End of Sabbatical

Well, in two days I start work at Critical Care, Pulmonary and Sleep Associates (CCPSA) in Denver full time and my sabbatical will officially be over. Critcaremd.com if you are interested.

I left Overlake Internal Medicine in the Fall of 2009 and the new year has rung, it is now Jan 1, 2011. Over this period I have been through Seattle, Denver, all over Montana and Wyoming, multiple times in the Twin Cities, Chicago, Cleveland, Atlanta, Philadelphia, Gettysburg, Washington D.C., New York City, Amsterdam, Berlin, Zurich and Prague. I have written about all these places and from the medical side I have written on National Jewish Health and how it got its name, military trauma, the devolution of evolution, sarcoidosis, high altitude physiology, prehistoric TB, leprosy and the Bible, the cost and politics of medicine while the legislature was trying to pass Obamas Health Bill, how chickens could be used as barter for health care as proposed by Sue Lowden-Senate candidate from Nevada, medical interviews I have suffered through in my career, nurse-doctor collaboration and other ethics issues while studying at the Penn Center for Bioethics, and how we could die from a broken heart. Other horsing-around topics have included Fourth of July in Billings, MT, living near the Target Parking lot, blizzards in Philadelphia, geographic illiteracy in the US, and how a Boeing engineer was killed by getting "too close" to a horse in Enumclaw, WA.

On the more serious side, my Mom died within the last last month and I will miss her very much. She raised five kids, four daughters and a son, with precision and most often grace, but she was in her 80s and suffering from recurrent lymphoma so her death was somewhat of a blessing. She was uncomfortable both physically and emotionally and her passing relieved her of that burden. God bless her. She was a bright woman with many interests and she taught all of us many important lessons in life, not the least of which was to enjoy reading. She read often and her children have been readers and have pursued strong careers in law enforcement, aviation, medicine, business, and communications and literature. She was a doctors wife with a life of her own, more like a Hillary Clinton first lady than many other first ladies of the White House. She had a career in the 1950s in home economics where she worked for General Mills, Economics Laboratories (now Ecolabs) and she had a cooking show for a time on Times Square in New York. I used to tell friends that she was Betty Crocker and she was. Her first husband died tragically in a plane crash while flying with the Air Force just one week into their marriage. She loved travel and she was always up for a visit where ever her kids lived or travelled. Although she had her trying moments, as we all do, I will miss her and I loved her as I loved my father. May they both rest in peace.

I have felt lucky over the past year or so since I have had the means and ability to pursue some interests outside of a career in pulmonary and critical care medicine and I would recommend time like this to anyone, although I acknowledge that without kids and by having a doctors salary I lie outside the norm, leaving me privileged. In addition to some scholastic interests I have also been able to rekindle relationships with family and friends that I would not have been able to do without the freedom of time. I have gone to baseball games, read books, and laughed a ton with those that I have not seen enough of in the past thirteen years, since getting into practice, and it has been priceless. I acquired a cat, Peanut Butter, from my friend Mary and her daughter Ollie and in addition was able to see Ollie off to school at the University of Chicago. Since I don't have kids of my own I have enjoyed moments with Ollie and Mary that I would never have been able to enjoy working 60-100 hours a week in a practice. Indeed, I even got to give a lecture at Ollie's high school. I also got to see my niece and nephew, Alice and Andrew, in Atlanta as well as in the Twin Cities. They are young and goofy in a great way. Again, over thirteen years I felt that I was losing touch with family. I have played hockey with the Quinlan's, spent a whole lot of time with Tom and Lily, my cousin and his wife, and my retired Army buddy Bruce, and master cabinet maker, has been up for travel at the drop of a hat. We have joked about how we are perceived as a gay couple, far from reality, not that there's anything wrong with it...And my friend John came to visit me in Philadelphia where we basically goofed around like we used to as teenagers working at Fort Snelling. God what a time. I wouldn't have given this up for the world.

But it's now time to get back to work. I am looking forward to my new position in Denver. The work has more trauma and generally more critical care than my job in Seattle. This is exciting to me, and I will work less but be paid more, a proposition that only a fool would hesitate to embrace. Also I hope to continue projects that I started at National Jewish and the Penn Center. I hope to get some data into publication on cavitary mycobacterial disease as well as well as on some subjects of bioethics which I have grown to be quite attracted to. A few books on ethics and time spent at the Penn Center have really piqued my interest. But who knows, as long as I'm doing pulmonary and critical care clinical work and having enough time to enjoy life I think I'll be happy. The academic stuff would be icing on the cake and my expectations are low since I have always kind of sucked at academic medicine.

I wrote this blog because I wanted a way to record what I did and thought over the past year and I wanted to get more experience with writing. As they say the best way to become a good writer is to write, so that's what I have done. In the future I will probably continue to write on topics that come into my head but these topics may be less directed around travel or medicine. I like the free-form aspect of writing a blog, so the future will tell if I develop any pattern or if I remain a hack. Thanks to the few of you that have been following, I have appreciated your feedback and compliments.

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.