Wednesday, April 19, 2023

Made in Japan




When an all too often purchase included a “Made in Japan” label, it was regarded as an inferior cheaper copy of US manufacturing products in the 50’s and 60’s, decades before Japanese goods were known for their quality and design. Living in Long Island, New York, Italians, Jews and a smattering of African Americans were the only groups that I had any familiarity with. However, there was one Japanese girl in my elementary school that I still remember vividly with her pigtails, posing pleasingly for her annual school picture. She was born and raised in the US so there was little to learn from her about Japanese culture, even if I was motivated to do so.  And anyway, I wasn’t particularly known for my social skills at the time, a characteristic that has unfortunately lingered with me throughout my life. 

It took moving to Hawaii to begin to understand sukoshi about Japanese culture.  With over a quarter of the population having Japanese ancestry and a growing expatriate population coming to invest in a second home during the booming years of the Japanese economy, or to escape the repressive expectations of Japanese culture, particularly aimed at women, Hawaii provided more than a snapshot of Japanese culture.  While in general, American freedom of expression and behavior was a contagion that attracted an increasing horde of Japanese, it is interesting that regardless of the motivation, most Japanese living in Hawaii retained a profound respect for the culture, behavior, and decorum of their motherland.  The US was an OK place to live, but its decadence, diversity and self-destructive behaviors would never replace the forbearing roots of their Japanese culture and humanity.   

It took an invitation to participate as a visiting professor at Chubu Hospital in Okinawa to teach the local pediatric residents and faculty members on two separate occasions to begin to appreciate Japanese culture.  Okinawa, as it turns out represents the origins of the historical migration of many Japanese immigrants to Hawaii. It represents a typically shorter, distinctive genetic variety of Japanese that is characteristic to this day of our Hawaiian Japanese residents. It is also the home of a longstanding relationship with a US military base, Naha naval base as best I remember. And it was my experience coupled with my later more frequent and recent experience as a visiting professor in Yokohama, Japan teaching at the Yokohama Medial Society and at the Shin Yokohama Women’s and Children’s Medical Center that truly shaped to this day, my work ethic and sense of professional responsibility.  In a sense, I got more out of my experience in Japan than those I had promised to teach about neonatology and high-risk infant care.  I sometimes wonder whether the picture that they had of me in the front lobby of the hospital still stands as one of their “Advise Doctors”.

One of the long-lasting and endearing characteristics of Japanese culture, the reverence for one’s elders and senior members of society, as it turns out, stands as one of the roadblocks in teaching medical education in Japan. That is, patient rounds are generally held with a “sensei” whose words are taken as gospel. Not much discussion after a command is passed down from a seasoned veteran of medicine. It would be in fact rude to question their wisdom and authority. To be sure, when Japanese doctors come to the US for training, it takes some time for them to adapt to the interactive discussions and freedom to question authority and or provide additional or opposing diagnostic scenarios that more adeptly decipher medical enigmas facing the treating team of healthcare workers - tasked with the care of their ever-evolving cohort of patients. (Sadly, this American tradition of Socratic back and forth discourse is seriously under attack.  Indeed, it is disheartening to witness the progressive deterioration of free speech, challenging public discourse, articulating unpopular opinions, and respectfully debating opposing views including in the practice of medicine, as the woke movement in the US infects just about every aspect of human life including medicine. But we will leave this discussion for another time or just hope it goes away on its own accord!)

Nevertheless, this reverence for hierarchical tradition and respect for the elderly is rooted deeply in Japanese culture, permeating much of Japanese behavior and civility, and ostensibly for much of the positive aspects of community life easily observed throughout the country. Having just started a two-week cruise of nine cities in Japan, the contrast with the US could not be more striking.  An insular society filled to the brim with native Japanese, cultural norms are imbued from birth into every aspect of life and behavior. The streets are safe, day and night, crime is rare, and everyone, young or old, male, or female is safe to wander the streets or public transportation without trepidation. No homeless or homeless encampments, the streets are devoid of even a hint of refuse, every street is swept, train stations are immaculate and kept up to date, and the news is filled with politics but not of the latest train derailment or mass killing, as we have become so familiar with in the US.  

But is this Japanese cultural indoctrination all positive? Clearly, we didn’t think so when the common lore in the 60’s was that the Japanese were great at copying American products but short on innovation. In such a strictly rule based society, is it no wonder that individual freedom of expression would be stifled and even discouraged?  Regardless, this storyline is never so simple or one-sided, and there are many personal stories of Japanese, particularly those moving to Hawaii escaping this repressive society and expected conformity, that demonstrates a growing trend in Japanese culture, particularly when it comes to women. Other trends have emerged in Japan itself, with a growing number of young women who eschew marriage and the burden of nearly continuous servitude that embodies its role. To be sure, the WSJ recently reported that 27% of Japanese women have never experienced childbirth by the age of 50. Many choose to pursue a career or live at home and spend the fruits of their labor on personal items, in a sense prolonging their adolescence and dependence on their family for support and comfort, often at the consternation of their family. To emphasize its significance, the fertility rate in Japan is 1.34, when 2.1 is needed to sustain a stable population. 

