R.I.P., Jack Bruce

The music world is reeling from the loss of one of its greatest frontiersmen, Jack Bruce, who lost his battle with liver disease yesterday.  He was 71.

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John Symon Asher Bruce was born in 1943 near Glasgow, Scotland.  He was an extraordinary bass guitar player–adept and gifted in the performance of both fretted and fretless basses–and a distinctive singer.  He was best known, of course, as bassist and lead singer for the seminal British rock trio Cream.  However, his musical interests were very eclectic, ranging from hard and progressive rock to jazz and blues.  He was a prolific live and studio artist, his musical output continuing until near the very end of his life.  His most recent recording, 2014’s Silver Rails, is a broad-based collection of thought-provoking songs full of hope and joy.  His influence on musicians–and particularly bassists–over the past fifty years cannot be overstated.  Undoubtedly, in the weeks to come scores of musicians Bruce impacted will pay homage to him and his legacy.

I had the privilege of meeting Jack Bruce at an awards show in London in 2008.  Though we had little time to speak at length, I found him to be warm and kindhearted.  I hope that he passed knowing that the world loved his soul and genre-bending musicality.  He clearly will be missed by many.

I’ll leave you with a clip of Bruce on fretless bass during his 2005 reunion tour with Cream.  R.I.P., Jack Bruce.

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How I Remember 9/11

 

“This must be a joke,” I muttered.

My alarm clock has gone off at 6:30 a.m. virtually every morning for years now.  I follow my own clinical advice and do everything I can to keep my sleep schedules regular, including on weekends.  The morning of September 11, 2001 was no exception.

The alarm provoked my arousal at its usual appointed time.  As my waking cortex struggled to climb out of its sleepy haze, I listened lazily for a few moments to the muffled words on the NPR station to which I kept my clock radio dialed.  I could tell immediately something was different this morning, even prior to my comprehension of the words.  There was an urgency to the voices, staccato, quick and breathless, unscripted and frightened.  Whatever was the topic at hand, this clearly was not a normal news day.  Then the words started to register in my brain:  “planes,” “World Trade Center,” “attacks,” “explosions.”

My first coherent thought was that what I was hearing was a hoax, a modern-day War of the Worlds.  A couple minutes of listening and then the first images on television terminated any hopes I had that it was so.  I jostled my wife awake and the two of us stared at the TV in mute, open-mouthed horror.  At that moment, I knew our country would never be the same.

My brief drive to work–under beautiful cloudless blue Seattle skies eerily similar to those above Manhattan that same morning–was a blur.  I walked into my clinic.  Not a single person said a thing.  We all just looked at each other in disbelief, our eyes all saying to each other, what is happening to our world?  

Not surprisingly, few of my patients chose to show up to clinic that morning, so I had some extra time on my hands.  I and my co-worker, Lamont, found our old little rabbit-eared lab TV, and we spent most of the morning staring at the fuzzy images, still trying to comprehend it all.  Needless to say, I didn’t sleep very well that night and for several nights thereafter.  Neither did my patients.  In the months to follow, I was bombarded by insomniacs filling my clinic.  The entire country suffered from collective insomnia as well as collective grief.

During my life there have been several events that I remember with clarity, defining moments in our country’s history.  I remember lying on the front bench of our family’s big ol’ sedan, watching my father stare at the AM car radio as Nixon’s resignation was announced.  I remember being in class hearing about John Lennon’s assassination and Ronald Reagan’s near-assassination.  In college I stood in a crowd in our student lounge after morning classes, watching images of Challenger exploding on television.  9/11 was one such moment, of course, and probably the most notable single historical event of my working adult life.  Twelve years later, it remains difficult for me to believe that such a thing even happened.

I must admit I grumble about some things from time to time:  the miserable state of our country’s health care administration and reform; traffic; the interminable meanness and passive aggression of some people; all the hassles and noise of modern life.  Each 9/11 brings me back to center, reminding me of how privileged I am to be alive now in this time and place, enjoying the family, friends, and prosperity with which I somehow, undeservingly, have been blessed.

As it is for millions of other Americans, 9/11 is and always will be a day of reflection for me.  As horrific as 9/11 was, it did crystallize in my mind some of my life’s most basic philosophies:  love fiercely, live boldly, and protect yourself and those you love from those who seek to harm you, whether they be silent or loud in their intent.

