pardon and remove excommunication from a bishop who declared that the Holocaust did not occur. The second was instruction that Catholic politicians (such as Nancy Pelosi) must vote pro-life, or risk church action. Wow. My first reaction to the first declaration was a fit of anger. How dare the pope do such a thing? But then, I got to thinking… who cares what Pope Joe declares? Do you really take him seriously in these sorts of matters? I don’t.  Secondly, I don’t know where there is an injunction in Scripture to hold in excommunication those with stupid beliefs. The strength of Christianity is that it tends to look beyond politics and our own screwed-up-ed-ness. Yes, it is possible that the Marxist  bleeding heart liberal Tony Campolo might even make it into heaven. It’s definitely not ours to judge. So, perhaps it is proper for the church to stay out of issues such as belief in the Holocaust. I know of nowhere where the Constantinopolo-Nicene creed, the Apostolic creed, the Heidelberger Katechism, Westminster Confession, or any Roman Catholic creed insists on a belief in the Holocaust as a ground for orthodoxy… But, Pope Joe just can’t stay out of politics, or perhaps, just has bad timing on his statements with heavy political implications… He now declares that pro-death politicians cannot be good Catholics. Certainly, I’d wonder if anybody that strongly supports abortion or PAS should even waste their time identifying themselves as Christian. I’m not talking about many, who tend to wring their hands on the issue of abortion or PAS. Like I said before, lot’s of confused and uncertain people will be going to heaven someday. I’m speaking of the Gloria Steinems or Nancy Pelosi’s, who view themselves on a mission from (god?) to make abortion common, accessible, and completely socially acceptable. These politicians should quit wasting their time with the “Christian” or “Catholic” label. Meanwhile, Pope Joe must learn that he can’t be selective about when he practices politics, or when he practices Christianity.

 

Katze 19.FEB2009. Katze threw up everywhere in the house for the umpteenth time. We realized that we would have a serious problem with Katze, being that we would be gone much of this year. So, we decided to have Katze returned to the Animal shelter where we got her 5 years ago. We gave Katze a good 5 years, and it was not without plentiful tears to wish Katze goodbye. We had Sarah take Katze to the pound as we could not bear to see her go. We will miss Katze’s vomitus on our rugs and floor. She was otherwise a good Kitty.

 

So I end my ramblings. Kreuzberger Nächte sind lang, aber denn? (For my English readers, I’m referring to the lead song, which was a German hit song in 1978. It remains for you to figure out what the song is all about.)

 

Nebel im Dorf – Nach Hause

February 8th, 2009

I’m home! Thank you to those who made this trip special. Tops of the list is to Herbert Feucht. Then, to Katja and Hannes, Debbie and Heinz, and of course, to the teacher who endured me for four weeks, Roman Truhlar. I feel much more comfortable with German, but also see that I have a ways to go to survive comfortably. After visiting the town of Feucht, we returned to Würzberg, where I went dog-walking in the countryside with Hannes and Tasso.

It was quite foggy in the Mainztal, giving the entire walk a surrealistic impression. We returned home, and attacked the currywurst restaurant…

As you can see, many German restaurants allow you to bring your dog. Arras peers over the tabletop, not wanting the currywurst, but the Rheinania Alt. Our last day, we went to der Pott, which is a term used for the Ruhr region of Germany. In its hey-day, der Pott was the massive industrial area of Germany, occupied by massive coal mining, and heavy steel works. The industry continues, but competition from elsewhere has lead to much less steel production than in the past. The best designed coal mining facilities, which also included the massive machinery for separating and cleaning the coal, was the Zollverein Schacht XII, which was turned into a UNESCO site. We did a tour of the complex.

The entire facility was absolutely massive, mining and processing, if I remember correctly, about 60,000 tons of coal a day.So, I have two cups in memory of Germany, one is white for Betsy, one black for me…

The first says “Ruhrpott”, and the second is a quote from the Coffee Cantata of JS Bach, commenting on how good coffee tastes.

 

So, I am back to Puyallup, and I have a mad dash to prepare for Bangladesh. Germany was wonderful, and the only failure of the trip was the awfully cold weather, making it impossible to do bike riding. This gives me a reason to return! I’d especially like to ride in Franken. More adventures will follow, so stay in tuned.

 

Logic

February 2nd, 2009

Why are Fire Engines Red?

 

They have four wheels and eight men;

four plus eight is twelve;

twelve inches make a ruler;

a ruler is Queen Elizabeth;

Queen Elizabeth sails the seven seas;

the seven seas have fish;

the fish have fins;

the Finns  hate the Russians;

the Russians are red;

fire engines are always rushin’;

so they’re red.

 

It’s good when a little poem can help make you a more solid and logical thinker. A little jingle like the Fire Engine question clears out cobwebs, and teaches one how to make logical constructs in a methodological fashion, observing the multiple and varied rules of logic that we had to learn as children. Or, did we? I don’t think I was ever taught formal logic in either grade school, high school, or college. Isn’t that a touch strange? I had to learn logic on my own afterwards…..

 

January was a truly uneventful month, winding down from the holidays. It was a month of struggling with the hospital, and trying to come to terms with one’s identity as an aging surgeon. I had the wonderful joy of going out to lunch with a patient of mine of whom I thought was long dead. I helped him write and publish a 100+ page autobiography with multiple photographs, since I thought him to be such a fascinating character. He tells of his boyhood, growing up in Germany, escaping East Germany as a young child, in a most miraculous fashion, and then adapting to the USA.

 

January was a month of being involved in a new church start, helping Pastor David Scott in the development of Resurrection Presbyterian Church in Puyallup. Since I did the sound system for a short while atFaith Presbyterian in Tacoma, I am able to do the sound for Res Pres. We meet only Sunday evenings, until the church can find a permanent home. More to come on that…..

 

I’ve updated the Movie, Music, and Book reviews. Please feel free to comment regarding my reviews on my blogsite. Occasionally, readers have sent me e-mail comments of my kritik, the comments of which would be most suitable for all readers to appreciate. Rather than e-mail me, please post your comments below.

 

You might have noticed from the initial photograph that Samuel is now trying to imitate the Indians. Or, perhaps that is actually blood on his face, and he shows the contentment of Jack the Ripper, or a son of Sam. Simply not true. Sammy is so harmless, why, he wouldn’t even hurt a fly. Just look at the sweet boy. . .

So, we’ll let little Sammy off the hook. Meanwhile Patrick and Ethan continue so be charmers in their own right…

Mini-me

Ethan/Jonathan

 

I had hoped to post photographs of a ski trip with Jon into the woods today, but, alas, when we arrived at the trailhead, we realized that we had one of the wrong pairs of skis. It was a sad trip home, not being able to freeze ourselves in the snowy hinterlands of Mt. Rainier. Oh well… my next post should have photographs of Betsy and me in Big Sky, Montana, getting CME credits by learning how to build snow caves.  Cool.

 

Aus Düsseldorf – Franken und Sachsen

February 2nd, 2009

This next post is a bit long. It was a very full week! Sadly, photos cannot compete with experiencing the sights and smells and tastes of Deutschland.

 

I have now finished studies at the Goethe Institute. All went well, but I feel like I am even closer to actually feeling competent with the language. The hardest part for me remains understanding language on the street, as well as remembering the articles. If German had no articles (die, der, das), it would be incredibly simpler to learn. At the end, we had a little test, and I did the worst in Grammar, the best in conversation. So, that means that I must study the Grammar more.

 

In the last week, I did a short trip down to Köln in order to run up to the top of the Kölner Dom.

It is difficult to describe in photos the massive nature of this church, standing as the most prominent edifice on the Köln skyline. The bell itself was about 16 ft high, with four other surrounding bells.

 

I had finally started to get to know most of the classmates, so it was a little sad saying goodbye on the last day of class.

Photo shows Fatima (Libya), Anna (Italy), Ela (Poland), Shigi (Japan), Nazim (Turkey), Aliraza (Iran), Evana (Uraguay), Elana (Russia), Nadia (Russia), Tseje (Japan), Mia (Japan) and our teacher Roman Truhlar.

 

I decided to walk home after the last class, since the weather was so nice. It was about 8 km and it took me about 50 minutes to complete.  That same last evening, a number of us from the school went out to the Füchschen for dinner. I tried the Eisbein, as no such thing can be ordered in Amerika.

 

It tasted great, far more than I could eat. All in all, it was a great time, with lots of food and beer, and yet not terribly expensive. Most of the group then went out for Salsa. Me? No way, José! Ich bin nur ein alter Knacker. Staying up way into the ungodly hours just doesn’t suit me anymore, unless I’m forced to do so, or am climbing Mt. Rainier, or ….

 

After touching base with Herbert, we headed out to Würzberg the next day. Our destination was a close couple of Herberts’, Katja and Hannes. They live in a small village close to Würzberg, so from there, we were able to see the Altstadt of Würzberg. This included many nights of chatting, mostly in German, about Alltag in Deutschland.

Much of Würzberg was not destroyed in the war, so many of the old buildings were still intact. *Correction: Würzberg was heavily damaged in the war, owing to an absolutely pointless and idiotic bombing raid by the Brits, in spite of the fact that Churchill had studied in Würzberg and should have known better than to bomb the town, achieving zero military advantage. It was at the end of the war, when there was no question as to the end of the war. It leaves me always wondering about who the most evil character was in WWII: perhaps it was Churchill and not Hitler or Stalin.  You can read about the damage (in German) athttp://home.arcor.de/christoph_rose/wuerzburg/zerstoerung_von_wuerzburg.htm.We went on a tour of the Residenz. Würzberg has an archbishopric here, and the Residenz was the home of the the Archbishop. It was probably nicer than many of the palaces I saw in Europe.  The Altstadt also had the place where Röntgen discovered x-rays (sorry, no photo), and the many churches in the area.

The next day, we went to Bamberg, also a city with an Archbishopric, and not heavily damaged during the war. There we saw the Altes Rathaus, which has river flowing on each side of it.

We also walked the streets, went up to the Bamberger Dom, where King Heinrich II and Queen Kundigunde were buried in the early 11th century. Awesome. There were many art artifacts, including the Bamburger Reiter (seen in the top-most photo and below).

We also had dinner in a quaint restaurant, and drank the beer unique to that area, which was a dark beer with a smoky taste, called Rauchbier, or Smoked Beer. It actually tasted incredibly good. Of course, we also ate Bamburger und Nurnberger Wurst with sauerkraut. Like I said in previous posts, the food doesn’t get any better than this.

Finally, we had to say goodbye to Katja and Hannes and headed up to Leipzig. Leipzig was not in our original plans, but instead, we were going to visit Hille in the Rothalmünster area, but she had a case of the Grippe (flu). So, plans were quickly aborted, the internet searched, and new arrangements made. From Leipzig, we will be going the Nürnberg, again to Katja und Hannes, and then back to Krefeld. Shown below is the Kakelofen in their house, typical for Germany, and their dog, very gentle like a Golden Retriever, but a bit larger, and behaves more like a watch dog.

 

By the way, I have in the title “Franken”. Northern Bavaria is a region of people that are called the Franken, and do not like to think of themselves as Bavarians. In fact, they have been to Oktoberfest only once or twice, and then, did not enjoy themselves. Nürnberg, Würzberg, and Bamberg are all in Franken. There is also a small region called the Spessart, close to where we are made famous by the story about the Wirtshaus in Spessart by Wilhelm Hauff. Unfortunately, I’ve never seen it translated into English.

 

Leipzig. The road to Leipzig was on a new autobahn, that included 5 very long tunnels, the longest being 7800 meters. It was snowy.

We arrived in Leipzig at about 3 pm, so didn’t have much more expected daylight. We first ran to the Volkerschlachtdenkmal, built to commemorate the victory of the German people over Napoleon, at the battle of Leipzig. It was a massive slaughter, but started the end of the “French Hitler”. Oddly, Napoleon is still adored by the French.

That evening, we went to the St. Nicholas church, where Bach regularly performed, to the St. Thomas Church, where Bach was cantor, and to the famous Auerbach’s Keller, described in Goethe’s Faust.

Herbert and I were able to enjoy a beer in the Keller, and Mephisto never showed up.

 

Here is the St. Nicholas Church. It was in 1989 at this church where students held regular non-violent protests that stirred the East Germans to protest, leading to the fall of the Communist DDR regime.

