Tuesday, July 22, 2014

The Alarm Clock Within

My eyes opened suddenly after a typical roller coaster night’s sleep, and I suddenly envisaged that it was exactly 7:30AM.  Not expecting to be precisely on target, I turned my head toward the alarm clock that read 7:30.  No longer shocked or surprised with this concordance, I am accustomed to predicting the exact time, or the time within a few minutes, an insignificant gift that some quirky force of nature has bestowed on me.

I only use an alarm clock when I have an important early morning event or when out of town experiencing a different time zone.  It helps me sleep the night before knowing that I have a failsafe method of waking.  The alarm almost never is allowed to bellow its bursts of squealing pulses.  Indeed, I invariably wake at least an hour before any alarm clock even thinks of waking me.  But “almost” always does not equate to “always”.  So, I am surprised but ecstatic on the occasion when I am greeted by the shrieking cry of the clock, realizing that I was able to sleep the maximum hours and that I might even be rested to greet the day awake and alert.  So often the case, waking before the clock beckons me - provides me more than enough time to prepare for the day in advance of need.  But it often leaves me hanging with time to spare and an insidious fatigue that suddenly envelops my being, demanding that I return to bed for a few more minutes of sleep. 

The truth is that my sleep has been permanently disrupted by years of medical on-call duty.  How can you sleep when you are worried about a dying baby?  Being called to rush to the infant’s bedside at any time, the call pierces through your deep sleep like a machete slicing through jungle brush.  This has created a perpetual uncertainty and insecurity while sleeping or attempting to do so.  When waked, you respond quickly and alertly.  You cannot say or even think…., Give me a few minutes to wake up, relieve myself, sip some coffee or brush my teeth and comb my hair (ha ha).  When you are called to the bedside, you shoot right out of bed, and run there expecting ready to act alert and be decisive, an act that may or may not save a baby’s life or send him/her further down the road toward death or disability.

And somehow this disruption in sleep that has remained long after my last on call day has passed still rules my day and night.  Early life’s experience weighs heavily on the present and future and the scar will remain as an everlasting remembrance of my work and past life, when I cherished every moment in my honored role as a medical caregiver.  Simply, this was the most meaningful phase of my life, and one that I will cherish for the rest of my days. 

Friday, July 4, 2014

Independence Day - A True Patriot

Yes, I’m a true patriot on this 4th of July, 2014.  Eating a hotdog (in truth eating two) to celebrate this day of independence is risking life and limb for my country.  Eating the fat, ungodly mystery body parts and heaven knows what else packaged neatly in the dog, savoring the burned flavor of the “meat”, the strong accent of mustard smearing the bread and mixing in the juices of the sauerkraut, all buried inside the spongy soft untoasted emptiness of the white bread is something I have been waiting for – for exactly one year since last we visited this day in 2013.

I’m so careful with what I eat; this is no dress rehearsal of my life but the real thing.  My cholesterol, my triglycerides, my PSA, my blood pressure, my weight, and my state of mind all depend upon my physical well-being, something I have wanted to contribute to willfully.  I eat only fruit for breakfast, one tomato, some low fat cheese and several olives for lunch (sometimes I add a little humus). But I indulge a little bit in the evening washing down mouthfuls of wine celebrating the end of the day with a little lightheaded abandon and lighthearted freedom.  My cholesterol has responded, my dose of Lipitor reduced to unapproved levels (10mgm every other day) and I feel good about my efforts to foster good health.  I may die tomorrow but at least I’m trying to always die the day after next, not today or tomorrow, never today or tomorrow.

Yes, I am a true patriot, willing to sacrifice my heath and my life eating this unhealthy symbol of American life.  But it’s worth it because I’m an American. 

