Travel log: Prague

Well, since Berlin I've been to Switzerland where I met up with an old friend and his family. Karl Klingler is a friend from my NYU days, a time when President Clinton and the Pope were in Manhattan at the same time, and Coast Guard gun ships were in the East River. Like they were going to heave some of those shells into Central Park if there was trouble. What? Karl worked in the lab next to mine when I was doing my research year of fellowship. He was doing a two year research fellowship and now has a very successful practice of pulmonary medicine in Zurich. His wife Armi is originally from Finland, and without meaning offense to Karl, carries the artistic flair of the family. His two kids include Timo, a college student with a cool desire to talk politics and to speak in tongues, or languages. I could only speak one and he was polite enough to oblige. Jari ("Yari"), Karl's younger son was known in the family as the athlete, everything basketball. Although Timo is athletic, he seems to be distracted by reading stuff. But Jari is very friendly and he has a great sense of humor like his Dad. Lest I paint Jari without an academic brush, he was working on a project that converts water to hydrogen gas for energy. I think the Swiss, generally, should slow down a little lest they make the rest of the world look bad. This is what my colleagues at Webb Publishing, when I worked on the book bindery line (a long time ago, Thank God!), would have said. They frequently seemed concerned about those that worked too hard, and for sure they would have been suspect of Karl and his family, and perhaps the Swiss in general. It is a place of great competence and beauty.

We trekked in the Alps, went to a Swiss hockey game, one team wasn't all that competent, sat around and ate and drank and generally had a great time. I don't think I was able to convey to them how delightful my visit was and how it was great to be able to have great conversations while traveling in Europe, since it is not hard to get too inside one's head when no one around speaks your language, not that I would expect them to.

Anyway, the rest of this will be about Prague. A city that is one of the most beautiful I have seen. Of all the cities I have visited I would put Prague in with Paris and Florence. It was exciting because I didn't know much about it's appearance or history, but now I do so I'll tell you a little about it. I like to concentrate of history since the usual description of tourist experiences doesn't turn me on as much, and I am less a creative writer than someone who likes to learn the history of a place, so writing about it let's me learn. I plan to upload some pictures of all cities to my Facebook page in the future. As a tourist, it is rather easy to travel in Prague because most service employees can speak a little English, but it certainly is not Amsterdam or Berlin. The public transport is amazing as usual, since Prague has buses, trams and an underground. It is very easy to get around. Yet, I could have walked the streets for days just wandering, since the architecture is expansive and majestic. But this leads to the issue of sore feet. Yes, I seem to always have 'em. And it was very hard to find ibuprofen, or even a pharmacy. The stoic Slavic culture seems to not believe in pain medication...nyet!

To give you some impression of how central Prague and the Czech region, Bohemia/Moravia/Silesia are to European history I tried to think of all the different peoples that have settled or generally wondered through the area through history: conquering, pillaging, governing, doing business, and generally having their way with and contributing to the culture. Although there are human artifacts from 3000 BC found in the area of Prague, it is thought the first "people" to settle in Bohemia were Celtic. The Boii tribe of the Celts are thought to have put the "Bo" in Bohemia. Then the Romans kicked them around in the 1st Century followed by a string of many conquering, trying to conquer, or generally causing trouble in Bohemia and Prague. There were the Slovs, the Avar Turks, the Ottoman Turks, the Mongols, the Tartars, the Franks, the Germans, the Austrians, the Hungarians, the Germans again, the Habsburgs (non Czech Holy Roman Empire people), the Vikings excluding the Swedes, the Swedes without the Vikings, the Poles, the French, Germans again (they wouldn't go away), German Nazis (a different breed from the usual German business people who at one time accounted for 50% of Bohemia's population), the Soviets/Russians, and the American Business Nation (post-Velvet Revolution). What a gang bang. But out of all this activity came a city with history, a sense of humor, beautiful women, and gorgeous Gothic, Renaissance and Baroque architecture. Some periods of Prague's history left me vexed. The amount of struggle between Lords and serfs, the Church and Estates, Catholics against Protestants, and totalitarian governments, left my head spinning. How do I capsulize this for myself, and family and friends who read this amateurish site. Well I can't be thorough but I can tell you some of the things I've clarified for myself.

Like who was King Wenceslas?, as in "Good King Wenceslas looked out, on the Feast of Stephen..." He was the grandson of one of the first monarchs of Bohemia and Slovenia. His grandfather Borivoj is credited for moving the seat of political power to Prague in the 9th Century and starting the structure of Prague Castle. After his natural death, i.e. he wasn't beheaded or disemboweled, his widow, Ludmila, was killed by Vikings and Wenceslas took the seat of monarch. Wenceslas (Vaclov in Czech, like Vaclov Havel) was apparently a kind and educated monarch and began building St. Vitus' Cathedral in Prague Castle. He was killed by his brother for being so kind and nice. Both Ludmila and Wenceslas are Saints in the Catholic Church. But I still don't know who wrote the lyrics to the Christmas song yet I suspect Bing Crosby, pronounced Bing in English, may deserve some credit, and he is from Spokane.

I also wanted to know what role Prague played in the Holy Roman Empire, and indeed, what was the Holy Roman Empire? The Holy Roman Empire was a rather loose consortium of states that began under Charlemagne, a Carolingian, in about 800AD. He was crowned secular leader of a reinvigorated Christian Roman Empire by the Pope. His relatives Charles the Bald of France and Charles the Fat of the Germanic states were made fun of so the Franks, or French, went their own way and the Holy Roman Empire that we know of from history has included all the German states, Switzerland, Luxembourg, the Czech and Slovakia regions, Austria and Northern Italy. Lichtenstein was included but few paid attention to it until Hanni Wensel won big in the 1980 Winter Olympics in Downhill and the Giant Slalom. By this time though the Holy Roman Empire had dissolved. Poor Liechtenstein. Anyway, the whole HRE thing was supposed to be the Empire of the Pope but there was often much wrangling between the Church, the Lords, the Estates of the Church and the Lords, and eventually of religious influence itself since the Reformation occurred within the Holy Roman Empire. Spain was included somehow in the reign of Charles V until his death. In 1806 the last Holy Roman Emperor abdicated after defeat of the Germanic States by Napoleon, nicknamed, That Little Guy With Big Feet.

Prague played a significant role in the Holy Roman Empire in the Middle Ages. There seemed to be seven elector states that voted for the Holy Roman Emperor and Bohemia was often in this electorate from the 13th Century to dissolution in 1806. Charles IV, King of Bohemia, and eventual Holy Roman Emperor, moved the center of the Empire to Prague in 1355. Matthius was also King of Bohemia and Holy Roman Emperor from the 15th into the 16th Century.

But soon after the move to Prague the Holy Roman Empire began feeling religious tension, including within Bohemia and Prague. While the Reformation was brewing in other areas, due to the officials of the Catholic Church thinking they were God, but as we all know doctors are God. So the doctors moved to France and went on strike. With the doctors out of the way, a gentleman named Jan Hus was speaking out against the Catholic Church, stating as Luther did that there should be allowed more direct prayer, or communication with God. Hus was summoned to Constance, Germany where he felt he could convince a council of bishops to ease up a little. While in Constance he was arrested and burned at the stake. That was a no go on the idea of reform. The followers of Hus, or Hussites, were pissed though and started to revolt in Prague and Bohemia..and beyond Czech borders. They even began fighting amongst themselves leaving the Eastern Wing of Bohemian Hussites defeated and a more centrist Hussite faction negotiating with the Church Council members. By the 15-16th Century the Holy Roman Empire principalities could choose between the Hussite or Catholic religions. Eventually Lutheranism and Calvinism would also change the nature of Catholic rule in the Holy Roman Empire.

So what is defenestration? This seems to be a behavior unique to Bohemia, i.e. if you wanted to rid yourself of enemies in Bohemia throw them out a window. Prior to the Hussite revolution in 1419 Hussite Revolutionaries hurled hated Prague Council members out a window. Later, in 1618 a collection of Bohemian National regents burst into Prague Castle and threw two Habsburg (Austrian/Holy Roman Empire) representatives out a window as well. But these two guys lived as they fell into a pile of cow dung (this is the truth!); they walked away but had few friends until they got a shower (this may not be the truth!). The Catholic Church considered their survival a miracle and this was the event that precipitated the Thirty Years War.

