Heart of a Lion, Hands of a Woman: What Women Neurosurgeons Do
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Friday, December 31, 2010

Is it a surprise?

Our population is getting older and increasingly, medical decisions are being made in a relative vacuum...what real experience is there for treating 85-90 year olds with breast cancer? how do we manage the couple each over 95 and generally healthy but now with one needing surgery?do we remove brain bleeds in patients over 90? over 95? over 100? How do we guide our decisions? And are the 85+ of today like those few who may have been studies a decade ago? and perhaps more importantly are today's 85+ the same as those that will reach that milestone in the next 1-2 decades the same?
There is so little that is known about this entire issue.  I have been proposing for years that a fortune could be made by the right enterprising person in establishing specialized medical facilities for our "geriatric" population.  I know we now have geriatricians but that doesn't mean we have figured out how to best administer care to this population or how to best manage their multifaceted issues.  Most people I know (personally or professionally) who are over 65 are seeing a minimum of 3 physicians and many are regularly seeing 5 or more (PMD, cardiologist, gynecologist, gastroenterologist, urologist, orthopedic...).  I see a high incidence of depression and as a specialist unrelated to most of the "common" disorders, I sense a complete lack of understanding of (on the patient's part) of the purpose of their medications and (on the doctor's side) or their potential for interaction.
So I was not the slightest bit surprised to see a recent article in the NEJM that demonstrated that coordinated care for medical and psychological issues leads to better outcomes.  The only surprise was that such a study need be done to prove such an obvious concept.  Our health care system is truly challenged and will only become more so with the advancing age of our population-we need to find a new paradigm for treating this group of patients and to better understand the effectiveness (and thus the need) for our interventions.  This must be a rallying cause for 2011!
The best over 90 woman I have ever known-my Grandmother Frieda

Friday, December 24, 2010

Anniversary

I was surprised to learn that I had missed the first anniversary of my blog (December 4).  Perhaps that is in part because I started out so slowwwww and really note the start more to January than December.  I have remarked before that my goal when starting the blog was to generate excitement about a book: Heart of a Lion, Hands of a Woman: What Women Neurosurgeons Do but it has become my "therapy"-a way catharsis for the stresses of being a neurosurgeon, mother, wife and all that comes with those "jobs" and responsibilities.  Writing on a regular basis again has given me a new view of the world and my daily experiences in medicine.  I have thrilled to see that people from most corners of the globe have at least opened my blog (and perhaps read it) and that some of my pieces have seemed to strike a note in the hearts of some of my readers.  I have particularly enjoyed the opportunity to resume writing poetry and sharing my travelogue from my "Roots Adventure" in Poland/Germany.  Thanks for tuning in-hopefully 2011 will be even bigger, better and more rewarding for all.

Monday, December 20, 2010

NYC Secret


Everyone knows about the spectacular views from the Empire State Building and before 9-11, the vistas from the top ofthe World Trade Center on a clear day were unrivaled.  Less well know but equally rewarding is the Top of the Rock with its historic and remarkable 360 degree panorama.  Before the cold winter days set in, I booked my reservation (I strongly recommend you take the 5 minutes to book on-line before you go-saves time and much hassle) sped upwards in the express elevator packed full.  I must confess, I have always been a sucker for a good view and while I have no problem climbing, having rapid elevator service is nice.  There are several really nice things about the Top of the Rock-for one, you can get outside and have views unobscured by windows.  Central Park stretches out on the northern side (filled with autumnal colors when I visited) while southern exposures look down on Times Square.  The architectural detail on the terraces is also noteworthy.  The gift shop (most items a miss) does feature some haunting photographs of these architectural details combined with historic scenes.  The sky was so clear during my recent visit that I could see far into Westchester, New Jersey, Brooklyn, Queens and Staten Island-truly remarkable.  I have already vowed to return one night as I have no doubt the effect will be magical.  Recently, I commended the place to a coleague who was looking for the perfect place to "pop the question". 

Friday, December 17, 2010

Pearl Harbor Day

I watched Monday Night Football as usual
They reminded me it would be Pearl Harbor Day
They said to thank those of that generation

I walked into the ICU and there he was
A shadow of himself but just the right age
Unable to understand or relate his secrets

But then his brother came and told all
13 brothers, all served, all survived
And my patient-the most special of them all

Behing the German lines he served
Scouting out targets, the most dangerous of spies
Directing the bombs to arsenals and more

So I said thanks, to his brother first
And later I crept in quietly
Held his hand in mine.

He had given much for so many
I was happy that I could repay with my hands
In some small way.

And days later when the fog cleared
And he spoke again and walked
I smiled even more.