And it’s to this last sentence that I claim veracity to in this otherwise silly waste of writing that I attest is indeed the truth.  Particularly on this day in 2014, when there are so many things wrong with America and its leadership (see The Daydream and the Nightmare – Peggy Noonan WSJ) that I feel sense of patriotism and loyalty for what America represents and has given to me and my family.  God only know what a retched life I might have lived being born a Christian Arab in the Middle East considering the history of the last 60+ years.  And America will recover from this latest period of misdirection and mayhem, I am certain.

Alas, to celebrate America's Independence day, I look forward each year to going to my best friend’s home, a Jewish dermatologist in Kailua, to enjoy my yearly dose of July 4th, and the next hotdog I have been thinking about and craving - for exactly one year.  Unfortunately, this year his wife, also my friend, cancelled the yearly barbecue July 4th celebration at their home due to an unexpected ankle injury. 

Too much for me to bear, a trip to Safeway to purchase a package of Hebrew National hotdogs, buns and sauerkraut was all it took to make the day.  A while later, after two dogs were consumed, my tummy weighed down with a foreign partially digested substance unfamiliar to its usual inhabitant, I was ready for a long nap. 

Now awake and still alive, I am documenting this moment just in case there is no one to follow, just in case July 4th, 2014 is the last one that I enjoy the hotdog I am already craving in 2015. 

Wednesday, June 4, 2014

Aloha Dancesport Center Grand Opening - PICTURES!

For those of you who are visual in your orientation, don't bother reading my written account of the event located directly below this collage of pictures - all documenting the Grand Opening celebration. However, if you do not read my carefully prepared account, you will miss out on most of the details and some of the flavor of the event.  And if you do read below, you might actually be entertained by some of my thoughts, at least I hope you will be!!!!  

Monday, June 2, 2014

Aloha Dancesport Center Grand Opening - June 1st, 2014

When I first walked into the studio, my first impression was OMG, this is too new and beautiful to allow anyone to dance in.  Like buying a new car, you promise yourself that you will wash it everyday and park it only in large lots that are far away from jalopies that invite scratches and dents.  But sooner or later, you see the first scratch and get over it.  Such is life and by the end of the Aloha Dancesport Center (ADC) Opening celebration last night, there were scuffmarks on the spanking new dance floor important from Denmark, and various other kinds of debris that became trapped at the bottom of my dance shoes that I could not identify.  Still the place was in relatively good shape at around midnight when I finally left tired and weary after a full night’s celebration.

Pictures are worth more than chatter, but it’s worth a little chatter to explain the capacity of the ADC.  Firstly, this center was build from an empty shell. The space was cleared and cleaned, and emptied; a bulldozer could not have done a better job of preparing it for the new phase of construction.  New walls and fresh paint, new mirrors, granite counter tops, roomy and clean toilets….. 3 of them….one for women, one for men, and a unisex bathroom that services the smaller of the ballrooms present in the center. The choice of color of the paint was bright - light colored pastels, with contrasting colors giving a warm, fresh and happy feeling to the rooms.  The choice of sound systems, lighting fixtures, carefully selected pictures including thoughtful collages of students, signs, a very obvious clock sitting centrally in the main ballroom and many other detailed touches left no corners unturned, no features left undone, and no other considerations to ruminate over in the near future.   Even the outside foyer was freshly painted as were the stairwells transforming the drab tired building into a new beginning as only plastic surgery can do to move back the clock by at least a few decades.

In the end, two large ballrooms, the largest of which was situated at the front, and a smaller narrower one in the back perpendicular to the larger front room (from the vantage point of Ward Ave giving the area an L shaped configuration) makes this space, centrally located in Kakaako, the largest and finest dance studio in Hawaii.  And somehow the anatomy of the space allowed for a separation of both rooms by a pass through room that serves at least two purposes.  First it allows for two events to occur simultaneously – both areas have separate private entrances and both areas are served by clean bathroom facilities.  Second, it buffers the potential noise drift from one area to the next to allow for a certain amount of autonomy and lively interactions in one ballroom without disturbing the activities of the other.

