Kenneth Feucht

The Lexus and the Olive Tree

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

Complete Book of Road Cycling Skills

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

Wagner: Tristan und Isolde

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

Another Day in the Life of Kenneth A. F.

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

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

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

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

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

Cross-Country Ski Trip on Huckleberry Creek Trail

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

Wagner: Lohengrin

Wagner: Lohengrin, EuroArts,  Bayreuther Festspiele, dirigent Woldemar Nelsson, Peter Hofmann, Karan Armstrong  ★★★★★
Issued in 2005 but actually performed in 1982, this opera follows traditional forms, with staging by Götz Friedrich. All in all, splendidly done. Hofmann is a better Lohengrin than Placido Domingo, in the other DVD copy of Lohengrin that I possess. It would be the choice of Lohengrin’s for the first-time buyer of this opera. Some may question that this also was a bizarre plot and that I unjustly attack early 19th-century Italian opera. That is simply not the case, as German opera has a much different character than Italian, including the almost universal use of magic or the supernatural. This is true in Mozart’s, Beethoven’s, von Weber’s, Wagner’s, and even later Richard Strauss’s operas. Note that character development is quite full in the Wagner operas, compared to that of Donizetti, Bellini, or even the English light opera of Gilbert and Sullivan, where all you really learn about the person is that “He is an Englishman”. Whoopee. Lohengrin is not the greatest of the Wagner operas, but certainly shows a path to his later mature works, including Der Ring, Tristan und Isolde, and Parzifal.

Linda di Chamounix

Donizetti: Linda di Chamounix, TDK, Opernhaus Zürich, Edita Guberova, directed by Adam Fischer
★★★
This production was produced in a fairly classic style, starring the wonderful Hungarian soprano Guberova as the title character. This opera is typical in musical style to most operas of Donizetti, the bel canto style providing a formidable challenge to Guberova, who performs flawlessly. The supporting musicians remained equally capable and accomplished in their talents and performance, all in all making a delightful performance. This opera will never probably achieve the “top 10” list, owing only to the fact that it is a fairly corny plot. Linda is being pursued by the Count, who shuns his advances because she is in love with Carlo, whom she discovers is actually the Viscount of Sirval. Carlo and Linda move to Paris to escape the Count and to pursue each other when Carlo learns that his mother wants him to marry someone else. He turns away Linda, who then goes mad. They both return to Chamounix, and Linda finally returns to sanity when Carlo declares his love for her and acts her hand in marriage in spite of mommy. Wow. OK. Whatever. A good opera if you love bel canto and music of Donizetti, but definitely not as great as Lucia di Lammermoor, L’Elixir d’amore, or Anna Bolena.

Der Ring des Nibelungen: Barenboim

Der Ring des Niebelungen by Richard Wagner, Bayreuther Festspiele, Daniel Barenboim   ★★★★
Watched the DVD version of this opera, or, rather, a set of 4 operas. All in all, very well done, staged in a moderately minimalist style. Oddly, the staging manager really liked to see the singers chortling at full volume while clinging onto ladders at a very high altitude. At least half the scenes had the ladder motif. Other than that, the musicians were stellar. Really, how can you condemn a Wagnerian singer, who has to memorize 10 hours of singing, perform it in 4 consecutive days, without any audience forgiveness for even the slightest error? I don’t know how anybody can sing opera. Yet, it is done and done quite well. Or, at least with the Ring series, it is done super-humanly well. For DVD recordings, I prefer the Met opera performance by Levine, though that is mostly for the fact that traditional staging was used. Even the Boulez recording, which is super-minimalist, is awesome as a soundtrack. Since it’s been a tradition to listen or watch the Ring each Christmas season, I’ll look forward to recommendations for next year.