Which begs another question, what was the Thirty Year's War all about? I don't think anyone really knows what precipitated the Thirty Years War from 1618-1648. Much was due to deterioration of trust between Protestant and Catholic factions over time since the Peace of Augsburg was struck between Charles V, Holy Roman Emperor, and German Lutherans in 1555. But European politics also played a role. Although the war was waged within the confines of the Holy Roman Empire other nations were involved. Spain was connected to the Holy Roman Empire through religion and political marrying amongst royal families. The French were surrounded by the Holy Roman Empire, so they, a Catholic nation, paradoxically fought with the Protestant side. Sweden was involved with Gustavus Adolphus being the headline act from Scandinavia, he was defeated in the last battle of the war. And the Ottoman Turks became involved. The conflict sounds a bit like WWI where one spark set the whole powder keg off, yet instead of a wild Serb shooting the Archduke, some wild Hussites threw Catholic bureaucrats out a window. Similarly to the post-WWI period, Europe was devastated after the Thirty Years War. As the Treaty of Westphalia was signed European nations had suffered from the death of soldiers and civilians from wounds, famine and disease such as dysentery, typhus and bubonic plague. Economies collapsed since there was no one to buy stuff or to pay taxes. In Bohemia, 50% of the population died as a consequence of the Thirty Years War.

So what about the architecture of Prague? It starts with Prague Castle with the Romanesque architecture of St. Vitus' first Cathedral forms and the walls of the structure. The Judith Bridge was also built about this time. In the 13th Century the rotunda of St. Vitus' Cathedral burned to the ground. But it was Charles IV, Prague's first Holy Roman Emperor (1355-1378) who moved the seat of the HRE to Prague and spiffed up the city considerably. He rebuilt St. Vitus' Cathedral, expanded Prague Castle, and built the Charles Bridge where the pre-existing bridge stood; apparently because Judith just didn't sound like a reasonable name for a bridge, more like the name for one's piano teacher, or a dam, or lighthouse, but not a bridge. The Charles Bridge is now only for foot travel. Charles IV was born enlightened in Paris before he moved to Prague and also started the first university in Prague, named...not Judith University...yes...Charles University. It has also been noted that he ate with the Charles Mouth and made babies with the Charles Private Parts.

The Habsburg ruler of Prague until 1611, Rudolf II, developed Renaissance architecture in the city and he brought status to Prague as an intellectual center by luring scientists such as Johanne Kepler and Tyco de Brah to the University. Through the Baroque period that followed Prague prospered and grew with both religious architecture and secular architecture. Later the neo-Renaissance period developed in the 19th Century. The National Theatre stood as its greatest example and......... ya know, I like looking at architecture, but it seems to be rather difficult, and out of my style range, to enumerate its history. Prague has a lot of different kinds of old buildings and its a beautiful place to walk.

Through the 19th Century Prague and the regions of Bohemia and Slovakia developed industry and commerce including iron and silver smelting, beer brewing, coal mining, glass works, and machine and tool production. By 1918, the end of WWI, the Austria-Hungarian Empire was crumbling and separate principalities, referred to as the successor states, were developed under the Treaty of Versailles. Czechoslovakia was born at this time. But authority by a central state was questioned, especially by Germans who now lived in the border regions of the new Czechoslovakia. Some areas were 50% German. The area most populated with Germans bordered Germany and later became popularly known as Sudetenland. Land reform, language laws and military excursions in areas of Czechoslovakia generally pissed everyone off, especially the Germans. Political parties were developed with names like the German National Socialist Workers Party, the German National Party, the German Agrarian Party, the German Social Democrat Party and eventually, you could probably see this coming, the National Socialist Party. Industry was huge in Western Czechoslovakia and included the shoe manufacturer Zlin, European Ford, and the Skoda Works which was the largest arms manufacturer in the world. Skoda now makes cars.

Though, as in Germany, the economy of the 1930s in Czechoslovakia was in shambles. This brought the work of communists and nationalists to the for. Hitler took power in Germany in 1933 and Czechoslovakia, like most of Europe got scared. They saw France building the Maginot Line and generally fortifying against German invasion. Czechoslovakia's foreign policy experts knew that they could be toast if alone diplomatically so they lobbied other nations for their safety through the League of Nations. They hammered out a treaty with the Russians and French stating that these nations would come to Czechoslovakia's aid if it was invaded. As we all know this was a toothless treaty since the larger nations of Europe generally didn't give a damn about Czechoslovakia. Perhaps rightfully so since they saw their own arses in slings when the Germans went mobile, but in retrospect, had the nations of Europe acted early, in unison, against German WWII may have been averted. But the reparations placed on Germany under the terms of Versailles were too great and the will to fight another war too slight in these nations. In March 1938 Nazi Germany annexed Austria, Hitlers birthplace. He became a German citizen in 1932. Czechoslovakia was nearly surrounded by Nazi Germany and now was abandoned by France and England. These nations put pressure on the Czech government to strike a compromise with Germany and in fact, through diplomats, were pressured to give up Western Czechoslovakia, where the largest number of Germans lived, as the Sudetenland. The Munich Treaty was struck and declared "Peace in our time" by Prime Minister Chamberlain. This was nonsense and WWII eventually came to full force and eventually all of Czechoslovakia was annexed by Nazi Germany. As the history books state Czechoslovakia felt abandoned and shamed over releasing their country to the Nazis without a fight. This later affected Czech politics when the war ended and the Iron Curtain came down. Czech Universities were closed by the Nazis, and Czechoslovakia was declared a Protectorate with some independence, but very little. The Nazis played a delicate game with the Czech people since Nazi Germany needed the industrial strength of Czech to build stuff for war effectively and efficiently. 75,000 Jews were deported and presumed killed between 1939 and 1945, along with political and religious dissidents.

By 1943 it was becoming clear that Nazi Germany would eventually lose the war so Czechoslovakia turned to the Soviets, and not the Western Allies, to make a treaty as they anticipated the end of the war. By my reading of history, including the weak behavior of France and England prior to the war, and the lack of will in the Czech and Slovak people to partake in democracy again, I better understand Czechoslovakia's intent for turning to the Communists rather than the Allies. By May of 1945 the Americans under Patton reached Bohemia but they were not allowed to liberate Prague by decision of the Allied command. Patton must have been P-I-S-S-E-D.

After the war, Czechoslovakia was restored to its pre-War borders and some flimsy government was started in Prague under the thumb of the Soviet Union. When the Soviets didn't like the cut of their jib it took over completely in 1949. In "Prague Spring" 1968 the government wanted to put a more "human" face on government so they gave a trial of easing up on social issues, Milan Kundera and Vaclav Havel were prolific during this time, but with this new freedom came criticism of the Soviet government, so Warsaw Pact troops were sent into Prague to show some muscle. This is when the protests in Wenceslas Square happened, and they were widely written about. The Soviets showed up with tanks. They thought the National Art Gallery was the Parliament Building so they shelled it, showing Picasso who's boss. Maybe this is what happens when troops drink jet fuel. In the 1980s Soviet rule crumbled and the "Velvet Revolution", or social and political change without violence, occurred allowing Prague and Czechoslovakia to get back to its former self, whatever that was as their history seems to be one of continuous flux. Vaclev Havel was the first head of state. Eventually the Czech Republic and Slovakia were formed as separate states in 1993.

Prague is a beautiful gem in the middle of a piece of real estate that seems be an epicenter for political and social chaos, and now, since 1990 the Americans seem to be joining the frey. There are reported to be about 20,000 American ex-patriots living here.

