Uncle Lawrence and Alzheimer's

B''H

Family

I had three uncles: my mom's brother and my dad's younger twin brothers. My favorite was Uncle Lawrence, the youngest of my dad's brothers albeit by only a few minutes. He was exceedingly energetic and endlessly positive. Not only did he work 40 to 50 hours as a journeyman electrician, but he would clean the house, do the laundry, cook the meals, do the dishes, wash the floors, and maintain the house. I am afraid this, however, became a problem for his daughters when they married. Each of them, I suspect, expected their husbands to be like the father. That was not going to happen. They have all been divorced.

When he would come to visit us at our home, unbidden, he would begin to repair things around our house much better than my father would ever could have done so. He was always happy to see me, welcomed me with open arms and wanted to know about my life. Nevertheless, he was given to fits of inexplicable anger out of character with the rest of his life.

On December 8, 1941, my Uncle Lawrence volunteered for the United States Navy. He served on two carriers, the USS Princeton and the USS Wasp both of which were sunk. Being a quartermaster, he was below decks both times and escaped. Family lore has it that my grandmother received two missing in action reports regarding him. The Wasp, off Guadalcanal, was hit by three torpedoes launched by a Japanese submarine, setting off gasoline fires, leaving the ship a blazing wreck. According to my uncle, he was in the compartment next to one that was hit and told me if that torpedo had been 20 feet in another direction I would not have been talking to him. The Princeton was sunk at Leyte Gulf after being struck by a bomb. When my son and I watched the episode regarding Leyte Gulf in the documentary Victory at Sea[1], I told him to watch carefully and perhaps we could see Uncle Lawrence's ship blowup. Indeed towards the end of the episode there was film of the Princeton exploding, causing the death of more than 200 sailors on the USS Birmingham, which was alongside the carrier to help fight fires. During both episodes, according to my uncle, he spent several hours in the "drink". Luckily he was the best swimmer of the three brothers.

To Examine or Not to Examine That Is the Question

B''H

I just read an article in JAMA[1] questioning the need for routine physical examination on a healthy patient as there is no "evidence" to support this. The author then presents an anecdote regarding his own father who on a routine physical examination was thought to have enlarged aorta by palpation: leading to an ultrasound showing a normal aorta but question of a pancreatic mass; leading to a CT scan showing a , of course, normal pancreas but a possible liver lesion; leading to a biopsy (of a hemangioma); leading to a hemorrhage; and , finally, the denouement, leading  to a stay in an ICU. Cost: $50,000. Admittedly, the author is trying to pick a bone with routine yearly physical examinations but the article gives impression that examination of a "healthy" organ is worse than useless and calls into question the usefulness of any physical examination.

Since we are in the realm of anecdote let me present a few. In my career, I have picked up on routine examination six or seven abdominal aortic aneurysms of significant size. All of these patients were smokers and had a bruit. My yield on this physical finding is about 80%. I suspect the author's father's internist had never palpated an actual aneurysm. When I taught in a medical school, I told my students and residents that the key to physical examination is not to be Dr. Joseph Bell[2] but just to do it. In other words, the key is to look for the obvious not the subtle.[3] Unfortunately fear of lawsuits has made all of us order tests for insignificant findings.

Beethoven and Yiddish

B''H

Many people have asked me to tell the story of how a Beethoven sonata is related to how people speak Yiddish today. Okay, I will take a crack at it. But a warning, it is very politically incorrect.

First, some background. My wife, spoke five languages fluently, English, German, Yiddish, French, and Hebrew, where German was her best because she has studied it most intensely and spoke multiple dialects, including archaic ones; played flute, alto flute, piccolo, recorders, historical flutes, piano, harpsichord, and harp; had received performance certificates from two music conservatories, one in France and one in Chicago; had studied music with Helen Kotas Hirsch, the first woman to be a first chair with a major symphony in the United States, the Chicago Symphony; and had received a Masters degree in musicology from the University of Chicago where her major interest was 18th-century German music theory (meaning she was unemployable).

Where is Joe Welch?