When touring the environs of Kagoshima, I noticed tree lined streets neatly lining the main thoroughfares of the city.  A good number of these trees were sculpted in a traditional bonsai looking layered and/or spiral staircase looking pattern typical of the iconic Japanese garden. Later that day we visited a beautiful Japanese garden, part of a historic property and home of a famous shogun. The garden was lined with sculpted bonsaied trees, bridges and waterways, stone structures of oriental designs, koi, plants, flowers, and rolling mounds of flowing terrain, distinctive, beautiful, and serene.  So much different than western style gardens, which to some degree allow the expression of living things to show their distinctive properties without fully constraining their shapes and appearances. True, trees and plants are cut back to maintain a certain balance in the garden but not nearly to the extent as those of its Japanese counterparts.  One wonders whether Japanese gardens are indeed an expression of a more profound element of Japanese culture, one poised at controlling their inward and outward emotions, boundaries, and environment to the extent possible with directive resolve.  

Nagasaki was on the list to visit. I was ambivalent about visiting the Atomic Bomb Memorial and Peace Park. It was indeed an emotional experience for me, much in the same way as the War Remnants Museum was in Ho Chi Minh City which recounted in graphic detail the damage the US inflicted in Vietnam during that war. Still, learning more about the horrific effects of the nuclear bomb was never one of high priorities, but you can’t help it when you visit ground zero and revisit the details of August 9th, 1945. It forced me to think about my birthday, November 18th, 1946, less than one year later, how I missed the Korean War because I was too young, and how I missed the Vietnam War because the US military stopped inducting young doctors in 1972, the year I graduated medical school. I luckily (or unluckily) missed any possibility for military service which I have always thought of as a series of lucky flip of the coins in my life.  

The experience of the memorial was indeed emotional - reading account after account of how Japanese families were torn apart in a matter of an instant from the bomb. Stories and poems and pictures of bloodshed and devastation were on display for those to witness as long as they could stand the graphic detail. When the museum was later discussed by the cruise ship resident historian, he broadcasted that the museum provided a one-sided view of the devastation devoid of context as to why the bomb was dropped and the circumstances surrounding Japan’s cruelty in war related activities.  He drew the contrast to Germany who has since acknowledged and apologized for the sins of the Nazi occupation in WWII.  While thought provoking, I’m not sure the purpose of this memorial was to describe the historical context, rather than to resolve for an overarching theme of global peace, across countries and continents as the only positive resolve one can arrive at from the needless death and devastation, which to the people of Nagasaki, will never be quelled by any military justification or rationalization, regardless of reason and or consensus.  

right hand points to danger of nuclear weapons, left hand symbol for peace

The most heart wrenching......

seven continents holding hands in peace

ground zero
# of victims to date

But is the nature of man likely to change or will war permanently plague the destiny of mankind. I’ll let others answer this question. Those who know me can easily predict my own answer to this question and I’ll leave it at that.

Several days later we spent the day in Niigata.  One of the most striking things in retrospect from our travels through Japan has been the presence of so many senior citizens – walking the town, driving buses, as tour guides, as small bento shop owners, etc. Everywhere we felt their presence, slim, healthy, and energetic – all reasons to marvel at their vitality and strength of purpose.  You seldom see such health and alertness and agility in seniors of equivalent age in the US or most any places other than the Asian countries.  Perhaps senior citizens from Asia have earned the respect they receive by their community!

It is impossible to encompass the many interesting moments in our two-week Japan adventure. I think the last item I would like to address is the one that was also an issue on my first trip to Japan, but at that time, it was the sticker shock of any item for purchase. In the 70’s and 80’s $25.00 could buy you a cup of coffee and a donut.  Today, the dollar is strong making it very easy to travel in Japan. Everything cost about half or less what you would pay in Most Anywhere, USA.  What a pleasure to return to the days when the dollar is strong and spending a few bucks on tasty noodles or taking a cab to the cruise terminal does not set one back an arm and a leg.  If that were so, I would be traveling only on one leg and no arms. Not much fun to be constantly hoarding what little money we have to spend for the time in Japan.  Instead, my yen to travel to Japan leaves little worry about the yen I will part with on this adventure.   


Sunday, March 5, 2023

One Must Shoulder the Pain!