 

The St. Thomas Kirche was truly impressive, being a very large church. The original organ no longer exists, though the present organ is quite impressive. I’m sure Jonny would have loved to have his fingers tickle the ivories of that organ.

Bach was originally buried in the Kirchhof (church grounds) of the St. Nicholas church, but was moved to the St. Thomas Church because of the destruction recieved to St. Nicholas church in WWII.

 

Off to Nürnberg. Much of the city was preserved, including much of the old city walls.

There is much I could say about the city, including the churches, the streets, the statues, etc., all of which were overwhelming, with a mix of the ancient and modern. The most impressive site of all was the castle (Kaiserburg), which was visited by every King of Germany since the early 11th century, including Heinrich IV and Heinrich V, Barbarrosa, etc.

The third photo shows the Turm (tower) that is the symbol of Nürnberg, and well as the well house, where a well 150 ft. deep through solid rock was dug to supply water to the Burg. The fourth photo is the room where the first Reichstag meeting was held for every new Kaiser of the Holy Roman Empire. The last was the chapel with a balcony where the king and queen sat, the regular floor where the dukes sat, and then a floor underneath, where the common people sat.

 

We then went to the Reichspartei grounds of the Nazi era. Unfortunately, we walked around alot, but I just didn’t take enough photos. The most significant was the Zeppelinwiese, which most people should recognize from the large rallies which were held there. I had to have Herbert take my picture standing in the place where Hitler stood 70 years ago.

 

Lastly, Herbert and I made a mad dash down to the town of Feucht. Not too many people have a town named after them, but we do.

It was truly a beautiful town, very quaint, extremely clean, everybody was polite and courteous, the most perfect place to have named after ones self. Eat your hearts out, dear readers.

 

I’ll be home this week. Thank you everybody for your e-mails and comments. I don’t respond to many of them, but always enjoy getting them.

 

Hamburg

January 26th, 2009

I’m not sure if hamburgers were invented in Hamburg, but I decided that my only hamburger on this trip would be in Hamburg.  The photo of the Hamburger hamburger is above. Don’t worry Betsy, I didn’t eat all the fries. It actually didn’t taste very good. American hamburgers are a zillion times better. The food here in Germany has otherwise been most extraordinarily good, and yet never so tempting as to over-eat. My main diet has been a piece of bread or pastry in the morning with coffee, and then either a Wurst mit Brötchen or a Döner in the afternoon. That’s it! The Döner in Düsseldorf are absolutely awesome. I have no idea why some Turk doesn’t take the idea to the US and open a Döner restaurant. He’d make a killing. I’ve also had sauerkraut here in Düsseldorf that was unbelievably good. It makes the Steinfeld’s sauerkraut at home taste like Hundefutter (dog food). In Stuttgart, I don’t remember the names of the things I ate, but they also were remarkable. No wonder our grandparents were such good cooks. It has been said that the best cooks in the world come from France and China. I don’t believe that for a second. While I love Chinese food, Thai and Korean food as well as Indian food competes quite amply. It was the Italians that taught the French how to cook. The best bakery goods in the world are not found in France but in Austria and Germany. I’d take a meal in Deutschland any day over the best French restaurant. This is not meant as an offense to my French friends, as they have much to be commended for. Jamaican food also is in a class by itself, and nobody could compete with Jerk as one of the best foods of all time. But, back to Germany.

 

Classes have continued. I find it easier to speak and read. I’m continually hindered mostly by remembering genders of things. It is very frustrating. Why should a wall be feminine and a window neuter? Why is a auto neuter but a wagen (car) masculine? It makes no sense to me, and frustrates my learning. I find that only after unbelievable repetition, one finally gets it. It’s probably why I will never be perfectly fluent unless I live in a German-speaking country for a while, but then, I don’t think that Betsy would tolerate that, and she’s the most important thing to me, than just learning another language. Oh well.

 

I’m getting around town a bit more, and finding my way downtown without problems. I’ve found some good bookstores, and even the bookstore where Heinrich Heine was born in the Altstadt, so I had to buy a book of Heinrich Heine poems in that store.

For my studies, I must say with Heinrich (Henry!)

Anfangs wollt ich fast verzagen,

Und ich glaubt ich trüg es nie,

Und ich hab es doch getragen,-

Aber fragt mich nur nicht, wie?

 

A rough translation (I hope is correct!) … At first I thought that I would despair, and believed I could not bear it. Yet, I did it, but don’t ask me how!

 

And a poem for Betsy’s and my Wander-year…

Wo wird einst des Wandermüden

Letzte Ruhestätte sein?

Unter Palmen in dem Süden?

Under Linden an dem Rhein?

 

Werd ich wo in einer Wüste

Eingescharrt von fremder Hand?

Oder ruh ich an der Küste

Eines Meeres in dem Sand.

 

Immerhin mich wird umgeben

Gotteshimmel, dort wie hier,

Und als Totenlampen schweben

Nachts die Sterne über mir.

 

Just like Shakespeare or Edgar Allen Poe fails when translated into German, Heine or Goethe fails when translated into English. My apologies to my English-speaking friends. Try learning some Deutsch! Eat your heart out, Doug Bond! Shakespeare sucks!

 

As mentioned before, the most expensive shopping mile in Germany is in Düsseldorf, on the Kö, or, Königsberger Allee. I take walks at least several times a week to the Altstadt, and so have to cross the Kö.

There’s also a large open-air market nearby in the Altstadt…

There is this strange fixation in Germany on Amerikan politics, and many bakeries now offer Obama bagels and Hillary donuts…

Both are fitting. The Obama bagel has a large hole in the center, and the donut has a central hole, plus sugar and spice but nothing nice. I don’t think that they intended those interpretations, but they are most fitting.

 

Hamburg. Hamburg was a beautiful city, and I enjoyed it thoroughly.  The Elbe river runs through the city, which you could see from the Jugend Herberge (Youth Hostel) where we stayed.

The Elbe is a bit larger than the Willamette where it runs through Portland, Oregon, but not as large as the Columbia in that same area. You don’t see bridges going across the Elbe, I presume in part because Hamburg has huge shipping traffic and a very large bridge would be required. A century ago, the first tunnel was dug under the Elbe, and we were able to walk it…

We went to the Speicherstadt, which was a part of town were duty-free goods were unloaded in the past, resulting in Hamburg becoming the 2nd largest container port in Europe. It looks like Amsterdam. It’s funny what the absence of taxation does to the overall economy.

We visited the St. Michaelis Kirche, and were able to go up to the top to see the city from an excellent view…

 

We visited the Rathaus, which does NOT mean “house of rats” but rather, is the City Hall. It was stupendous, with a large fountain in the center court…

By evening, we made it past the Music Hall, which had a Memorial (not seen) commemorating Johann Brahms, who came from Hamburg.

The next day, we went to the FischMarkt, took photos of Hamburg, and took a boat ride up and down the Elbe, looking at the massive harbor cranes and ships in the harbor…

 

They also do ship-building and repairs in Hamburg, and the last photo shows a massive ice-breaker in dry-dock for repair. Finally, one of the students, a Russian-born kid, now living in New Zealand, speaking both Russian and English perfectly, insisted on going to KFC for lunch. As per my comments above about Hamburger hamburgers, KFC in Germany is not as good as at home.

The last photo shows the group with Marcel and Hannes, who were our German Zivis. They were wonderful. We also visited a Modern Photography Museum, and all agreed that it was awful (sorry Diane, but modern art is just plain sick-it’s not that modern art doesn’t say anything, but that what is says is offensive).

 

So, now I’m back in Düsseldorf, and I’m wrapping up the last week at the Goethe Institute. My next post should be coming from Herbert’s Haus. Until then, hang in there.

 

Noch in Düsseldorf

January 19th, 2009

The memorial words of JFK “Ich bin ein Berliner” were laughed at by the Germans. The above photo shows you a Berliner. It is a jelly filled doughnut. Don’t worry, Betsy, I bought only one, just to say I had a Berliner. JFK should have said “Ich bin Berliner”.

 

Last week, I returned to Krefeld, and spent the weekend with Herbert. I had a wonderful time practicing German, and Herbert had a not-so-wonderful time listening to the most horrid butchered German one could generate. I am finding that I know more German than I thought, but far less than I’d really like to have. Conversations are becoming easier, and I’m constantly learning more abstract words, and daily phrases, to allow for better rapport on the street. I am amazed at how many people speak English. Virtually all the students from Japan are fluent in English, the student from Iran, the student from Turkey, the student from Italy, and the students from Russia all are quite fluent, and will often ask me to explain a German word or phrase in English to them. I am also overwhelmed by the extreme kindness that others from foreign lands are to others. I’ve never felt the sense of “hating” the dirty American. The German people also have been outstandingly kind to me, so that I just haven’t seen the Prussian Militarist type sentiment yet in Germany.

 

While with Herbert, we went to Venlo, which is an ancient town on the Maas River in Holland. It was a little strange having to contend with yet another language. Dutch is sort of a form of bastardized German. All you need to do is either say the word in English (Street vs. Straße), or add a “j” here or there, and double some of the vowels. Then you have Dutch. My apologies to my Dutch-speaking friends. Venlo was nice, and we went to the Altstadt, where it is now many shops on several streets. Here are some photogs.  One building had the most grotesque door header. I have no idea what it was meant to symbolize.

Other street scenes showed many shops and old buildings.

This last week, no Stammtisch. It occurs too late at night. I wouldn’t get home until about midnight or later. So, you probably won’t get any reports about Stammtisch. The snow is now mostly melted, and the only thing that makes one uncomfortable is that it is a little windy. It is now much easier to walk the streets. Classes are going well, and I am doing nothing but speaking, reading, and even thinking and dreaming in German.

 

This weekend, I had the most wonderful time with an old friend Debbie (Gasser) Fuchs and her husband Heinz. Heinz had moved to Portland soon after Betsy and I moved to Chicago for residency. During that time, they had gotten married and moved to Germany. So, I knew Debbie quite well as a young girl, but had never met Heinz. It was a most unusual meeting. I took the train from Düsseldorf to Stuttgart, and then transfered to the train going to Benningen, where Heinz and Debbie live.

I should mention that train travel is incredibly easy in Europe. You can easily go just about anywhere, and at a very low cost, if you purchase Eurail passes in the US. The trains and busses run unbelievably on time, even on the day when there was a horrible snow fall. It should be the envy of Americans, though even our best city transportation is horrid compared to the transportation system in Germany. While visiting Heinz and Debbie, besides the wonderful fellowship I had with them and their family, I did four things.

  1. 1.Visited the Schloss Ludwigsburg. This is the largest palace in Europe outside of Versaille, and the magnificence was breathtaking. It was not damaged during the war, so has been kept intact. Some of the many scenes follow…

    There was a full theatre with orchestra pit for opera, a large chapel, hunting lodge, enormous gardens, etc., making the splendor beyond imagination.

  2. 2.Finsterott – Heinz offered to take me to Finsterott, about 30 km away, which was where my grandfather came from. By the time we arrived, it was fairly late at night, so I couldn’t take the best photos. It is a very small village, up on a plateau that was quite hilly, mostly used for wine growing. Just north of Finsterott was the Evangelical Taufer Gemeinde Kirche, which is almost indubitably the church that grandfather and great-grandfather attended. There is a connected Altenheim (old folks retirement center) where I wish I could have asked the folk about our grandparents.  Here are photos.

  3. 3.I went to church with Heinz and Debbie at the Ludwigsburg ETG church. What a delight! It was absolutely wonderful hearing Zion’s Harp songs (from our old church Hymnal) being sung, except auf Deutsch, and other songs, such as “How Great Thou Art” being sung entirely in German. Fortunately, I was able to understand over 90% of the sermon. They serve lunch in the church immediately after the service, and I was able to talk to a number of folk and eat traditional Wurttemburger food. Just awesome! The church had a wonderful mix of young and old, with many children. I felt totally at home.
  4. 4.Stuttgart. Heinz and Debbie took me to this hill overlooking Stuttgart, I don’t remember the name, but it is where the WWII rubble was stacked as a remembrance of the war.

    The last photo is overlooking Stuttgart.

I’m back in Düsseldorf now, and ready for another week of study. Stay in touch. Viele Grüße auf Düsseldorf!

