The Best Medicine

Play Ball!

2010-04-25T19:02:00.000-05:00

I was in the park yesterday playing ball with my kids. It was a beautiful day. The sun was shining on my face and a cool, crisp breeze was giving my mind a much-needed sense of clarity. I stared down at the baseball in my hand. My first two fingers covered both rows of red laces and I wondered if I could still throw a curveball. I tossed the ball towards my son, but he barely got the wooden bat off his shoulders before the ball bounced off the tree behind him. As he swung the bat, his whole body followed along and he made a complete revolution. “Good swing, William. Just keep your eyes on the ball.” He slung the bat back up on his shoulders and almost tipped backwards. “This bat is kind of heavy, Daddy. Is this the one you used when you played?” I pondered the question for a few moments and, like many times before, was instantly transported back to 1976.

1976 was a life-changing year for me. Not only did I get puked on during my school play (see “Places!”) but I also began playing Little League Baseball. I’m not sure whose idea it originally was, but my Dad was clearly more excited about it than I was. I enjoyed watching the Yankees play on television with him, but putting myself out on the field just didn’t seem like a natural progression. “What do you have to be nervous about?” my Dad would ask. A few of the words that popped into my mind included, PAIN, FAILURE, HUMILIATION, REJECTION, but my mouth would always sum them up by saying, “I don’t know.”

Before opening day, my Dad and I went out shopping for supplies. There were only a couple of left-handed gloves to pick from, so that was pretty easy, but getting my hand into it took a little twisting and shoving. “I know how we can break this in”, my Dad reassured me. When we got home, he took me to the garage and found a can of 3-in-1 oil next to the lighter fluid. With a rag, he lubed up the glove pretty good, placed a baseball inside and bundled the gooey pile of leather with twine. I was perplexed by this whole turn of events, but was also energized by my Dad’s excitement. He then took the glove and placed in down in the middle of the street. “Now stand back, Billy.” Just when I thought I could anticipate all of my Dad’s next moves, he surprised me by revving up the engine of our sky-blue, 1966 Dodge Dart and running it back and forth over the glove as it bounced back and forth on the pavement trying to escape.

The first game took place on a cold weeknight in March. I looked sharp in my new uniform and blue hat. My Dad and I hurried over to the field in the Dodge, which was missing the door handles on the passenger side as a result of an unfortunate encounter with a garbage truck. It was also completely deficient in seat belts, so I slid freely from left to right on the vinyl front seat bench as the car rounded each corner. When we got to the field, my Dad gave me a box of orange tic-tacs to hold in case I needed a snack during the game. For that entire season, I was known as the player who made a strange clicking sound when he ran, as if I was packing a secret set of maracas under my uniform.

My coach put me out in right field for that first game, and it didn’t take me long to realize that nobody had the skills yet to hit the ball out that far. Boredom began to set in, but as the game proceeded, I learned various ways of amusing myself. I looked around and noticed that my glove was the only one with tire treads on the back. I took it off and placed it on my head. It was still pretty greasy, and smelled like the inside of a gas station, but it certainly was velvety soft. It fit on my head quite nicely and my right hand welcomed the ventilation. I reached down to pick a bouquet of dandelions and danced around right field like a principal dancer at The Met. Suddenly, my fantasy was put on hold when I heard the nauseating crack of the bat. One of the opposing players, whose parents had obviously slipped some steroids into his applesauce, had swung for the stars and the ball was headed right towards me. Actually, it was headed right over me. I dropped my bouquet and peddled backwards, my eyes as wide as saucers. I looked all around for my glove before realizing that it was still on my head. I grabbed it and tossed it in the air like I had just graduated from the College of Baseball Incompetence. Through some miracle, it made contact with the ball and deflected it onto a completely different trajectory. Long after the player made it around the bases, I was still rummaging through the dandelions looking for that stupid ball.

The next inning, it was my turn at the plate. We were hitting balls off a stationary tee instead of having it pitched to us. I stepped up to the plate and spit into my palms because I had seen players on television doing that. It didn’t work out so well for me, but I quickly cleaned myself off and took a couple of practice swings. I swung as hard as I could, but instead of hitting the ball, I hit the tee, launching it like Sputnik over the infield. I looked down and saw the ball lying at my feet. The shortstop, confused about what to do next, ran towards me and tagged me with the large, rubber tee as I stared at him and remained perfectly still. Back in right field, I was re-evaluating my career path. Suddenly, my nerves and the cold air got the best of me and my bladder muscles began to twitch. This quickly turned into intense pressure, and I crossed my legs for as long as I could before taking definitive action.

I ran off the field to where my Dad was sitting in the stands and explained my dilemma. We rushed across the parking lot to the back of a Chinese Restaurant, and I was running so fast that my tic-tacs were no longer in rhythm with my footsteps. The heat of the kitchen and the smell of wonton soup were welcomed by all of my senses as I relieved myself in the small, bathroom off the kitchen. As I emerged, my hands were still painful and throbbing as the re-warming process continued. “Ready to go back?” my Dad inquired, but the look on my face was all that he needed to see. We walked back to the Dodge and drove home in silence.