In 2009 I was 62 years old.  At an evening event held in the most exclusive part of Diamond Head, I was at the UH Cancer Center director’s house for a gathering and presentation from a Nobel Prize winner.  The evening was enjoyable, informative, and entertaining until my friend and I started walking back to the car after the event had ended.  In the pitch darkness of the night and fueled by one too many, I fell over a boulder of asphalt that separated the walkway from the car parking section. I favored my right shoulder in the fall, avoiding using my hands while protecting my head from the direct impact with an unforgiving, solid pavement.  My right shoulder and rotator cuff met the ground simultaneously with a reflex muscle contraction completely tearing 3 tendons and partially tearing the 4th.  Unfortunately for me, there are only 4 tendons in each of my two shoulder rotator cuffs. Moreover, as shown on my magnetic resonance imaging study, in addition to documenting the tears, it was determined that the quality of the tendons of this 62 year old who was addicted to playing tennis, serving thousands of serves over a 35 year period, was marginal at best….they were described as looking like dirty shoe strings.  

The best orthopedic surgeon in town gave me less than 20% chance of recovery!  So, I flew to NYC to find one of the most famous shoulder surgeons in the world.  He walked in with his perfectly shined $500 shoes and had his assistant do all the talking. Less than an hour in the operating room, they put humpty dumpty back together again.  Fast forward 14 years, my right arm and shoulder are strong and pain free, with an amazing range of motion that any 76-year-old would be ecstatic to own.  What a lucky man, I was instantly deflated by the prognosis I received from my local orthopedist, but somehow by the grace of God, I was given another chance at full function of my arm and shoulder.  While I ultimately should have had the common sense to avoid this fall, the absence of illumination of this Diamond Head common walk and parking area prompted the neighborhood association to offer me enough funding to compensate me for the out-of-pocket expenses in seeking a remedy at the famous Hospital for Special Surgery at Cornell Hospital, New York City. I was happy to accept, and they were happy to get off so lightly- no pun intended.  

The mind is a powerful thing….. there is no limit to its potential.  One’s body is another story.  No matter how hard you try to keep in shape, time will slowly degrade your physiological and anatomical infrastructure-both from inside out and outside in.  At first like a termite infestation, you won’t notice it.  But then you push on the wall, the baseboard, the floor, and its either soft or it collapses to the touch. With the human body over the age of 40 years, tendons weaken as muscles lose their strength and with age and usage, and if you fall with outstretched arms or bluntly on your shoulder like I did, there is a good chance that you will injure, or possibly fracture your rotator cuff tendon(s).  Indeed, the prevalence of rotator cuff tendon tears (RCTT) in one study of the public at large was 22.1% overall, increasing with age and non-existent in the population under 40 years of age.  It is interesting that more than half of those with RCTT were asymptomatic. 

What is also interesting was my perception before and after the injury.  Yes, I have two arms and two legs, but they were simply taken for granted. I never individually regarded my body parts whenever I achieved anything of physical import; my limbs were commanded by higher forces, and they obeyed.  But after my injury, I could not control my arm to perform certain functions. I could not raise my hand and arm above my head and there was constant pain and inflammation, serving as a constant reminder of my injury.  How frail the human body, with skin easily bruised and impaled, limbs that are connected by strings easily breached, and bones that withstand only modest tension before breaking. 

What is the purpose of dredging this unfortunate experience from the recesses of my mind? Two weeks ago, as I have done for decades, I was walking down my driveway on a particularly nasty, rainy day to fetch my mail from the mailbox, taking heed of the rain and walking cautiously. My driveway emerges from the street reaching my house with approximately a 20-degree incline, so walking in the opposite direction carries some small risk I have managed to avoid for 26 years since moving to Manoa. Not on that day. Too much rain and it felt as if I was hit in the ankles by a baseball bat – both feet slipped simultaneously off the pavement instantly plummeting my torso to the ground, landing on my padded derriere while also hitting my left elbow to the ground ostensibly jolting it upward toward my shoulder and rotator cuff.  While shocking to me that I could experience such an uncontrolled fall while creeping along my driveway, I expected the pain and discomfort in my arm, elbow, and shoulder were minor and would abate with time.  But it didn’t.

On Monday after a three-day weekend, I called the office of my orthopedist, Daniel Lim.  By 11:30am I was in his office being examined, X ray in hand, and scheduled for an MRI of my left shoulder for that afternoon.  A full thickness tear of my supraspinatus tendon was found to my horror.  I am scheduled for surgery in two days, just 2 ½ weeks after the initial injury!  I only wish I could push back the clock before my injury or move the clock forward 6 weeks to avoid the postoperative recovery period which I’m still hallucinating will not be too unpleasant.  

Thank you, Dr. Daniel Lim, for your patience and concern. You have been the bright spot on this unfortunate moment in my life.  

What is amazing to me is not that I have had injuries in my life.  I certainly owned the medial meniscus tear of my right knee after relentlessly playing tennis at every free moment I could muster in the 1970-80’s.  But I also ran races and marathons, skied while reaching speeds of 30-35 miles an hour, swam sometimes in treacherous waters, competed in ballroom dancing for the last 15 years, and walked carelessly for 3-5 miles/day at Ala Moana Beach Park for the last 10 years. While I have had aches and pains, my injuries have been self-limited and eventually healed. So, to experience the most serious injuries of my life from an otherwise innocuous activity makes no sense. I should at least have had a more exciting story to tell about this latest tendon tear.  Yes, I’m nervous about the upcoming surgery.  