Monday, December 13, 2010

Journey Back-Poland (Germany) 7 (Halberstadt)

Streets of Halberstadt
We don't know why my grandmother's family left Poland when she was three and moved to Halberstadt (200 km southwest of Berlin near to Magdeberg).  It may have been motivated by a particularly gruesome pogrom (there is historical evidence for this), by the need for better employment opportunity (there is the suggestion that my great-grandfather had trouble finding work), by the growing and thriving Jewish intellectual community, or my some combination of all of these.  What we do know is they were not the only family to make this move so they had a number of contacts and perhaps friends among from Smigrod among the community in Halberstadt. So perhaps it was fitting that when my mother and I arrived for our visit, we were greeted not only by our guide but by a visitor from Israel who was originally from Smigrod but who had grown up in Halberstadt (knew my great-grandmother) before fleeing the Nazi's as my family had done.  
Mom getting oral history
And so we settled in not only for lunch among resettled Russian Jews (who are the only current Jews inhabiting this city) but for tales of life in Halberstadt, including ones about our family.  A culinary and emotional treat!  I learned that my great-grandmother was known for her baking-the neighborhood children would gather outside her home when they knew she was baking in hopes of catching a morsel or two.  She also confirmed where my family lived so we were able to visit not only the street but see the actual home!  We had left a relatively short time to visit Halberstadt on our way from Poland to Berlin and after meeting this woman, I regretted our plan.  Here was a slice of history and our opportunity limited.  Fortunately, we also learned that in Israel, she lived near to our relatives ther and through the wonders of modern technology, she has now met them and has continued to relate her oral history and memories to us through them.  So the world may indeed be flat!
"Silk Bag"-my family's street
Mom in front of our family's home

One of our priorities in Halberstadt was to visit the grave of my great-grandfather.  For some reason, the Jewish cemeteries in Germany were sometimes left alone (I have previously written about the desecration of most of the ones in Poland) and we knew with advanced arrangements, we would be able to pay our respects.  Our guide first showed us around the remains of the synagogue, a lone wall standing in a semi-arranged garden as silent memorial to Nazi devastation.
Synagogue in Halberstadt-silent memorial
We then traveled through the other limited remains of what was once a thriving, prosperous intellectual center for Jews including a Mikva.  One of the former synagogues (Berend Lehman) has become the Moses Mendelssohn Academy serving as community center, gallery and overseer of Jewish history.  We then made the short trip to the large cemetery where we located Joshua's grave and said I said a silent Kaddish.  Here, more than anywhere else I had been on this trip, I felt inexorably connected to my ancestors.  I guess there is something to be said about gravestones as a palpable way to honor our past.

Soon after, we said goodbye-we had one final stop to make before returning home.  Following my grandmother's path, we pointed ourselves toward Berlin-where she traveled after marrying my grandfather.

Monday, December 6, 2010

Relief

He took himself to Ghana
To search his inner soul
Or so he told us,
When he clearly failed all else.

At first the stories flowed
Through Internet Cafes
New friends, new loves, new life
The experience of a life!

But then the current stopped
No calls or otherwise
A few days then weeks flew by
I imagined so very much

And just like that it came
A call from another shore
All fine, not even aware
Of a mother's eternal woe


Note:  Thanksgiving may be past but today I am thankful all over that all is well.

Monday, November 29, 2010

Venice: First Look


My Venice

I have just returned from a fabulous, relaxing trip to Lake Garda, Venice, and London.  As soon as I returned, I was stuck into the whole Thanksgiving Holiday and am just now coming up for air.  I look forward to writing about some of my adventures and the highlights of this very special journey.  For now, I thought I would tempt you with my photographs.
Venice Photographs

Monday, November 15, 2010

Traveling: Happy Thanksgiving!


For the next week, I will be traveling through Venice and the Veneto.  When I travel, I like to remove myself from the routine as much as possible and for me that also means my connection to computers and the internet.  SO I will return around Thanksgiving time.  To all my readers, I am thankful that you are there and take the time to read my musings.  I hope you have a joyous, warm, and peaceful Thanksgiving holiday.

Friday, November 12, 2010

Creating Balance

I recently addressed a group of enthusiastic medical students considering neurosurgery as a career.  I spoke on creating balance between a demanding career and home/life/family.  The following is a distillation of that address.

My mother told me I couldn't be a "superwoman", the somewhat pejorative term used for early generations of working women who were also moms and more.  Fortunately, I lived in a different era than my mother and my options for lifestyle choices were greater.  Those of you entering the workforce 20+ years later have even greater options.
Achieving balance requires:

  • Hardwork
  • Dedication
  • Creativity
  • Constant re-assessment
  • A little bit of luck
There are so many variables in every confluence of work/home/family that there is no one answer that will work for everyone.  That being said, those entering this world now need not re-invent the wheel-there are now many who have blazed the path and found creative solutions that may apply to others situations.  There is no magic, just real life people who have found there way in the brave, new world.

What are some of the greatest challenges/questions to those who wish to enter a career such as neurosurgery?

  1. If I become a neurosurgeon, who will take care of my children?  You have many options:you, your spouse, friends, nanny, au pair, or day care.  I chose to place my children in day care though when I completed residency and moved to NY, I found I needed to supplement that with a caregiver who collected the kids from daycare and started their dinner.  Of course, they soon became much more independent and soon needed more taxidriver than babysitter!
  2. If I am a neurosurgeon and have a family, how can I exercise and live healthy?  This can be a challenge but certainly eating healthy (packing your lunch, for example) takes no more time than the alternative and actually saves money.  Consider just walking 15-20 minutes a day until family life stabilizes and permits more.  We started walking with our children at a young age so the fitness of hiking became an important family activity!
  3. If I am a neurosurgeon and my spouse also works, can we find jobs together? Sure, this is a challenge and you may have limits on your choices but employers like stability and if two of you are connected to a job (or region/city) that is a big plus.  These days, many jobs (though not neurosurgery) allow work from home for all or part of the week.  There are many options.
Just a few more myths/truths:

  1. You can't have it all-TRUE! Even in an ice cream shop one must make choices!
  2. There is never a good time to have children-TRUE! But we try to choose better times and know that for generations, we have survived this challenge, too.
  3. Few go to their grave wishing they worked more/earned more money-TRUE.  I do know many who have regretted missing that school play, the birthday party, or sitting by the bedside of a loved one who will soon die.
  4. There is one right way for...marriage/parenting/career development-FALSE.  There are as many options and paths as there are stars in the sky!
  5. Working longer hours increasing productivity-FALSE.  Many studies show that those that structure their day and leave the office at a reasonably scheduled time outperform colleagues whose days stretch on for many additional hours.
Don't be afraid of change! Inertia can be your enemy in life.  Live, love, and follow your dreams!