 

Nach Düsseldorf

January 10th, 2009

As I sit in the Chicago airport, with a four hour delay until my next flight to Düsseldorf, I am barraged by the sewer pipe. I learn that Obama now is opening up and growing up. Wow. I earn that there is a mess in Israel (Gaza strip), that is a very hard problem. I heard that phrase before, when the intellectual elites discuss things such as medical ethics. It a really hard problem to tell somebody that their physician will not kill them(?). I don’t think so. If somebody were to go on a lunatic rage, all would have no problem identifying the person as crazy. But, what if an entire group of people go on a lunatic rage? Then whose fault is it? Why do we treat groups of people completely different from individuals?  There is such a thing in medicine as a Folie a deux, where two people are insane when together, but normal when separated. Can such a thing happen to groups of people? I think so. Maybe the world is crazy? I learn from the Gaza strip games that sane people do very insane things. Both sides! It is the worst setup for disaster.

 

I simply could not sleep on the airplane, but it was most delightful to Herbert waiting for me in the airport. The next day was spent at the Düsseldorf zoo, but I’m not sure on which side of the cage stood the most dangerous animals.

 

Monday AM. Woke up, the alarm clock was keeping time, but making no sound. Looks like I need a new Wecker. I eventually discovered that my iPhone has a clock in it with an alarm, and it is working just fine for that function.

 

It had snowed the night before, and there were at least 8 cm of snow on the ground. I couldn’t roll my baggage, and so had to carry it to the Bushalterstelle where one catches a bus. I needed one connection (Umsteig) in downtown Krefeld, and then was off to Düsseldorf. The busses ran on time, though traffic on the Autobahn was in standstill (Stau). The people at the Goethe Institut (from now on GI) were all very friendly, and I proved an efficiency of about B1-B2, so they decided to stick me into B1, which was what I preferred, since I needed nothing but a lot of practice speaking, and Grammar work, so an easier class would suit me fine. I took the taxi to my Hausmutter, a very pleasant older couple, who had an upstairs room for my use–alles sehr bequem (very comfortable). So, tomorrow I start my German lessons.

The last photo shows the stairwell up to my room. It’s a fairly steep climb. The bus ride takes about 20 minutes, but it’s a 10 minute walk to the bus stop, and a wait from 5-20 minutes, so ties up about 1/2 -1 hour to actually get from “home” to the class and then the same time in return.

 

Lessons are with a middle-aged male teacher named Roman. He is actually quite adept, and much of the time is spent repeating and repeating various sentences, with many corrections. It’s nice to learn from the mistakes of other students. I spend a little time after class, which ends at 1 p.m., and study in the Media room. It is there that I am also able to make internet connections to you all.

 

I haven’t had much ability to explore the city. The temperature remains below zero, and it is really biting cold. They had a walking tour today that I skipped out of, since it was too dastardly cold to consider staying in any longer than I needed.

 

Thursday 08.JAN2008 The temperature has finally warmed up a touch, though most of the snow remains.Here is the outside photo of where I am staying… it is still early morning and quite dark outside when I leave in the morning.

It was comfortable enough to take a walk downtown, and see Königsallee (Kö), the most expensive shopping district in Germany. It was. I didn’t buy anything.

This evening will be our first Stammtisch. You’ll hear about it next time. Until then, keep your stick on the ice. I’ll stay in touch. BTW, it is extremely difficult for me to write this is in English. Ich hätte nur auf Deutsch geschrieben. Bis bald.

 

Es Weihnachtet ein Wenig!

December 18th, 2008

For English only speakers, the title means, “It’s Christmasing a little”. Yes, it is Christmas time, that most happy time of year. We should be having all the children home, including Rachel, who originally thought that she couldn’t make it. We are cutting costs a touch this Christmas season, not so much because of the economy, but rather owing to my pending absence of salary for a year.

 

The week before Christmas is cookie time, and we have been baking cookies fast and furiously. It wouldn’t be Christmas without Christmas cookies! Recently, I also made up a bunch of Jerky and smoked salmon. The stuff you get in the store is more like leather than good jerky, so I like making my own. Essentially, you cut of a 2 cm thick piece of tough steak into thin 3-5 mm strips. They then get brined over-night, in my own personal secret solution.

The pieces are then washed and dried, peppered, and placed on racks to insert into a smoker.

Finally, the jerky is allowed to cool, and then placed in Ziploc bags in the refrigerator, to help keep them very fresh.

 

The Krankenhaus continues to be built, and it slowly is taking form. The hospital administration is telling us that it will be completed in December 2010, though the construction workers tell me that it is more realistic that a June 2011 timeframe is more probable. Here’s a few photos for you.

Parking Structure

Main Building

View with old hospital in the background. It’s coming along fairly steadily. We wait anxiously. Meanwhile, I am cleaning out my locker. The photo of my locker at the hospital is on the top of this blog. It is the only locker in the men’s changing room that has any stickers at all. I will not miss my locker or Good Samaritan Hospital, but will miss my patients seriously. There are too many patients that I have had very close interactions with. Many are giving me a call in the last few weeks. I hope that I can come back to Puyallup as a surgeon, though I will never return to the situation of call and administrative arrogance that has been plaguing me for the last few years. We’ll see what happens…

 

It remains my duty to continue philosophizing. I’ve appreciate Udo’s comments on Ayn Rand, and remain to be corrected. Adam Smith remains the Grundlage of conservative economics, yet it is not surprising to learn that he was a very close friend of David Hume, of whose thinking we owe the downfall of Christianity in the British Isles. His statue sits right outside of St. Giles Church in Edinburgh where John Knox preached for many years. It was Hume who essentially stripped the Scriptures of any form of miracle, identifying reality as only that which could be known by sense or experiment. As a polar opposite to Adam Smith was Karl Marx, who oddly found his safe haven in Londinium, after being expelled from Deutschland and France. Marx’s railing against capitalism identified that capitalism alienated the person from his work and social environment. Oddly, Marx failed to realize that his thinking alienated the person from himself. The self, in Marx’s system, has no sense or meaning save for what is conferred on that person from the state. Neither capitalism nor communism succeeds in the end since it fails to identify the true object of our alienation in the world. Both capitalism and Marxism are systems of greed, with Marxism actually being a more perverse form of greed, since it concludes that because everybody cannot have everything, everybody will then have nothing. Governmental forced wealth distribution according to Marxian principles will ultimately lead to the vast majority of the population being poor, with only a few having all the wealth. It is interesting to note how few societies had a substantial middle class such as has been seen in the non-Marxist Western world in the last 200 years. As society becomes more socialist, we are quickly loosing our middle class with the increasing separation of the very rich and very poor and fewer people in the middle. Scriptures speak of personal capital, suggesting the error of Marxism, yet makes very clear that our personal wealth is a gift from God, and not to be hoarded or acquired by means that are either dishonest or at the unfair advantage somebody else.

 

Und so ich weihnachte. Time to think about Christmas, God becoming man, a totally unique event in the history of mankind, and irreproducible, thus undiscoverable by Hume-ian methodology. Yet, the incarnation remains the most logical event that ever happened, the event that defines all existence and meaning. This makes Christmas is a most joyous time of the year. No time for sadness or philosophizing, but of family, friends, Christmas cookies, and Christmas carols that honor the Christ-event.

 

Frohe Weihnachten und Prosit Neujahr!

 

My next update will probably come from Düsseldorf, where I will try to update on a weekly basis, and thus will not announce with each new blog that comes out. Stay in touch, and drop me a line while I’m in Deutschland.

 

Habe nun ach! Philosophie

December 6th, 2008

Habe nun, ach! Philosophie,

Juristerei und Medizin

Und leider auch Theologie

Durchaus studiert mit heißem Bemühn.

Da steh ich nun, ich armer Tor!

Und bin so klug als wie zuvor;

Heiße Magister, heiße Doktor gar . . .

 

Yes! The immortal rantings of Faust in the prelude to the poem written by Goethe that has swept the world by storm. It just sounds so much better in German than English. It’s like trying to translate Shakespeare into another language – it just shouldn’t be done! There are too many days when I feel like Faust. I’ve even memorized the opening lines to Faust. They really are as good as anything from Shakespeare.

 

So I sit listening to philosophy lectures. I’ve worked through the Greeks, Bacon, Hobbes, Descartes, and Spinoza, then Locke, Hume, Kant, Hegel, Marx, Rousseau and Adam Smith. The nineteen and twentieth centuries await. All of this is done through the agency of the Teaching Company recordings titled Great Minds of the Western Intellectual Tradition. I’m doing this while I exercise. Yes. True, I miss a little bit, but I catch a lot also. This lecture series is done by a group of 12 lecturers. I’m not sure how they split things up. As an example, Adam Smith is taught by Jeremy Sheamurs, who is a bleeding heart Marxist, and speaks blatantly against Adam Smith from the very start. As a result, he not only misrepresents Adam Smith, but also Karl Marx. All of this professorial blathering brings me to mind one of my favorite quotes, offered by Paul Johnson, the British editorialist and historian, writing in 1991, in a book “To Hell with Picasso”

 

“Universities are the most overrated institutions of our age. Of all the calamities which have befallen the 20th century, apart from the two world wars, the expansion of higher education, in the 1950s and 1960s, was the most enduring. It is a myth that universities are nurseries of reason. They are hothouses for every kind of extremism, irrationality, intolerance and prejudice, where intellectual and social snobbery is almost purposefully instilled and where dons attempt to pass on to their students their own sins of pride. The wonder is that so many people emerge from these dens still employable, though a significant minority, as we have learned to our cost, go forth well equipped for a lifetime of public mischief-making.”

 

I will now include Teaching Company series and other lecture series in my book review section. All of this philosophy stuff has brought back to my mind how my thinking has been so thoroughly influenced in the college years by the writings of Francis Schaeffer. It’s maybe time to re-read his works. It seems like his writings, though 30-50 years old, remain contemporary.

 

I haven’t written much about my reflections on politics. This is mostly because I choose to be hopeful in my depression. I would have been profoundly depressed had McCain become president. I feel the same about B. Hussain O. Neither candidate has a strong concept of economics. BHO is profoundly inexperienced—something that no amount of personal élan or cabinet appointments could make up for. So, we wait with baited breath. Meanwhile, do you know who John Gault is? I’ve reached the point where I need to re-read Ayn Rands’Atlas Shrugged. You will learn who John Gault is in this book. I now have an audio version of A.S., and so might just listen to it. Ayn discusses the possibility that the few movers and shakers of society, those that really are productive (not the George Soros’s of the world who get wealthy by spending their time trading stock, but those who actually generate wealth in a society) if they were to go on strike. Well, my year off for Sabbatical is slightly a reflection of my agreement with Ayn Rand. It’s time for Atlas to shrug.

 

Will Cut for Food

November 16th, 2008

Dr. Mike Brown was the anesthesiologist, and we got the team together for a photo of my last elective case at St. Samaritan Hospital. I am still performing smaller procedures at our surgery center, but have refused to take any further hospital call at GSH and so am restricted on performing elective cases at the hospital. That’s okay with me, but their underwhelming friendliness and willingness to accommodate to my particular issues induces a reluctance on my part to ever return. Who knows? There is always locum tenens, the Fransiscans (another hospital group in our region), or possibly focusing primarily on mission work. Meanwhile, it is a little slower at work since I am not taking on the huge cases, and elective hospital cases that I see in clinic are fed to my partners, so that they are busier with paying cases.

 

I’ve been saying goodbye to many patients, and will miss them. One patient had a total esophagectomy by me, followed by a major colon resection, and is alive and well ten years later-one of my miracle patients. He used to drive a beer truck, and would always ask me for a beer. His first comment whenever I’d walk in the room was “&*^#@!, hurry up, I don’t have all day!” So, his last visit I gave him a few brews to take home.

 

Bicycles… Another Mike Brown is my bicycle consultant, and he has ordered my Steelman bicycle. I am waiting anxiously. I will probably get a cheap Rennrad (road bicycle) in Düsseldorf in January to get around with. Perhaps later in the year, I could return to do the Rhein or pop down into France and do the Alpes d’Huez (yea, mon!!!). Meanwhile, I did the almost unthinkable. I always thought that I would be totally safe with my bicycle mounted on the trainer in the garage. Well, three weeks ago, for some unknown reason, the back wheel flipped out of the trainer, and completely wrecked the back wheel. I had to completely replace the back wheel. Schade!  So, I am back pumping on the cycle. I must be the only person to ever have totaled a bicycle while on a trainer!