Building the Monster
Only Lucas and Yanna know the full details of the million and one items that they have dealt with these last few months to complete this enormous undertaking. The rest of us can only imagine the work involved: it was certainty not for the faint of heart. 

To be honest, my job was to prepare Yanna for the worst.  Having witnessed the empty promises of contractors whose job it is to lie as much and as often as possible while leaving the client dependent and miserable and in the end delaying the completion and inflating the final cost of the project, I was prepared myself for the worst.  Thankfully I was mostly wrong and they were able to put their mark on keeping tabs with most every aspect of the project and to keep the wheels rolling.  As a result, the most important aspects of the ADC were completed on time.  To be sure, if you had seen the ADC one week before completion, you would have joined me in my pessimistic outlook…no dance floor, no lightings, no sound system…yikes, are we really having an opening party in one week??????

Grand Opening Party Preparation
Of course, Lucas and Yanna orchestrated the preparation of the opening celebration.  And only they know how each of their loyal students contributed because they do not advertise who does what for obvious reasons. So my observations and acknowledgements are not meant to be all-inclusive but rather to just serve as examples.  Paul is always building something to adorn the ballroom, Uncle Wes is like an Eveready powered bunny running around in every direction doing everything he can do to fill in the gaps.  Marie is endlessly brokering behind the scenes deals with politicians, church leaders, and others students to support DRD.  And Maria is in her element orchestrating the production and distribution of large volumes of tasty food for the masses of guests using her personal staff to make it happen.  Again, there were many other students filling other functions that I did not witness. However, what I do know is that Lucas and Yanna were eternally grateful for every student’s contribution!  I for one probably did the least, performing chores that took just a few trips to Sam’s Club and Longs to accomplish.

The Big Event
I was truly on pins and needles but when the final moment came, almost everything was ready, working and the night went amazing well. A blessing, opening remarks from Lucas, dance performances from the keiki’s, and a revolving introduction of short student performances that were aimed more at introducing them to the audience rather than demonstrating dance skills, highlighted the evening’s event.  With over 200 people filling the tables and chairs on the perimeter of the large ballroom, remarkably, there was still enough room for general dancing.  The food was served in the smaller ballroom where people mingled and talked, and everything more or less worked like a charm.  I’m sure Yanna and Lucas appreciated the support from the community, the attendance of other dance teachers and amateur couples, and the generally gleeful atmosphere present at this Divino Ritmo Dance sentinel event.  In the end, I believe everyone there was duly impressed with the beautiful studio, and the splendor and grandeur of the evening festivities.

What I think most people didn’t see was the glow on Yanna and Lucas’s faces, a glow that also extended to their long term and loyal students.  Many of us are old enough to be at least Yanna’s parent and we were all filled with the joy and satisfaction for a dream come true.  We all knew the plan……you relocate to Hawaii, teach ballroom dancing, earn enough to buy a house, and then find a way to have your own studio.   Ha ha…..sure, dream on.  How many dreams come true?  What were the odds, 100 to 1? This one DID come true and the students, most of us having already passed the phase in life when dreams like these are real, took part in the joy.  It was their success and it was our success.  

Some Final Thoughts
The ADC is now the finest dance studio in Hawaii.  This is the time for everyone interested in ballroom dancing to ask themselves how they can participate, utilize, and enjoy the center.  Yanna and Lucas will fill the studio with activities, new students, dance and non-dance related activities, private and public parties and meetings, sports related exercise class and non-sports related events, and soon it will fill up and not be available for those who wait too long.  Indeed, there were a number of individuals wanting to come to the Grand Opening last night that could not be accommodated.  Don’t wait too long: this is the time – early - to make your request.

Lucas and Yanna will appreciate but not be desperate for your support.  They have succeeded in turning their dreams into reality.  They are here to stay.  We - friends, students and other supporters should appreciate their exceptional skills and congratulate them for a job well done.