Sunday, November 7, 2010

Face of Opportunity Entry: Confronting Type-2 Diabetes in 21st Century


A colleague and friend of mine (and contributor to Heart of a Lion, Hands of a Woman) is trying to create the opportunity to build an educational medical community in her native Zimbabwe.  Please support her noble cause by voting for her submission!  She and I and many others thank you.
Face of Opportunity Entry: Confronting Type-2 Diabetes in 21st Century




Cholera in Zimbabwe

Friday, November 5, 2010

Journey Back-Poland 6 (Wroclaw)

Wroclaw Flower Market

From Tyczyn, the drive on to Wroclaw was long and arduous.  Despite significant growth and modernization, the main road of southeast Poland remains just two lanes with multiple lights and intersections.  As we approached the outskirts of Krakow, the road finally became highway and the pace picked up considerably.  As late afternoon arrived, we finally left the main road and navigated the usual bedlam of the old city.  Our hotel (Art Hotel), was just a 1/2 block from the Rynek where we headed once we had dropped our luggage and parked the car (no small feat in a teeny, underground lot).  Unlike most of our prior stops, Wroclaw-while enormously historic-had no specific, personal poignancy.  The city is the main city of Lower Silesia and is situated on 12 islands in the Oder River.  The city was part of Germany for much of its history (known as Breslau) accounting for architecture distinct from much of nearby Poland.  After WWII, the city was re-inhabited by Poles, many displaced from eastern Poland which had become part of Ukraine.  During the 1980s, Wroclaw was central in ousting Communist rule from Poland, orange graffiti gnomes were both secret communication and symbol of the revolution.  Today, small, nearly hidden gnome sculptures dot the streets in tribute to this past.
Wroclaw Gnome-symbol of resistance
Adjacent to the main square is Plac Solny (originally where salt was traded) which has become a colorful flower market surrounding a stunning fountain.  From there we wandered through the old city, across many bridges and through the streets of the historic university.  Some of the joy of the city was turning a corner and encountering an unusual piece of local art.
Wroclaw Civic Art







It was restorative to have a few hours to just wander and not concentrate on family or Holocaust history and the streets of Wroclaw were a perfect balm.  To rest our feet, we stopped at an outdoor cafe and sipped cool, local vodka and beer while watching the locals stroll by.
Wroclaw's amazing Rynek
After dinner, we couldn't resist the opportunity to return to the Rynek and we weren't disappointed.  The soft glow of the lights only highlighted the unique architecture and the brilliant fountain.  Some call this the Venice of Silesia...I can't really comment as I have not yet seen Venice (stay tuned as I am scheduled there in mid-November) but I can say that it seems a lively, vibrant, modern city steeped in history, science, education, and architecture.  A welcome respite.  The next day we would head back into Germany, following in my grandmother's footsteps.

Wroclaw Rynek at night

Monday, November 1, 2010

Neurosurgeon Foodie

Last week I was finishing up my pre-operative routine with a lovely woman suffering from a recurrent brain tumor when she stopped and inquired whether she could ask a strange question.  I know this patient and most of her family well so I figured, sure, why not? I nodded and she continued-I was seeing my podiatrist the other day and I told him I would soon be having brain surgery. He asked who my doctor was and when I mentioned you he grinned and said, "She makes the best butternut squash soup I have ever tasted."  I laughed and my patient continued, he wants to know how much heavy creme you use?  Now I could really smile, "None, and it is all vegetarian, too."  Her extended family immediately asked for details.  For them and for any of you who may want to enjoy this fall favorite of mine, here is the recipe.
BrainDame's Butternut Squash Soup

1 medium butternut squash
1 medium to large white onion (peeled and diced)
1 tbs cumin (toasted and ground)
1 tbs aleppo pepper
1-2 quarts good vegetable stock or bouillon
Salt and pepper to taste


  1. Cut squash in half lengthwise and place face down on greased pan, bake at 350 until flesh soft.  Cool.
  2. Scoop seeds out of squash (save if you want to roast them), then scoop flesh away from skin and save pulp.
  3. In a large sauce pan, sauté onions in small amount of oil until soft.
  4. Add toasted cumin and pepper and stir.
  5. Add prepared squash pulp and cover with stock.
  6. Simmer for at least 15 minutes.  Adjust seasoning.
  7. Puree soup (in pot with hand held device or in blender) and adjust consistency with additional stock if desired.
Enjoy!