A Mother’s Day Wish For Better Sleep

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This is my mom.  Please spend a moment and look upon her beautiful face.  Perhaps you may see some of the same qualities that I do:  the hopeful happiness in her smile, the joyful but fiery intensity in her eyes, the serene youthfulness in her gaze.  She looks so young and new here, new at adulthood, parenthood, American life.  But for me, her son, I also see wisdom, awareness, a vague sense of knowing, some ill-defined proficiency in everything she does, though she was much newer at this parenting thing when the photo was taken than I am now.  A lifetime of observing my mom’s way of being and burning love for her family gives me well-informed license to perceive these special qualities:  this unique perspective creates a sensation, and feeling you cannot know unless it’s your own mother you see looking back at you from that old, black-and-white photograph.

Mom had gone through a lot to get to where she was when my dad snapped this photo.  She had left her native country and a life of comfort and stability–a true rarity in Korea at the time–for a modest life with a young Japanese-born, American-trained professor of Korean descent, now living and teaching in Michigan.  An accomplished pianist and young scholar in her own right, she threw herself eagerly into the responsibilities of being a wife and parent, managing to earn a master’s degree in mathematics along the way.  Looking at her young, smiling face, one wonders if she had some inkling of the adventures to come:  all the soccer and baseball games, the world travel, the many times playing hostess to friends and her husband’s many colleagues and students, the maturation and graduation of her sons, the germination and success of her businesses.

She could not have known, however, about all the challenges that lay ahead.  Apart from the passing of my father–the most devastating event in the lives of everybody in my immediate family–the biggest challenge of them all was her diagnosis with Parkinson disease, which has over the past several years gradually robbed her of her agility, coordination, and ability to walk.

A neurologist by training, I have counseled many patients and families regarding the management of Parkinson disease over the years.  No clinical experience or medical training could compare, however, to the education I have received from helping a parent cope with this cruel disorder every day.  It has been a truly humbling experience, realizing the true personal effects of Parkinson’s as I have through my mother.  This knowledge now in hand and without dwelling on details, I am qualified to offer this one, non-doctorly piece of simple, universal advice:  never get Parkinson’s.  It blows.

Today’s entry pertains to sleep because Mom started having substantial insomnia–without a clear trigger–years prior to her diagnosis with Parkinson’s.  Parkinson disease is commonly associated with sleep disruption and it is not uncommon for the first symptoms of Parkinson’s to be very nonspecific, starting well prior to the onset of more specific symptoms (tremor, slowness of movements, and the like), so I wonder in retrospect if her difficulties sleeping represented the heralding problem of her particular disorder.  Her neurologist, a movement disorder specialist, is doing what she can to manage the insomnia, but Mom still struggles with her sleep from time to time.

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Last year I had the pleasure of introducing my mother to Michael J. Fox, whose public battle with early-onset Parkinson disease has been the inspiration for many public speaking events and several excellent, highly recommended books (which Mom and I have both read), including Lucky Man:  A Memoir and Always Looking Up:  The Adventures of an Incurable Optimist.  Mr. Fox told Mom, “You look great!”  It was wonderful for her to meet someone who has lived what she is living, someone who understands.  She smiled quietly in response, and in her expression I saw that same hope and determination she’s always had, qualities so relentlessly challenged in recent years by this crippling disorder.  I believe that that fight will always be there, despite the fatigue, because that’s who she is and who she will always be.  And my family and I will continue to be there for her, helping her fight.  When it comes to my mom, I took off my doctor’s hat long ago.  I’m just a son, a boy loving and trying to help his parent.  That’s all I can be now, and I think that’s what she needs most.

Today’s Mother’s Day.  Dang it, man.  Love your mom.  Remember her if she’s gone.  Squeeze her tight if she’s not.  Call her if she’s away.  Just don’t waste a second of her presence.  Moms are incredibly precious.  I know mine is.

Boston, You’ll Get Through This

Memories of Boston.

Grimy rides on the T.  Bewitching days in Salem; late nights at Mama Kin on Landsdowne Street.  Morphine (the band, that is) at the Brookline Festival; Green Day at the Shell.  The Citgo sign from behind the green posts at Fenway Park.  Leisurely walks through Back Bay, Bunker Hill, Boston Common.  Uninterpretable street signs and a thousand wrong turns.  Pool at Jillian’s; chess in the Living Room.  Hidden treasures at Newbury Comics; cheap t-shirts at the Garment District.  Scorpion bowls at the Hong Kong.

These fleeting bits of my young adulthood resurfaced in a white flash yesterday as I watched horror unfold at the finish line of the Boston Marathon on Boylston Street.