Travel log: Berlin

I'll try to give a history of Berlin in one, very long paragraph. Here we go...Berlin's history dates back to 1197 when a log was found in what is now the city. The name comes from the Polabian root meaning "swamp". The first recorded community was Spandau, now a suburb of Berlin, where there was a prison and surprisingly Rudolph Hess, one of Hitler's adjutants captured by the British early in WWII, was found there confirming the fantastical science (a Nazi found alive in 1197) espoused by Hitler. Spandau prison was razed when Hess died in 1987. I know this makes no sense but neither did Hitler, nor the Ring Trilogy. Anyway, Berlin puttered along through the pre-Enlightenment age until Frederick II, sometime in the 17th Century, was thought to bring architecture to the city. He was known by the name of "Irontooth" after an outing which included bicycling in Amsterdam. The Edict of Potsdam (another suburb of Berlin) 1685 was part of a move toward enlightenment by the Northern European countries which allowed French Huguenots (Protestants) refuge from Catholic France. This Edict also allowed for emigration of many from Poland and Slovenia, including Jews. The Jewish diaspora, occurring after the Romans destroyed the Temple of Israel in 70AD and dispersed the Jews to Egypt, Greece and Spain. In the Iberian Peninsula the Jews were known to be good citizens but helped the Moors (Middle Eastern terrorists and Jew haters, what were THEY doing working together?) invade Europe as of 700AD. The Spanish and Portuguese never got over this and under the reign of Ferdinand and Isabella circa. 1492 the Jews were dispersed, again, "Thanks for coming!", from the Iberian Peninsula into many parts of Europe including to Germany and Eastern Europe. I think Jews were not liked because they were good at holding onto money and this made Christians jealous, since all the Catholics had to send their money to Rome so they could buy a place in Heaven (I think the song went something like this, "When coin in coffer rings the soul from Purgatory springs...") Anyway, you can see where this is going-the Germans are becoming more welcoming to others and there are many Jews in the market for a home after the Spanish Inquisition. Frederick the Great was known as the philosopher King of Prussia, and Berlin, in 1740 and everybody was happy living together in square buildings with not enough windows. Napoleon marched into Berlin in 1806 and made everyone wear scarves, which nobody in Berlin liked, so he gave Berlin self-rule until he was sent to an island. In 1871 Bismarck tricked the French ("Nobody will make my people wear scarves!..You will wear scarves!") and Germany became a country with Berlin as its capital. WWI was a bust for Germany. President Wilson, England and France forced the Treaty of Versailles on Germany making them pay heavily for a war that everyone seemed happy to participate in. Wilson was good at moralizing but didn't seem very practical since everybody knows you shouldn't make Germans mad, and they were mad, oh baby, they were mad! So Germany did the best they could under the Wiemar Republic. In the 1920s Berlin was the largest municipality in the world but their economy was terrible with runaway inflation. Chaos ensued. The German people seem to like order, and not chaos, so they started listening to some lunatic that hated Jews as he clearly outlined in the two volume Mein Kampf (My Struggle), and everyone else who was short and had dark hair. But hey?! Hitler was short and...oh, well... Hitler was shrewd at playing politics and the German people. Since his minority party couldn't get enough votes for a coalition in the Reichstag's the Nazis decided to burn it down in 1933, but the Nazis successfully blamed a Dutch Communist, van der Lubbe, for the fire and arrested him while he was riding his bike (It has been thought that Hitler, as a propagandist in the 1920's, and Goebbels, propaganda minister of the Nazis, used mind strategies based on writings of Freud, a Swiss Jew. Freud was also the mastermind behind bacon and eggs for breakfast, but that's a distraction from this story). The chaos was great in Berlin and Germany which lead President von Hindenburg to give Hitler, as Chancellor, the right to suspend civil liberties and, for some reason, the Reichstag's gave Hitler the ability to write his own laws under the Enabling Act. (I'm whispering this..."What were they thinking?"...ssshhhh). After reading some history and experiencing Berlin, I believe as others do, that the German people were experiencing a sense of confusion and low self esteem lingering from WWI and the chaos that developed in their country as a young republic. Wiemar Germany couldn't make democracy work and their people were disgruntled so they reverted to a despot, claiming to enmesh national pride, nationalism, and a planned egalitarian economy, socialism, that later became a nightmare for Berlin and the country. This and the Jewish issue, one that was created through history by their dispersion from Palestine to Spain to Europe, led to a situation that we all know. I can't find a way to joke about this. The pictures in Berlin and Dachau prison that I have seen, that we've all seen, speak for themselves. The Third Reich, the Reich of a thousand years, fortunately did not come to fruition. Leaving still the only thousand year reign in Europe's history to be the reign of the Catholic Church, 400AD to about 1400AD, until the Reformation. The record remains. I'll back track a little and say that in addition to the distasteful behavior of the Nazi government I also think that doctors who torture and kill the ethnically impure and mentally unstable should not be invited to research conferences. Anyway, let's move on. Are you tired yet? Had enough of the Nazis? Let's move on to the communists. After Hitler killed himself in his bunker, now a parking lot, Berlin was in chaos, exactly what they were trying to avoid by putting Hitler in power. First the Russians moved in, then the Allies. In 1945 Berlin was partitioned into Russian, American, French and British quarters. The French and British fell out of the running early and eventually there was Russian Berlin and American Berlin. The Russians got East Germany after they beat the Americans in a game of Risk (A game of world domination!). So this left American, or West Berlin, an enclave in the middle of communist East Germany. The Russians got greedy and isolated West Berlin which lead to the Berlin airlift of 1948. It is said that every 3 minutes an American or British plane landed in West Berlin during its peak. But the hole in East Germany to West Germany let 3.5 million East Germans defect to the West. There was a hole in the Iron Curtain, so the Russians sent some spinsters to Germany and they mended the whole by knitting mittens, AND BUILDING A WALL. The East German government employees also realized that they had too many friends so they started spying on them through coffee pots, and arresting them, and torturing and killing them. "That should teach those people for being friendly", they thought. If you want to see a good movie dramatizing the Stazi Secret Police see The Lives of Others. So the wall coursed about 100 miles through the city of Berlin and went up in 1961. There were about 100 failed attempts to escape through the array of barbed wire, attack dogs, guard houses with men who had good eyesight and shooting skills, and eventually the wall. People tried to tunnel under it and fly over it in balloons. There is a memorial here to a kid who tried to escape, he was shot but not killed in "no man's land" and left to bleed to death without attention. They didn't even finish him off. Not friendly at all. Kennedy wrote a letter to Willy Brandt, West Berlin mayor, in 1963 stating that the wall was a sign of political cowardice by the East German government but the United States would not go to war over the issue. But Kennedy did go to Berlin in 1963 and it was here that he uttered those infamous words, "Eich bein ein Berliner" which translated means, "I am eating one Berliner". The crowd roared because they knew he had good intentions. Another presidential speech was given by Ronald Reagan in 1987 where he demanded that the USSR President demolish the wall as a symbol of Eastern intentions to lighten up a little, "Mr. Gorbachev, tear down this wall!" The West had the USSR on the ropes, or Russia had the USSR on the ropes, and the Eastern block was crumbling. Finally, in the evening of Nov. 9, 1989 without any fanfare an East Berlin television station announced that there would no longer be travel restrictions between East and West Berlin, and then she moved onto sports. According to a cabbie that I discussed this with he, and others, had a difficult time believing the news was real. But when the Western stations began corroborating the news he and others were out of their apartments and planning to miss a few days of work. He also said that within about twelve hours the wall was being picked apart by the people. Apparently no one had said, OK you can go ahead and demolish that wall for us. No, it was a spontaneous and powerful thing. Berliners taking their city back. Now it looks great and apparently getting better. Berlin was again declared the center of government in 1991, Allied forces were gone by 1994 and the Bundestag (parliament) officially moved in 1999.

Travel log: Amsterdam

Headlines today include a drill reaching Chilean miners trapped in a mine for the last two months, a British woman killed by kidnappers in Afghanistan, fury over a book by Bob Woodward from the National Security Advisor who recently resigned over reports of being "out of step" with President Obama's top advisors, kids texting to buy marijuana in Montana get a wrong number and text their request to the local sheriff, and the handle on the cold water tap of my bathroom sink fell off. The last one hasn't made it to the papers yet but there has been a work order submitted by hotel officials.

Here are some things I have learned or experienced while in Amsterdam. The city, by fable, was initially a small church outpost in the Middle Ages. As conveyed in the Amsterdam History Museum a gentleman vomited after receiving the eucharist at mass sometime between 1200 and 1300. The emesis was scooped into a fire still containing the eucharist but the eucharist didn't burn. This was perceived as a miracle and people started to make pilgrimages to what is now Amsterdam, the dam on the river Amstel. The city grew under the watchful eye of the Catholic church until the Reformation occurred and Protestants overthrew the city leadership. It became a conservative center of commerce, Dutch Reform was hatched. But it remained a city of religious tolerance since this was good for business, so Catholics and Jews could stay as long as they didn't worship in public. Small churches and synagogues remain in hidden places.

The city developed although it was soggy as it is at or below sea level. Canals were dug and the soil from the canals were used to raise the level of the habitable parts of the city. So there are many homes and businesses along canals. This makes for a beautiful city. Bikes abound since it is flat but crowded. Cars are allowed but they don't seem practicle. Bicyclists include businessmen in suits and fashionable women riding with straight backs often on cell phones, like Americans use cell phones in their cars. It's a very quiet city with near accidents between bicyclists occurring regularly but no one gets bent out of shape, they just repel each other silently with their narrow force fields of bicycle space and ride on--astounding! But not all accidents are avoided. There was an article in one of the local papers of how the dentistry community thrives on patients with teeth chipped or knocked out in bicycle accidents. I imagine these accidents occurring in silence, or maybe just the clank of bicycle parts meshing: no swearing or angry exchanges. Be mellow and happy and kind and friendly...this seems to be the respectable credo of the city. I enjoyed seeing families happy together, out in the public squares and eating at restaurants together. Friends giving presents and laughing amongst themselves. There is a softness here, nothing bawdy.