Saturday, October 23, 2010

Going, Going, Gone

Last Thursday my husband drove both my son and me to JFK airport.  I was leaving on a routine flight west to San Francisco for a neurosurgery meeting.  My son was departing on a bit more of adventure.  Early that evening,  Daniel would begin his full day journey to Accra, Ghana and then on to the remote village of Akropong where he will live with a Ghanian family and work on building projects (schools, community buildings) for three months.  Like many late teenagers, Daniel had been been nothing short of challenging for much of the last few years and I had long anticipated the day he would depart for Africa-a chance to gain a little corner of peace and quiet.  So I was unprepared for the emotions that flooded through me when I had to finally hug him and say goodbye.  I spent much of the first part of the journey to California completely unable to complete any of the work I desperately needed to do.
A week has passed and we have received a very brief communication that he arrived safely and another with some very rudimentary details about his placement (he is an hour from the nearest internet cafe and cell phone reception is inconsistent and very expensive).  We do know it is very hot and that the work proceeds slowly as a result.  He has met many other volunteers and in one of those amazing coincidences, one grew up in the same town as his British father!  Perhaps he will make his way to an internet site this weekend and we can see some photos and hear more about his existence there. For now, I have made the decision-for reasons I can't really explain-that I will only communicate with him via hand-written letters.  Perhaps I think he will enjoy getting mail and perhaps it seems more personal and appropriate given where he is living.  It is strang being 2010 and having a loved one be away for a really extended period of time (7 months total) with little means of communication.  It takes me back to when I was growing up and even long-distance phone calls were unusual and very short.  It also reminds me how dramatically communications have changed in a relatively short period of time!
Daniel wanted to get away and to do something completely different that also helped mankind.  It seems he has accomplished that geographically.  I hope the emotional change will also be all that he seeks.  For me, I will be in New York waiting...yes enjoying the lack of mess, late nights, and overly boisterous behavior but also wondering what will great me when we reunite in May 2011.
Daniel leaving home for Ghana

Monday, October 11, 2010

My Oxford Challenge


My son is going to do volunteer work in Africa for 6 months and was prescribed malerone to protect him against malaria.  He obtained the prescription, took it to the pharmacy AND...we were told it would cost nearly $2000, even though my health insurance policy carries an expensive prescription drug benefit.  Thus began my odessey with Oxford.
First Call: (32 minutes): Informed it was not a covered medication because it was for travel.  They agreed that there was no such provision in my policy but that was "Oxford's general policy".  Informed I could ask for an APPEAL OF COVERAGE, expedited with an answer in 48 hours.  Great.
Wrote appeal, sent to provided address with registered mail.
Second Call: (48 minutes): Requested response on appeal, informed after some time that in fact medication was covered and what I needed was a QUANTITY LIMIT OVERRIDE APPEAL since he had 6 months of pills ordered and was only entitled to one.  Again told an expedited appeal would be answered in 48 hours.
Faxed appeal as instructed.
Third Call: (32 minutes) Couldn't find my appeal, couldn't find anyone who could tell status of appeal, tried to get through to a medical department and was told they weren't answering their phones I could continue to hold or call back later...as I had to go back into the operating room, I concluded the call.
Fourth Call: (36 minutes) Got lovely woman who apologized profusely for all the calls and trouble but after invetigating informed me in fact malerone was NOT a covered medication! After I got a little angry, she put me on hold, and ultimately agreed I needed a QUANTITY LIMIT OVERRIDE APPEAL and gave me a different fax number and instructions how to use the facesheet to prompt a definite response.
Re-faxed appeal as instructed.
Fifth Call: (49 minutes) Kind man said the pharmacy stated I could only get 2 months worth-I tried to remain calm and ask why the appeal had been rejected and who could I speak with as the whole point of the appeal was to OVERRIDE this limit and I though as he would be far from a real pharmacy and even a reliable postal service I had good grounds to request this.  I was put on hold again and when he returned he apologized profusely and said I was misinformed...what I needed was as VACATION OVERRIDE APPEAL-this process means I have to purchase the medication out of pocket and then after I complete 5 pages of paperwork (without leaving out a single crucial item), Oxford will decide if I am entitled to reimbursement that they can send me at their leisure.

And we wonder if our health insurance system is broken?
Bon Voyage!

Friday, October 8, 2010

My Nudge Contest

nudge 
tr.v. nudged, nudg·ing, nudg·es
To push against gently, especially in order to gain attention or give a signal.
nudge or nudzh or noodge Slang (Yiddish)
n.  
One who persistently pesters, annoys, or complains.

Of these definitions, my Yiddish-flecked childhood reflected primarily the latter. So, thanks to Howard Luks for first bringing the notion of using the nudge (ie first definition) to medical use and studies that have shown the clear effectiveness in areas such as diet and exercise.  For those who haven't had the time to absorb the ever-expanding global world of nudges, I can recommend the nudge blog by Thaler and Sunstein devolved from their book of the same title.  The concept has acquired so much traction there has been a serious call for research into the effective use of the nudge in medicine.  Already in Australia, when filling a prescription, an Aussie can enroll in a nudge club that will prompt proper use of the medication.  The daily nudge is a service you can use to create your own health inducing nudges.