 

I’m ready for the year off. I can’t wait to touch base with Herr Doktor Herbert Feucht in Krefeld. I’ve always enjoyed visiting him. Hopefully, I could be a little more independent in Düsseldorf, and thus be forced to speak German. With Herbert, he usually talks English to me, and spoke for matters when we were out. So, I’m cramming my German right now, while also teaching myself the Sanskrit of the Bengali language (much slower progress!) and a few Bengali words. Bengali definitely is an indo-european language, and I can see similarities in many words, such as numbers.

 

Our (Betsy and I) only significant activity was a trip to Maui for a Wilderness Medical Society meeting. I didn’t really enjoy Maui. It’s expensive, and crowded. I find that it is hard for me to just lay out on the beach and get any serious reading in. So, we didn’t lay on the beach or at the pool even once. We did get around the island a bit, and that was enjoyable. While in Maui, we learned that we now have a little Commie Pinko freak as president. I wasn’t really crazy about McCain and so voted for neither McC nor BHO (I wrote in Ron Paul), and do not feel that mine was a wasted vote. But, I was still a little disappointed about the election. BHO’s presentation at the Democratic convention would most appropriately be called the apotheosis of BHO. Later, school children would sing songs worshipping him on television. Older folk of all intensities of skin pigmentation on television would lapse into trances of rhapsody for their savior and redeemer from the capitalistic pig, a behavior more fitting for a Pentecostal church service than a political rally.  It really seemed like BHO was competing with the Almighty as #1 of the Universe.

 

I was even more dejected by the vote in our state to approve physicians’ ability to help a patient commit suicide. You don’t need a physician to do that. Any dimwit can figure out how to kill themselves swiftly and cheaper than a physician. It just isn’t our role to assist in killing. So, I am a bit leery about even practicing medicine in our state any more. Now that we have seen the death of Hippocratic Medicine, I am left frightened by what will take its place. Medicine no longer has a definition as to its goals. Is it to simply prolong life? Is it to maximize the profits of the pharmaceutical firms? Is it a means of giving the State control of the most personal aspects of our lives? Is it entirely a utilitarian function of maintaining maximal functionality of the States’ citizens?

 

I am left thinking about St. Basil the Great. Basil the Great of Caesarea (in Asia Minor) was one of the Cappadocian church fathers in the 4th century, one of the brightest theologians ever of the church, who also started the first hospital. Sick people were left out in the woods to die by getting eaten by wolves—certainly a convenient way of dealing with the sick! Basil decided to re-incorporate the sick back into society through the use of hospitals.

Kudos to St. B. Is it no wonder that Christianity took the world by storm, without force and without might, but rather by its’ adherents simply being obedient to Christ and being servants of others? Lord, give me both the wisdom and caring heart of St. B.

 

Finally, thanks to Dr. Middelmann for noting some German grammatical errors on the blog site. I’ve hit the one-year mark for my blog/web page. My children, who inspired me to start a blogsite, are no longer diligent at maintaining their blogsites. FaceBook has kind of stolen the show. What next?

 

Treading Among Immortals

October 19th, 2008

OK. I have a confession to make. I’m absolutely nuts about J.S. Bach. And the more I listen to his music, and learn about him, the more I appreciate the absolute genius of his character. I’ve spent some time re-listening to the Greenberg lectures on Bach and the High Baroque (www.teach12.com) and remain amazed at the sheer complexity of his compositional technique, engaging in musical styles that took until the 20th century to grasp, such as Stravinsky’s technique of having two simultaneous key signatures being played (and sounding great!), odd-metered timing, 12-tone rows of Schönberg, and the likes.

 

I don’t review all the music that I listen to, and notice that over the last 30 days, I’ve listened to over 84 hours of music, just while sitting at my desk, reading or doing the computer. These have included the symphonies of Glazunov (well worth hearing & owning, though they still don’t come in a compiled set), and much of the piano performances of Alfred Brendel, including the Beethoven piano sonatas, and Schubert piano sonatas. Both are wonderful performances by a superb Wiener Klavierspieler. I know of no better Schubert interpreter than A. Brendel.

 

Now that autumn has arrived, I have my bicycle mounted on a trainer. The summer was wonderful for cycling, but very disappointing for backpacking. Maybe next year will be better. I have a new bicycle on order, a steel framed bike with Campy Chorus components and Campy Neutron wheelsets, that hopefully will arrive by early February. I am ordering this wonderful little machine from a friend of a friend, Mike Brown, who is just opening up a bicycle shop in Tacoma. The frame is coming from California, and you can look over their website atwww.steelmancycles.com. This cycle should last me the next 20 years, unless it gets stolen or run over by a car.

 

I’m nearing the end of call  –forever. October 28 is my last call day. I will never again take call under the conditions that we have been having to endure. It will be either 12 hour shifts, or hospital call with substantially more assistance. For two months, I’ll be winding down my practice, in preparation for the year Sabbatical starting 01 January 2009. More on that in future blogs. For now, I need to prepare for a month at the Goethe Institute in Düsseldorf. I’m also doing a little brush-up on my French, while teaching myself the Sanskrit style writing of Bengali.

 

It is the political season. I hate politics. I’ve just read a blog of a relation that makes them sound like a little commie pinko freak. Scary! I didn’t think that we had that in our blood. Amerika seems hell-bent on socialism. Though the public has massive distrust for our “leaders”, they wish to put even more responsibility on their laps. The Gov is now responsible to make sure we never have an economic downturn and so is taking possession of our banks (i.e, our money, our wealth). The Feds are responsible for “educating” our kids. We want to give them the care (and control!) of our bodies in the form of health care for all. We don’t respond in horror when a near-president suggests that we have to “spread the wealth around”. Lenin, Stalin, and Mao were effective at spreading the wealth. It looks like Amerika will be re-inventing their failed experiments in economics. Plan on a 10-20 year depression.

 

It’s not fair to end on a depressing note, since I don’t really feel depressed. Probably best to end quoting the prophet Habakkuk…

 

Though the fig tree should not blossom,

nor fruit be on the vines,

the produce of the olive fail

and the fields yield no food,

the flock be cut off from the fold

and there be no herd in the stalls,

yet will I rejoice in the Lord,

I will take joy in the God of my salvation,

God the Lord, is my strength,

he makes my feet like the deer’s;

he makes me tread on high places.

 

In memoriam

September 11th, 2008

This week, I received the shocking news that one of my special mentors in Surgical Oncology passed away. Dr. Michael Walker was a fellow for the year that I did my internship, and then stayed on as an attending, and serving as an advisor for me. He was one of my favorite attendings, and very influential in getting me to go into surgical oncology. A quiet and private person, he was patient, kind, with excellent bedside manner, very bright, and most exemplary as the kind of doctor that I myself wanted to be. Michael was quite physically fit, ran all the time, and never had much fat on him. He worked hard, and that got him a position at Ohio State. It was an e-mail from Dr. Das Gupta that informed me of his death. My heart goes out to his wife Lee. Dr. Walker will always be remembered with pride by me.

 

The only person that ranked higher than Mike, in my opinion, was the professor, Dr. Das Gupta, who still remains the greatest doctor I’ve ever worked with, ever, and there were many greats.

 

Of all of my mentors in Surgical Oncology, Dr. Henry Briele remains the most quoted. Cut! Cut! Cut! Today! were repeatedly screamed at me in a sharp, staccato fashion, with me gasping in frustration, worried about cutting the wrong place or the wrong thing. We always used these large blades that looked more like sabers, which I continued to use until they became unavailable.  I still say Cut! Cut! and Today! to others in the operating room, and there are countless techs that have heard of Dr. Briele, even though they have never ever met him. Another favorite quote…I’ll have the electrocautery turned way up, and then say, “If they didn’t want it to go that high, they wouldn’t have made it go that high”.

 

Well, I can go on, but I’d do a disservice to my real hero, Dr. DasGupta.  I don’t quote him much, except something he told me when I was taking too long to close a mastectomy, “If you keep up this pace, you’ll never make it downtown”. Dr. DasGupta will be proud to know that my average modified radical mastectomy with sentinel node biopsy (and completion axillary dissection) rarely takes more than 60-90 minutes. I’ve gotten faster, but also much more precise in my surgical technique.

I decided to do surgical oncology research, since the surg onc docs seemed to be the most intelligent and caring surgeons in the residency program. When they criticized, it wasn’t just to make you miserable-they were actually trying to teach you. The very first day of research, Dr. Das Gupta sat Dr. Tate and myself down in his office, asked Peggy the secretary to turn off the phone, broke out a very expensive bottle of Port, and offered Dr. Tate and myself a good cigar. We were his boys. He was our boss. We called him “the Boss”. The only other thing we ever called him was “Scooby”, from what a patient called him once. Dr. Das Gupta once was asked by a patient whether he was German, since his name had “Das” in it. I believe that his response to the patient was something like, “yes, I’m from VERY east German!”. My favorite quote of Scooby was to let a patient know that they got better “in spite of us”. Dr. Das Gupta was, more than anybody else, responsible for me getting a Ph.D. He has always been my superior, but also my friend. It is nice to be able to occasionally still ask him for advice or direction. A few years ago, Dr. Das Gupta made the news because he apologized to a patient after making an operative error. The national news lauded this as a unique and unusual form of behavior for a physician. Yet, this honesty and forth-rightness were taught to me by him from my first day on service with him.   There is no person in all of Surgery that I would be more proud to call my mentor than Dr. Das Gupta.

 

The lead photo is a surgeon from the Cameroon who was visiting Puyallup. I shall be spending some time next year in Bangladesh, so am now actively trying to teach myself Bengali. It’s hard. I may also spend some time in Africa with Ngoe in Cameroon. My hope is to find the best fit for myself, or be able to be available, so that I could spend 3-6 months every year overseas.

 

I am unfortunately persistently agonizing over the absence of respect that is given to the older surgeons by our hospital. I keep getting the feeling that they want to get rid of me, yet, when I give them firm statement that I really, really am leaving, they come running like lapdogs, trying to make amends and promote unity. Today, the Lord Grand High Executioner informed me that I cannot go on courtesy privileges, finding about any loophole possible within the text of the hospital bylaws to refuse me courtesy status for two months while I cover my service but not actually take hospital call. He finally agreed that he would pay me for call, but, my price is not cheap. I am not a well-worn whore. Several days ago he send me a letter reprimanding an order I placed in a chart. I had a patient on whom I did major and serious abdominal surgery, and she remained with an unusually prolonged ileus. Finally, one day, I walk in the room, and, rather than vomiting on me, she begged me to get her an iced Cappuccino. YES! She opened up! I promptly ordered “Iced Cappuccino, i po qh prn”. Two months later, I get this lengthy reprimand stating  that the hospital simply could not provide the cappuccino, so I made the hospital look bad. Oddly, nobody ever spoke to me, or called me to inform me that the order was unfillable, but that alternatives were possible. I would have personally walked over to the hospital and purchased her an iced cappuccino. Unbelievable paperwork was generated by nursing, dietary, and then administration over an iced cappuccino order. Dudes, this goes on all the time. It’s sad to see the “caring” profession to be the least caring people of all, and especially those that try to protect the patient from the “uncaring” doctor.

 

I fixed the “comment” device, as it wasn’t working well. Please feel free to leave comments. I’ve also included reports of some more bicycle rides, movie, music and book reviews. Some time soon, I’ll leave  more detailed note of our future plans.

 

A wet August

August 25th, 2008

It’s been a busy but wet August, probably one of the wettest that I can remember. I did a moderate amount of training for the Portland Century, but often had to fight the nasty rain. The Portland Century was dry, but it started raining quite heavily as soon as we completed the ride. You can read about the Portland Century in the “Bike Rides” section. I noted that after riding the Century, there were those that had done only 25-50 very flat miles, and were struggling to get up a very mild hill on Broadway in downtown Portland as it goes south. Oddly, that would have been me a year ago. Fortunately, except for minor leg cramping, I couldn’t have felt better on this ride. Other outdoor activities have been limited by the amount of rain that we’ve had.

