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.

Big Sky, Montana for Wilderness Medicine Conference 07-14FEB2008

We decided, much to Betsy’s chagrin, to drive to this conference. At first, it seemed slightly unlikely that we would make it since the West was having more snow than we initially imagined. We had to travel across several passes, including Snoqualmie Pass in the Cascades and Lookout Pass in Idaho, and both were intermittently closed due to excessive snowfall. Fortunately, we made it across both passes in a narrow window when they were open. Before the start of our adventure, we were blessed by a visit from several of our beloved relatives, Jim & Joann Dietrich from Silverton, Oregon, and Wes & Esther Moser, from Lester, Iowa. They also were heading for the mountains, going to Leavenworth, Washington for a brief break from herding sheep & electrons. Joann and Esther are cousins of mine, on the Feucht side of the family. I had stacks of old Feucht photos that mom left when she died, and nobody in our family knew who they were. Well, Joann and Esther immediately recognized just about everybody. There were even childhood photos of Joann and Esther, which I felt their children would prize more than I would. So, I let them take the whole shebang. (Last year, I scanned all the Sam Feucht family photos and digitized them, so that everybody in the family has access to our photos on request. It’s a nice way to not only preserve photos but to distribute photos without everybody fighting over who gets what.) Anyway, after lunch, they took off, and then we took off. Barely making it across Snoqualmie Pass, we arrived in Spokane, Washington for the night. The next day, Lookout Pass was formidable but open, and Montana was quite easy driving.
Big Sky was a beautiful resort, and the conference was quite delightful, in fact, probably one of the finest medical conferences that I have ever attended. You might see more details on the corresponding blog site. I downhill skied two of the three free days available, since the conference lectures would start in the early morning, end around 10 AM, and then re-convene at 1630 in the afternoon. There would also be an evening lecture, as a preview of a new upcoming documentary film on the events on Mt. Everest detailed in Jon Krakauer’s book “Into Thin Air”, or Conrad Anker speaking with slides, on his climb of the Tibet side of Everest, leading to his discovery of the body of Mallory, and how he showed that Mallory probably did NOT summit Everest.
Skiing was nice the first day on packed snow, but much harder the second day, since there was fresh snowfall, and I was totally not used to skiing in 6 cm of powder. It takes too much work to turn, and I was sore after only about 3 runs down the mountain.
 

Getting ready to do some blue runs. I’m not quite good enough for most black runs but was really tempted.
 

Self-photograph. I wear the ugliest orange helmet so that my friends can easily find me when I am up skiing. Also, I prefer a helmet, in order to protect my second favorite organ. This boy will not get photo-keratitis or snow blindness, and I am wearing SPF 50 suntan lotion.
 

Second day up skiing. Lots of powder, visibility down.
 
As a little tidbit that we learned at this conference, the rule of threes… most ski injuries happen after the third day of skiing, at three in the afternoon, after a third beer. When studied more carefully, the number one factor that falls out in ski injuries is visibility. So, I now retreat to green slopes or to the lodge when visibility deteriorates to the point that I can’t see the texture of the snow I’m skiing on.
 
Betsy and I brought our cross-country skis but decided not to cross-country at the last moment. This area is ideal for cross-country and would love to cross-country into Yellowstone someday.
 
Driving home was another stress on poor Betsy. We came on I-90 and decided to return on I-84. Getting to I-84 was a problem since the road to Idaho Falls was almost entirely mountainous, and also in extreme winter conditions. We got down to West Yellowstone and found that a large semi-truck overturned across the road, and so nobody was getting through and the road was closed. Quickly looking at the map, I saw an alternate route by going back about eight miles. After going about twenty-some miles through the most desolate roads, not seeing another soul on the roads, Betsy began to freak. I began to be thankful that I had just learned winter survival techniques and was ready to practice these newfound skills. Finally, after about 30-some miles of the most desolate winter conditions, we saw a caravan of semi-trucks roar by us in the opposite direction, so knew we were on a road that led to somewhere. After reaching Idaho Falls, and the weather looking a bit better, we got onto I-84, but we ran into the most frightful snowstorm, with only light snow falling, but high winds, and snow freezing on our windshields, making visibility almost impossible. We survived by following a truck that seemed familiar with the road, until about 30 miles later, we broke through into a wonderful sunset. That evening, we learned that that section of I-84 was just closed because of the problem we experienced. I’m just glad we got through in time, having a truck to follow.  We stopped that evening in Boise, Idaho, then drove the next day on I-84 to Portland, across the Blue Mountains, and down the Columbia River Gorge, stopped at Roses in Portland to have a Reuben, and headed home, arriving home at 1530.  We thank the Lord for safe travel. Next time, I’ll bring some Valium for Betsy.
 
Stay tuned for our next adventure to Deutschland und Österreich in April.

Frozen to Death

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 that 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 of 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 make 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 1970s. 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 lose 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.