ADDENDUM to Eulogy Post — Post Achille Lauro Exchange with Senator Lautenberg–October 1985

The following anecdote was part of the original eulogy but I have placed it under separate heading because of space constraints.

For those too young to remember there was a hijacking of an Italian tourist vessel, the Achille Lauro in October 1985 by Palestinian terrorists.  During that 50 to 60 hour period my parents were separated.  My Mother remained on the ship with other friends and relatives, My Father and others were off the ship touring the Pyramids.  Sadly, Leon Klinghoffer, wheel-chair bound, having suffered several strokes was cruelly and inhumanly pushed over board to his death. 

The following took place at Newark Airport upon the return of the survivors including my parents.  Senator Frank Lautenberg was present for an easy "photo op".  The similarities between my father and Lautenberg were striking.  Both were tall, distinguished looking, gray haired Jewish men named Frank.  What followed was the basis for the Eulogy comments.  I overheard the following as the two men shook hands.  My Dad spoke:

Senator Lautenberg, I have a bone to pick with you.  When President Regan went to a Nazi SS officer cemetery in Vitburg, Germany and laid a wreath there, I was so outraged that I sent you a letter and threatened to return my Purple Heart.   And you sent me back a form letter.!!

As I commented to the attendees at the funeral.  I would bet that was the first and last time that Lautenberg was speechless.

EULOGY FOR A FATHER — King Solomon Cemetery 2 / 23 / 11 (died 2 / 21 / 11 )

To  Assembled:

As is known through Kabbalistic understanding, the soul is in transition after death for the week of mourning, Shiva.  Therefore, we all attend our own funeral.  With that in mind this eulogy is directed to you Dad.

To  Dad:

I am speaking openly to you with all these mourners around to hear.  I know you would want us to celebrate your life rather than mourn your death–and we will–but allows us to do a bit of both.

How much easier, Dad if you would have been less than you were. I could have made up some noble sounding descriptions which people would recognize right away as "eulogy talk".

But the problem is anything I say about you will just be words.  Those of us fortunate enough to have known you, know the truth–words will never do you justice.

Perhaps a silent eulogy of the heart would be more appropriate–one you would hear as assuredly as you are with us today.

You had special qualities which defy easy explanation.

I could say you were kind, loving, attentive to the needs of others, self-sacrificing, modest, decent, caring.  There was a strong, gently quality about you, a sweetness that permeated your smile.

You had some kind of knack of meeting everyone on the same level–human being to human being–with a broad warm smile, an easy laugh, an open heart.

To you there was no difference between rich or poor, king or servant–they were just people–human beings like yourself.  You would engage them in conversation–they would remember you always.

I could say you were grateful for what you had in the world of material possessions.  Jealousy and envy were such ridiculous wastes of time to you.  But most importantly, your gratitude was for the gift of love which you shared with so many.

You had your share of adversity–from the wounding on the battlefield in Nancy, France in WWII, your life-long disability which never defined you, to the loss of your first born daughter Janice, to the loss of the love of your life–Millie. 

You remained undeterred in your exuberance for life and hope for the future.

Even after that long and tortuous hospital stay this Fall at JFK you spoke to Seth of your hopes and dreams.  We still marvel at your courage and optimism.

I could say that you valued family, friends, country and faith.

Family. You told me of your first job working as a young boy at a soda fountain.  You came home and gave half your money to your mother, some to your sisters and kept the rest.  But you admitted you probably ate more in ice cream than your salary.  When I asked you why you did it you answered, "because I saw my siblings do the same.  That's just what my family did."

Friends were always important to you.  Especially when they exhibited the devotion to others you so highly respected.

Faith.  You were deeply committed to Judaism.  It had sustained your ancestors over thousands of years of travel and travail.  But as dedicated as you were to it, I never heard you disdain any other faith.  You only expected mutual respect–and you always showed it.

Country. You loved the land that welcomed your immigrant parents from the interminable anti-Semitism of Czarist Russia. You were proud to serve and nearly give your life for the Armed Forces. But you could criticize it when you felt it was necessary.  ( Post Achille Lauro  exchange with Senator Frank Lautenberg–under next posting)

Role Model.  Not with words or platitudes but with your deeds, how you lived your life did I learn the meaning of love in action.  You honored and respectded your wife, my mother–always.  You were always there for us as well.