And now that I have injured both right and left shoulders in my life, I’m hoping that I have paid my dues and can enjoy the rest of my life walking, dancing, skiing, and swimming with strong arms artificially glued together with string and anchors. I am again reminded of, and thankful for the amazing advances in medicine and the kindness and expertise of those engaged in healing other humans of their ailments.  For this expertise and dedication, I do not take for granted. 

Sunday, December 25, 2022

Christmas 2022

It's been a decent year. My health issues are still there but nothing new to dampen my enthusiasm for life.  Nothing much good can be said about the world, the market, the politicians that control our lives and thoughts. Focusing on the positive.  Just a few random thoughts.

I saw a mother and child while driving home from the medical school - beautiful!


I started an intermittent fasting regimen that I believe will help with weight control and insulin regulation.

My children and grandchildren are doing well.

My travel schedule continues to be exciting and full - 9 trips already planned for next year: 5 already secured. 

My dancing has improved, when it really shouldn't as my body grows old and my joints weaken with arthritis and decalcification. My last Showcase was arguably my best performance.




I've already started my ski season with an IKON pass.


My work life is winding down; I think next year will be my last!

My house is in decent shape and I'm working on revamping my yard with all sorts of artistic Islands of plants and rock and concrete.

and Finally, I bought an old truck - just like me - OLD, worn down with age 17y/o with 250k miles, and needing a face lift.

Tuesday, December 13, 2022

Deer Valley REVISITED - December 2022

 






One of the most beautiful sights to the senses is freshly fallen snow captured in flight by the intricate latticework of naked tree branches that meet its path - not only passively resting, but often weighing down these branching tentacles in creating imaginative, artistic images, and when the snow is violently dumping, even "snow ghosts".  The photos above were helped by the work of the snow making machines that are busy 24/7, adding to the already generous accumulation of snow at Deer Valley......very unusual to see such snow so early in the ski season, prompting Deer Valley to open up one week earlier than expected. 

Arriving early at Deer Valley,  I was joined by a fellow skier on the lift. I was complaining about something or another, attributing my limitations to my old age.  The fellow next to me asked my age, I exclaimed 76.......... so I felt compelled to ask him the same....... he responded 90. Yikes, I kept my mouth closed for the rest of the lift up the mountain....

Other tidbits to chew on..... 

Day 1: I have been lucky to meet up with other old men on the ski lifts; everyone is friendly and tells me their life’s story in the ~ 5-7 minute ride up the mountain. From Arizona and Texas, all happy to be on the mountain enjoying the day’s fresh snow and sunny and pleasant surroundings. There is nothing like the panorama of white blanketing the visible reaches of the earth, including snow covered trees and the delicately balanced mounds of snow outlining the terminal branches.  The snow machines produce another perspective, filling in large swathes of terrain in heaping mounds of snow that tempts you to jump off of the lift into this artificial cushion of soft snow…..to disappear from site and the harsh world that we presently inhabit.  

The second day was mostly sunny, and the softness of the snow prevented it from having a crunchy, iced over feel.  Plus it snowed the night before to add another few inches of reserve for the afternoon skied over terrain.  I started to venture out to blues I had avoided most of the time over the last few years.  All tolerable, some more enjoyable than others but the choices were few given the limited number of runs that were groomed.  Still a very enjoyable day ….. skied for about 4 hours = 18.3 miles top speed 37mph.  I knew when to quit, but I felt a little sad to leave Deer Valley in the afternoon with the sun out and lovely ski conditions that one could guaranty would not be there the next morning.  The third day proved me correct in my prediction, but I concentrated on the groomed blues which were in more abundance than the previous two days.  Another great day.....

One of the best things about the skiing this time was the dearth of skiers on the runs.  I was a little concerned as I skied from run to run wondering if I fell and hurt myself how long it would take for someone to pass by and lend a hand.  

Alone, I was hardly adventuresome in my apres ski moments.  Two trips to Costco, two trips to Walmart which is conveniently located behind the home 2 suites – and a 20 yard walk from my room out the back door of the hotel….. how sweet these suites……..

One night at Roberts, one night at a recommended pizza place called The Pie… excellent! - salad and 14 inch pizza that sent me packing with half of the pizza to bank into my refrigerator at the hotel.  I also have one of two Sapporo beers I bought at Walmart. The big question for me is do I scrap the left over pizza and beer and venture to the Mumbai House that I have been wanting to do since getting here?  I’m sure I will ruminate over that question for the rest of the day and then make an irrational last minute decision that will somehow feel anticlimactic................. I did in the end go to the Mumbai House and was treated to an OUTSTANDING meal - what a great restaurant!


