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.

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]

An Open Letter to President Obama

B"H

Why People Hate the Government



There is a small valise beneath his side of the bed. 

"Don't touch that!" my mother said.   Her tone and manner I understood.  I never bothered it again. 

Sixty years later that valise remains ever ready, ever vigilante, still beneath his side of the bed, the contents, a mystery.  I never asked what or why.  I simply understood.

My father has always been our eyes and ears in a realm beyond the one he showed us.  We should never know what he has known.  And so, WE THANK YOU, DEAR G-D, FOR AMERICA, THE GREAT, FREE LAND, where a small valise may ever remain under his side of the bed, always untouched. 

Today with my own family and household I know of other realms.  But I have neither the time nor the tools to deal with these details.  My husband has been my eyes and ears while I care for the homefront.  This other realm requires an awareness and temperment I have never possessed. 

I introduce you to my husband, the historian.



Dear Mr. President,

First let me say I do not hate the government. The United States government has done many good and great things, to wit: the development of inter-changeable parts in manufacturing, the canals, railroads, lasts in shoe manufacturing, diesel-electric engines, nuclear power, the space program and all its spinoffs, computer technology, the Internet; freeing the slaves, defeating the Nazis, creating democratic republics in Germany and Japan, ending Jim Crow in the South, and winning the Cold war. But now, Mr. President, our government no longer seems to work.

 As we are Jewish, when my son was born almost 16 years ago, he was not named in the hospital but eight days later at his circumcision. Dutifully, 10 days later we changed his name at the Cook County Clerk's office from "Blank Blank Rubin" to "Isaac Shalom Rubin", paying our fee. We obtained a copy of his birth certificate, got him a Social Security card, and in the ensuing five years we moved six times. Fast forward to roughly two years ago, when my wife suggested we take a trip to Stratford, Canada to see Shakespeare, which unfortunately now requires a passport. We could no longer find the original copy of my son's birth certificate and decided to get another in the Great State of Illinois. My wife had no problem getting my daughter's birth certificate or ordering hers from 1955.  I, of course, have a passport and, in addition, have an original "long form".  My son's birth certificate, however, came out "Blank Blank Rubin". My father-in-law began to blow a fuse but my wife kept her presence of mind and asked what to do. The response, call the State.