Monday, December 28, 2009

World on an island

Walking in midtown Manhattan the week after Christmas is akin to forging through the wilderness. The frigid wind blows relentlessly down the canyons of glass and steel. I was prepared with gloves and a scarf, but since I had a suit on today, and I don’t own an overcoat, the chill burrowed through to my bones. We all are familiar with aggressive drivers; however, as one enters the domain between 5th Avenue and Time Square, only aggressive walkers survive. The sidewalks are a mass of hundreds of thousands of pedestrians moving and pushing into the streets in semi-total chaos. Every momentary gap between humans must be entered or lost. Forward motion feels like fertilization; only the strong get through. I am not that strong anymore, but I am experienced in this urban jungle.
To escape, I descended underground only to find a dead-end as all three Metro Card dispensers in the 49th Street station for the N-R trains were “out of service”. I climbed back up to face endless tourists walking toward me as I headed for the 42nd street station. They were all looking up and pointing their cameras and cell phones toward the walls of the surrounding buildings to collect photos of advertisements for Twizzlers and Nivea Face Cream. I wonder how many will go to Target to print these pictures to show their friends and say, “See this three-story high M&M, this proves I was in New York.”?
Finally, I made it to the station in Times Square, and like a well trained rat, worked my way through the labyrinth there to the stairs for the R train to Brooklyn. As I waited, I heard the sound of percussion and my curiosity drew me down the platform to see a young man playing a very unusual ‘drum set’. “This guy is good.”I thought to myself. I had just missed the previous train, so I had time to enjoy his performance, and it was truly a performance. His primary drum was a 5-gallon bucket. But he also had a small snare, cymbal, chimes and maybe 8 other small and unusual percussion devices. As the station slowly filled and provided an audience, he began to interact with them and was soon rewarded with dollars and coins filling his cut-off 2 liter bottle. Directly over his head, people were paying $140 to see a musical. Within 2 minutes he had engaged an audience of 100 people, some dancing, all smiling. Then the train came and we moved on.
I love New York. To me, Manhattan is the whole world on one small island. Not the physical world, but the world of humanity. Whatever peoples and cultures exist out there, they each own a small corner here. Today an older gentleman, well dressed, emerged from a limousine as a chauffeur assisted him to the waiting doorman of the building 8 feet away. Sitting to the side of the door was a man of similar age looking down at nothing in particular fighting off the cold with layers of bags and newspaper. I don’t judge either, they are each products of their decisions and circumstances. But they reminded me of the diversity of extremes that co-exist here in such close proximity.
New York is a collage of many villages juxtaposed against a paucity of space, all pushing and maneuvering to carve out their little piece of pie that is the ‘Big Apple’. There is an energy here I don’t really feel in any other city. A part of me will always feel at home here, but New York is a walking city and I tire out after about 15 blocks now. That just means I have to stop, sit for a while and just watch the humanity go by, all hurried to get somewhere to do a million things; most of them completely unaware of the other humans that surround them. I will often pick an individual out of the crowd and wonder who they are. Are they happy? What experiences have they had? I will watch them as long as I can until they disappear into the crowd, never to intersect with my life again.


Friday, December 18, 2009


Yesterday we laid in bed until 1:00 AM going over Barbie's anatomy. Wait, let me rephrase that. Yesterday we laid in bed until 1:00 AM reviewing anatomy to prepare Barbie for her final. I was impressed with how well Barbie knew details about every system in the body. She took her tests yesterday, first the lab exam followed by the lecture exam. Today she got her results and was excited to learn that she did extremely well on both exams and got a "B" as her final grade.
I am both proud and amazed at how diligent and unrelenting she was in her efforts to master such a difficult subject. Nobody worked harder than she did. Now she can relax and begin to prepare for a house full of family, beginning tomorrow. Rebecca comes home tomorrow. Barbie's brother, Daniel, comes on Sunday with Emma and their two children Elena and Kevin. Jeremy and Alexandria arrive soon after, while Samuel and Michelle will journey from Southern California to Lincoln the day after Christmas. Barbie's parents and brother Lloyd and his family will also be here from Utah. It will be a wonderful Christmas with so much family so close.

Today I had the opportunity to again speak at Grand Rounds at Kaiser, as we did last year, to give an update on my progress as a patient. The theme of the meeting was miracles and many doctors presented cases of patients who had unexpected recoveries where death and disaster were assumed to be the only outcome. I was the last speaker and spoke not only of the miracle of my own recovery from septic shock after the bone marrow transplant, but how this whole experience has changed me in my interaction with patients now that I have returned to work. I was grateful to be able to share what I have learned. And I still learn new things every day.

Nothing can stop us as long as we have hope. Neither the daunting volume of anatomical terms to memorize nor the ravages of disease; with hope, all things are possible.