So here is my challenge: Submit you best idea on how to use THE NUDGE  to promote health!  Think big or small, technical or spiritual, systems or individual.  Humor welcome.  Please submit to: womenneurosurgeo@aol.com

Monday, October 4, 2010

Autumn High

The cool air assaults me as I step outside
The dogs lope gracefully in anticipation
The sun glints against the coloring leaves
Some trees already ablaze in glory

The trail is firm and welcoming
The dogs throw caution and romp
Light filters and flickers through thinning leaves
Our feet crunch on already fallen

Apples crisp and pears, too
Cider bracing and sweet every morning
Still produce in great abundance
Meals a treasure like no other time

My autumn high

Tuesday, September 28, 2010

Journey Back-Poland 5 (Rzeszow and Tyczyn)

Town Square Rzeszow
We arrived in Rzeszow (don't even try and pronounce it) following an extremely long and emotional day (we dropped our guide at his family home.)  Navigating the old city center to find our hotel-even with a GPS and detailed Google maps-proved a major challenge.  In the end, we succeeded through the kind help of a police escort-our first sign that we were in a special place.  And special it was!
New Synagogue Rzeszow
Old Synagogue Rzeszow
Our hotel looked out over the spectacular, colorful square seen above and was crowded with enthusiastic locals enjoying a sun-drenched drink while watching World Cup soccer on strategically placed huge screens.  the local tourist center had already closed but there was plenty of light so we followed our interpretation of the Polish map to find the two rebuilt synagogues.  I always find it amusing to see the "old" synagogue and the "new" nearly side-by-side.  These two were huge and spoke to the large population of Jews in the region for centuries as well as their relative prosperity and freedom.  Again I was directly confronted with the sweeping destruction Hitler promulgated in just a few short years.  A small plaque on the new synagogue gave a poignant tribute.
We slept and ate well, rising early for what we knew would be another long day.  Our guide rejoined us and we headed due south to Tyczyn, the family home of my grandfather.  The town dates back to 1398 and underwent the usual sequential sacking and pillaging through the ages ultimately becoming a part of Galicia (of the Austro-Hungarian empire).  The town square sat on a small hill, commanding control over the surrounding rural villages.  The Stryj River was nearby and served multiple purposes including swimming for the local boys!  We had spent some of our many driving hours reading a memoir of one of his brothers and had already learned about the remarkable mobility of this community-both during times of distress (pogroms) and for business (trading and commerce).  Unlike the villages we had visited the day before, the Jewish population of Tyczyn was relatively small (under 1000) and in the minority (though there were still two competitive synagogues).  As elsewhere in this region, the Jews were primarily shopkeepers.
Rynek Tyczyn
The town square was small and shaded, anchored by the Rynek (town hall).  Within the town hall we found the library where an extremely helpful woman showed us her impressive section of local history books.  While many were in Polish, just looking at the photos was worth the time though there was great focus on the many churches and Christian life.  Then suddenly she seemed to remember something and pulled out what looked like a college term paper-our guide grinned and translated: The Jews of Tyczyn! Here was gold-an entire treatise, even if it was in Polish.  After a set of negotiations, she agreed to let us take the manuscript to the one nearby copier so we could have it properly translated back home (I did leave my passport in exchange).  Just as we were about to leave with our precious document, she called us back, with the even more startling news that the author was still alive and living in Tyczyn!  More chaos ensued as our guide acquired the telephone number, called the author, was declined a visit.  Clutching our precious sheets, we emerged back onto the square, found the copier (hidden in the back of a tiny variety store) and began to circle the square to identify the crumbling remains of the synagogue when the next miracle struck-for some inexplicable reason, the author now called back and agreed to a visit!
For the next hour we were thoroughly entertained by a remarkably healthy 90 year old who managed through a combination of English, German and Polish to relate many memories about his life in the village.  During WWII he had been forced to serve in the German army (having been a Polish army officer before the occupation) but after being wounded, returned to witness some of the final carnage extracted upon the Jews.  His property bordered two important landmarks-one was a dilapidated, abandoned, crumbling home that he identified as belonging to the Tuchmans who were cousins of my mother!  Apparently no one wanted to disturb the building as it was known the last inhabitant were the mother and children who had been shot by the Nazis right near the village.  The second was the Jewish cemetery.  While the cemeteries we had seen in Smigrod and Dukla were chilling, the one in Tyczyn was overwhelmingly somber and distressingly sad.  The large plot is fenced and locked, access is almost impossible, and it is clear there is little care given to the place.  Through the fence, we could just glimpse one remaining tombstone-standing in silent witness and memorial.
Cemetery Tyczyn
We thanked our gracious guest, understanding just how special it was to have met and talked  with someone who walked the streets with my grandfather, who visited my great-grandfather's store and who had taken the time to write down what could have become the lost history of the Jews of this small town. As we left, Mom took a few mournful photographs of the Tuchman house, we claimed the copies of the manuscript, retrieved my passport and headed out of town.  A long drive was ahead of us-it would give us both time to ponder another rewarding, revealing but emotional day in eastern Poland.

Monday, September 27, 2010

A Thoughtful Man

I recently read a commentary by Dr. Manoj Jain in the Washington Post about the impact of malpractice on the way we practice.  Dr. Jain has become a physician leader in the arena of quality improvement and he writes honestly about the spiritual jolt every physician feels when they receive news of a malpractice lawsuit or even a potential lawsuit.

"I stood, stunned. My white coat, which held the daily tools of my profession -- my list of patients, the Sanford antibiotic manual, a black stethoscope -- felt extraordinarily heavy."

He relates the statistics all physicians know so well-that most suits (>80%) involve NO malpractice and also that injury that results from medical negligence (98%) never result in a malpractice case.  Before concluding he reminds us about the cost of this errant system.

"A lawsuit threatens my livelihood. It alters my judgment; it's like the difference between the "right thing to do" and the "politically right thing to do." Surveys of physicians conducted by the Massachusetts Medical Society found that 80 percent practice "defensive medicine," ordering extra tests that some say add billions annually to our health-care expenditure."