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My heart aches for those killed, injured, or otherwise affected by those two bombs.  Boston deserves the nation’s support, assistance, and love.  I don’t really think it needs our sympathy, though.

Let me tell you something about New Englandahs.  There are a couple qualities I’ve come to understand and admire regarding people living in New England, having lived there myself for four years.  First, they are resilient.  You don’t germinate a new nation and win a Revolutionary War in -10 degree temperatures without inner strength and a hardy disposition.  Second, they are honest.  They speak the truth, even if it’s uncomfortable or hard to hear.  As we as a society become gradually more soft and squishy, I think we might benefit from reminding ourselves of the virtues of these qualities.

Last night over dinner, while discussing the day’s events with our boys, my wife asked, perhaps more to herself than to me, “Do we all just have to live with this kind of thing happening forever?”  In New England fashion, my answer, perhaps more to myself than to her, was “probably, yeah.”  Why?  Because 1) history as shown over and over that there always have been, and therefore likely always will be, some people far removed from the bell curve whose violent actions affect the course of history; and 2) because this modern world is full of passive aggression, of which yesterday’s attack was a particularly extreme form.  We all encounter it on one level or another regularly throughout the course of our lives; it’s unavoidable.  And though our everyday encounters with passive aggression may be less violent than a homemade bomb in Boston, they carry with them their own unique risks and potential for danger.

Having children obligates you to redefine and reorganize your thoughts so they can be explained specifically and clearly.  How do you explain how a risky, even seemingly brave act is actually cowardly?  Here’s the best I could come up with yesterday.  If you detonate a bomb and claim responsibility, you’ve communicated with the person or organization you have a beef with indirectly, and at the expense of innocent people.  If you detonate a bomb and don’t claim responsibility, then you’ve hurt many people without communicating anything but pain, simply to satisfy some twisted, unmet inner need.  Either way, you’re a coward.

Boston will rebound with a vengeance, as it always has.  I have no doubts about that.  I agree with its mayor:  Boston is a strong city.  I’m providing no sleep advice today.  I will offer this, however, fully recognizing that I’m no more qualified to comment on such things than anyone else.  Love the ones you love with truth, man.  Communicate and behave directly and honestly.  To me, honesty is every bit as important as kindness; it is in fact a form of kindness, even if the truth hurts. What does it say about humankind when there is so often the appearance of kindness when something sinister lurks underneath?

R.I.P., Phil Ramone

The music world lost a giant today.  Legendary sound engineer and music producer Phil Ramone passed away this morning.  He was 72.

Ramone was born in 1941 in South Africa and raised in Brooklyn, New York.  He became a naturalized American citizen in 1953.  In 1958 he co-founded A & R Recording, a recording studio in New York.  He subsequently became known as an innovative music engineer and producer, and he went on to produce music for dozens of seminal artists from many important genres, from jazz (John Coltrane, Stan Getz) to rock and roll (Elton John, Bob Dylan) to blues (B.B. King) to R&B (Aretha Franklin) to folk rock (James Taylor, Peter Paul and Mary).  He also produced classical music, broadway musicals, large-scale concerts, music for television shows, and movie scores.

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I met Mr. Ramone in early 2011 when he dropped by a recording session at Avatar Studios in Manhattan.  He was incredibly warm and welcoming, brimming with soft-spoken humor and wonderful stories.  We took a break for a couple hours and sat in a semi-circle around him in the control room as he regaled us with stories of coming up in New York, gaining prominence in his field, working with Paul McCartney, producing for Billy Joel (coincidentally, the subject of my blog entry from yesterday), and navigating around the music industry.

So much of the music I love exists because of Phil Ramone.  I hope he’s still making music somewhere.

A St. Patrick’s Day Anecdote

 

Long ago during my training years, a man in his early sixties—I’ll call him Karl—was admitted to our hospital service one day in mid-March. Karl had metastatic cancer, and he was dying. We on the in-service team liked him very much, remarking quietly to each other how it so often seemed to be the good ones that die early of such tragedies. Despite his terrible prognosis and physical discomfort he was pleasant–jovial, even–during morning rounds, putting everyone at ease with his polite disposition.

One day we walked into his hospital room, and he was having a tough morning, though not for physical reasons. He was really down, uncharacteristically so. We asked him what was troubling him. A little embarrassed at first, he shared that it was St. Patrick’s Day, and true to his Irish roots he normally celebrated that day with a glass (or two) of green beer. Doing so was a custom of his and his family’s for decades. He told us how unfortunate it was that he wouldn’t be able to celebrate this way this time ‘round.