The top photo shows progress in the construction of the hospital addition. Note the cloudy skies in late August. The construction goes on feverishly, rain or shine.

You might notice that I rearranged my website to make my other events more accessible. In particular, I added a number of movie reviews, music reviews, book reviews, a pitifully failed hike, besides my bicycle rides, to the respective pages.

After great reflection in the past month I probably will NOT
a) hike the complete PCT at one time ever
b) ride my bicycle completely around America ever
c) sail all the seven seas ever
This doesn’t mean that I don’t want to do some serious hiking or cycling. I’d like to get a real touring bicycle (Cannondale Touring I), and possibly a real road bike someday-I’m currently looking at a bicycle that would be a Torelli frame with Campagnolo Chorus components, and Campagnolo Eurus wheels. There is a shop in Tacoma that assembles the bicycle for you if you buy their components, and they are reasonably cheap.

My heart is becoming increasingly desirous of
a)  doing time in a foreign hospital, the current list being possibly China, Bangladesh, or Cameroon. Any would work for me, and hopefully, Betsy and I could try out several places.
b) spending more time in Europe, especially Germany, possibly taking language classes, and hopefully having a decent bicycle to ride around Europe with.
c) taking a break from American medicine. I’ve never felt more at peace about a decision than when I decided to check out of my practice for a while. I am absolutely decided not to continue practice with call at Good Samaritan Hospital, or any other hospital in the US without adequate compensation and limited work hours (less than 12 hours/day) on call. I don’t think that will happen soon at GSH. So far, my group has agreed to allow me to drop to courtesy privileges at GSH as of 01NOV08, and then take a 1 year Sabbatical during the 2009 calendar year. This will give me opportunity to explore a) and b) above, and to also consider what to do with the rest of my life.

 

Ich genieße Deutsch zu lernen

August 5th, 2008

Manchmal lernte ich Franzozisch mit «French In Action». Und dann, habe ich Onkel Herbert kennengelernt, und er sagte, dass ich sollte Deutsch lernen. Ich dachte, dass Deutsch war sehr schwer, weil die Sprache haben Zeitformen und jedes Wort eine Geschlecht, alles das ist nicht für mich gewöhnlich, oder leicht zu errinern. Aber, ich habe sehr viele Freunden und Freundinnen die könnte Deutsch zu mir sprechen. Und denn hatte Tochter Diane «Deutsch Perfekt» mir empfolen, und es macht spa?, Deutsch zu lernen. Werde ich wieder Franzozisch lernen? Vielleicht, weil «French In Action» mit Pierre Capretz ist wirklich wohlgetan, und die beste Sprachkurse noch dass ich erfinden haben. Bitte, wenn du kannst diese Schreibung lesen und verstehen könnte, schreibe mir nur auf Deutsch!!!

 

Since most of my readers don’t read either French or German, I will stick mostly to English. Please note that I have added a page that includes a number of writings (Die Schriften) that I have done in the past. So, far I have up a number of articles that I wrote which were published in the Pierce County Medical Society Bulletin. Much has happened this month, and so will have a bit longer blog than previously. Please note one thing…I don’t heavily re-read my blogs, and will find grammatical errors in my writing. Please ignore them, as I am also aware of them!

 

  1. 1)As a continuation of my language study, we were visited by a French student who is here in America to learn English. So, it was a crash re-learn of French. I can’t believe how much I forgot. I need to review French once in a while to keep my brain active.
  2. 2)Bicycle riding– on 02-04AUG, I did the Courage Classic, a three day bicycle ride across three of the higher passes in Washington. The details can be found in Kritik/Bike rides. It was 172 miles (277 km) total, and about 5000 ft (1500 m) climb every day, but went well, and mostly beautiful weather. I think that we last went across Snoqualmie pass this winter during the most harsh winter storm. And to think that Stevens pass and Blewett pass were barely crossed at the same time by several visiting relatives, the Dietrichs from Oregon and Mosers from Iowa. I’m sure they will see the posted pictures and fail to recognize anything with the snow gone and wonder how anybody could get across those passes on a bicycle!
  3. 3)Sammy had his 2nd birthday. Cool!!!!

  4. 4)Decisions, decisions… time for a Sabbatical. Hopefully, my group can adjust to a year’s absence. It has become clear to me that I must take a year’s break to prevent absolute and total insanity from hitting. See below for thoughts on this…
  5. 5)Diane returns home. That will happen this coming Saturday. Rachel comes in early next week. I’ll be taking a week off to do some backpacking with them. I am discovering more fully and deeply that my best friends are my own family (sorry, Ara and Petie!–you’re still my best friends.). And, I’ll be training to do the Portland Century on 24AUG. I hope to do this with Lucas Anderson, who was with me on the STP, goading me on. He’s a super rider and a super-guy, a real pleasure to spend time with him. This will all be in my next blog.

 

OK. That’s the month. What’s on my mind? There are several things that I would like to do in the coming year.  First is to do some overseas medical/mission work. I now have a number of opportunities arising. a) Bangladesh would be my preference, although it doesn’t seem to be sorting out well, for reasons I don’t know. b) China. I helped an Oncologist in town get settled into practice, and so he will be looking for a hospital in mainland China where I could spend some time. He will be back to China for the Olympics, and then touch base with a number of hospitals for a possible place for me and Betsy. Apparently, the Chinese are desperate for American trained surgeons to teach and instruct them, since they do not have Western exposure to our surgical traditions, and are trying to incorporate into the Western world. c) Thirdly was a possible opportunity to go to Africa.

 

I also would like to do some thru-hiking. What that means is when one hikes for longer than just a few days at a time. Considerations include doing the Pacific Crest Trail (PCT), and 2600 mile trail which goes from Mexico to Canada, and takes about 4-5 months. See the PCT websitefor details. The main problems with simple Mexico to Canada thru-hiking is that one never hits many of the most splendid sections of the trail at the right time of the year. The other possibility is to do sectional hiking, which is to do portions of the Appalachian, Continental Divide, and Pacific Crest trail in order, hitting them at the right time. As an example, one of the most beautiful parts of the PCT is the high Sierra around Kings’ Canyon/Sequoia National Park, which you are hitting in early June when it is still under snow. Better to do it a little later in the year. I am looking for friends to do some thru-hiking with me, and I already am encountering a number of people my age in medicine or at church who have hit the “burn-out” phase of their life in their early 50’s, looking for a diversion like this. Sign up early at a discount…

 

I would also consider a long-distance bicycle ride, either across country, or from Mexico to Canada along the coast, or possibly in Europe.

 

The only thing that discourages me from long-distance hiking or bicycling is that Betsy would probably not do it with me, since that doesn’t seem to be her cup of tea. That’s okay, but, she’s the only person in life that I really enjoy being with for months to years at a time. If I do something long, I’ll probably try to get her to drive a car along as a support vehicle. That would work for either hiking or bicycling, and be a super support and make the organizational strategy much simpler. But, I haven’t talked to her yet about this, so give me a chance to break it in slowly with her!

 

Other news. I now am going off of Plavix, which is a drug which inhibits platelet activity. Multiple bruises and painful joints later, I can stop that cursed drug.  I’ve been given a SecurID from the hospital. I have no idea what to do with it, and it’s just another thing to tie up the multiple thingies that I need to constantly keep on my key chain. It’s that silly blue and grey thing in the upper left hand corner.

I’m going to need a larger pocket for my keys. I also gave up the regular cell phone and Palm pilot for an iPhone.

I got Betsy a white one, and me a black one. They are wonderful, especially since I use Macs, I am able to integrate my scheduling calendar, contact list, phone, iPod music, and everything into a small gadget that I toss in my shirt pocket and goes unnoticed.

 

Finally, I received notice that Aunt Dolly was fighting a fairly advanced gastric cancer. Since our family moved out west, we really never got to know our uncles or aunts very well. Dolly and Emma were the two that I remember most of the aunts, and uncle John, Raymond and Gus of the men in dad’s family, though I also have vivid childhood memories of many of the others like Alfred, Carl, and Paul. Apparently, after Dolly, there are only two uncles left on dad’s side of the family, and neither are in the best health. It is pause for reflection that sometime soon, as another generation passes, that we too will soon be a past generation, and that every one of us will have to give an account before God of our life on earth. I will end with a saying of the wisest of all men, found in Proverbs 16:1-9

The plans of the heart belong to man,

but the answer of the tongue is from the LORD.

All the ways of a man are pure in his own eyes,

but the LORD weighs the spirit.

Commit your work to the LORD,

and your plans will be established.

The LORD has made everything for its purpose,

even the wicked for the day of trouble.

Everyone who is arrogant in heart is an abomination to the

LORD; be assured, he will not go unpunished.

By steadfast love and faithfulness iniquity is atoned for,

and by the fear of the LORD one turns away from evil.

When a man’s ways please the LORD,

he makes even his enemies to be at peace with him.

Better is a little with righteousness

than great revenues with injustice.

The heart of man plans his way,

but the LORD establishes his steps.

 

So, Betsy and I carry on, these are our marching orders, plotting and planning, but trusting in God to so order our lives to please Him, giving thanks to Him for our life and health and for the life He gave for us.

 

Not Bad for a Heart Cripple

July 14th, 2008

A little over a year ago, I was having stents placed in my coronary arteries. Thirty pounds of weight loss and lots of exercise followed, as well as a focus on stress reduction. I purchased my bicycle (a Novara Trionfo) in early September, and found that I could only do about 10 miles before becoming exhausted. But, I decided in October to do the STP this year (an annual Seattle to Portland bicycle ride). It was a wonderful feeling to do 203 miles at a reasonable pace and yet never feel really drained. I’m already thinking about doing it again, hopefully in just one day. We’ll start a little bit earlier in the day, before daybreak. My main problem is mis-tuning of the bicycle had the chain coming off. My bicycle worked perfectly well until I took it in to be tuned at REI several weeks ago. I have never had such a bad time with chains coming off. Fortunately, we had no flats on the trip, though my tires looks rather chewed up, and in need of replacement at the end of the trip. I hope that son Jonathan would be able to do the STP with us next year. He’ll have to get riding a bit. I also hope that Ara could make it out next year. Start riding, dude! I’ve learned to tune my own bike, and feeling comfortable about riding long distances, I don’t anticipate any problems next year.

 

Today is Bastille Day! Vive la France! J’adore le Français. Our family is relishing the wonderful freedom we have from our revolutionary forefathers. That is why we try to suppress the spirit of revolution, because it’s already been done for us. Now, our benevolent and all-caring politicians will supply our every need, big or small. If your name is Freddie or Fannie, and you just somehow squandered 3-4 trillion dollars, hey, no problem, Uncle Sam will bail you out. Freddie and Fannie might get a slap on the wrist, or given a few additional regulatory orders, but that’s it. The kind and ever gracious benevolence of our dear politicians also wishes to provide for your’s and my healthcare. They will make the rich pay. The rich are anybody that are not buried six feet under.

 

When I put on my libertarian Ron Paul hat, I demand that the health care system be as far removed from government as humanly possible. There are several problems with that. 1) The feds require that health care be provided for all. Though the emergency room is only for emergencies, eventually every disease will become an emergency, in which you can go to an emergency room and demand care for free. 2) The feds have imposed massive rules on health care that make it nearly economically unstable. These rules are most prevalent in hospitals, governing the most inane items, such as initials that have been used for orders since the development of medicine, and are uninterpretable only to the clueless, like lawyers. 3) The legal profession has defined an ethereal standard of care which forces maximal possible care in all situations, and makes you guilty even when right. 4) The feds have defined pricing for all but the most elective procedures, such as plastic surgery and dermatology procedures. This means that we have absolutely no control over pricing. We take what we can get, and rarely is it comparable to other highly professional services rendered and always without the extreme risks that are assumed by the physician. 5) The feds have removed value from the cost of medicine, forcing costs to sky-rocket. 6) The third party payor system has removed cost impact on the health care consumer, thus removing any sense of value to any drug or procedure performed. How much is an appendectomy worth? What about a perforated appendectomy in 500 lb diabetic smoker with heart disease that stays in the hospital for 2 weeks. Under medicare, the surgeon gets about $400 for any case of appendicitis, slightly more if the appendix is ruptured. That is barely enough to cover overhead costs. Medical care no longer has value, and the public expects it for free. 7) Our current system was based on a historically previous better economic arrangement for physicians, which allowed them to often render services for free, such as caring for indigent patients or offering their time as “community service” to the hospital as call. With the loss of any margin to health care, most physicians (especially surgeons) can no longer freely give of their time, creating extreme tension between physicians and hospitals, with physicians now demanding to be paid for their hospital service call and hospitals insisting that such care continue to be rendered for free.