But there's no Eiffel Tower, Houses of Parliament, Empire State Building, Golden Gate Bridge or Space Needle. There doesn't seem to be an icon of the city. Yet there are many beautiful old buildings including the RijksMuseum where the paintings of the Dutch masters are housed. Paintings from the Golden Age of Holland, the 17th Century. A time when not only were the Dutch ruling the seas and business (Dutch East India Company...) around the world but the great landscape artists and portrait masters like Rembrandt were high on their craft.

Van Gogh was Dutch and after a religious transformation felt it was his calling at the age of 26 to become an artist. He tried preaching in a mining town of Belgium for awhile but thought painting more his style. He lived in the Neatherlands, Paris, Arles in the south of France and eventually in an insane asylum. He then shot himself in the chest. He was said to have a "seizure disorder" but after cutting his own ear off and trying to knife Gauguin seizures seem an unlikely explanation for his behavior, unless partial complex seizures were occurring. It seems more likely that, at his age, he had developed paranoia or schizophrenia, or both. Creativity and mental health problems seem to coincide. Despite his health problems Van Gogh seemed very talented and the Van Gogh Museum had a great display.

Last night I spent a night on the town. The evening started at a pub in a square on Spuistraat. I sat with some older Amsterdamers(?) watching a group of youngsters get wasted while wearing some very bad Oktoberfest outfits. The real Oktoberfest ended last week but they were not detered, and indeed seemed quite proud of their Oktoberfest tardiness. Then I went to a restaurant where I had the pleasure of eating a meal with a very friendly and spirited family from Belgium. Mom ran a law business, her daughter was in law school and her son was a film student. We talked history and travel. There was no mention of Oktoberfest since no one else in the city, including them, cared...not like those kids at the pub.

Tomorrow I'm off to Berlin. I'm thinking of my Mom who is sick again and feeling weak. But she remains spirited. I think I got my interest in travel predominantly from her. My Dad gave me medicine, and they both gave me a love of discovery.

The Lighter Side of Anne Frank

Ghost Of Anne Frank: 'Quit Reading My Diary'

My friend John Robinson sent me this news from the Onion below in response to my last post. Black humor takes the edge off stress.

February 11, 1998 | ISSUE 33•05

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Shocked to learn that the diary containing her most intimate thoughts and feelings has been read by millions of people worldwide, the ghost of Anne Frank held a press conference Monday to tell the world to "stop reading my diary, and put it back where you found it right this second."

Enlarge ImageAnne Frank

"I am so embarrassed," Frank said. "I cannot believe that for the last 50 years, millions of people I don't even know have been reading my diary, reading about my first kiss, my huge crush on the boy upstairs, my first period—everything."

"It's bad enough to have your sister sneak into your room and read your diary. But to have it bought by Doubleday and published in 33 languages? That's just mortifying," Frank said. "I knew I should have gotten one with a lock."

Frank said she first found out about the publication of her diary last week, when Edward Walther, a recently deceased 57-year-old from Toronto, approached her in heaven and expressed great admiration for the young girl's diary.

"He said to me, 'Are you Anne Frank? I can't even begin to tell you how much your diary has meant to me. I must have read it at least a dozen times. I've always been particularly moved by your discussion of your budding sexual curiosity, such as that great longing you felt to touch that older girl's breasts and the rush of life-affirming exhilaration you experienced when you got your first period. That kind of self-awareness and honesty is incredibly rare in any human being, much less one who's just 15.' And I said, 'What? What are you talking about? You've read my diary? You know about me and that girl? You know about me getting my period?' I was absolutely humiliated," Frank said.

Added Frank: "That stuff was supposed to be between me and Kitty."

Frank said she was even more distraught to learn about The Diary Of Anne Frank, a theatrical version of her private journal currently playing on Broadway. She called the play—which opened to rave reviews and was hailed as "powerful, gripping theater" by New York Times drama critic Vincent Canby—"like, the most embarrassing thing ever in the history of the world. It's enough to make me want to crawl into a hole and never show my face again."

Frank said she strongly suspects it was her older sister Margot who gave the diary to Doubleday. "Margot would do something like that, stealing my diary from under my bed and getting some major publishing house to print four million copies of it," Frank said. "I cannot even tell you how mad I am at her. I swear, if I find out she did this, she is going to be in such huge trouble."

Jay McInerny, the author, said he had a friend who played Anne in that Broadway play, "The Diary of Anne Frank". She was such a bad actress that when the Nazis broke into the Franks' home in the play the audience yelled, "She's in the attic!"

Amsterdam and Anne Frank

I have gone to Europe for a few weeks. My first stop has been Amsterdam and here I am. I'm writing from a beautiful, albeit small, attic room at the Ambassade Hotel along the first canal of Herengracht. The room is well appointed with a royal blue bed cover, blue and yellow drapes and a yellow, vaulted ceiling with chandelier. Amsterdam is surrounded by three canals that are lined with row houses essentially built on stilts through hundreds of feet of marshy soil to reach solid ground. Some of the houses lean left and some lean right. The canals are lined with house boats. From inner to outer canals they are named Herengracht, Keisergracht and the Prinsengracht. It's softly raining and from my open windows I see an array of rooftops and windows of other apartments. Quite a rich urban setting.

Since I saw the Anne Frank house today, 263 Prinsengracht, quite near my desk and computer in my attic, I want to reflect on a time when an attic setting on the canals of Amsterdam may not have been so settling. I don't want to dwell on the Holocaust itself but outline the thoughts of this girl and her family. The Franks' anguish, as outlined by Anne, was a mere example of the turmoil in the minds of individuals that lead to eventual death at the hands of the Nazis. Maybe her diary remains popular because it lends insight into the horror that each individual Jew, and other social and political outcast, must have experienced before their eventual capture and death in the 1930's and 1940's. It puts emotion to the statistics of genocide and could probably be thought to apply to those individuals killed in Cambodia in the 1970's, Rwanda and the former Yugoslavia in the 1990's and perhaps in North America in the 19th Century.

I bought a copy today of Anne Frank's Diary since I don't remember reading it for school. Maybe I did but if I did it didn't make the impression on me that it has today. She's writes to an imaginary friend named Kitty. Kitty eventually becomes us as she feels the eventual doom that we are now aware of. Her diary starts with the innocent musings of a thirteen year old girl in the Summer of 1942. She was excited to get the diary for her birthday and starts by making entries about a Rin Tin Tin movie, her ping pong and volleyball games, flowers, and her own humility since she admits that it is likely no one other than herself will enjoy reading the entries. She also wrote of her anguish over getting passing grades in school. She got a C minus in math, and a B in writing.

When her older sister gets a call from the Gestapo saying that she will be deported to an area for girls her father decides that the family must go into hiding, at 263 Prinsengracht, the building where he worked. The diary makes a transition. She begins recording the tension between herself and her Mother, the spats between families in the Annex, as the hiding place is called, the famine they experience, the heat and the cold, and the fact that they eventually can't open their windows for fear that others would discover their presence in that "Secret Annex". My windows are open and given a cool breeze. She describes the tension that the bombing of Amsterdam creates and the sound of gun fire so loud that they can't speak to each other. She even saw a "dogfight" between British and German planes from her closed window. She describes the toilet habits of others and describes her genitals. She also falls into fantasy as she seems to love Peter, but Peter seems to be a composite of two Peters living in the Annex. Continuing to regress, eventually she turns onto herself, letting us know that she wishes she could be a better person. The last entry in the Diary ends like this, somewhat confused, "Believe me I'd like to listen, but it doesn't work, because if I'm quiet and serious, everyone thinks I'm putting on a new act and I have to save myself with a joke, and then I'm not even talking about my own family, who assume I must be ill, stuff me with aspirins and sedatives, feel my neck and forehead to see if I have a temperature, ask about my bowel movements and berate me for being in a bad mood, until I just can't keep it up any more, because when everybody starts hovering over me, I get cross, then sad, and finally end up turning my heart inside out, the bad part on the outside and the good part on the inside, and keep trying to find a way to become what I'd like to be and what I could be if...if only there were no other people in the world." With that her diary ended. It was recorded that the Gestapo entered their house and found Anne, her family and others hiding in the Annex. Anne's Mother and the Peters were killed at Aucshwitz and she died of Typhus at Bergen Belsen. Her father was the only survivor of the camps and lived until 1980 in Switzerland. He was responsible for the publication of her diary in 1947. She had written that she looked forward to becoming a famous author, and she achieved this. Wow. Being three or four blocks away from this house in an attic I suspect similar to that on 263 Prinsengracht left feeling close to her.