B''H

(slightly cropped)

While decluttering my house after the death of my dear wife, I found this photograph (yes, that is me), taken circa 1980. Whenever I show this photo, the immediate response is laughter. If I attempted to do this today, assuming I could get this close, the end result would probably be a bullet through my head. Back then, nobody cared. I am sure if I had jumped the fence, something would have happened. We, as a country, have gone overboard.

Consider what happened to the lady who either had a mental breakdown or simply panicked when she approached or tried to run her car into the grounds of the White House. She was shot down like a dog. It is not that she was simply shot but that she was shot so many times "they had difficulty identifying her because of the extent of her injuries"[1]. If you take the time to view some of the videos taken after the incident, you will see the officers involved carrying M-4s: the same weapon our troops use in Afghanistan. Lethal military-style force with overkill was used against an unarmed civilian who probably had a psychological disorder with a baby in a car. And nobody, at least in power, seems to care.

Our country has a long history of periods of overreaction against foreign threats: the Alien and Sedition Acts over fears of the French Revolution coming to the United States; the Know-Nothings in the 1850s after the revolution of 1848 in Europe associated with the influx of immigrants from Germany and Ireland; the Red Scare after 1919,  the Russian Revolution; the McCarthy era in the 1950s; and, I believe today, after 9/11.

On continuing the process described above, I discovered correspondence between my wife's grandfather and his relatives in Europe prior to and during World War II. The letters are written in Polish, Yiddish, and German. When I showed them to my 92-year-old father-in-law to find out who was who, he expressed interest and surprise, asking "where did I get them?", having never seen them. They had sat in his basement for 30-plus years in a box after the death of his mother. I have inherited them. In 1939 the return address on a series of them changed from Lodz, Poland to Warschau (German for Warsaw) with a Nazi stamp on them. Until 1941 the postmarks in Chicago are dated fairly contemporaneously, but after that date the letters were not received until 1946. This entire family perished.

A Technician Not a Doctor

B''H

William Osler examining a patient.

I recently read an article in JAMA[1] wherein a transplant surgeon describes his consultation with a patient.
From my reading, the surgeon almost accidentally finds out the man had been shot seven times and tortured. Much to my surprise, the surgeon does not want to ask any personal questions for fear that he would be "pry(ing) too much". As far as I can tell the patient was never examined by this highly specialized surgeon at an elite Medical Center. Instead, our protagonist discovers that the patient, a Visiting Professor of Theater, has written plays about his experiences in his native land in Africa by "Googling" him rather than taking the simple human expedient of asking questions. He then orders the patient's play from Amazon.com, reads it, and is justly disturbed. His mother notices this (during Mother's Day) but he ducks her questions for fear of "violat(ing) my patient's privacy". Remember this patient has published all of this. I found this entire story quite disturbing: this physician seems to deny both his and his patient's humanity. He seems to miss the whole fun of medicine: meeting people from all walks of life and helping them. When I discussed this incident with several of my colleagues, one of them very astutely said, "Perhaps we should call him a transplant technician rather than a surgeon".

The Perfect Student

B''H

Hannah Rose told me many times that she was the "perfect student": doing everything the teachers asked in an overly thorough way. She felt thinking independently only came to her after a professor in graduate school rightfully, in her view, called her a "silly little girl" (lucky he he did this 30 years ago). This occurred when she was doing a presentation on Bach and the professor pointed out how she had stumbled on a very important question. My perfect student then continued with her pedantic report at which point the professor stopped presentation with the above exclamation and told her not to go on. This was a life-changing episode. I ask you, would this happen today? Are we too afraid to correct?

I recently read an article published in the New England Journal of Medicine roughly three years ago[1] recounting in first person singular an event that happened on an airplane to the author. A passenger coded. The author, a neurologist, and his wife, a hospitalist, began resuscitation assisted by an AED, and an Ambu bag, and other equipment. Three other physicians, passengers, an oncologist, a surgeon,  and an anesthesiologist, rapidly volunteered to help. A dang good code team.

After 25 minutes, despite the efforts of, and in the opinion of, these highly qualified physicians, the man was dead. They turned to his wife and informed her that further efforts would be useless. They called the code. At this point in time, the stewardess informed the physicians present that airline policy insisted that CPR be continued until the plane landed and that she and the other flight attendants would take over from five board-certified physicians.