Sunday, November 20, 2022

Villa Thai Orchid


One of two identical rooms in the 2 bedroom suite I refer to as the Sanctuary

Breakfast Room for Guests

Another photo of BF room

and another

and another

lobby partition

cute touches everywhere

Outside courtyard

birthday boy's picture - 11/18/46 - 76 Years old

Few people have much experience with boutique hotels.  Rather, the usual scenario for both business and leisure travelers is to find a Hilton or a Marriott or a Hyatt, etc., make a reservation and saunter mindlessly into a large, ostentatious lobby looking for the registration desk and the queue to check in.  You’re leave the lobby with the unreliable plastic key that forgets itself if placed near your mobile phone. You’ve already studied the website and the photoshopped pictures of the gym, the indoor or outdoor pool, and the business center, etc., facilities that you would seldom or ever use, while imparting the false impression that you’re getting value for your money when you are doing nothing of the kind.  In fact, what you’re doing is contributing to the profit margin of those big chains of hotels that no longer provide any service without an apologetic request …..in the name of COVID.  Oh, I’m sorry Sir, you needed to request your room cleaning the night before!!!!!!! 

You painstakingly wait for the elevator, you find your room with a dilapidated view of a rooftop, an outdated office building, a back alley, or a view of something or nothing if you’ve paid extra for a hotel room that is already overcharged.  The room is musty with the taste of its previous occupants, hundreds of them, day after day, night after night.  If you look beyond the surface, everywhere there is evidence of its prior occupants and years of use, abuse and neglect…..coins, candy wrappers, deep dust in hidden crevices, items left in closets and dresser draws.  The bed is concave, evidence of the hundreds of prior occupants’ bodies molding and weakening the springs that were never that good to begin with.  I could go on, but you get the picture.

Thailand is a wonderful place to visit, but Bangkok is just too large and busy.  The second largest Thailand city is in the north where slightly cooler and more tolerable temperatures prevail; the city of Chiang Mai.  A delightful safe place filled with history, a plethora of restaurants, the old and the new and the not so new, natural beauty and important landmarks, things to do outside the city, cooking schools, dirt cheap massage spas on every corner, and night and weekend markets you can bargain for not only the usual junk touristy items made in China, but a lot of thoughtfully crafted items made in Thailand. The markets are a sprawling testament to the entrepreneurial mentality, culture, and history of the Thai people. They are composed of an endless stream of individual stalls filled to the brim with thousands of neatly arranged items to consider. For some, the sensory overstimulation may be overwhelming. Nevertheless, the experience is unique and worth the effort. I’m truly amazed at the creativity and endurance of the Thai people.  

By the way, there is something for everyone in Thailand, but Chiang Mai is a composed, energetic city filled to the brim with cottage industries, devoid of many of the sins, attractions, and temptations found elsewhere in Thailand, catering to the young and old, to the rich and not so rich, and to the adventuresome and not so carefree.    

Finding a hotel in the old city is a must. Very few 5 star hotels, there are mostly boutique hotels to choose from.  I’m only an expert on one of them; the Villa Thai Orchid. It’s hard to know how to start. I’ll start with some of its cons.

The Villa is located on a side street, which feels like an alleyway rather than a legitimate street. Wide enough barely for two cars, it’s a miracle to witness two cars passing each other from opposite directions. No place to park in front, but fortunately the road is not congested or busy, relatively speaking as compared to those bordering contiguous streets.  The hotel has a smallish footprint, but the overhead sign marks the spot to enter. A smallish courtyard neatly designed leads the way to the clean, comfortable, functional check-in desk, which is the home of a shortlist of family members greeting new and existing guests, handing out keys, responding to the thousands of questions posed every day by new guests arriving day and night to populate this 12-room hotel. Another shortcoming is the absence of elevators in the hotel. BUT, we never had to lug our luggage one foot out of the reception area. The hotel staff are programmed to do this for you, night, and day! 

Our first visit was three years ago, only 10 rooms were available then. The pandemic put an end to hotel occupancy, and instead of sitting on their bums, the owners built another wing with a new living area and kitchen and adding what amounts to a second floor two-bedroom suite. They call it Villa 1; I call it the Sanctuary.  

A lockable glass door leads to a staircase that rises one floor up - to a common area with tables, glassware, dishes, coffee mugs, a water heating canister, and a great combo refrigerator/freezer. Tasteful touches of art, wooden sculptors, pottery, plants, etc. are found everywhere in the hotel; there is nothing that is plastic or purely utilitarian. Real wood, not laminate, even the doors have their unique designs; everything is solid! The sanctuary has high ceilings including the two large rooms that connect from the Sanctuary’s common area. I’m guessing the size of each room is 300 sf, not including a decent sized bathroom and shower. Again, the bathroom is tiled, counters are granite looking, the fixtures attractive and functional. The bed is advertised as king but seems larger with a pretty wood frame. The mattress is remarkably comfortable. 