I was going to wax on how the Nazis exemplified a bad outcome of the Enlightenment and it's attention to science, and the Nazis eventual misappropriation of social darwinism, and the ethics of Kant and his encouragement to treat every individual as an end, not just a means to an end, in his categorical imperitive, and how every culture and government, including our own, may have similar embarrassing events in their history as epitimized by Nazi Germany, but I'm too off the subject now by writing about Anne Frank and thinking about her suffering, not just the physical suffering, but the emotional suffering that the anticipation of capture and death must leave with the victims of genocide, to go on. Maybe we should revisit the events of the Holocaust...and Rwanda, and Cambodia, and etc... periodically: to never forget.

The Dutch smoke like it's a profession and now the cool breeze through my attic windows has begun to smell like cigarettes.

(the spell check setting has essentially outlined my whole essay, maybe a consequence of the Dutch Wi-Fi. So, sorry for spelling errors that have gone un-noticed.)

My vote is for the worst doctors in the city

Most cities have a list of the best doctors...or lawyers, or dentists, or architects, etc. Instead I suggest that we publish the worst doctors.

First, I have to admit that I haven't been the best at anything that I have done. I also know that even if I am good at what I do there will always be somebody, somewhere, better at it than me, even if I was considered the best in my confined area. This the law of the West, where there is always a better gun, and the rest of the world. So I have become resigned to being a strong person at what I do but not the best. But the best also seems rather hard to define in such a deep and complicated field as medicine...or law, or architecture, or any adult profession except professional sports where winning is the definition of success.

Look at it this way, the best doctors have become that way because they have been in practice long enough to establish a reputation with patients and other medical professionals. But this means that they have already been receiving a number of referrals that have left patients and referring physicians impressed with their work. And they are probably quite good at what they do, so this means there are already a number of patients clamoring for their services and you could wait until your dead until you see them, or be referred to one of their partners, which kind of defeats the purpose of the list. I tried to get into a gastroenterologist (age 50=colonoscopy) that was one of Seattle's best and was told that I couldn't see him for about six months. By then I could have cancer and be dead, or at least vomiting blood, or having other messy problems, that would leave me unsatisfied. If I wanted this I could try to find a doctor in Canada or, God forbid, in England (sarcasm marker here).

Instead why not list the worst doctors in the community. At least this would allow one to know who not to see, and it would allow the unknowing to get an appointment in a reasonable time frame with a perfectly fine doctor. Maybe they wouldn't be the best but they wouldn't be the worst either. If you believe in lists, somewhere tomorrow, a patient will be walking into the office of the worst physician in the nation (thanks John Robinson). I would rather avoid this than wait 6 months to see the best.

This is meant to be tongue in cheek since I think the legal ramifications for any publication to take this on would be huge, but it also isn't without merit because doctors and nurse, those usually polled for these Best Of... lists, also know who not to see. Perhaps when a friend or family member asks who to see in the community we, as doctors and nurses, should tell them who not to see instead.

Hole and Weezer: The Bands

Before getting to the day's events I'll convey some Woody Allen lines: 1) Intellectuals have proven you can be absolutely brilliant and still have no idea what's going on, and 2) A patient says to his doctor, "Doc, I think my brother is crazy, he thinks he's a chicken." The doc says, "Well why don't you turn him in?" The patient says, "I would but I need the eggs." Somewhere in Woody Allen there is philosophy.

I spent the weekend watching monitors in the electronic ICU of Swedish Hospital in Seattle. This is my transition job while I ease myself back into the clinical world. I managed a patient over a visual monitor and loudspeaker for an hour last night, he eventually died. It is a bit surreal to watch someone die on television, for real, especially when it's a consequence of unsuccessful interventions from you, sitting watching a monitor of the patient, writing orders into a computer and interacting with nurses who can only hear my voice from the ceiling.

I got home this morning and watched the Sunday morning news shows to defervesce. Christiane Amanpour interviewed Tony Blair on ABC's This Week. They were both witty, intelligent and likable. He commented that he still gets butterflies on Wednesdays, a day when, during his time as PM of England, he had to stand and deliver on Prime Minister's questions at Parliament. Although I can understand I had not realized that it was such a nerve racking thing for him. On the PBS broadcasts of the events he seemed so poised and in control, even enjoying it.

I got some sleep in the afternoon and went to Bumbershoot, a music festival in Seattle held every Labor Day weekend in the evening. This is what I want to talk about most since I got to see Hole and Weezer in concert this evening. I have not been to a rock concert for years and have to admit it was not like rock concerts I remember as a kid. My most memorable concert was the Rolling Stones concert I went to in high school with my friend Pat Gleason. We snuck into the concert by holding cutout cardboard tickets that we held in line until we got to the ticket takers. When they looked down to take our fake tickets we bolted into the St. Paul Civic Center, I ran into someone carrying beers and splashed them in my wake while running onto the concert floor. A hooligan without a violent streak maybe, but it was worth it since the concert was sold out. And everything seemed so crazy then anyway. The Stones were about an hour or two late to come on stage. The whole place was blue with pot smoke and my friend Larry Olson, who paid top dollar for his tickets, passed out under the seats right as Mick Jagger came onto the stage. He didn't wake up for the whole concert. After, the crowd toppled some police cars and St. Paul banned rock concerts for a few years. That's the kind of concerts I remember.


Bumbershoot is an annual celebration in Seattle held over Labor Day weekend. It brings an array of bands, from big names to local acts, and has food stands and face painting, etcetera. The main stage tonight had Courtney Love and Hole as well as Weezer. They were both cool in different ways. Although Courtney Love is a psychological marsh, by reputation, she makes good music. Wikepedia reports that she was raised in communes in Oregon, that her father gave her LSD when she was 3 years old and that she will be an heir to the Bausch and Lomb eye care fortune when her mother dies. She was the wife of Kurt Cobain and was sued by the remaining members of Nirvana. She also reformed Hole without the contractually necessary consent of co-founder Eric Erlandson, they officially disbanded in 2002, which suggests there will be more business fun to come in her life. Apparently in Spin magazine Eric Erlandson said something to the effect of, "She can't do that".


I got to the stage early so was able to get up close. This didn't matter for Holes' performance since not many people showed for that but it did make for a "mosh" when Weezer came on. Courtney Love didn't seem frankly psycho during Holes' performance but she did have her moments. She wore a dress and repeatedly put her foot up on a speaker monitor leaving her crotch exposed during the show. I am happy to report that she did wear underwear. She smoked during the performance and at one point stopped a song and asked for a cigarette from one of the stage hands. She also commented alluded to Kurt Cobain's death, he shot himself, by saying, "1-7-1 Lake Washington Boulevard...Wow!" This was the address where he was found dead, kinda without a head. That same day in April 1994 was my first day, visiting from New York, in the Seattle area and I remember hearing a DJ on 107/The End breaking the story.

After Courtney L. stopped gazing at the Space Needle looming over the stage like a nun behind a misbehaving school kid she left the stage without much affair. Seattle, a place she referred to as home as in "Hello Home...", doesn't seem to like her very much. I think it's because she smokes, or because she screwed (legally) the remaining members of Nirvana, or just because she didn't have a tight set tonight, who knows. I think Europe likes her.

Then the All American boys came on. Weezer has some good singles but I never knew that they were such a cult band. The stage area filled in hugely before they came on and the crowd started to move and undulate even before they came on. It was all good natured and because I was so close and so tall I started to get some jabs from kids behind me. But even that was all good since it wasn't mean stuff. The Weezer fans were of a younger generation than mine but they were cool.

The lead singer/songwriter is named Rivers Cuomo and he was "on" tonight. He looks like a cross between Woody Allen and Elvis Costello with a yamika balding spot and black framed glasses. He wore a pink Polo shirt under a stripped rugby sweater with jeans and white tennis shoes. He walked like a duck but acted like Mick Jagger. And he was all over the arena! He climbed the scaffolding of the set and with wireless technology sang from different areas of the arena with a spotlight picking him up wherever he went. The rest of the band was muscular and tight and very cool. It was invigorating to see and hear.