Pop.  I could say that you were eternally young, optimistic.  You said, "if I can just get a little stronger I'll go to Florida next winter."

You were so comfortable in your own skin that you allowed others to feel comfortable in theirs.

During those long hospital stays over the past 4 1/2 years you continually bounced back from life-ending disease stated.  Bad enough to take out someone half your age.  I began to compose eulogies in my mind many times. But you fought back, defying the experts.  Good thing you didn't know how sick you really were.

And even now when your body could not sustain the strength of your spirit, as you approached death, you never stopped knowing that life was a precious gift, not a guarantee.

You loved openly and deeply.

For this and more I will be eternally grateful and will always love you.

E V O L U T I O N — Deriving Life From A Toxic Excretion — Oxygen

Oxygen must be the most valuable element in the Universe.  Right?

Ah.  It is interesting to change perspectives.  What if oxygen was a poisonous waste product?  What if we evolved as opportunists who could use this waste product, this toxic gas in order to live?

Early cellular life on this planet were anaerobes.  Oxygen was essentially nonexistent in their primeval atmosphere.  Procaryocytes as these early cyanobacteria were called grabbed COs from the atmosphere and in a miraculous alchemy known as photosynthesis created themselves.  In the process they released a toxic gas known as oxygen.

They were so successful as living beings that they nearly created their own demise.  In what is known as the "oxygen catastrophe" 2.4 billion years ago, nearly all early anaerobic bacteria were extinguished by an excess of this toxic gas.

What evolved were known as eukaryocytic cells who were advanced enough to have nuclei and cytoplasm.  They "knew" how to take advantage of this toxic gas and through a biochemical reaction known as respiration derive energy and life from it.

We are their descendants. Go figure

I B S — The Art vs The Science of Diagnosis

Readers of this blog already know that I am fascinated by IBS.  It is both a diagnostic and treatment challenge of the highest order.  It is clearly a condition in which mind and body interact to produce a myriad of distressing symptoms.  It causes enormous suffering.

In many ways it is difficult to diagnosis, for certain.  There is no biopsy or single blood test which will make the diagnosis.  It also can manifest itself in a variety of forms.  It can share signs and symptoms with other more "serious" conditions in which therapy is very different.

There are attempts to make the diagnosis more scientific.  Prometheus is a pharmaceutical and testing company which launched an IBS diagnostic panel of lab tests in an attempt to rule in or rule out IBS.

They are a fascinating complex combination of ten assays whose names themselves might trigger an IBS attack.  Forgive me if I list their names.  For the sake of brevity I will not explain what each is supposed to reveal.

Trust me that the names of each assay seems foreign even to me. Several reflect activity consistent with IBD which is inflammatory bowel disease (ulcerative colitis & Crohn's disease), others suggest celiac disease.  The remaining suggest immune dysfunction or motility disorders.

The problem with this approach is that although it may confirm the diagnosis, it doesn't lead to therapy, to healing.

This is the challenge of treating IBS in the real world.

It still comes down to tailoring the treatment that works for the individual who sits before me, behind the exam room door.

SEX, BRAIN CELLS & EXERCISE– Confusing Article ?

One of my favorite sources of material to blog on the New York Times offers some information on exercise and neurogenesis (brain cell growth) that seems unnecessarily confusing.

It does on rely on scientific studies with mice and rats which are difficult to translate into a human context.  But there are inferences made to human behavior in this article anyway.

The question seems to juggle the factors of exercise, human interaction and, of course, sex.  Does the sex element count as human interaction, exercise or both?

Guess it all depends on the individual situation.

But the simple explanation might just be in seeking a balance.  Exercise, social contact, sex–they all work to help create a "better" you.

Of course we all know that anyway.

The challenge is how to get there.

“TRANCE” EATING — Not Being Present, The Ultimate Diet Buster

A personal observation–I sometimes find myself eating in a "trance-like" state.  This usually occurs at my office or surgicenter in between patients or cases when I have time and no patience to just sit and be still.  This is known as "noshing".

This constant need to "do something" rather than be quiet and in the moment leads me to grab at some cashews or potato chips or pretzels.  Although I don't eat a large quantity at each time, there is no reason to do what I do.   I am clearly not hungry at that moment.  I realized that I am in some altered state of consciousness, and it isn't good.