I wish more conversations about liability reform could maintain this civil, thoughtful analysis rather than the usual hyperbolic rhetoric.
Dr. Manoj Jain

Friday, September 24, 2010

Robert Glick-Neurosurgeon

The following is reproduced from Heart of a Lion, Hands of Woman: What Women Neurosurgeons Do .  With the holidays approaching, I thought you might enjoy!
Thanksgiving from hell…Almost! (1996)


Roberta Glick, M.D.
Roberta Glick

I am eight months pregnant. I am 43 years old. My husband invited 20 guests, “his family” for the “second night” of Thanksgiving. Need I say more.
Let me give you some background. Several Jewish Holidays have traditional second nights, including Passover, Rosh Hashanah and Hanukkah (which has 7). In this era of “post-modernism”, we’ve created a new tradition of “second night” of Thanksgiving at our house. Friday night following the usual Thanksgiving celebration, we invite my husband’s brothers and their families who have come into town for the grand Thanksgiving party held at my step-mother-in-law’s house. We also invite several of his relatives from the side of the family we don’t see on Thursday, and other friends.
Our party was originally for 10 to 12 people and I was told, by my husband, “Don’t worry, you won’t have to do anything”. By Tuesday before Thanksgiving, the count was up to 16 people. By Thursday, Thanksgiving Day, it was 17. And by 3 p.m. Friday, it was 20. Our “traditional “second night” meal is spaghetti. The recipe is one my husband’s mother used to make for the kids some 25 to 30 years ago. She was an artist who died of breast cancer, and her legacy includes her 3 sons, her paintings, and her spaghetti sauce recipe. We still have the original one written on disintegrating paper.
My 5 year old son and I spent much of Wednesday and Thursday evenings decorating the house for Thanksgiving and Hanukkah (which was one week after Thanksgiving) and setting the table. Because it was Friday night, the Jewish Sabbath, we light candles and say blessings over wine and bread, challah. The table must be set so that all of the woman have a set of candlesticks to bless, all the men have prayer caps (yamalkes) and everyone has a special Kiddush wine glass and prayer book. This is in addition to all the usual silverware, dishes, drinking glasses, and wine glasses.
I am going to reveal one of the very guarded secrets of marriage that no one ever talks about. That is, before a party, there are tremendous tensions and “discussions” between spouses. Something like this. I, of course, am the one with great expectations who wants to make a “perfect party” with matching cloth napkins, lovely polished silverware, glistening crystal, fresh cut flowers, and candles. But I’m no Martha Stewart, nor do I know who Martha Stewart really is. I’m a working pregnant mother, with grand illusions and with morning sickness for 8 months.
My husband on the other hand, believes that good food and good friends are all you need for a great party, and don’t worry about the rest. “We can use paper plates and paper napkins,” he says, as I cringe, appalled. So after two days of “setting up”, as my son calls it, I thought everything was under control, especially since my husband (Don’t worry, you won’t have to do anything but rest and relax) had ordered flowers, chickens, all kinds of salads, fruits, cakes, pies, and other desserts from a wonderful local caterer.
So feeling confident, we went to the circus. On the Friday morning of the dinner party, we decided to take 12 brothers, sisters, nephews, and nieces to the 3-ring Barnum and Bailey Greatest Show on Earth. It was a great time.
After the circus, at 2 in the afternoon, we went to pick up the food at the caterer’s shop. But the caterer was closed. No one answered the phone or the pager number that we had been given. Because we had used their services often in the past, we totally trusted the chef (a 450+ pound guy who was always sitting down when we saw him). He was obviously a great cook. We had even faxed our order 2 weeks in advance and received a return fax message earlier in the week. So why worry. I kept telling my husband, “Let’s give them another hour, they’ll show up”. Always the eternal optimist, I am.
At 3 p.m. we had to reset the table from 17 to 20. Actually, we had to add a third table for the kids and rearrange all the furniture in the living room to accommodate it. At 4 p.m., still no word from the caterer. Dinner was called for 6 p.m., and all we had so far was spaghetti and spaghetti sauce. My husband said, “I better go shopping””.
“What about the flowers?” I asked.
“I’ll pick some up,” he said.
“Find a bakery and use the health food store for fruit and chicken,” I said.
“I will,” he answered.
“Stop and Chop” became our mantra because at 5 p.m. we started making green salads and fruit salads and chicken for 20 people. In the meantime, maybe it was hormonal (which translates as the unknown “woman” factor), maybe it was my way of dealing with reality and insanity all at once, maybe it was because I was 8 months pregnant, but as I was getting out more silverware to reset the table, I sat down on the kitchen floor and started shedding tears and having bouts of laughter in succession.
A race to the finish. The first guests begin to arrive. I handed them knives, cutting boards, bowls, and plates to help prepare the food. Finally dinner was ready and we all sat down. Just as I was sitting down and finally relaxing, the phone rang.
It was a friend whose father, a university professor with some recent visual and mental changes, had just been diagnosed with a malignant brain tumor. He called to tell me that he had been doing some reading and found out that this tumor, called “Glioblastoma Multiforme”, was the worst tumor one could have and that his father may have only a few months to live. He was shocked, and severely upset and angry all at once. Portable phone in hand, I left the table and wobbled back to the kitchen to talk to him.
When I returned to the table 15 minutes later, I realized that a Thanksgiving party that nearly went off track, one that I knew I would laugh about later, in the years to come, was not the life drama or tragedy I saw it as just minutes ago. My perspective on life at that moment was like looking through a telescope as I refocused the lens. As I looked around the table, I was thankful for all the good friends and family, joy and good health, and good times we were able to share that night.
And I thought of my friend.