During a couple of the hits, "People say, Rivers, why don't you sing the hits? Rivers why not sing the hits?..." Well he did, and the crowd was crazy. The spectacular part of it was being so close to the stage and seeing the undulating arms like cilia waving and moving kids that were thrown up and moved on the wave of hands to the front of the crowd. I guess since I looked strong enough I had a kid tap me on the shoulder to ask if I would throw him up. I cupped my hands, he put a foot in and I hoisted him up onto the hands and away he went. It was very cool to have a ground level view of this. He just got carried away on the undulating hands, laughing with his limbs moving all akimbo. Since the first try was successful another asked me to do it, then another. The last kid was an Asian girl with braces all of about 15. She asked, "Can you do that to me?" and I have her face burned into memory since she seemed so sweet and so ready for the ride, like an excited kid at the fair ready to get on the roller coaster. She was the last one I hoisted onto the swaying arms and as she drifted away on her back, on the hands, she giggled intensely until she was gone. What a vision. All the while Weezer was cranking the music and the crowd was swaying and the kids on top were giggling and full of fun. I walked out of the concert a new man for awhile since I hadn't had so much fun for a long time.

Music can be intoxicating and Weezer was an intoxicating band. Bumbershoot was a success with me and Seattle gets credit in my mind for sponsoring such a good event. Good on ya Seattle.

How can we die of a broken heart? The physiology.

Back to a less controversial subject, how we die from a broken heart. The syndrome of Takotsubo's cardiomyopathy is interesting since it may account for the death of people who are so upset about a subject for a length of time that they actually die, much like we sometimes see when patients die soon after the passing of a loved one. Takotsubo's was first described in Japan thus it got its name, tako tsubo or octopus trap. An octopus trap is shaped such that the octopus can crawl in the trap but can't get out. It is like a wine carafe where the neck is narrow and the decanter is broad. This is what happens to the heart when someone has a lot of adrenaline floating in their system from stress, the outlet of the heart can remain narrow as the body of the heart becomes bulbous, making it difficult to emit blood. On angiogram the coronary vessels appear normal but there may be a correlation with the length of the front coronary artery, the left anterior descending artery, and risk of developing takotsubos cardiomyopathy. From the adrenaline there may be microvascular obstruction to blood flow in parts of the heart that are important for emitting blood. Patients often present with symptoms of a heart attack but can sometimes present with heart failure for otherwise unknown reasons. The treatment is with beta blockers or calcium channel blockers which can alter the strength of heart contractions and protect the heart from detrimental effects of adrenaline. This is how one could die from a broken heart.

Zoo Seattle

This will be a dark blog today. Last night I watched a documentary called Zoo, "an extraordinary glimpse into the life of a seemingly normal Seattle family man whose secret sexual appetites led to his shocking death". Basically this guy was being screwed by a horse who perforated his sigmoid colon and the guy died of peritonitis. The documentary was shown at the Sundance Film Festival in 2007. My nurse Janet gave it to me awhile ago since we had discussions of the event but I have been hesitant to watch it. The documentary interviews those involved with the secret taping of men having their way with farm animals in the fields of Washington and it seems to dramatize some events with actors. I didn't know what was real and what was staged with actors, but I do know it was the weirdest thing I have seen in some time.

The guy who died was a Boeing engineer and at least one of the perpetrators emigrated from West Virginia. During his bus ride we got to hear his reflective thoughts about of zoophobia. "It's like I really care for the animals". But these guys were sneaking onto the property of others in the middle of the night to have their way with the animals of other people, and they filmed it, and put it on the internet. There were no laws against this practice in Washington State so although there were arrests made the only charges rendered were for trespassing. Animal Rights reps were suggesting that the horses were being taken advantage of but for the first time in my life I agree with Rush Limbaugh, who was arguing on tape that the horse had to be a willing partner in this so it seemed unlikely there was animal abuse. But maybe there is a Mary Kay Letourneau argument here, another Seattle curve ball, regarding a woman who had an affair with her 12 year old student and eventually had two children by him while in jail (huh?). She was arrested and convicted for having sex with a minor but is it rape since he had to be a willing character? I guess so. By this argument it seems wrong that the horse would be put into a situation of being tempted by the pheromones of the man they referred to in the documentary as "Mr. Hands". There are now bestiality laws in Washington State so all you guys hoping for some poke outside the local Starbucks can find something else to do. Maybe the bathrooms at the Minneapolis/St. Paul airport...the Larry Craig (R-Idaho) Memorial Stall is waiting.

So in one of the interviews an organizer of the Zoo or Fun in the Fields suggested that he was an innocent. He was astonished when the County Sheriffs came to get him. As he stated, "I don't see myself as a bad person, I love these animals" but he sure took off when the cops showed up at his door.

A patient of mine in Bellingham had such bad scoliosis that he couldn't breathe but when I told him that his shortness of breath emanated from his severe scoliosis he told me that he "didn't have scoliosis" and stormed out angry. Another patient got angry when I told her she had emphysema, and when she inhaled a peanut in Miami she told me that she wouldn't pay my bill because I had missed a peanut in her lungs that was causing her shortness of breath, not emphysema. I was an idiot. But she did have bad emphysema and she was still short of breath despite the removal of the transient peanut.

Yesterday the New York Times published an article on Alaska. Alaskans were recorded saying that they wanted government out of their life, but when told that Alaska gets the most per capita distribution of money of all the states from Washington D.C. they will say, "Yeh, we sure do get a lot of money from the federal government". What is this all about?!

I have persistently encountered some weirdly contradictory and self-centered individuals that just do not frame the social world in a fashion that's understandable. Maybe this is what the Middle Ages were like.

After living in the Pacific Northwest for about fifteen years I have outlined an analogy that I want to get record: when one encounters a porcupine in the forest one tends to avoid it and each party is happy. But when a porcupine appears like a cuddly house cat and you pick it up and you get "porcupined", this is distressing. Not only that but if you cry out, "You're a porcupine and not a cute, cuddly cat" and the porcupine says, " I'm not a porcupine!" Then it's time to leave the forest that has porcupines made up like cats who don't know they're porcupines. Or at least take some pill that will calm the inner weird meter. Do the guys who screw horses and place the video on the internet really love animals? They don't act that way but they may truly feel that way.

Nurse-doctor collaboration

I have finally landed a job in Denver with a 15 member critical care group that oversees care at three hospitals, covering about 120 critical care beds. That's a relief, and now I can continue on with my plans to write a couple papers, maybe to be published or maybe not. I submitted a draft of a paper on nurse-doctor collaboration in the hospital this month to a lawyer I'm working with at the University of Pennsylvania that essentially states that it's better for patient care and it's cost effective to have better collaboration between nurses and doctors ( a kid might say, "Well doy!") Since doctors and nurses come from different backgrounds it may be helpful to have some training together in medical and nursing schools. This might include having medical students and residents shadow nurses in hospitals and vice versa. Each could learn the stresses and duties of the other, allowing for better understanding of each other's roles, and perhaps breaking some of the barriers to communication that exist at varying levels of care.

The problem is that there would still have to be a decision-making hierarchy. The empowerment of nursing has stressed the traditional hierarchy of the hospital in that physicians have traditionally held decision making responsibility while also being held predominantly responsible if something goes wrong. The call for cross training in school has been from nurses since the risk for distress in interactions is usually born by nurses. Doctors can be assholes at times. Although I believe that more cross training may actually limit some of the stress felt by both parties it seems that our biggest problem in the profession is narcissism predominantly from the physicians side, less often within the nursing profession. Many in the hospital get their undies in a bundle because they aren't getting enough attention and praise. I'm guilty of this like everyone else. Maybe we would be better off if we could somehow send a message to doctors in training that we often bear eventual responsibility for the care of a patient, be it positive or negative, but that we work in a complex setting that requires the input from not only nurses but also pharmacists, respiratory therapists, medical assistants, nutritionists and effective administrators and an array of others that can make or break a system of delivery. Some humility seems in order. Physicians are successful, or not, as a consequence of the huge and complicated network of human interaction that makes up a hospital. The reputation of the Mayo Clinic was partially an outcome of two dedicated and inquisitive doctors, Charles and William Mayo, but it survived into the future because of Dr. Henry Plummer, who set up the administrative infrastructure at the Clinic that is second to none, the Sisters of St. Mary nuns who collaborated with the Mayo brothers to develop a deep system of nursing and the people of Rochester, Minnesota who helped the Mayo brothers establish there rather than somewhere else, supplying help with making hotels into hospitals and acting as host for this world renowned institution. The Mayo Brothers would not be the icons we know without the infrastructure that Dr. Plummer and the people of Rochester created.