I’m not sure whether the two rooms located on this second level were designed to be rented individually.  And there is nothing wrong with that notion because they are entirely separate, and the walls, outside and in are concrete, ensuring their capacity to filter out any noise coming from anywhere. But other than one common concrete wall separating the two suite rooms, the rest of the walls are outside walls, meaning no other rooms or areas are adjacent to them, ensuring privacy and seclusion, and the absence of any noise pollution except for any filtering from the street which never happened in our five-days stay.   

Renting the Sanctuary as a two bedroom suite is the best way to guaranty a well-appointed stay that would arguably rival most hotels in any city in any star category,…… in my view.  You get space and privacy and cleanliness, and facility at a bargain price.  I don’t want to divulge what we paid because it’s way too low.  Suffice it to say that even if the price was tripled, it would still be a great deal.  To be sure, if you are travelling with family or friends, this two-bedroom suite complex would serve your purpose magnificently….or even if you didn’t fill the second room with any occupants.  

Three years ago, our room was in the original building, courting the 9 other rooms for rent.  Considerably smaller, it was more than adequate and private for our purposes. The price is also about half of what it would cost to rent the Sanctuary for those bargain minded travelers. 

The amenities at the Villa Thai Orchid are really what takes this hotel to the next level.  Read the reviews; they are consistently 5 out of 5.  The owners make every effort to provide the best customer service to the patrons.  Ask a question, and it is answered.  Want a share ride to somewhere, they will help you with your Grab app.  Want a taxi instead, they will arrange one. Want a recommended restaurant, a place to color hair, a massage parlor, directions to the night market, a good jewelry store, etc, etc…you get the picture. An endless supply of bottled water, a common area filled with a few staples such as cereal, bread, jam, butter, peanut butter, bananas, coffee, tea, water, etc are there 24/7 for guests to enjoy free of charge. Breakfast is an add on expense – presently at just over $4, it’s hardly one to pass up. The French toast rivals any I’ve had in my life, and fresh fruit is served with every choice selected the evening before for the next morning. You choose your breakfast and the time you want it served (anytime between 7-10am), and when you arrive the next morning, the breakfast will arrive with little to no waiting. 

One story to share.  We had need of a jeweler to resize some rings and perform some surgery on a gold bracelet to allow to fit a larger wrist. Not only did A (yes, A is her name) help identify the jeweler, she went with us to ensure the performance of services would be completed on time and that we would be taken seriously.  We did NOT ask for A to do this; she volunteered.  

Here's one for you that will make your stay even better. The hotel does your laundry for you – free of charge!  This year, I factored this into the quantity of shirts and undergarments I packed, and I saved a considerable amount of space in my luggage knowing that all I had to do was put the basket of dirty clothes outside my room by 9am to be cleaned and returned by early evening.  Thailand is hot and there is a lot of sweating going on. It’s wonderful not to have to worry about laundry or smelly clothes and the like.  

Well, I can go on, but you get the picture.  We are sold on this hotel and I’m already planning on returning next year.  Hopefully too many people will NOT read this blog and make it difficult to schedule my next reservation with the Villa Thai Orchid hotel in Chiang Mai.

roomy bathroom in each Sanctuary bedroom

The common area of the Sanctuary

isn't this room lovely?

Cooking School

more cooking school

making friends

going places

and the magic of the night market!

Tuesday, November 1, 2022

Sestri Levanti, Italy, Rapid City, South Dakota, Nashville, Tennessee, Louisville, Kentucky and the Freedom to Control Your Day.



I recall when applying for a visa to go to India, they asked applicants to list the countries that have been visited in the previous 5 or 10 years I can’t recall which one. What I do remember is stopping after listing 50 countries.  I’ve probably travelled to 100 over my lifetime, the great majority after my transition from full time to part-time faculty status at the University of Hawaii – 15 years ago in 2007. Since that critical moment in time, I have taken the attitude that - what I want to do comes first, and all the rest including work related duties are subjugated to this self-empowered primacy.  If that does not satisfy my employers, so be it.  So far it hasn’t, but it eventually will and that will finalize the end of my career.  After all, I’m no spring chicken…… 76 in less than a month.  

It’s still worthy of emphasizing how truly wonderful it is to have control over one’s day.  This is ESPECIALLY true of someone like me, a former, devoted intensive care physician who was tethered to his phone and pager, subject to the whims of subordinates, other health care workers, and anyone else needing advice or assistance. This is truly the value of any type of successful partial and/or total retirement from work, the ability to call the shots, day after day and night after night without guilt or duress; otherwise, you’re exchanging one type of subordination for another.  This freedom cannot be overstated; it is simply the ultimate expression of happiness and self. 

The title above suggests some type of relationship between one village in Italy and several cities in the US. There is not, other than the fact that they represent the destinations of my last three trips taken over the last three months. Ordinarily I would blog the details of each of these trips in fine detail and include a potpourri of visual representations. I will forgo the details and focus on a few snippets, and quirky moments and reflections.  Each of these destinations was travelled for different reasons, not that I need a reason to travel most anywhere. 