Sunday, May 11, 2014

My ONE Yearly Pediatric Research Meeting

famous view at the Convention Center
A little time for a walk in the countryside
the view from my hotel
On the surface, it seemed like just another Pediatric Academic Society Meeting.  A horde of well dressed and exuberant young people scurrying around with rolled up posters, schmoozing with one another and with their senior faculty members and mentors who were hobbling around, hunched over and struggling to navigate the roomy corridors of the convention center with their broken down frames.  And so it is of course common to recognize someone I have seen for decades….looking twice as old and twice as run down as the last remembrance.  And it seems that nothing really changes otherwise as I witness them pontificating their wisdom relentlessly to the younger generation of research want-to-be’s and to other colleagues ostensibly demanding to be heard.  Maybe I’m jealous I’m not still engaged….sour grapes?

And you have to factor in the usual effect of my aging on my perception of how young everyone else looked at the meeting except of course the old guard like me.  Nevertheless there were a few impressions this year worth highlighting that I think reinforce those of the recent past and others seen more severely than in the past.

I’m told that 75% of those training in Pediatrics are now women, and so it seemed as though the largest band of new researchers at the meeting appear to confirm this notion.  Well dressed, articulate, knowledgeable, women in Pediatrics are clearly in charge of the field, certainly for the future if not in the present.   Where have all of the eager young men gone?  Surgery, Internal Medicine, or out of Medicine all together? 

Another observation was the disproportionate large number of East Indian Physicians presenting at the meeting.  It’s clear that Pediatrics is well represented by this group of physicians, hard working as they are, intelligent and focused on being successful US academics.  This year - as my hearing is further declining with age, I found it harder to filter out their heavy home-styled accents - although maybe it was also the acoustics of the cavernous conference ballroom that added to the background cacophony.

Finally as in the past, I found it more than ironic that the OBESITY conference sessions I attended, the proportion of overweight and obese presenters mirrored those of the general US population.  At least I would be embarrassed to be researching a problem that I was striving to become an expert in that I was concomitantly plagued by. 

I suppose the aspect of the meeting that bothered me the most was a sense of despair with the flow, flavor and taste of the meeting in general.  It seemed like the groups representing and contributing to this meeting, the American Academy of Pediatrics, Pediatric Academic Society, the American Pediatric Society, etc, etc were out of touch with present day reality.   An aspect that I have valued throughout my career, the sense of optimism and ownership that Pediatricians have for the lives and health of children seemed to be conveyed in a shallow and hollow manner, the rhetoric outdated, unrealistic and even seemingly insincere.
So many aspects of our society are broken, our economy is drowning in debt, hospitals and universities are subjecting every potential expenditure to microscopic scrutiny, and physicians have never been unhappier with medicine in general.  The problem is global: we are unhappy with our government’s intrusion ala Obama Care and the time wasted filling out piles of useless forms, third party carriers and shrinking reimbursements, the student bills that gnaw on our every waking moment, the impatience and unrealistic expectations of some of our patients, the restrictive demands and increasing meddling of our employers, etc.

Back to PAS: much of what I personally attended at the meeting was old, outdated or so minimalistic it could be hardly considered research, let alone groundbreaking research - which this most prominent of national Pediatric meetings is supposed to represent.  What ails most of American health including Pediatric health is not a mystery, and it is clearly not fixable with the kind of short-term research meant to further the careers of young researchers trying to get ahead in their university. 

But its not their fault, it’s the fault of the system that parses out small grants that last 1, 3, the most 5 years to deal with conditions that are increasingly chronic in nature.  Indeed, how can you even conceive of a method of showing progress in addressing Type 2 Diabetes, Asthma, overweight and obesity, substance abuse, suicide, etc, from research grants that fund you for only a few years and you have to spend most of that time gearing up and then writing your next grant while diverting your attention and focus away from the research at hand.