Yehudit bat Aharon

B''H

Hanna Rose's actual name was Joanne Galler Rubin (Yehudit bat Aharon v'Esther V'dorah-Judith daughter of Aaron and Esther-And-Her-Generations).  She died on 24 April 2013 peacefully surrounded by friends and family.  Below are the notes Rabbi Jonathon Bienenfeld used to deliver her eulogy.

Joanne Rubin – Yehudit bat Aharon

·       We pay tribute today to Joanne Rubin, to Yehudit bat Aharon v’Esther Vedora—wife of Steve Rubin, mother of Isaac and Rachel, daughter of Mr. Aaron and Mrs. Esther Galler.

·       Joanne’s was a life that was cut far too short, finally succumbing to a protracted battle with cancer. Yet it is a life that one cannot do justice to—for she accomplished more and touched more souls in her shortened life than most people possibly could in ten lifetimes.

·       And it is difficult to speak of Joanne for another reason—because of her complexity. If you knew one facet of Joanne’s personality, you’d make certain assumptions, only to be thrown completely off guard by another facet. If you knew her from angle A, you’d soon be blown away by angle B.

·       Joanne was brilliant. Growing up in Chicago, she attended Northwestern University, then receiving a masters in musicology from University of Chicago. She was fluent in numerous languages. I was recently having a conversation about studying Talmud with Isaac, and she mentioned that she had a wonderful textbook we could use—the subject matter was ancient Aramaic, the instruction in modern German. She was a deep thinker and an avid reader—studying both secular and religious subjects passionately. If you knew Joanne’s brilliance, you would expect the cynicism that often goes along with it—a philosophy that all can be studied and all can be explained. And you would be completely taken aback by the simple, pure faith in G-d that such an intellectually sophisticated person could possess. Her brilliance made her shrewd and thoughtful, not cynical, never disbelieving. Her faith was awesome and awe inspiring. True faith is not the belief that something will happen, but that anything can happen. True faith realizes the G-d can do anything, that G-d can make miracles, but that the miracles don’t always unfold the way we might like them to.. Joanne’s take on miracles is best expressed in her own words, words she shared as “Hannah Rose,” her blogging pseudonym:

"Oxygen is smooth and comforting.  It is the breath of G-d, the elixir of life when the lungs are filled with fluid.  Oxygen keeps the body at peace while the siphon drains liters of fluid from the pleura.  Then the pleasure of coughing begins.  It is important to puff up the lungs so they may work again.  There is nothing boring about breathing.

There is nothing boring about any aspect of life.  Miracles are multi-dimensional and have nothing to do with that little purple and pink wand with the star and the ribbons and the glitter that sings a song when you tap or whack someone. Miracles assign many responsibilities.  It is difficult business to rise to the occasion of this gift." 

A Last Entry*

B''H

"Courage, courage, courage, courage, courage.... This mystery is not so great."

This is what Rachel said as she cradled my head and whispered into my ear. She stroked my head and kissed me on the kepe.

Life as a doctor

B''H

Dear Readers,

Hanna Rose has been very ill and thus has not been able to place any entries for several months.  Her husband, the "Historian", yours truly, as you can guess (vide infra) is a physician and is taking up her cudgel.  I do not write as well or as easily as she which will result in far less frequent entries. One final note, please pray for her.

Reflections on William Halsted

William Stewart Halsted (1852 – 1922) was, and still is, the most famous American surgeon. He was one of the founding faculty members of Johns Hopkins University, which was consciously set up to be the finest medical institution in the world. Instrumental in pioneering aseptic technique, use of rubber gloves in surgery, wearing surgical garb rather than street clothes, wound healing, vascular surgery, mastectomies, hernia work, and excision of goiters, he was, and is, the father of modern surgical training. Many of the finest physicians of the first half of the 20th century considered him to be their mentor.

For example, William Sidney Thayer said, "In Halsted's little operating room with the old wooden table, the antiseptic technique was so perfect that there was never a moment of anxiety. I could not believe my eyes. It was like stepping into a new world. At this time Halsted's technique was unique, the sureness and perfection of his results seem to me then… The nearest thing to a miracle that it has been given to me to witness."[1]

There is no such thing...