The answer will require some act of will.  I must think before I enter familiar territory and remind myself that I will be aware of each moment.  I will hopefully stop myself before entering this altered state in which automatic actions based on habitual behavior takes over.

Be present, be aware and be careful.  It may be the best diet advice ever.

THE LOCKED DOOR—Look For One That Opens

Life is only understood looking backwards.  Unfortunately it has to be lived moving forwards.  This is a paraphrase of a quotefrom Danish philosopher Soren Kierkegaard.  What do we do when the path we are on includes a door which seems locked?

I am not advocating changing paths especially when one feels a powerful connection and desire to pursue a specific goal.  I'm merely suggesting a different approach.  Try looking elsewhere for a path/doorway which is more amenable to entry.

This may manifest itself in changing a particular tactic you are using.  Re-evaluate your methods, for instance.  Look to meet new people associated with your goal.  Consider changing your geographical location.  Perhaps a literal change of scenery will re-invigorate your efforts.

Your frustration in facing a locked door is a message.  The Universe is blocking you for a reason.  Perhaps it means going back to school or seeking more experience before approaching this same door.

The possibilities are endless.  Just be aware that when the you find a door that opens more easily, enter and continue your journey.  It is very likely that this is the right path for you.

Remember the concept of flow.  It feels natural and you get where you want to go.  The open door leads you there.



A recent essay by Dr. Sandeep Jauhar in the NY Times describes physician discontent as connected with the gradual rise and power of insurance / managed-care companies over our collective and individual fates.

Sure we cringe as we see our reimbursements decline without reason or recourse.  No one likes making less money for what they do.  Likewise we deeply resent having to play their game regarding paper work, phone calls, rejections, appeals etc. for medication we prefer or procedures we believe necessary.

But of all the issues that have diminished the appeal of this noble profession none are approach the level of malpractice concerns and the defensive medicine they engender. 

There is a built in assumption that when a physician is sued for malpractice, that there was some kind of intention to do harm.  This is never explicitly stated.  And any obvious intent to harm would automatically be considered a criminal offense.

But I do have a shocking revelation to make–we ARE human beings.  We take on enormous responsibility for the health and welfare of other human beings.  By and large we do the best we can.  We are not perfect.  If that isn't OK then we are all in trouble.

The usual case of malpractice involves some form of human error–a lab result not reviewed properly, a complication of a procedure, a mistake in diagnosis, a missed diagnosis.

Now all of the above are errors in medical practice.  All need to be adddressed.  There are consequences to dealt with and compensation to injured parties be acknowledged.

But to drag a physician in front of a jury who are, by the way, not his peers (in a medical information sense) and to render judgment is ludicrous and insulting to the profession.

Juries are greeted by "expert" witnesses who are paid by each side to present "expert" opinion on the guilt or innocense of the accussed.  Strange how two "experts" could have diametrically opposed opinions.

Hmmm…  How is a jury to decide which one is correct?  I don't know and neither do they.  The decision may be based on their subjective perception of the sincerity of the physician.  Do they seem concerned, sorrowful, contrite?  Do they seem like "nice" people?  Or are they arrogant, unfeeling, cold and aloof?

You can pretty much predict an outcome based not on the facts at hand but on subjective impressions. This is not the right way to adjudicate issues of malpractice.

The American justice system is based upon the right to sue anyone at anytime.  But the venue in malpractice cases MUST by taken out of the jury system and placed before panels of experts.

These panels would be comprised of doctors, nurses, laymen, lawyers, clergy, professors, or any other trained group who can objectively view the merits or weaknesses of a case and render a fair verdict.  Damages for "pain or suffering" of a reasonable amount can be part of their job description.

Often the emotional toll for sued physicians extends far beyond the hours away from their families and practices.  Let these cases by handled swiftly and judiciously.  Allow my fellow physicians to move on in their lives.

Speak to anyone in health care.

Despite Obama's declaration that defensive medicine is not responsible for health care costs, everyone else on the planet knows that it absolutely IS!  (To me, that statement completely linked him with a tremendous source of his campaign revenue– the Trial Lawyers).

So regardless of party affiliation, let's please face the obvious need in this country.  Make me happy.  Deal with tort reform. Now!!