Parenthetically, I am bothered by the steeply rising prices of flights to anywhere, particularly since I am committed to purchase business or first-class fares with mostly lie flat seats to insure comfort and privacy.  Fares have doubled in the last year along with general inflation, but President Biden assures me that it was Donald Trump, Vladimir Putin, and world inflation that are at fault, and not Joe Biden and his reckless multi trillion-dollar giveaways. And from his perspective, the economy is doing well, and I believe him.  After all, the windfall of dollars from China and Ukraine that his trusted son, Hunter has earned, has been generously shared with the big guy, his beloved father.  

Chapter 1:  Sestri Levanti is a beautiful northern coastal town on the Mediterranean nestled in the heart of the Italian Riviera just north of the famous Cinque Terra.  You fly to Milan, take a train to and then south of Genoa, and you’re there.  The town has a little of everything! Beautiful surroundings, excellent cuisine, coves and beaches with crystal clear waters for swimming or sunbathing (it irks me that so few people understand how damaging the sun is to one’s skin!).  People are friendly – with exception – I was kicked out of a restaurant after waiting for an hour for service, unwilling to pay for what was ordered that was yet to be served! Through my eyes, the world of Italians seem to revolve around hedonistic pursuits and self-fulfillment.  A truly beautiful place to visit and enjoy.  

Italy is a place that everyone should find the time to visit. If only one foreign country is ever visited in your life, make it Italy.  It truly has something for everybody.  Perhaps we would discourage those Americans who have the desire to destroy historical artifacts, topple monuments, and/or deny history, or those easily offended by opinions not condoned by their woke taskmaster liberal academic advisors. 

Using Milan as the home base for Italy allowed me to revisit the Milan Cathedral or Duomo. This arguably is the third largest church in the world, but to me is the most impressive and powerful religious building I have ever visited, with the exception of the Vatican. You are allowed to venture below the church to see some of the remains of the earlier construction, and also, for a price to climb to the top of the cathedral and witness the majesty of its complex architecture from above as well as a panorama of the surrounding city below. Truly a meaningful experience for believers and non-believers alike! Hope you like some of the pictures below!
 
Chapter 2: Rapid City, South Dakota is not the most popular destination in the US, but it serves as an appropriate home base to see some beautiful sites of the black hills, and some notable landmarks: Mt Rushmore, Crazy Horse Memorial, Devils Tower, Custer State Park, and Deadwood to name a few. Too much hype about Deadwood’s history, the fate of Wild Bill Hitchcock and Calamity Jane, the significance of Saloon #10 was the luring attraction, but the reality is that this town is a disappointing tourist trap and nothing more.  

Depending upon the number of wonderful hikes you are planning, overall, I think a minimum of three days is adequate to see most of what’s worth seeing.  I was spooked out because September was a popular month for rattle snakes to make their presence known, and after all I am hard of hearing, which may have been a benefit. In any case, I was not accosted by a rattle snake although I was prepared as much as anyone with eyes peering back and forth in a nystagmoid fashion and my walking stick in hand and ready for the fight.  In any case, September was a better month to travel to Rapid City because August is the month that a horde of motorcycle enthusiasts converge on a nearby town called Sturgis, leaving little room for the run of the mill tourist to maneuver.   

Rapid City was not a bad small city; it had the interesting distinction of having statutes of life size US presidents on street corners in the downtown area.  Lots of tourists, a decent assortment of restaurants, and the smallish size and lack of congestion created a rather relaxing environment.  A very nice extended park and playgrounds seems to butt against an industrial area; the extent of the city’s charming areas extend only a short distance before the city deteriorates into a worn-down US look alike middle America anywhere town. 

Verdict:  South Dakota is a good as any tourist destination in America. Mount Rushmore is worth the trip in itself.

Chapter 3: I went to Nashville to visit my old college campus at Vanderbilt University, and out of curiosity to venture to Music City’s country western music dance scene.  I can’t remember the last time I was in Nashville, probably about 30-35 years ago. The Vandy campus had grown to a sprawling community, no longer a contained university that can easily be walked without crossing major thoroughfares. Buildings were mixed modern, and others were old and reminiscent of the old Vandy campus I attended in the late 60’s.  Its seems that medicine had taken over an increasing part of the footprint and that specialty centers for just about any type of medical care was now offered.  Vandy had swallowed several other neighboring schools such as Peabody, where many of us had to resort to frequenting looking for coeds to date, giving up on the persnickety Vandy girls who were flooded with too many suiters. Moreover, no one would prefer a Yankee to a good Southern boy.   