Note: About one hour into the dinner, we received another phone call. It was one of the partners of the catering service apologizing and letting us know that they went out of business that very day. Something about taxes. They didn’t even offer a cake.

Monday, September 20, 2010

Sad, So Sad

She was 78 with bones to thin I could see through them on xray
And a spine so crooked, she could challenge a pretzel
She had seen three world class surgeons who had said "No"
But here she was,hope in her eyes, asking for my help

She was 78 and in pain and her predicament so sad
Her problem was nature and the bad hand it had dealt
And no medicine nor surgery could outwit Mother Nature
So no one wanted to help, it just wasn't their job

She was 78 and her husband even older
No one wanted them to suffer but there was no easy answer
And together they refused to accept and so on they wandered
Wasting resources and time and getting less help than they should

She was 78 and in pain and the system conspired
So that she kept up her futility, remained in great pain
And once again, I shook my head and knew in my heart
She had failed the system and the system failed her.



Friday, September 17, 2010

Waking Up America

In Sunday's NY Times, Thomas Friedman confronts the issue of what ails America with such directness, it struck me like a bolt of lightning.  In talking about why many of our systems have failed to thrive (e.g. education), Friedman places the balme squarely on individuals and the resultant collective mentality.  He writes:
We had a values breakdown — a national epidemic of get-rich-quickism and something-for-nothingism. Wall Street may have been dealing the dope, but our lawmakers encouraged it. And far too many of us were happy to buy the dot-com and subprime crack for quick prosperity highs.
In contrast, he talks about the "Greatest Generation" and why they succeeded:
First, the problems they faced were huge, merciless and inescapable: the Depression, Nazism and Soviet Communism. Second, the Greatest Generation’s leaders were never afraid to ask Americans to sacrifice. Third, that generation was ready to sacrifice, and pull together, for the good of the country. And fourth, because they were ready to do hard things, they earned global leadership the only way you can, by saying: “Follow me.”
He adeptly depicts our status quo:
For a decade we sent our best minds not to make computer chips in Silicon Valley but to make poker chips on Wall Street, while telling ourselves we could have the American dream — a home — without saving and investing, for nothing down and nothing to pay for two years.
And to tackle our current malaise our national debate must begin between:
Democrats and Republicans who start by acknowledging that we can’t cut deficits without both tax increases and spending cuts — and then debate which ones and when who acknowledge that we can’t compete unless we demand more of our students — and then debate longer school days versus school years — who acknowledge that bad parents who don’t read to their kids and do indulge them with video games are as responsible for poor test scores as bad teachers — and debate what to do about that.

Thomas Friedman is probably one of the better known opinion writers for the NY Times because of his many best-selling books including The Flat Earth (how the internet is changing the world ), Longitudes and Attitudes (the world after 9-11) and The Lexus and the Olive Tree (globalization).  I was fortunate to hear him speak and to meet him in a small forum afterwards.  I have generally found his writing thought provoking but perhaps mildly simplistic and sometime redundant.  However, this Sunday he wrote this column that is clear, direct and thoroughly appropriate not just for education and politics, but for medicine as well-we need far greater honesty from all sides of the debate and then greater cooperation in finding creative solutions to move forward.

Monday, September 13, 2010

Journey Back-Poland 4 (Smigrod and Dukla)

Zmigrod Seal
Now the time came for us to delve into the very personal portion of our journey.  Up to this point, we had gotten a taste for Jewish life in Poland but now we would visit the very cities and towns where our fore-bearers had been born, lived and worked.  To do this, we had hired a local guide who knew the area, had some experience with genealogical searches, and perhaps most importantly-spoke Polish.  We left Krakow and headed East into the foothills of the Carpathian mountains.  Our first challenge was traffic-usually bad in this rapidly developing part of the country but made impossible by recent floods that had rendered nearly all the local bridges impassable.  After driving for what seemed like hours, a kind trucker finally escorted us through a most convoluted route and delivered us very close to Nowy Zmigrod.  In preparation for this trip, I had found incredible information about Zmigrod and the surrounding region on shtetlinks.  The town had a long Jewish history dating back to the 15th century.  From then until WWII, the population of the town was about half Jewish.  Along with several surrounding towns, Zmigrod was an important component of the Ukrainian-Hungarian trade routes-critical in the wine/salmon/horse and timber trade.It was an important center of Jewish learning and boasted two elaborate synagogues!
Old Synagogue-Zmigrod
Unfortunately, there are few remnants of Jewish life in Zmigrod today.   After a stroll around the town square, we made a futile attempt to establish which buildings might have been the synagogues.  From our research, we had a map of the town at the turn of the 20th century but nothing connected-our forays into several local shops were rebuffed, the purveyors seemed concerned by our enquiries.  Next we tried the municipal center and after several false starts, we were directed to the cultural center, home of the local historian-an individual working hard to establish a Galician museum.  What luck! He was a treasure of information.  He had many old photographs of the town, showing the splendor of the square and of its Jewish heritage.  Later he proudly took us on a tour of the Jewish cemetery, just outside of town.
Cemetery Zmigrod
Covering more than four acres and four centuries,  the partially restored plots reflect the history of Zmigrod's Jews-up to their final slaughter (the 1250 men, women and children shot and buried in a mass grave in Halbow on July 7, 1942 have their own memorial).  While I could not read the Hebrew inscriptions, it was very special knowing there were people buried here who knew my grandmother when she was born, who worked beside my great grandparents, and perhaps even generations before them!  I was also struck by how different my grandmother's family life was from my mental images.
While I have little doubt that their lives were very difficult-like most of the rest of the world there was no electricity/refrigeration/automobiles- but they were considerably more mobile than I would have imagined.  Trade routes brought goods and people from Budapest, Prague, Warsaw and beyond.  I have since learned that the "Fiddler on the Roof" image was promulgated in part as propaganda to serve political  exigencies.  While my grandmother (Frieda) only lived in Zmigrod for a few years (more on her later history to come), this was her first home and the documented home of her father and as such, represented for me a generational connection of great importance and I was commensurately moved.