B"H

...as a part-time person

Ready or not here you are, a brand new baby plopped into my arms. 

You looked up at me with those big dark eyes scrutinizing every attribute of me.  You were wide awake.  After twenty five hours of labor I was exhausted, thirsty, and very hungry. You were hungry too.  You were always hungry during the day but at night you always slept, thank G_d!

Two years later your little sister was born.  The miracle of you is that you always treated her as the complete person she has always been. ... perhaps more complete than most.  And that little baby girl with Down Syndrome, our Rachel, showed you another way to experience life.  

Everywhere...

B"H

...acts of life

She did not look very strong.  Her steps were tiny and deliberate.  Most people who need oxygen constantly either wear the canister in a back pack or roll it on wheels.  This older lady was holding her metal canister like a beloved baby.  I understand.  

Oxygen is smooth and comforting.  It is the breath of G-d, the elixir of life when the lungs are filled with fluid.  Oxygen keeps the body at peace while the siphon drains liters of fluid from the pleura.  Then the pleasure of coughing begins.  It is important to puff up the lungs so they may work again.  There is nothing boring about breathing.  

There is nothing boring about any aspect of life.  Miracles are multi-dimensional and have nothing to do with that little purple and pink wand with the star and the ribbons and the glitter that sings a song when you tap or whack someone.  Miracles assign many responsibilities.  It is difficult business to rise to the occasion of this gift.  

The Letter

B"H, 

From a Desperate Realm

(early 20th century)

Oak Park, Illinois:                         There it sits... on my desk next to my bed.  Tante Sara has kindly placed it in my room while I was at work.  She even left writing paper, ink, a pen, a blotter, and an envelope to answer it.  The author is my sister Avigail.  I look at it sitting there.  We never enjoyed each other.  Why is she writing me?  I always felt that she was glad to see me leave her presence forever when I left Minsk behind me. 

Minsk, 1917, To my dearest sister, full of wisdom, overflowing with love and compassion, I write to you with humility in my heart, emptiness in my body, and fear in my soul.  Oh, my beloved Rishkeh, father writes to you that we are hungry because he does not want to scare you.  The truth is more frightening than we could ever have imagined.  We are starving.  The new buds on the evergreen trees are edible and make a sweet/sour broth only if you harvest them before the dried, brown cap falls away.  Then it is pure bitterness.   Why do we know such a fact?  I am begging you to help us.  My heart cries at the memory of every intentional pain I created especially for you.  Why did I receive pleasure from your pain and suffering?  You never did anything to harm me.  When you were old enough and thoughtful enough you simply avoided me... which made my unkind schemes ever more difficult to carry through to completion.  Perhaps our beloved mother mentored you.  Perhaps our housekeeper, Anya.  

My tears of regret fill oceans.  I beg your forgiveness in the same breath that I beg you for food.  We are starving.  ...

What's the difference?

B"H

After all these years...

It does not matter...

His name was Peter White.  

A brand new file showed up at the Jewish Family Services...  Peter White, the photographer?  Was he even Jewish?  After being a devoted member of the local Unitarian Church for over fifty years you might think, "no."  But his given name was Peter Weiss.  The son of an old Jewish family from Berlin.  They made it to the States before WWII.  

His girl friend of fifty years wanted to get married.  She told him that she would do anything for her husband.  He told her that she already did everything for him so, why bother.  He missed the point.  At seventy years old, Ruth had been with Peter since she was twenty.  She loved him but she was tired.  First she spoke with the social worker at the Jewish Family Service office.  They should know what was about to happen.  She left them a few phone numbers of his living relatives.  And then she left. 

Who am I?

B"H

O R 

My Summer Vacation

It is an old story, I suppose.  An old rabbi is sitting in his study in the middle of the night learning with Eliyahu HaNavi.  What an amazing study partner!  Or perhaps it is the peach brandy.  They read, they argue, they question, they challenge.  They finally come to the point.  ...  Who is the greatest general of all the generations of their people?  Eliyahu knows.  And he will show the old rabbi this amazing soul just after morning prayers when the market place comes to life.   The old rabbi is overcome with honor that the greatest general ever lives in their midst.  