And we consistently have little to show for our research efforts in the grand scale of American healthcare.  Our health indices in infant mortality, population longevity, obesity and overweight, etc continue to lag way behind other developed countries, despite spending much more on healthcare and research. In fact, it is acknowledged that the dollars we waste on healthcare is more than some countries spend altogether, not something any American wants to gloat about. We are simply not facing the facts that our system is increasingly broken and needs fixing.  This is where our research efforts should be focused on.

I do not want to exit on a negative thought.  And truthfully, as ironic as it may seem after stating the above, I can’t help but feel that America still has the best medical care in the world, which must reflect the system in some way that I’m baffled to explain.  It maybe true that the global public health issues are not being addressed adequately, but somehow the most advanced medical and surgical care in the world is still here for the taking.  I can’t think of any condition – medical or surgical that you could not find the world’s most celebrated doctor available somewhere in the country.  Many of these doctors have thrived through word of mouth aided by glamorous websites.  They continue to attract patients from around the country and around the world who are willing to pay their prices.  This care is obviously not for everyone……………..as their charges are sometimes oppressively high and increasingly independent of the system of reimbursements that are doled out by 3rd party and government insurance carriers.  As always in life, it seems that at least some of the time, you get what you pay for.  

Saturday, May 10, 2014

One Happy Moment Until.......

Happiness is measured in serendipitous moments, sometimes unexpected.  At least some are not the defining moments in your life like the wedding, the birth of your children (who appear normal at birth), passing your subspecialty boards, buying your first house, receiving a normal PSA result, beating your fellow dance competitors who have been pulverizing you on the competition dance floor, etc, etc.

I was very happy for a moment in time last night at the Sugino Showcase at the Sheraton Waikiki Hotel, and it was caught on a picture or two that created a permanent remembrance.  I was happy for the moment of the picture, feeling and looking younger than my age until I had to hobble back to the dinner table aching from overextending myself on the dance floor, the soles of my feet and ankles feeling like I had just walked over hot coals.....sore and swollen, my knees and hips stiff and immobile, my back hunched over in agony.  But at least I created an illusion that existed for a moment in time until reality struck it down like a fly swatter neutralizing its intended target......  

Tuesday, April 22, 2014

Sea Lions

Isn't this a beautiful shot?
Narrative Copied from the internet, all pictures c/o Frances: 
"Often confused with seals, sea lions have their own distinct intelligent identity that makes them the favored ones to be trained by the U.S. Navy's Marine Mammal Program based in San Diego to detain and help scuba divers. They are mammals that live in the oceans and roam the land close to it. In their natural habitat, they live up to 10-15 years. However, in captivity, aided by a healthy environment, they can live up to 25-35 years. They are not very aggressive towards humans, and although there have been instances of attacks, they are few and far between. Most species are readily trainable and widely-used for entertainment as well as rescue operations.

Sea lions can be easily distinguished from other members of their order as they have external ear flaps and long front flippers that let them walk easily on land. Depending on their type, they weigh about a ton and are 2.4 to 2.8 meters in size. They have slightly-elongated faces with little whiskers on both sides close to their nostrils. Their 'cute' appearance has made them a popular attraction in aquariums and zoos worldwide. However, they are vicious carnivores, and strangely, evolutionarily related to wolves and bears. They hunt fish, squid, octopi, and smaller pennipids (seals and smaller sea lions) using their conical-shaped canine teeth. Although a part of oceanic life, they can only stay underwater for 10-15 minutes at a stretch.

They cannot survive far from the ocean. As a result, they can be found on coastlines of virtually every ocean except the North Atlantic. This includes the tropics as well as subpolar waters near both poles. For instance, the largest type, the Steller, is found on either side of the Bering strait. As apex predators, sea lions follow their prey and choose the most fertile oceanic regions to colonize. These include the Pacific coast of both American continents and Polynesia. Due to the large size of their colonies, they need suitably large and plain (sandy or rocky) shores to colonize."

From the Galapagos via the eyes and clicks of Frances...