Sunday, December 13, 2009

Chistmas Carols

I love Christmas music. I miss caroling in Connecticut with friends when it was 5 degrees outside. We would go with our friends, the Smiths (Michael and Mary Jane had wonderful voices). Tromping through the snow we would find neighbors at home and then harmonise carols. Wassail would be waiting when we were done.
Tonight we attended the Youth Christmas Concert at church where Caitlin, in addition to being part of the choir and two other groups, had a solo as well. I have always been partial to altos and Caitlin sings like her mother, in that pure alto tone. She did a wonderful job. The crowd was large so we had to sit in the back. A family sat next to us that I did not recognize. Their four children were very well behaved so afterward I commented on such, knowing that parents like to hear that kind of feedback. We visited for a minute and I asked if he was there to see someone in the choir. He responded that he came to support a student in his history class, Caitlin Anderson. As a beaming father I blurted out, "Caitlin is my daughter." How wonderful it is to have a high school teacher that supports his students like that. He told me what a great student she was and I readily agreed.
Soon our other children will be home and we will have one soprano, two altos, one tenor and two baritones. It's time to sing.


Thursday, December 10, 2009

Heart Transplant Celebration

Tuesday I drove to Santa Clara to attend the annual Heart Transplant Holiday Party. The food was wonderful and not necessarily heart healthy. (There were no salt shakers to be found) Mostly, it was great to visit with fellow heart recipients. You cannot get a new heart and not become a new person. We all have common themes, we are all grateful, we don't worry as much about trivial daily inconveniences, we are all excited to return to our passions, or at least find new ones to replace the ones we can't do.
And then Dr Weisshaar began the traditional roll-call. The old guys stood first; a transplant done 22 years ago, 20, 15 etc... These guys looked great. We kids all looked am them with childlike hope. "Maybe I'll be at the party in 20 years." Each year had its graduates, some only had one. My year, 2008, was well represented. But 2009 was impressive; 22 heart transplants. Remember,this is just from one Kaiser clinic that serves only Kaiser patient in Northern California. It was not that there was more people with heart disease this year, there were just fewer people dying from it. This is due to the tireless efforts of our transplant cardiology team, the surgeons at Stanford and the Northern California Transplant Network with their amazing ability to match families in that most difficult moment with well trained teams and earnestly waiting patients.
Sir Isaac Newton gave us the first law of thermodynamics which teaches that every action has an equal and opposite reaction; a man's life is given up and life is given to a new man. One must die so that one can live. A hard reality to digest when first considered for a transplant, but then the social worker, Janet reminds us that death happens every day. Our wishing for a heart does not cause it. Then you accept it and prepare yourself. One day the call comes and as the heart flies in your dream fly with you on you last trip with your old heart. Most of your heart is then removed and the new one is sown to what is left of the back wall of your right and left atria. Your aorta is sown to his aortic root; pulmonary vessels accept and return oxygenated blood to the alien organ and, on its own, it begins the first beat of hundreds, thousands, millions. My metronome is set at andante and my dynamics forte.
We honored those who had passed in the last year and welcomed the families of a few of the donors who had so courageously given, in the words of Lincoln, "The last full measure of devotion." In the silence that followed we all recommitted to live our lives to honor their legacy.
It was a joyous reunion,
The we had a raffle fundraiser, generally I never win, but today I won two. First a bath spa set in a beautiful basket. That was for Barbie. I was just about to leave when I stopped to great Yolonda and her family. She is like me; AL Primary Amyloidodis with a heart transplant, waiting for a stem-cell transplant. She is the third. And then I heard my name from the front. 'Kevin, come get your prize' As I walked forward I noticed Dr Weisshaar hold a complete Wii Console with sports bundle. I was in shock. I took the mike and blurted out something like "With this I can help my urology patients NOT to Wii, Wii, Wii all the way home.
In the end, we all looked at each other and were amazed that we all looked so healthy; life goes on and on and on and we build our homes in our new normal.


Monday, December 7, 2009

Snow in Lincoln

It never snows here, well, let me rephrase; it almost never snows here. Yet today we woke up to a view that we didn't expect. The entire neighborhood covered in white. Californians that live below 1000 feet react as if it were an alien invasion when this happens. The rest of the country yawns and pull out the snow shovels. The media sends out troops of reporters to stand in the middle of the street in various towns to say, 'Yes, there is snow in Lincoln, or Granite Bay, or Rocklin.

I must say, it made me very nostalgic. I love the snow, always have, because I am a California boy and grew up in its absence. Driving to work through my neighborhood felt surreal as the gray-white mist diffused and unfocused the view of all the lawns and roofs as they blended into the sky beyond. It felt like, for a moment, I was back in New England. I loved it.

Years will pass before we see this again, it is its rarity that makes it fun. I know that those of you that reside in Colorado, Alaska or Connecticut, wryly smile and consider us silly at such glee in something that just annoys so many others, but it is the simple unexpected pleasures that make life fun, like opening an unexpected gift on Christmas morning. Don't worry, soon we will go back to our perfectly boring California warm weather.