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

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.

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". 

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.

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.

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.