 

The only difference between the current US health care system and most European health care systems, such as that in Great Britain, is that the socialized system in the US is funded mostly by entrepreneurial private dollars, while that the socialized system in Great Britain or Canada funded by public funds. In reality, we are giving the feds a very foolish deal. They can carry on the most asinine regulatory actions, pretend to offer tort reform, offer grandiose promises to the public, and act truly sincere about caring for the health care provider. They reluctantly save the health care system at the last moment after doctors throughout the nation have kissed the derriere of their local politician with begging and pleading not to enact Medicare cuts (which still is a cut, since current inflation is estimated at between 3-16%) thinking that we should be ever grateful for them. As a response to decreased Medicare reimbursement, private enterprise is trying to become increasingly creative about making a profit. Historically, our response to decreasing reimbursement was simply to work harder. Now, we are working as hard as possible in order to maintain financial equity. Several years ago, a colleague announced that he was going to take a week a month off, since that would then give him the equivalent of an eighty hour work week and provide some sanity to his life. Several months later, his revenues plunged to not even supporting his overhead. He is now back to much less time off, and making a modest profit, though his investments are probably more financially rewarding that his profession itself, and he rarely ever seems to be happy or enjoying himself at work.

 

With all of this under consideration, I have several proposals. 1) Private enterprise quit funding federal health care programs. We should back out of investing in health care, whether it be for our own private offices, or for community driven ventures. 2) We should encourage medical care to go to a purely socialized venue like Canada. This will force the feds to live by the insane rules that they create, since they will be creating them for themselves. This will also not allow for “boutique” practices, which is healthcare that tries to escape from the “system”.  3) We should quit funding the entire bureaucracy through taxes. The state is currently sucking us dry. If you count all the taxes that we are forced to pay, including Medicare, income, property, sales, telephone use, vehicle, and many other taxes, all but the most poor are paying over 50% of our income into taxes. Stop working. Retire. Go on Medicare. Leave the country. Find another profession. Live off the inheritance you were planning on giving to your children. 4) The final solution (Enderlösung!) is to find a system whereby the hospital or state assumes all of your overhead, and truly pays you on a per hour basis that is commensurate with your skills and level of training. This would also allow you to work as much or as minimally as possible without incurring major debts through massive overhead. Sadly, such a system doesn’t exist. If physicians would uniformly refuse to continue funding the system and allowing to hold us in forced servitude and quit, go on strike, shut down, or terminate virtually every state and third party payment, the system might be forced to correct itself. Until then, the fed is going to be content with letting private enterprise fund their health care follies.

 

With all of this under consideration, it would be best for me to get out of medicine altogether. Yet, I continue to look for alternatives, with less stress and less work hours. I will not be a sacrificial lamb to the state.

 

Vive la France!

Dennis, if you comment, please keep it short, and mention something about your celebration of Bastille Day.

 

Time to Blow this Popsicle Stand

June 24th, 2008

The photo is that of me in from of the Wiener Staatsoper. Betsy and I had a most wonderful night at the opera in Vienna, forever fixed in our memory. The only sad thing is that of returning to the reality of Puyallup, WA.

 

As I write, this, the little bird in the cuckoo clock will periodically emerge from her den and remind me of who I am. That Vögelchen happens to be the most honest person in my life. Whenever she comes out to say hello, I greet her with great joy. Her running commentary remains the same, which at least suggests that one of my friends is persistent and unchanging. God happens to be the only other person in my life with a strong sense of true honesty. It must be that God is now speaking to me through my pet birdie in the clock. Other cuckoo clocks will sing Edelweiss or “Somewhere my love” to you, but my little feathered friend just lays on the cold hard facts, speaks her mind, and then shuts up for another 1/2 hour.

 

Today convinced me that I am too old to continue practicing medicine where I am at. The “chief doctor and Lord Executioner” of my hospital just informed me that I was a very bad boy for not dumping my asleep patient on the operating table to care for a trauma patient that was undergoing CPR in full cardiopulmonary arrest in the ER. I informed him that I would never abandon a patient in the operating room under any circumstance, and he went into a tizzy. E-mail or call me for details–I want to watch my language on the blogsite and not publicly speak evil of anybody. Well, I’m going to relieve him of some tizzy-ness. I’m quitting. October 31 is the very last day that I’m contractually obligation to St. Samaritan Hospital, and then I will either a) just retire, b) accept a deal from the Franciscans in Tacoma, c) leave the state and move back to Portland, and find a job pumping gas, etc..  d) work out something with my group to be on employed rather than partner status.

 

Regardless of which of the above I do, I would like to do missions work. My friend from Bangladesh  wants me to come. I’ve been suggested to go to the Cameroon or Niger. My Bangladesh offer sounds the most appealing, since 1) it is cheap, and I could semi-retire and still do missions, 2) my wife could be involved as a nurse (hopefully), 3) they are attentive to preaching the gospel while delivering health care–there is no point to saving the body but not the soul, 4) I really like my friend in Bangladesh, even though I don’t know him well, 5) I’d love to learn some Bengali, and 6) if a short-term goes okay, and they like me, I can always return and feel like I’m really helping somebody, without fear of violation of some kooky government regulation or a lawsuit.

 

The other thing that will be factored into our life is me doing the PCT. In case you are wondering, the PCT stands for the Pacific Crest Trail, which runs from Mexico to Canada. It’s only 2800 miles, and can be done in an easy 5-6 months, starting in late April. I would like to solicit people to join me for sections of the hike. I’ve already gotten several people from the hospital, as well as my wife. You too can do it. Hike a 100 with ole’ Cuckoo Ken. I’m contemplating this in either the year 2009 or 2010, preferably the latter (2010). Time to start planning is now. I’d like to chronicle the event, and have a decent camera to photograph the whole event. Stay in touch if you have any other ideas about the PCT, and when/if you would like to join me for sections of the trail.

 

It’s been a year since I had my stents placed. My laboratory evaluation shows normal serum lipids. I refused to take a statin drug, so did it natural including a) excercise, b) diet, with about 50% fish, c) niacin, fish oil, flaxseed oil, garlic, etc. It works, but it was hard. I now have to get the cholesterol down to LOW normal. I think I’ll try curry for that.  Meanwhile, I need some means of cutting back on pills. This is what I do for the month…

There are only four prescription drugs, which I get from India. The rest are vitamins and other dietary supplements. My blood pressure is now normal, but there are too many unnecessary hospital episodes that ruffle my feathers and send my BP up, like the episode this morning. I’ll spend a blog in the near future talking about what is really going on in medicine, and my impressions of the health-care scene in the USA.

Meanwhile, I seriously plot my exit from the severely uncomfortable and stressful situation that I am now in.

 

Opera Katze

June 15th, 2008

Our cat has developed an insane love for opera. Whenever I am playing a DVD opera, he will hop up on my lap, and just sit there, watching the entire opera. Here you see him watching the Verkaufte Braut by Smetana.

This has been a busy month, which has included a major trip to Moab, I did my first “official” Century, and have been quite busy reading and listening to music. For those activities, you can find reports in the Kritik section of my webpage.

I’m tempted to further chronicle my disappointment with how we were taught history in government schools, especially related to the history of Germany during the Second Thirty years war (WWI & II). I’ll be very brief. In Patrick Buchanan’s magisterial treatise on this topic (found in the book review section), he details, to my surprise, much of what I have said already in other blogs, about the real causes of the European conflict. Buchanan especially labors on the role of Great Britain, most notably Winston Churchill, as being a major, if not dominant factor, at creating the conflicts that have acquired the nomenclature of two world wars. I always thought of Mr. Churchill as being quite disgusting and horrendously evil, equal to that of Stalin and Hitler, and felt that the self-righteous British people were hypocritically quick to absolve themselves of all blame, claiming only to be acting for the moral good of human-kind by suppressing evil and promoting good. Yet, Britains’ duplicitous behavior instead created far more harm, evil and suffering than if they would have minded their own business and stayed out of the wars altogether. It’s a lesson for Amerika.

One of the other three books that I have reviewed is titled “Hiking the Triple Crown”. I don’t believe that I would ever get the entire Triple Crown under my feet, especially since the Continental Divide Trail really is not adequately developed to permit safe hiking of the trail in a single season. Yet, the Pacific Crest Trail beckons, and perhaps the Appalachian Trail. Betsy might even be interested! We know a young man at church who did the PCT 2 years ago, between the time he got out of the military and the time he came home. Well, this is becoming a bit more appealing to me, especially since I am increasingly distraught with the field of medicine–if I don’t take a Sabbatical, or change what I’m going, I’m going to become a looney-tune or an axe murderer, or something horrible like that. If I wait another ten years until retirement, I’ll possibly be too old to do the PCT, or I’ll possibly come down with a cancer, with all that poison I’m consuming to fix my blood pressure which is too high because of the stress of work, etc., etc. Onkel Herbert has pestered me on this point, suggesting that I need to slow down a little bit. It’s tempting to say that it is easier to do that in Europe, but that isn’t true. All one needs to do is to throw in the towel for a year or two, and reorient their life. Perhaps Betsy and I could also do some mission medical work in Bangladesh, as that has also been a dream, of serving as a surgeon in a third-world country. I am thinking about doing the dirty deed of the PCT in the year 2010, when I will be 20 years out of fellowship, and 28 years out from the intensity of being a surgeon. So, Betsy and I will be spending the next two years training and planning for hiking a 2800+ mile (4500 kilometer) trail.

Today, Betsy and I ran down to Portland to attend the memorial service of  John Revesz, who lived a good life of 97 years.

His wife is Betsy’s aunt. He will always be remembered by me as a most humble, loving, delightful, and godly man. There are many episodes where John and his wife have been special to me and Betsy, and he will be missed. The memorial service permitted meeting many old acquaintances, too many to list here. It seemed like a flashback in time for us.

Also notable, is that today is Father’s Day, and my children went together to get me a cuckoo clock.

It is already hung in my room, cuckooing on the hour. Somehow, they knew that I really wanted a cuckoo clock, and was able to get Diane to pick up a nice Swiss Lötscher. I remember loving to watch Aunt Rose’s cuckoo clock, but am not sure whatever happened to that clock. So….thank you children for a wonderful gift. p.s., I think you realize that father has gone cuckoo, and the clock has a little bird to remind me of that every hour on the hour.

 

Der Sommer ist gekommen

May 17th, 2008

Sommer ist angefangen, und mir ist Wanderlust. Bergklettern oder Fernfahrraden ist für mich besonders gut, und gibt schönes Gefühl. Letzte Wochenende gehen ich und Freunden nach Mt. Hood, um zu klettern, mit Seilen und Steigeisen. Heute habe ich mein erste “Century” – 100 milen (162 km) am Fahrrad gegangen. So kannst du die Reiseberichten lesen unter “Kritik” -  Bike Rides and Hikes. Jetzt kann ich nicht aufhören du denken, wie schön war unsere Reise nach Deutschland und Österreich. Für Betsy und ich war die Treffen mit Herbert, Diane, Annita und ihre Eltern unvergesslich. Wir wissen nicht, wie wir könnten unsere Freunden und Familie danken für alles was sie getan haben. Wenn sie kommen nach Amerika am Besuch werden wir nicht Fahrraden, sondern Autofahren zu Mt. Rainier, Seattle, Puget Sound, und alle unsere Lieblingsorte. Bitte wir haben extra Schlaffzimmern, und für uns werde es eine große Ehre sein, sie als Gaste zu haben.

 

Since most of my friends don’t speak or read Deutsch, it is only proper for me to do some Englisch. I have some new hiking and bike ride reports. Summer has arrived, and the Northwest becomes a veritable Paradise. We have about 30-40 Rhododendron plants in our yard, and they all start blooming in early May, which will go through mid-June.  Here are a few examples…

Since they bloom at various times, about half the Rhodys are not yet bloomed, and we can anticipate beauty in our yard for the next several months.