Pandora Prescription

The Pandora Prescription, by James Sheridan  ★★
The Pandora Prescription was written by a self-acclaimed US government contract pilot who flew secretive diplomatic missions between Miami and Havana, thus claiming inside knowledge in the underworld of international politics and espionage. The book is a fast-acting chase between a government agent working for the Department of Homeland Security, and Travis, who is attempting to locate and possess a so-called Apollo document. The book takes on the similitude of a Borne series movie, with near-omniscient government agents solving in methodological brilliance achieving a fantasy status.
Sheridan attempts to weave within the action his own thoughts on the construct of internal and international politics from a US perspective. His thesis is that following WWII, German agents, who in actuality were planted Soviet double agents, took over and dominated the internal workings of the CIA, making it a partial puppet of Soviet interests. In partial defense of that, he argues how the Kennedy assassination was actually a Soviet action performed through the intermediacy of Cuban agents, willing to seek revenge for US desire to assassinate Castro.
The contents of the Apollo file were documents from a Bilderback conference detailing how the international pharmaceutical industry had actually wished to suppress data regarding Laetrile as the cure for cancer, since it was cheap, effective, and without side effects. Many pages are labored over the thesis that Laetrile is indeed a cure for cancer, the truth of which is suppressed in the interests of maintaining the cost-laden health care industry, which in turn supports the US economy. In the end, the truth ends up in the hands of Soviet agents, who would use it to blackmail US interests.
Unfortunately, Sheridan mixes truth and fiction, attempting multiple theses, including a) the renegade nature of US government, which is a government against the people, and especially true of the Homeland Security, b) the subterfuge of international politics, and “conspiracies/clandestine operatives” such as the Bilderback society and not mentioned Trilateral Commission and Club of Rome, and c) the vast health care conspiracy to suppress the cure for cancer and other ailments. Each of these theses has some truth to it. I simply could not speak with authority regarding either a) or b), but refer you to writings such as are produced by brother Dennis, who has much to say on this topic, which I hold to be mostly accurate and consistent with Sheridan’s thought. Like Sheridan, brother Dennis also has much to say regarding the health care industry, but remains less informed, considering that since there are conspiracies behind every tree and under every rock, it must also be true of health care. As a physician, I certainly have grave concerns about the health care industry and believe that Pharmaceutical concerns heavily influence the data, and its interpretation. There is not a week that goes by where some drug rep is trying to buy me lunch and pawn some expensive, useless, and toxic drug off onto my prescription pattern. I just look at the demise of tamoxifen and the rise of aromatase inhibitors, which are far more expensive with more side effects, but marginally, if at all better than tamoxifen, and certainly with virtually no difference in overall survival. Overall survival is a number, unlike disease-free survival or time to progression, that cannot be manipulated. You can’t fudge on the death of a person by more than a day or two.
But what about Laetrile? Are we really hiding the cure for cancer? To even ask the question betrays a naiveté about cancer. Everybody would love a cure for cancer. The book mentions a small province in Nepal where cancer is not reported. Either they do have not the sophistication to identify cancer when it is present (quite probably true) or they die young (also quite true) and so don’t have the chance of getting the old-age disease. Why do people in Cuba and Mexico die of cancer, where they supposedly know the “truth”? Why have the Russians not opened up massive Laetrile clinics for their citizens, since they don’t have drug cartels, yet know the “truth”? I’ve had many patients go to Mexico for the cure, only to come back worse off than before. They should have laid on the beaches and drank their Tequila, rather than wasting their money on worthless cures. Why is Fidel dying of cancer? Odd thing, is it not? Is the drug cartel in Cuba restricting Laetrile from him? Are there cures for other diseases? If so, why haven’t they been discovered before the modern era? It seems like people live at most for 70-80 years, with higher rates found mostly in societies with improved public sanitation and a reasonably adequate diet. Alternative health care varies extremely, from chiropractic, naturopathic, Eastern mystical, Christian Science faith healing, and the list goes on. Having trained at the U. of Illinois, we are all too aware of the Krebiozin incident, which proved to be worthless (sterile water with less than 1 part per billion of any active ingredient). Now, maybe Krebiozin was just another pharmaceutical cover-up, yet I don’t see Brazilians flocking to Krebiozin clinics, since this is where that supposed miracle drug came from. In actual fact, all cultures and societies and levels of sophistication have their quacks. We will someday look at what we do as barbaric, and my enthusiasm for what I have to offer my patients is less than ebullient. If one cannot cut it out, then cancer will probably not be cured. Sheridan’s ignorance of the types and vagaries of cancer and his solution offers me nothing. This book had a “Bourne Identity” style excitement to its plot, some semblance of truth, but overall, a faulty thesis that distracts from the enjoyment of the story.

Into Thin Air

Into Thin Air, by Jon Krakauer  ★★★★
Into Thin Air is the account by Jon Krakauer, a reporter working for Outside Magazine, chronicling a climb on Mt. Everest. Krakauer, who was originally slated to climb with a group called Mountain Madness, based in Seattle and directed with Scott Fischer, was then switched to a group called Adventure Consultants, based in New Zealand and directed by Rob Hall. This book is a blow-by-blow account of the approach, climb, and disaster that occurred on the summit day, leading to the deaths of Fischer, Hall, as well as four other people. While Fischer and Hall were quite accomplished climbers and experienced with Everest, major decision errors, and arrogance, led to the catastrophes that occurred. Firstly, both groups took extreme pride in getting anybody with any experience at all up the mountain. Secondly, neither group followed their own rules. Neither would fix lines, expecting the other team, or, two other completely inept and inexperienced teams, to fix the ropes, and neither obeyed their own decision to turn back at a certain hour if the summit wasn’t achieved. In addition, there were simply too many people on the mountain attempting the summit push at one time to allow for speed, efficiency, and safety. It was a perfect setup for disaster. Understandably, clients pay reasonably high fees to be personally escorted to the summit of Everest, but, when one needs to be carried and dragged to the summit, as happened with Doug Hansen and Sandy Pittman, it defies the honor of actually having climbed the mountain. One of the guides, Anatoli Boukreev, a Russian climber of unbelievable fitness, came under the harsh scrutiny of Mr. Krakauer for reportedly abandoning several clients to look after his own personal safety, even though it was Boukreev’s personal valor that saved several clients, Pittman and Fox from otherwise sure death. Boukreev actually wrote a book The Climb to defend his own actions. Criticism of Krakauer’s writing, and failure to also look out for his fellow climbers by going ahead of the rest of the team. Part of this was understandable, as the rest of the team was not in good fitness and did not belong on the mountain, or should have turned back long ago. It has been argued that Krakauer’s slick journalistic prose tended to minimalize his faults and accentuate others, though I didn’t sense that this was domineering. Certainly, constructive criticism looks at the climbing errors, which occurred in virtually everybody on the mountain, rather than a single person. So you might ask, did they learn their lessons? I don’t think so. Get into the expedition groups’ websites (http://www.adventureconsultants.co.nz/AdventureInternational/ & http://www.mountainmadness.com/ ) and you will find that they are continuing this madness. You can even sign up for a several-month ski expedition to the South or the North Pole! Not a good idea. Everest, and even smaller peaks, like Denali or even Rainier, should be limited to those who climb on a regular basis and have a clue how to do advanced rescue and techniques of the mountain. A recent catastrophe on Rainier was exactly this sort of thing–poorly prepared clients who went through a short class on self-arrest and knot tying being dragged up a capricious and unpredictable mountain.