Rabbi's grave Zmigrod

From Zmigrod, we traveled 8 short miles to Dukla-home of Frieda's mother.  This town is strategically situated at the lowest and easiest pass through the Carpathian mountains-a critical link between Hungary, Slovakia, and Poland (the Austro-Hungarian Empire).  It was a prosperous trading town that was more than 80% Jewish.   An old baroque palace (of Mecinski) remains the only real evidence of Dukla's former glory.  The original town square is quite large and an ornate, but now decrepit, Town Hall commands the central place.  Several of the building around the square had clear evidence of former mezzuzah (a religious ornament placed on the door frame) but no Jewish life remains.  We took pictures of every house here in hopes that one day we may determine where my great-grandmother lived.  Dukla did have a small tourist center where we got directions to both the synagogue and the cemetery.  I also bought a spectacular little book of late19th and early 20th century post-card photographs of the town (it is written in Polish but the pictures tell enough fo a story).
Synagogue remains, Dukla
The synagogue was built in 1758 (nearly 20 years BEFORE the Declaration of Independence) but like most of Polish-Jewish life was destroyed during WWII.  Today, the external brick structure remains as an eerie monument that I found more poignant than many "official" memorials.  I closed my eyes and tried to imagine my great-grandmother, standing in the women's galleries, praying within these walls.  And I thought also about how this woman took her family out of Poland to Germany-the beginning of the journey that had now come full circle with our visit here.
The Jewish cemetery would be our next stop in Dukla and I was glad we saved it for last.  By now, we expected the graves to be desecrated but devoted locals have worked to restore what they could to a state of honor with a respect for the departed.  I watched my mother wander through the few rows of tombstones and I felt a deep ache in my heart for all the sad history of repression, pogroms, and death that have despoiled the lovely Galician hills and the nearby mountains that we splendidly visible from the hillside position of the cemetery.  I had seen Auschwitz-Birkenau, Schindler's Factory, the Krakow ghetto, and more but for the first time, tears sprang to my eyes.  Why this spot in Dukla helped serve as my catharsis I will never know but I sensed my mother felt similarly and we returned to the car and began the long drive onto to Rzeszow in silence.



Cemetery, Dukla

Friday, September 10, 2010

Days of Awe


Jews around the world are celebrating Rosh Hashanah, the new year and next Friday, we will celebrate Yom Kippur (Day of Remembrance).  The time between is a deep time of reflection, sometimes referred to as "The Days of Awe".  As this time occurs in the fall, I often find myself walking trails with the leaves exhibiting their finest wardrobe and with the air redolent of harvest, apples, and drying leaves.  Taking a small amount of time for introspection-whether driven by traditional holidays or another motivation-can be a good thing.  Too often I find in our "modern world" we are swept along, so busy doing work, caring for family, paying bills, exercising and the like that we don't STOP, listen to ourselves and take the pulse of our loved ones.  Every year, I promise myself to make sure I do STOP from time to time, not just during the Days of Awe but on a more frequent basis.  And then another holiday season rolls around and I realize, I have reflected less than I hoped in the past year.  Certainly looking inward can be painful but I also know that it helps bring me peace and serenity.
For those who celebrate, I wish you Shana Tova.  For all the rest, I wish you your own path to a small share of peace and serenity.

Friday, September 3, 2010

Happy Birthday Randy!

This weekend I had the distinct pleasure of celebrating my sister's 50th birthday.  When Randy was born, just 9 1/2 months after I arrived, my parents were told many sad things about Down's Syndrome children.  To their credit, my parents decided to raise her (not place her in an institution) and to fully integrate her into our family.  Though they were told she was "uneducatable and only partially trainable" she now reads on a 4th grade level, can do simple math, cooks a spectrum of foods, and can challenge most people on tv trivia!  When I was young, I had to cope with the notion that her probable life expectancy was only 20 years (at that point, most Down's Syndrome children were institutionalized and died of institutional diseases, not their Down's).  During college, she would come to visit me at Brown and while I went to classes, she would befriend everyone in the dorm, even some I barely knew.  Her charm and congeniality was infectious.
For nearly 25 years, Randy has lived semi-independently in a group home and worked steadily.
There is no doubt, having Randy as part of my family has influenced much of who I am.  My career in medicine is probably related as well.  If so, that's one more reason I have to thank her, as it has been a wonderful and rewarding career.
What lies in Randy's future is unknown.  Statistically, she has a high chance of early Alzheimer's but otherwise, her longevity and well being is probably very similar to others her age.  I look forward to celebrating many more landmark birthday's with my very special, "baby" sister!