If You Wear The Uniform...

B"H

...Are You Able to Practice What You Preach?

Why now?

A good shidduch is a good shidduch.  This is a very good young man and he is interested in meeting someone now. 

My neck is falling apart with these three ruptured discs.  I'm walking around in a Philadelphia collar.  I'm in pain.  Pain makes me grumpy.  What's the point in meeting someone when I'm grumpy?

Reality is honest, it is good.  Do you really believe that people can stay on their best behavior for an entire marriage?  Of course not!  There are times when you want to kill your spouse.

Are you trying to recommend or to discourage marriage?
***

The Attic

B"H

Dream World of a Different Era

Golden hair with gentle waves, she looked like a Russian princess to me.  Not that we learned any great love for the czar and his family.  All that I heard was that G-d should keep him far from us.  But this Russian princess had her own chest of clothing and her own dressing table and chair with a perfect little brush that matched it all.  I spent hours playing with the attic doll.  My sister, on the other hand, found an exquisite wooden horse.  That is who she wanted every time we visited Uncle's big old attic in the big old green house.      Cereal and milk was the food of choice for the horse.  Bailah said that horses eat oats and this cereal had oats.  I don't know about the milk.  My princess had tea and cookies.  And so did I.    

How long did we spend in that attic?  Who knows?  Untethered by time we spent our summer afternoons with Uncle.  When the fall began to find us, life stirred, it hustled and bustled, and carried us to a New Year with a New Book of Life where good, healthy, safe lives were supposed to be inscribed therein for us all.  

The Big Old Green House

B"H

A Shelter For Us All

It was green. It was old because there was still a carriage in the carriage house and two stalls for horses.  And it was a shelter for us because my uncle loved us all so much.  

We felt that the house had secrets.  Special hidden staircases that allowed you to appear out of no where.  A jail in the basement and tunnels that led you out of the house to cellar doors three houses down by the big old oak tree.  The sub-basement had thousands of dusty, dirty old bottles filled with something.  Who knows what was in them?  And again, more tunnels in another direction.  Those tunnels met up with brick walls.  Here and there we saw playing cards on the ground with our flashlights.  Who would be nuts enough to play cards down here?  Exploring inside was much better than hide and seek outside.  But, Uncle's neighborhood was changing.  All the big old houses were being torn down and replaced with apartment buildings.  Where once only one family lived or by our time, one old, old woman lived, now twenty families lived.  All tunnels lead to brick walls.  And the carriage was gone replaced by a car.  

Papa Was No Tzaddik...

B"H

But, Perhaps His Teacher Was.

"Listen," said my Bubbe, "Papa was no tzaddik, he was just a lonely man.  I was his wife.  I took care of him.  I fed him, I did his laundry, I gave him sons, I kept house, I made Shabbos and holidays.  I took care of his brothers one by one as they came out of Russian hell.  But, a woman gets tired as she gets older.  It's nice to sleep at night.  And that is why I say Papa was no tzaddik."  

Fragments of Confession

B"H

Another Year

Dear Beatrice, 

We just received notice of your approaching yahrzeit.  As in past years I will most likely be the one to buy the candle, set it up, and light it.  Your son, my husband, might be there because I will have called him to participate in this gesture but then again he might still be working when the time comes to light this candle... so, who knows?  Perhaps you do.  

I must admit diminishing anger.  You no longer occupy my every waking moment.  Your boxes of stuff never got dealt with to a natural conclusion.  I kept seeing things that had no connection to the version of you that you bestowed upon me.  I saw a wonderful, vivacious, and confident woman.  But that is not who I knew.  I stopped going through your worldly possessions the day I found your perfume.  

A Good Daughter...

B"H

...Makes Shabbos For Her Mama

But, there was no daughter, there were no children, and so Yosef lit the candles for his beloved Lina, he said the Kiddush, and he held the two loaves of challah close while he said the Motzi.  Lina always could speak to him on Friday night, ... to tell him good Shabbos... and she could always smile back at him when he kissed her a good Shabbos.  It was just the two of them.  And some rabbis tried to take even that away from them.  What had the world come to be?