As for nurses, these are generally the most kind and compassionate of the medical professionals that directly impact patients. They care for the comfort of a patient with such dedication and this is often out of a doctor's emotional range and ability to regulate time given the pull of many patients as structured expectations would have it. Nurses also gather personal information about patients that no doctor could gain since they are with patients and their families more during a hospital day than any other member of the hospital team. But a flaw in the nursing literature and one that I have noticed by practicing with nurses is that there is a desire for control and decision making that may not be institutionally warranted. It would take a social change to allow more control and responsibility to be given to nurses, and this would also require that nurses accept more responsibility for negative outcomes. At the University of Pennsylvania less than 10% of law suits name a nurse in addition to the doctors involved. It is even more of a rarity that nurses are solely named in law suits. If nurses want more decision making responsibility they would have to be willing to help restructure the decision making hierarchy in the hospital and accept the responsibility of negative outcomes due to that decision making. Not out of the question, but I think it would limit their ability to be the nurturing arm of care in the hospital, maybe I'm too paternalistic here. The evolution of nurse practitioners may prove me wrong. This seems to be a work in progress.

If I were king of the hospital I would suggest that doctors take a little more time to be genuinely more kind to their nursing colleague and to take advantage of the wealth of personal knowledge that the nurse may know about the patient that we are unable to obtain. Information that may be helpful in their care. To nurses, I would have to stress that in today's society doctors have eventual responsibility for the outcome of the patient so in cases of disagreement there must remain, for the time being, deferral to the treatment plan endorsed by the doctor. In the end some of this lack of understanding between the two groups, doctors and nurses, shadowing each other in training may allow for better understanding of each other's role in patient care and a chance for discussion and exchange of ideas that does not currently exist.

These suggestions are made with humility and a desire not be thought of as a know-it-all but as someone who cares a lot about how patients get treated in a hospital. Don't we all.

Fourth of July in Montana: The Shooting of Rattlesnake Jake

I found a good Fourth of July story reported by Mary Pickett in the Billings Gazette. This was a well constructed, front page, above the crease, story in this Sunday's paper describing Lewistown's 1884 Fourth of July celebration: it's first. Since they had just established a post office it considered itself a town and the town had to have a Fourth celebration. The story was told by a 90 year old retired history teacher, Margaret Seilstad. Her father had been a twelve year old kid in Lewistown, MT in 1884 and she gathered the story from him and his friends.

That 4th of July day residents of Lewistown planned a parade, including a local resident Bob Jackson dressed as Uncle Sam, horse races, and a dance in the evening. But Granville Stuart, a historic Montana figure, who ranched in the area, conveyed concern about the celebration since he knew that horse thieves and cattle rustlers were in the area, thinking that they may steal livestock while the ranchers were in town. The townspeople wrote him off and the show went on. Indeed, by Granville Stuart's prediction, a particularly nasty pair of thieves came to the celebration that day, Charles Fallon and Charles Owen, or Rattlesnake Jake, as Owen was known. He had shifty eyes, "like a snake".

Bob Jackson, Uncle Sam, had probably been drinking and got into an argument with another local resident at the horse races but, as it was reported, a fist fight did NOT break out. Jackson was Indian and French (Metis, or mixed native and European race). Fallen and Rattlesnake Jake were drunk and approached Jackson after the disagreement that did not end up in a fist fight. Jake didn't like Indians so he hit Jackson, Uncle Sam, in the face with his pistol. Fallen and Jake then mounted their horses and left. After Fallon and Rattlesnake Jake left the races local residents converged on Main St. and stocked up on rifles at the T.C. Powers and Brothers Store because...because why not? There was something brewing.

After the altercation at the races Fallon and Rattlesnake Jake went into Crowley's and Kemp's Saloon for a few drinks, apparently already drunk and in a foul mood according to Margaret Seilstad. Jake spotted another Metis member of the local community, Doney, and shot at him but missed. Doney drew his pistol and hit Jake in the shooting finger. Jake took his pistol in the opposite hand and returned fire. After Rattlesnake Jake returned fire the angered townspeople, with their recently acquired rifles, opened fire on Fallon and Jake. Although it's not clear exactly how the gunfight progressed one version has a wounded Rattlesnake Jake riding out of town trying to escape only to notice Fallon kneeling in the street "making his last stand", said Seilstad. A loyal Jake stayed with his friend and died, riddled with "five or nine bullets", the number and any other circumstances were not perfectly clear. Both men were wearing multiple coats, in July, which apparently made it harder to kill them.

Margaret Seilstad told the Gazette that as soon as the shooting started her father went back to his tent with a bullwhacker, the driver of a team of oxen, "to get more guns." The bullwhacker was eventually killed by a shot to the head, by Rattlesnake Jake.

Before the dance started that night citizens convened a coroner's inquest and decided that the residents killed Fallon and Jake in self defense, then they danced. Although it was impossible which of the many bullet shots actually killed each man, "half the town claimed firing the fatal shots."

The bodies of Fallon and Rattlesnake Jake were stored in an ice house and the next day were displayed against a wall in town. Fallen and Jake were initially buried on Hospital Hill, where the first hospital of Lewistown existed, "but it's now the location of the Fountain Terrace condos." The man who owned the land at the time objected to their initial burial site so the bodies of Fallon and Jake were dug up, lassoed, and dragged around town, eventually to be buried near a coulee outside of town. Margaret Seilstad's father followed the body on his horse and saw bits of hair and skin from the decomposing bodies snagged on brush. According to Seilstad, "he nearly lost his lunch".

There's a skull on display in Lewistown that is thought to be from Rattlesnake Jake, but a University of Montana graduate student specializing in forensics has argued that the displayed skull is probably from a much younger man with at least some African ancestry, not Jake. Another subtle fact remains as well. It seems that Jake was shot in the head with a buffalo rifle and there was no evidence of bullet trauma in the skull thought to be Jake's. But the skull is still on display as that of Rattlesnake Jake. This is the story of the first Independence Day celebration in Lewistown, MT.

There was no mention in the story of discussions between town members of the Second Amendment right to bear arms. Not in this town. There didn't seem to be disagreement. Happy Fourth of July.

You can find it in the Target parking lot

I'm in Denver again interviewing for a job at one of Denver's trauma centers and doing more work at National Jewish. I'm trying to study 140-some patients who have a cavitary form of Mycobacterium avium complex lung infection, a bacteria like TB. This bacteria slowly eats away at the lungs over years and it's thought that 10-20 people in every 100,000 may have some form of this disease. Asthma occurs in about 1000 in every 100,000 people, giving you some perspective. TB occurs in about 4 in every 100,000 in the United States. I'm having computer data problems which is slowing me down but that's not what the blog is about tonight. It's about the Target parking lot.

I'm staying at the Staybridge Suites hotel, a subsidiary of Holiday Inn, having a stove, freezer and refrigerator and a couch for my comfort. It is not quite in the suburbs but it's hard to tell. Thus when I asked about a good place to eat I was directed to Applebee's, "in the Target parking lot." When I asked at the front desk if I could work out somewhere they directed me to the 24 Hour Fitness Center in the Target parking lot, and when I wanted some Pepcid for my stomach I discovered that there was a Walgreens, yes, in the Target parking lot. There is a SuperTarget in the Target parking lot, a store that not only has the red decor and array of goodies that a normal parking lot, sorry, Target has, but also this Target has a grocery store and indeed has a HUGE parking lot. Not only is there the above establishments but there is also a sporting goods store, a KFC, a Wendys, a gun shop and a strip bar. All in the Target parking lot. Just ask the front desk.

The Target parking lot is also the hottest place in Denver, in my opinion, or the world. It is bigger than a few football fields and it's newly covered in black top making it kind of a tar pit in the 96 degree sun. There were dead people in the far regions of this lot, clasping their doggy bags from Applebee's. I saw a mirage as I was crossing to the 24 Hour Fitness and before embarking to Walgreen's I left my driver's license and contact information with the front desk for fear that I might not return. I asked my friends Tim and Ginny to inform my family if someone found me dead in the Target parking lot. I have never crossed a desert, I've just gone to get some tennis balls in the Target parking lot. "Make sure you have enough water, sir!"

Interviews through medical history.

I don't remember the interviews I had for work at Fort Snelling as a tour guide, a 7-11 store clerk, Webb Publishing where I loaded a book binder, or Economics Lab (now Ecolab) where I worked to assess the clarity of dish cleanliness from dishwashers. I do remember some of my interviews for medical positions.