We went to the Grand Ole Opry and that was a fantastic experience.  Now relocated to the outskirts of the city, it was surrounded by restaurants and music venues crowded with young people watching sports, drinking beer, and eating burgers and fries.  Not everyone was overweight, but it was truly an unpleasant sight to have so many millennials frequent these establishments in an endless sea of fast food, beer, TV screens and live music all converging into a frenzied crescendo of gluttony and cacophony.  Every third person had a cigarette hanging from their lips; one young girl was passed out in the ladies’ room during one outing.  The place we went to for lunch had 18 TV sets strategically placed in direct line to easily catch the gaze of all patrons who were mindlessly rooting for one team or another.  

Downtown Nashville was not much better, lined with country western music venues, musty and weathered bar rooms with sticky wooden floors, and an endless flotilla of tourists eager to donate to the Nashville economy. I didn’t see anyone dancing other than the occasional flailing tourist with beer bottle over one’s head and a glazed look of stupor. Nothing like the memory of the past, more like New Orleans rather than old Nashville. Can’t think of why Nashville has become so expensive a place to visit or why it has become a favorite destination of relocated easterners and west coasters. It would clearly not be a place I would ever choose to return to without design or purpose. 

Chapter 4: Louisville, Kentucky was much nicer overall. Downtown was tolerable, a little drab except near the waterfront, but it was outside the center city that was pleasant and scenic. After all, it was autumn, and the bountiful leaves displayed a striking variety of bright greens, reds, yellows, and browns. There was Cherokee park where I lived during most of my medical training and internship, and I was thrilled to find the exact location of the house that I occupied during this critical juncture.  

I almost forgot to include the drive from Nashville to Louisville, passing through Bolling Green, being reminded of the historical significance of the establishment - Pauline’s, crossing over a 133-year-old bridge that we visualized collapsing under us during crossing.  We were also reminded that Abe Lincoln was born in Kentucky, and we visited his old log cabin home enclosed in a museum describing his roots and early years.  It was very pleasant especially because we were one of only a few visitors present, and we had the time and the attention of the attendants to tell the stories and answer questions.

Back to Louisville, we visited a one-hundred-year-old candy shop – Muths- and ate at a Vietnamese restaurant, both favorites of my best friend Buzz – who came from Louisville and attended Vanderbilt with me. We also had tickets to attend a Jack-O-Lantern Spectacular in Iroquois Park – a truly amazing experience worth the struggle to get there, wait endlessly in line and endure the procession of families parading around an open arena passing time to allow those who preceded our time slot to begin the adventure. Viewing the photos tells a much better story than anything described in a hyperbolic narrative.  

My visit was intended to participate in the festivities of my 50th medical school reunion at the University of Louisville, now part of the University of Kentucky state school system. I won’t bore you with the details or too many pictures of old, mostly retired doctors that we reconnected and reminisced with.  Who was alive and who passed, who was healthy looking and looked younger than 75ish, and who looked older than their age and amorphous. It gave us great joy to be there realizing we were the lucky ones, alive and able to tell our stories. We were also unanimous in our recollection of the life changing experience of the Anatomy lab, cutting and dissecting cadavers in the first year of med school.  Situated in the old medical school – now 153 years old, the anatomy lab commanded the top floor – 4th – the smell of formalin, the endless line of cadaver laden stainless-steel tables, the late-night hours we spent stuffing our brains with the alignment of muscles, nerves, vessels, visceral organs, and bones, created a sense of macabre that was not easily escaped or forgotten. Most of us had never seen a dead body, no less a room full of preserved, naked, dead bodies lined in rows and columns to accommodate nearly 100 medical students with four students assigned to each body. In any case, it made for a good story line during the reunion and probably responsible to some extent for weeding out some of the 15 of our class that never made it to graduation. Moreover, we made it a point to visit the old medical school, which gave me goose bumps until we found out that the building had turned into a Ronald McDonald House that we could not gain entrance to.  

The dinner itself was a lot of fun, and as usual in those kinds of events, I had too much to drink and was too loose with my tongue.  

Chapter 5:  There is no chapter 5; we came home the next day after the reunion.  It's been about a week since that time, and I’m packing for another trip in 3 days, this time to visit my son in his new home in Oregon.  Then back for a week and off to Thailand. I’m hoping that December will bring snow to Utah and a reason to fly to Salt Lake City for some skiing. 2023 will be here before we know it and with it, more trips to enjoy and describe.  Stay tuned!

Sestri Levanti, Cinque Terra, Milan Cathedral













Milan Cathedral




                                                  
                                                      Rapid City, South Dakota
              
Bill Clinton
Rapid City
Abe
David Sr and David Jr
downtown Rapid City

Mt Rushmore

Crazy Horse


Will it ever be completed ?


son David





                                       Nashville, Tennessee
        

                                         


                          



Grand Ole Opry 

    
                                                   Vanderbilt University








                                              On the Way to Louisville


Lincoln's home/ Monument

                                                                  Louisville 

My old domicile during medical school 
and Internship
                                                    

My Old Medical School

Vietnamese Restaurant






                             







Reunion Dinner