 

OK, nothing controversial is expounded in this post, so I will instead just mention the book review of Ron Paul’s book “The Revolution”. Since I am a Ron Paul advocate, and will vote for him even if he is not on the ballot by writing him in, and I anticipate that all of my friends will do the same. Alright, go ahead and vote for somebody that you really can’t stand. Obama’s scary. McCain will escalate the mideast war. Hillarious is a joke. I never voted for Bush, I don’t typically vote Democratic, and the new Republicans are really Republicrats. Only Paul takes stands on economics, foreign policy, and moral issues that I could live with. Please, if you are Amerikan, purchase a copy of The Revolution and read it. Then, write in his name on the ballot at the next election. It’s that simple.

 

In Gedächtnis

April 27th, 2008

The bombed out remains of the former splendor of the Kaiser Wilhelm Gedächtnis Kirche in Berlin reminds us of the lasting effects of war. There was a true statement found written inside this church, that in war there are no winners. We often forget that, especially as we try to achieve a sense of “peace” in the world. One often wonders when the next great war will occur. It is only childish naiveté that would cause one the imagine that we have evolved as a species to the point where detente, liberal sentiments of tolerance and acceptance, and goodwill will bring an end to major wars. An example to this is the violent sign we saw posted in old East Berlin, saying “Fxxx Off Amerika”. Violent reaction to war is a contradiction in terms, seen only too realistically in the first world war, which was a war most certainly guaranteed to cause even more war by the way it was settled in the Treaty of Versaille. We will not forget that WWI was the war to end all wars.

When we visited Diane, she noted that she had one student tell her that he hated all Americans and wanted to kill Americans. He was Greek. I guess he would have preferred to have continued German involvement in Greece under the rule of the Nazis? How quickly he forgets the good, as well as the bad that comes out of America. Perhaps his thinking is only a reaction of Greek public group-think.

I don’t have good answers to America’s woes. Certainly, the world thought it right for us to intervene in Bosnia. I disagree. Europe should of taken care of their own backdoor problems, yet they are too militarily weak to do so. True story. The world thought it right for us to intervene in freeing Kuwait. I disagreed. The Arabs should have sorted out their own problems. The world is upset that we re-invaded Iraq. I don’t have a perfect answer on this, and I don’t believe that the case is entirely settled regarding weapons of mass destruction. Saddam gassed the Kurds, and that was cause enough to terminate that evil man. Yet, we should have followed the gospel of Wilsonianism, and given the Kurds their freedom, and not force the Muslim factions of Sunni-boys and Shits to endure a joint government-it’s like asking the followers of Malcolm X and the Ku Klux Klan to kiss and make up. It won’t happen, so don’t try it. It is here that my true red-blood Calvinism makes its stand, believing that all men, including the “good” ones, are intrinsically evil to the core. Only the grace of God allows an occasional resemblance of peace in the world.

I still feel askance about the strong sentiments of hatred toward America. There are two aspects of this. One is our involvement in Iraq. Yet, those who have the loudest voice have the fewest answers, or the least pity toward the 9-11 New York Twin Towers incident, to the Kuwait invasion, and the most naive sense that everybody in the world really just wants to get along. I was opposed from the start to the second invasion in Iraq, mostly grounded on arguments of Ron Paul. Nobody in America, I repeat, NOBODY else, including Hillarious or B. Hussain Obama was making a loud stance against the war.

The second aspect of the American hatred is our economic instability. I think that everybody feels that if America has a depression, this would draw the entire world into a depression. It is possibly true. America has been most foolish in its economic management, but, this started in 1912, and not in the start of the reign of Emperor George II. He only exacerbated the problem by spending like a mad housewife, and “a chicken in every pot” mentality toward winning Republican votes. He lost mine. Yet, if the world is mad at us for our economic instability, it is like a child whose parent takes a toy away from them. It was our economic largesse that fueled international prosperity throughout the world. The Marshall doctrine of rebuilding Europe and Japan led to those nations being the most prosperous in the world, possibly more so than the US itself! The economy will probably crash in the next 10-20 years, and this will have both good and bad consequences, though I shudder to think of what those bad consequences could possibly be.

European sentiment against America has some grounding, but seems to be the fostering of a love-hate relationship with their best friend. It is like one student in Diane’s school stated to her, “we hate America but we love its culture”. Well, that doesn’t make any sense at all. America is diverse enough, that we ARE our culture. And, most Americans hate their government.

Lastly, Europe must remember that we are them. There is no such thing as “Americans”. We are English, and Germans, and French, and Italians, and Jews, and Poles, and Greeks,  and Australians, and Africans, and Mexicans, and Indians, and Japanese, and Chinese, and Koreans, and Russians, etc., etc. There is no nation that can’t be found in America. And, they are still coming, many times, quite illegally coming, forcing their way into America. All of us have brought our particular cultures and beliefs with us. The only one uniting factor that used to exist was a prevailing Christian faith, and Judeo-Christian mindset. This no longer exists in either America nor Europe. So, if you truly hate America, look in a mirror, and scream at the top of your lungs, “I hate you”. You are experiencing inverted Narcissism. Don’t worry. We also hate you. The world hates you. God hates you. The Devil hates you. Even the mirror hates you.

The ultimate solution to war is through the Prince of Peace, our Lord Jesus Christ himself, also the Lord of hosts, strong and mighty in battle. Such is not a contradiction. While I do not expect that we will see true peace in our time, I will not look to alternative solutions to peace. Such alternatives may consist of politics and government, individual solidarity, movements, resistance, group protest, religious experience, or any other human activity. My personal responsibility is for purity of thought and action, resisting evil and fighting for the right, as defined by the Scriptures of the Bible.  When Christ asked us to love our enemies, he didn’t mean this in a theoretical or philosophical manner, but rather, in true love and concern for all that come your way. So, just in case you wondered, I love you.

Please see the Kritik section for a review of our trip to Germany and Austria, and also new music and bike ride reviews.

 

A Humpty Dumpty World

April 6th, 2008

Today I wax philosophical and political, sneaking in a blog before our trip to Europe.

Above, you see the building being torn down that Dr. Knittel built about 20 years ago. It was still a very good office, just located in the wrong place, close to St. Samaritan Hospital. The rooms that you see being chewed away by the crane is probably one of the rooms Sarah went to have her pre-natal check-ups with Dr. Eun. Edstrom and Eun had legal first right of refusal on purchasing the building, but the hospital, being bigger and stronger and more politically correct, avoided the law by means I know not how, and purchased the land to build a new hospital. True, St. Samaritan needs a new hospital, but not at the expense of its integrity. Lesson: when somebody or some institution advertises their honesty, know that they are lying.

New topic. As Betsy and I are preparing for yet another trip to the Vaterland, our thoughts reflect on the history of the region. I am currently listening to Prof. Thomas Childers’ lectures on WWII. He is superb, and you can get his lecture series from www.teachco.com. Some people will read my comments and think that I am some left-wing wacko liberal pro-Nazi, pro-bad, pro-evil commentator. Think what you will, but I will not let the prevalent left or right opinion determine my opinions, as public opinion has been more often than not wrong throughout history. I am conservative, not neo-conservative. My vote will be for President Ron Paul, even if McCain happens to have the Republican nomination.

History is written by the “victors”, who usually get things wrong, I ask what history might have been written if the “losers” wrote the history. To this I thank Uncle Herbert, who introduced me to Joachim Fernau, a total must read, if one can read German, as I don’t think he will ever be translated into English. Two books are a must, “Deutschland, Deutschland über alles” and “Halleluja, die Geschichte der Vereinigten Staaten”, translated “Germany above all”, and “Hallelujah, the History of the United States”.

Okay, back to WWII. What is the scoop? Germany invades Poland. England and France have a pact with Poland to defend them against invaders. They declare war on Germany. Germany has no interest in war with France and England, but now have no choice. England’s defense is that they must stop aggression. Stop. Ask the Indians (in India) about British aggression! England controlled 1/3 of the earth surface, and they were worried about aggression? Nicht verstehe!!! England must stop aggression, so long it was not them that was being aggressive. They must defend Poland. The raison d’être for WWII was the protection of Polish sovereignty. Strangely, England had no qualms about giving Poland to the Soviets after the war, who made life worse in Poland than anything that Germany ever did. Oh, but you say, the Germans were killing the Jews!!! Yea, right. That was true, and that was wrong. Just don’t mention that England expelled the Jews, France expelled the Jews, Spain expelled the Jews, Italy ghetto-ized the Jews, and Stalin murdered about 2.5x as many Jews as Adolf. Besides, Adolf simply wanted to export the Jews, and England blockaded that effort.

So, the USA enters WWII after being attacked? Whoa! Try again, Pedro! The USA never ever ever ever behaved neutrally toward England, France, Japan or Germany. First, England should have never entered the war, and backed out peacefully. The USA should have reprimanded Great Britain. France? One seems to forget the France and Germany always seem to occupy each other temporarily, and things would have worked out. Remember the French version of Hitler (Napoleon), who is still honored by the French!!!! Can you believe that? It would be like the Germans setting up a memorial to honor Hitler!!! Really! Read the life of Napoleon. He was totally disgusting, just like Adolf. The French temporarily occupied Germany in early 1800’s, but had to be forced out. In 1870, the Germans occupied France, but did not have to be forced out, as they left peacefully. The blame for WWI will never be resolved (contrary to the treaty of Versailles), but probably all parties were equally responsible. The USA NEVER was neutral in any of these wars, in spite of our profuse profession of innocence. During the first phases of WWII, we were actively supplying England with massive, I mean, massive amounts of aide, just like WWI. No wonder Germany should take umbrage. And then, in the south Pacific, we were actively interfering in politics of the region, aiding China, who themselves were divided extremely, and later blocked Japanese ability to obtain oil. We had no reason to do that. The region would have sorted things out. There were virtually no American interests at stake, save for our occupation of the Philippines. We left Japan with absolutely no choice, save to go to war with the US. The ultimate result is that we ended up with China in an even a bigger mess than ever, with communism overtaking the country—we could not have had China’s best interests in mind. WWII is often presented as a moral war of good against evil.  Really now? Stalin was our ally!!! Stalin was nuttier, crazier, loonier, eviler than Hitler at his worst. Stalin was our friend. We would support him by any means possible, knowing that he would return a kind deed to us, and liberate his population after the war. Yea, right.

The total aftermath of WWII was simple. England wanted to maintain their world hegemony, and lost it. The Soviets, with Stalin still in control, were able to engage in continued lunacy through to the end of the twentieth century. Germany and Japan were humiliated, and then became the strongest economic states in their parts of the world, and the USA, hoping to replace Great Britain as the controller of the world but not learning their lessons, is now getting into a mess where-ever the USA sets foot. Only a few sane voices, such as that of Pat Buchanan and Ron Paul, seem to understand what a mess we are making of ourselves. The end of the book Halleluja by Fernau delineates the wars that the USA has been in in the twentieth century. It is just astounding, the length of the list. We are numb to how the US has their fingers into every part of the globe, wanting to control and dominate. Unfortunately, we will experience the same fate as Great Britain. We will wake up too late. When, we (the USA) fall off the wall, who will be there to put us (US) back together again?

 

Erderwärmung

March 29th, 2008

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 dampered 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 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 newsclips show the opposite. We also learned that Obama’s book about daddy failed to mentioned some important fact, like, that he was a womanizer that ran out on mama, and was a 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 bowel from the tumor, and had to resect about 20 cm of 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.

 

Another Day in the Life of Kenneth A. F.

March 2nd, 2008

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. afterwards. 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 left colon, distal pancreas, spleen, and greater curve of 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, colon below, but the pancreas behind all that yellow fat that’s tumor. The photo of afterwards 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, that 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 not actually get Hep C, and that your time in Paris will inspire you to new and higher ventures.

 

Frozen to Death

February 14th, 2008

It was brother Gaylon who first recommended the movie “The Shining” to me. Maybe he knew that I would find this horror film a particular favorite, and have frequently watched the deteriorating mental status of Jack Nicholson, to his eventual demise by freezing to death. While the location is supposedly a Colorado resort which is shut down every winter, the outside of this resort is filmed as none other than Timberline Lodge on Mt. Hood. If you haven’t seen the film, watch it. Brother Gaylon rarely is wrong in his film recommendations.