First, I interviewed for medical school where I was interrogated by a radiologist and a pathologist, two specialties known for the dynamic, personality piercing individuals they draw. The radiologist was at the Minneapolis VA hospital and since I was interviewing at a time where the Vietnam War was still in the minds of America, about 1981, he asked me if I would serve if drafted. In 1980 I had registered for the draft after some soul searching, and soul bashing, with some friends, Pete and Tim, whom I travelled with in Ireland. The year of Ronald Reagan's election to President. Neither of them had to register, but I respect them anyway. My friend Bruce actually served in Vietnam, so I bow to him. It is surprising how this issue has lingered through my life, and through the lives of our generation. I had decided to register, and I told my interviewer that I would serve if I believed in the cause, including, merely, in duty to country. But I thought that I wouldn't serve for idiots, which it seemed we were asking our soldiers to do during the Vietnam era. It would have been hard to serve for W. Bush and Rumsfeld too but I might have just done it out of duty to country, I don't know. The consequences of not serving in a draft would have been significant though. Get shot at while serving under fools, or be a pussy with a record, that's what I thought. What a choice. I'm glad I didn't have to make it.

The pathologist was at the University of Minnesota Hospital. In a dusty, Ichabod Crane manor he asked me what I would do on a first date. Oh God!!! I think I told him that I would shower for once, shave, dress in my usual green polyester suit and pick up my baby in a rusty blue Plymouth Satellite of that Racing Age. Then I would listen to her make a list of entitlements that being a cute suburban woman brought. We would eat, me ordering chicken, and she ordering the most expensive dish with liquor. The guy paying all bills was part of the entitlement... and then I would bring her home. Period. I told him how fondly I remember those halcyon days. He seemed to nod off. I got into medical school anyway.

Medical school happened over four years, then it was time to interview for Transitional internships since I wanted to do internship, then go overseas to work and travel, to come back to do a residency. It was 1987.

Some highlights of the trail included going to San Francisco to see my Aunt and cousins and going to Portland where I met a couple of surgeon candidates from Seattle leaving me with a good feeling about the Seattle area medical environment, since they didn't seem like the usual surgeon candidates that I knew, they were likable. I had limited exposure to surgeons then, but over time I have come to like and admire many surgeons.

I made a trip to Chicago to see my sister Kate in Evanston. This is where I eventually ended up. After passing through Chicago on my way to Grand Rapids, MI, in rush hour traffic, it took four and a half hours to get from the North Chicago suburbs to the Indiana border, 30-40 miles.

I got to Grand Rapids where I also interviewed. After the interview I was trying to get back to my hotel while rain was coming down in sheets and it was windy. So windy that while I was trying to get onto a freeway the wind blew my windshield wipers apart. The driver's side wiper got blown so that it was ticking against the section of the car that separates the windshield from the side window...tick, tick tick...while the rain blanketed the car and the road, all while I was going 60 mph trying to get onto a freeway. Luckily a container truck, minimum eighteen wheels, was not going to yield to me, a small Chevy, maximum four wheels. I slowed down to try to sneak behind it, but ooops!-the eighteen wheeler had another trailer, two behemoth trailers, something I couldn't see through the rain and the wiper ticking against my side window and mirror. So I had to drive on the grassy hill bordering the freeway with the sheets of rain covering my windshield and the fear of the car turning over. I think I had the radio on as well; too bad cell phones didn't exist since having the phone to my ear would've added to the excitement. As I got tucked onto the freeway the rain stopped and the sun came out. Just in time to get back to the hotel for the six o'clock news. The weather was clear for the drive back to Chicago. I didn't need the windshield wipers in Michigan, on my American made car. I also went to Pittsburgh without event.

I finished a Transitional, or rotating, internship in Chicago, went to India to work, travelled through SE Asia, and returned to do residency at Hennepin County Medical Center in Minneapolis. I decided that I wanted to do a pulmonary/critical care fellowship so I hit the interview trail again, circa 1992.

I went to Boston, New York and Baltimore, where at Johns Hopkins I was told that one of the attendings had just been kidnapped and stuffed into the trunk of a car by a group of the local hooligans from the crappy neighborhood around the hospital. And this reminds me of a medical student who was killed near Cook County hospital in Chicago while she was waiting at a stoplight after call. Working in teaching hospitals in the city is not without risk.

I hit the West Coast where I went to New Mexico, San Diego, San Francisco and Sacramento. I made two stops in San Francisco, neither was without hitch. I had a friend in Chicago from the Bay Area. Her father owned an abandoned Chinese grocery store in San Francisco and for some reason I took her up on an offer to stay there. I think I was delirious for not staying with my relatives both times I was in San Francisco. The Chinese store was actually a bomb shelter in disguise with the requisite dank, crumbling walls and a bath tub, not shower, with rusty water that was cold. The bed was like sleeping on a prairie dog village and it got broken into the night of my presence so I had to listen to people downstairs while trying to sleep. There was no phone.

I took off to Sacramento and upon returning, for my interview at UCSF, the next day, I stayed at a Holiday Inn on Lombard St. where I thought I would be safe. The next morning when I got to my car it too had been broken into. San Francisco seemed to have a problem with breaking intos. They took the radio and left the dashboard on the front seat. After reporting to the police I drove to the interview at San Francisco General hospital with the dashboard in my lap. I was late. I also noticed that during a research conference in a very crowded room, after some meetings with staff, that my fly had been open, yawning to the world. This was a trip that I have written off to bad chemistry and payment for previous indiscretions in my life. I didn't end up in San Francisco, but did get to New York at NYU. Nothing but bad hair during that interview, and I liked the city.

Finally, following another fellowship after NYU, at Stanford where I did not stay in San Francisco, I interviewed for work in the Pacific Northwest. There was little to be had at the time since the Clinton Health Care plan scared pulmonary groups into limited hiring. But there was a job in Bellingham, WA. As fate would have it one of the physician leaders there had me sit in an old church pew waiting for him while I stared at a life size framed photograph of himself and his ten year old son in the same suit with matching red bow ties, arm in arm. The Hale Bopp comet led the way to this interview, the only available job in the Pacific Northwest for me. Everything was buttoned and zipped and I got the job in 1997 at the age of 37. I was ready for practice. After a few years I got work closer to Seattle where I have been until recently.

I am now interviewing again after a delightful sabbatical at National Jewish and University of Pennsylvania. I can't seem to get enough of the interview trail, or put another way, I want to find a job that will leave me off the trail forever. My conflict is that I want stability but I love a story. Ugh.

Unemployed doctor?

It's cloudy with intermittent showers in Seattle. I have essentially finished my travel for the sabbatical and am now struggling to write stiff medical writing which causes me no end of frustration. This has never been my career calling but I consider it necessary to be a rounded clinician. It is PAINFUL!!!

I will make intermittent trips to National Jewish although my money is running out so I can't go for long periods. It has been job hunting time for me over the past couple months and that has been harder on me emotionally than I was expecting. I left my partnership on the Eastside last Fall after announcing my departure a year and a half prior to that. When I announced my departure I was being stalked and receiving murder threats, I was working 80 hours a week, had few friends, and I was having visceral disagreements with a few of my partners. It was clear that I needed to change my life drastically or I was going to lose my composure in a big way. I thought that I was part of a haunted practice and hospital, but I know I was a contributor to the problem as well. I sometimes couldn't keep my mouth shut when I should have and I could not seem to gain alliances. So what does that mean? I was odd man out, wrong in the context that I worked. And as much as I enjoyed many of my patients and other doctors at the hospital, as well as the nature of my work, I was driving some of my partners, and administrators, nuts: as much as they were driving me nuts. I was a Democrat in a Republican society, a city guy in the suburbs, a square peg in a round hole, etc. As much as I disagreed philosophically with them, they disagreed with me. I couldn't contain my opinions to my eventual detriment since I now have no job, by my own doing. As much as I maintained my ideals I also cut myself off from what I enjoy immensely, medicine and the milieu of the hospital/clinic social community. I would like to think that I have learned something from this and I plan to be more politique and reticent in the future.

Ideals are important but happiness seems to lie somewhere between inward looking idealism and being an emotional whore. I haven't found that middle ground and hope that I do someday, otherwise I'm going to be a cranky old man who yells at kids and smells like moldy leaves. Ernest Hemingway had rooted ideals and boasted of judging the worth of his life by the number of enemies he had; but eventually he shot himself. That's no way to live. Maybe attending to ones deeply held beliefs is important, but not being stiffly judgemental seems similarly important. It can be isolating and off putting, and different than mere disagreement. The path between disagreeing and judging seems fuzzy. But also, when is enough disagreement enough? Enough to suggest that you're in the wrong crowd? I have learned that ethicists often pose more questions than they answer so I'll pose this answer to the above question. It's in the hands of the Lord! OK, that one isn't so satisfying. How's this? When the burden of maintaining a relationship becomes more than the benefit, it's time to move on, hoping to find something more congruent and comfortable. I hope to find it but it's not comfortable looking. It's lonely and uncertain. But indeed I brought it on myself and must deal...

I have wanted to write about some interview experiences, so I'll do it in the next blog. -Jim O'B