Upon examining him and talking with him further, we took our leave and somberly continued morning rounds. Afterwards I stood at the nurses’ counter with my chief resident. I was post-call and yearning for sleep, so I wasn’t paying much attention to what he was doing; I was hanging around until his exit off the floor, which was tacit permission for me to go home and go to bed. He made a couple brief phone calls and wrote something in a patient chart. He slammed the chart shut, startling me, and grinning widely he proclaimed, “That oughta do it!” And he walked off, swinging his stethoscope in his hand as he disappeared down the hall.

I looked down: it was Karl’s chart. I couldn’t help it, of course. I opened it, flipped to the “orders” section, and read the following in my chief resident’s barely legible scribble:

“Administer 1 glass beer p.o. x 1. Apply green food color prior to ingestion.”

I smiled as I left the hospital that morning.

After awakening from my post-call nap I called the floor and spoke with Karl’s nurse. He had enjoyed his green ale. Several days later he went to hospice a happier man.

That was a couple decades ago. I hear that beer is still available in some hospitals. But I wonder how difficult it would be for a dying person to get it these days. The process of health care is so burdened now with endless complexities—regulations, statutes, administrations, commissions, regulations, third party payers, boards, committees, and did I mention regulations?—it seems hard to believe that underneath all of that still exists the original idea that I went into medicine for in the first place: to actually care for people, to make what is miserable less miserable, to heal, to help make life a little better, maybe lengthen it too. All this sounds so quaint and clichéic now, things one might say in a medical school interview. But isn’t it still true, what we’re all still supposed to be doing in health care? If so, does the administration of health care now really have to be such a struggle, such a fight all the damn time?

To some of those non-clinicians who have their hands in the business of health care, I would ask what they would do if charged directly with the task of making a person’s life better. What rules that they themselves created would they try to bend to grant a dying man a green beer? Or would they? A green beer would be difficult to pre-authorize.

As my life continues on, I am increasingly grateful for what I have, who I have it with, and what I am allowed to do every day for work. I think of Karl every St. Patrick’s Day. To my readers, if you choose to celebrate a little tonight, I’d appreciate your lifting one up to Karl and cheering the greatness of life. We’re lucky to have each day we have.

Happy St. Patrick’s Day, and Happy Selection Sunday!  Lá Fhéile Pádraig Sona Daoibh!

 

R.I.P., C. Everett Koop

It’s with a heavy heart that I write this brief piece in tribute to C. Everett Koop, our nation’s former surgeon general.  He was born October 14, 1916.  He passed away peacefully yesterday at his home in Hanover, New Hampshire.  He was 96.

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Dr. Koop was born in Brooklyn, New York.  He completed his bachelor’s degree at Dartmouth College, his medical degree at Cornell, and his doctor of science degree at the University of Pennsylvania.  For decades he served as surgeon-in-chief at the world-famous CHOP (Children’s Hospital of Philadelphia).  He was also a professor at Penn.  He was well-published and he developed numerous important surgical procedures.  Then, in 1981, he was appointed by Ronald Reagan as deputy assistant secretary for health and, shortly thereafter, surgeon general of the United States.  He remains the one U.S. surgeon general whose name I consistently remember.  During his tenure he steadfastly championed several important health and social issues, including AIDS awareness and the importance of smoking cessation.

Following his service as surgeon general he eventually returned to Dartmouth, where he held professorships and founded the C. Everett Koop Institute at what is now called the Geisel School of Medicine.  I met and spoke with Dr. Koop following his lectures while I was a resident there.  His personality was as colorful as his bow ties.  I thoroughly enjoyed speaking with him and hearing his thoughts regarding the direction of medicine and the politics of the administration of health care in this country.  These issues were not otherwise routinely taught to us postgraduate trainees, and no one at the time could have dreamed about how important an awareness of health care administration would be now in the 21st century, a genuine health care crisis looming as it now is.  It was abundantly clear to me that Dr. Koop honestly cared about the welfare of all Americans.  I loved his enthusiasm and his ongoing interest in teaching, despite his advancing age.

I believe the United States would benefit from more physicians like C. Everett Koop, those who have the courage to stand up for what they believe in and what they believe to be right.  He will be missed, both in the Upper Valley and way beyond.  Sleep well, Dr. Koop.