By the way, this is NOT a movie review. I am actually leading up to a recent trip that Betsy I just got back from. The full details of the trip are included in Kritik/Travel, which you might want to read if you are really bored and desperate for entertainment.

 

The trip was to Big Sky, Montana, to a Wilderness Medical Society conference. That’s right! The Wilderness Medical Society. We learned all kinds of things, including both travel medicine (the treatment of bites and stings, poison plants, exotic diseases in rare places), as well as the full gamut of what one might see in a wilderness or outdoor setting, like on climbing, rafting, hiking, or skiing adventure. There were lectures on the types on injuries one would expect from skiing, from kayaking, etc., etc., and also how you go about rescuing such an individual. In the climbing arena, we learned all about hypothermia, frostbite, and the various altitude sicknesses, their pathophysiology, how to recognize and diagnose them, as well as how to treat them. We learned how to evacuate someone from deep in the woods, or high on a cliff, when they might have multiple fractures, a pneumothorax, spine injuries or organ injuries, or even brain damage (in many circumstances, they might have been brain damaged before they ever started the adventure). We also spent a moderate amount of time learning how to prevent various injuries, and how to survive in such adverse settings. So, I built my first ever igloo, and dug my first snow cave.

This igloo will hold two grown people. I realized that my previous attempts to build igloos were a total failure, since I failed to angle the first blocks rapidly enough. If you do that, it is actually quite easy to build an igloo.

 

Off to build the snow cave

 

Digging out the cave

 

In the cave, all hot and steamy

 

The cave from the entrance-large enough for three people!

 

It was actually quite warm in the cave, and I am told that such a snow cave could be warmer than a tent. Igloos are a little easier to live in, as you could sit up in an igloo, something you could not do in a snow cave, unless the snow were really, really deep. If Jack only knew how to build a snow cave, he wouldn’t have ended up looking like the top photo. All work and no play makes Jack a dull boy.

 

Actually, when people freeze to death, they start taking off all their clothes, and often, you will find somebody in profound hypothermia or frozen to death in various states of undress. We now understand why that happens. Your body senses whether you are cold or not by the temperature of your skin. If your skin is cold, you feel cold. If your skin is warm but your core temperature is quite cold, e.g. 32 degrees centigrade (profound hypothermia), you will feel warm because your skin is warm. This is true, and has been proven by the Military on human Guinea Pigs in San Francisco Bay in the 1970’s. Sounds like an experiment Dr.  Mengele would have devised in his heyday. So, as you get colder and colder, your skin gets cold, and vasoconstricts because of autonomic activity to preserve core temperature. Once the core temperature drops too low, you loose your autonomics, your skin vasodilates and warms up, your brain thinks your warm, and you start taking off clothes. Pretty bizarre, but true. I don’t think brother Dennis in Belize will ever need to worry about this problem. But, I’d rather freeze to death, than die of Dengue, malaria, snake bite, or botfly infestations.

 

Can you imagine getting CME (continuing medical education) credits for building snow caves? Yes!!!!! The law requires us to fulfill so many CME hours every year. Up until now, I’ve gone to Society of Surgical Oncology meetings, American College of Surgeons meetings, various breast cancer meetings, and other specific cancer meetings. If I go to another cancer meeting soon, I am going to puke. So, I discovered the Wilderness Medical Society. They are for real, dudes and dudettes! This summer, I will be doing more WMS meetings, including getting my advanced wilderness life support (AWLS) certification. Pretty cool. I encourage all my doctor friends to join me in Moab, Utah in late May for this great event. E-mail me for details if you are interested. In addition, since it is a business trip, you write off the entire adventure on your taxes! Super-cool, dudes and dudettes, friends, fiends, and acquaintances. They have trips to Patagonia, Antarctica (REALLY freeze to death), Nepal, Tuscany, and all over the place. Why I didn’t discover this sooner is a total mystery to me. Don’t worry…I’ll be back to cancer meetings, but, this year, I need a sanity break.

 

Late January 2008

January 19th, 2008

Well, Monday is Martin Luther King day, and we try to maintain a tradition to help celebrate this great man, like eating fried chicken and watermelon. Unfortunately, I cannot talk freely about this day, since I am not of Negro African descent (there are Caucasian Africans–really!!!!), and fear any reprisal for not being politically correct, so I will eat my fried chicken in silence and reflection. My heart is right, and my lips are sealed. p.s. Our grandson may have a touch of African blood in him.

 

I had no intention of posting this blog so soon, since I intend on posting only once a month. But, people tormented me, and I am condemned to publishing this drivel for public review. Please note again the side comments for lawyers or litigious folk.

 

Several things are happening. One. I wrote a bunch of book, movie, and music reviews. You’ll find those under the subheading “Kritik” on my website. Two. Our medical office moved down the hallway to a larger office. We needed more space. It’s nice. Three. Struggling to re-invent medicine. It is intolerable in its current state. Four. Loving a new start-up church in Puyallup, called Resurrection Presbyterian Church. I’ll try an update on that in a few months.

 

I’ve gotten to talk over the phone in the last few days with the peregrinatous and dearly beloved daughters (Rachel and Diane) and am delighted to hear that they are both doing well. Jonathan is so way-out cool, at the U of W, and doing well. Sarah and Andrew remain just too wonderful for words. Andrew got a new bicycle, and so look forward to running him to death on the asphalt.

 

Meanwhile, stay cool, and keep your stick on the ice.

 

Update Early January

January 5th, 2008

  1. 1.I passed my boards. I am now limited to only 13 more years of hell, working for the state, enduring miserable hospitals who truly could care the least about patients. I love medicine dearly, and I love most of my patients dearly, I love our office staff, but wish that an earthquake or volcanic explosion would slough the hospital off into the sea.
  2. 2.As you can see above, I am developing a miserable sweat. I mounted my bicycle onto a trainer in the garage, and am riding most every day. My goals are to a) do the Flying Wheels Century in June (a Century is a 100 mile bicycle ride), b) do the Seattle to Portland 205 miles in July, my best friend from Michigan Dr. Ara P. will be flying out to do it with me, as well as about 20-30 people from the hospital whom I talked into doing it with me  c) Do the Courage Classic (168 miles over 3 major mountain passes) in August and d) the Ride4Life (only 62 miles though hilly, supports pro-life efforts in the state) in September, and possible the Portland Century in September. I will probably be visiting Diane in Berlin in April, and very well may bring my bicycle with me. It’s tempting, since Europe is more adaptable to cycle riding.
  3. 3.I have resumed grammar exercises in German. I find it to be a most enjoyable way of relaxing, and opens up an entirely new world to me, being able to read German (and eventually speak German) without translation or translators. I really hate visiting Germany and then speaking English.
  4. 4.I’m sick of studying medicine. The law requires that I still obtain CME’s (Continuing Medical Education), and so will be doing a variation of CME this year. No cancer. No surgery. Medicine doesn’t change that much any way, and staying too close to the current trends means that much of what you do will be discovered to be wrong in a year or two, meaning that you have to undo everything. Unfortunately, with the internet, patient’s come in supposedly “educated”, demanding the latest and greatest, and usually not realizing how foolish that really is. So, this year, Betsy and I do CME at Big Sky, Montana in early February with the Wilderness Medical Society, which entails learning to make snow caves, and how to treat frostbite, etc. Cool. Really cool. Freezing cool. Oh well. In June, I will also probably do the Wilderness Life Support Course in Moab, Utah. There, I learn to raft, ride mountain bikes, and treat snake bites. Ouch. There are a lot of snakes at the hospital. This course will be useful.
  5. 5.Rachel left back to Iowa in late December. Diane flew out to Deutschland on 03JAN08, and Jonny moves out to college (UW Seattle) tomorrow. We are now truly empty-nesters. That makes us both happy and sad. Happy, because it’s nice to have just Betsy, and quiet, and less mess, sad, because we truly love all our children and enjoy being with each and every one of them.
  6. 6.Music – we listened to the Karl Richter and Münchener versions of the Weihnachtsoratorium. Both renditions are excellent, and couldn’t say that I preferred one over the other. We watched the Ring des Niebelungen, conducted at Beyreuth by Barenboim. The music was excellent, but the staging was downright wierd. Like I said before, I don’t enjoy operas where everybody is wearing a trenchcoat. While they would like me to think that they are being creative, they are actually just the opposite. I’m currently listening through a collection called Mendelssohn-the Masterworks – a budget production, but very well done.
  7. 7.Reading – several books are ongoing…1) Systematic Theology by Wayne Grudem – almost done, 2) Nachgefragt: Deutsche Geschichte – easy text and learning lots of new words, 3) Complete Book of Long-Distance Cycling – self explanatory, 4) Exegetical Fallacies by DA Carson – excellent book, though a little more difficult reading, I love Carson’s thought processes and writing style. I’d dearly love to meet him someday. 5) A Practice Grammar of German – Die neue Gelbe – probably the best German grammar book that I’ve been able to find to date.
  1. 8.Ethan got baptised. Rev. David Scott is doing the ceremony, who is starting the new Presybyterian church in Puyallup. I hope they didn’t use ordinary old tap water. I wonder if you could request something like DaSani bottled water for your kid’s baptism?

 

Liebe Freunden und Freundinnen

December 8th, 2007

I have just be accused by Töchter Rachel of not updating my blog. Schäm mich! I nearly forgot that I was even running a blog. A friendly reminder once in a while helps.

Last week I completed my Re-certification exam in General Surgery. It was quite frustrating, since I am specialized enough that I generally don’t remember much about obscure pediatric or vascular surgical problems. There were quite a few questions on ventilator management, which I haven’t done in years. I suspect that I passed, and will find out in mid-January.

Christmas time has been punctuated with an increased work load. I also have enjoyed working through Heimat II with Betsky. Heimat II is a continuation of Heimat I. Heimat I is the story of a family in the ficticious town of Schabbach, located in the Hünsruck area of Germany. It involves the time period from the end of the Great War until Maria’s death in about 1980. Maria’s youngest son is Hermann, who is an artist and musician that goes off to München to study. Heimat II is the story of Hermann’s life in München. The Heimat series would never make it onto American TV since 1) it is entirely in German, though the British version that we are watching has provided English subtitles, 2) it’s too sophisticated for average American tastes, like, lot’s of 20th century music, and 3) there are some risque  scenes, that if edited out for American television, would ruin the entire sense of the film.  Pfui Teufel! Abscheulich! The greatness of the film is an ability to record in a very realistic fashion the various crises, joys, emotions, and angst that transpired among the various portrayed lives. He paints the life of an artist in a most realistic manner. It is almost as though you are sitting next to them as events transpire. It also reminds me of my years in college at Portland Stadt Universität. Anyway, once we finish Heimat II, we will still have Heimat III to go.

Every Christmas I try to listen to two pieces from two of my favorite composers. 1) J.S. Bach, the Weihnachtsoratorium. Absolute genius. I love the way he introduces his 3 hour Meisterstück with Kesselpauke (ketteldrums). It took until the twentieth century to figure that one out and duplicate old man Bach. But then, every thing new was first invented by J.S.B., so I’m not surprised by modern music, if music it truly be. 2) Wagner, Der Ring des Niebelungen. We have a new DVD of Barenboim performing the Ring in Bayreuth. I’m not a real Barenboim fan, but apparently this production is highly rated. It is also modernistic. What ever gave stage designers the idea that principle characters should be dressed in overcoats? I think that it’s disgusting. Especially Wotan. Also, Die Walküre just don’t look right if they are not wearing horns and brass bras. Don’t tell Betsy, but I’m getting her horns and a brass bra for Christmas, so that she could look like Brünhilde. She will need to also put her hair up in zwei Zöpfe, which I doubt that she would do.

It will be a delight having Rachel and Diane home for Weihnachten. We’ll probably do nothing special, save for maybe a day of skiing.

Stay in touch, and Fröhe Weihnachten, und Gottes Segen in Neues Jahr.

 

New Blog Site

October 13th, 2007

This blog site is about as sad as the sad soul that appears above. Unfortunately, this will be the only page that keeps you up to date on current events with the Feuchtster.

Note: I have since had to move my files from Der Feuchster to feuchtblog. The style of the blog is different, but hopefully the person behinds the blog remains the same.

 

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