I was determined to make it to the next game, and the next and the next. And for that matter, my Dad made it to all of them as well. I had many good times over the years, but I got nervous before and during each game, and my Dad was well aware of that. Sometimes I wondered whether I kept playing to prove something to myself or to him, but in the end it did not matter. I played until I reached High School and in the last inning of the last game I ever played, I was in left field. I chased down a high fly ball and caught it perfectly as it made a dull snap in my glove. It’s similar to the sound a book makes when you close it fast, which made sense because I knew that I had finished that chapter in my life and a weight had finally been lifted.

“Come on, Daddy, pitch the ball!” I realized that I had taken too much time thinking about the past. I threw the ball and William had timed it perfectly. “I think it’s a double, William!” “Maybe a triple”, he added. After I had retrieved the ball, I paused before pitching it again. “So William, do you want to join Little League?” He thought for a moment as the bat wobbled back and forth. “Nah”, he concluded. I looked at him and smiled. “OK, here it comes ...”

Pi in the Sky

2010-03-29T21:46:00.002-05:00

I’d like to wish you all a happy belated Pi Day. You know what I’m talking about, right? Every March 14th (3.14), families across the land gather close to honor the most special irrational number in the world. Everybody has their own way of celebrating. I change all the batteries in my calculator and bake, well ... pie. Sure, it doesn’t get all the publicity that Christmas or Thanksgiving gets, but it’s still one of my favorite holidays. I was in the card store just the other day looking for Pi Day cards, but I couldn’t find any. I guess they must have sold out. Wow, and I thought Valentine’s Day was big!

I tried to spread a little Pi Day cheer while I was walking down First Avenue the other day. Most people just looked at me like I had something large and green in my teeth, but one man actually put a quarter in my coffee cup. Too bad it still had coffee in it. One man with multiple tattoos of fire and skulls looked at me and said, “%@#$ off!” I felt bad. The holidays are such a stressful time for some people.

As you may know, π is the Greek letter for pi. If you multiply pi times the diameter of a circle, you’ll get the exact circumference. How cool is that! But it’s all one big lie, just like the Easter Bunny or a conservative Democrat, because pi is actually an irrational number. That means you can’t determine its exact value. I think that is why pi has always had a special place in my heart. I can also be irrational at times and there have been many times I have questioned my exact value.

As a child, I became obsessed with finding the exact value of pi. The computers at the time had calculated it out to thousands of digits, but I knew I could do better than that. I though that my 8th grade math teacher might hold the key to this mystery, so I approached his desk one afternoon like Apollo reaching the oracle of Delphi to ask him my burning question. He didn’t look up, but his bushy mustache twitched as he paused between marking red Xs on the paper he was grading. “Just divide 22 by 7.” My mouth was wide open as I slid out of the classroom in silence, stunned by the profound simplicity of his answer.

I rushed home that day, found the largest piece of paper I could find and began dividing 22 by 7. I was dividing like crazy for about an hour when I realized that the answer kept repeating in a pattern every 6 digits, 3.142857142857142857 and so on. I was broken, but not defeated. I figured that I could get the answer by working backwards. I found my Mother’s finest china plate, which I figured was the most perfect circle, and measured the circumference with a string and ruler. Then I measured the diameter and was planning to divide this into the circumference when my Dad walked into my bedroom.

He was perplexed, staring down at his son sitting in a pile of cardboard, string, tape, markers and fine china. “What are you doing, Billy?” I quickly thought up a few feasible stories, but settled on the truth. My Dad contemplated the situation. He was not a man who would dance around a topic. He was always able to cut through the murky waters of confusion with surgical precision and provide clarity where there was none, leaving everyone around him wondering, “Why didn’t I think of that?” He was an amazing problem-solver, so I anxiously awaited his assessment at that moment. “Billy, this is a futile exercise”, he calmly stated and walked out to of the room. I followed after him, shutting the door and throwing myself down on my bed. I rolled over, grabbed my dictionary from the dresser, and quickly looked up the definition of “futile”. Angrily, I opened the door and yelled, though not loud enough for anyone else to hear, “It is NOT futile!”

The First Time

2010-03-07T22:25:00.001-05:00

How did I get up here?

I contemplated this question as I stood at the top of that snow-covered mountain. I was wearing more layers of clothing than ever before, but the wind seemed to find a way through each layer. To make matters worse, my outfit could not even pretend to be color-coordinated. It looked like I had closed my eyes and grabbed garments at random during a frantic trip to the flea market, but the truth was that I borrowed most of what I had on. This was my first skiing trip in Junior High School. My friends had finally convinced me to come along and they each lent me an item that they no longer used. Jeff had donated his bright green ski pants, while Kenny provided the orange jacket. I’m not sure where the red gloves came from, but that was OK because nobody was asking for anything back. I convinced myself that at least I would be easy to spot in the snow.

My parents dropped me off at the bus waiting in the school parking lot early that morning. They had never skied, and were not completely in approval of my new sport, but went along with it just fine. My mother was already discussing ways to accessorize my motley wardrobe, and my dad came right to the point with, “Don’t kill yourself, Bill”.

I started feeling butterflies as the bus wound its way up the snowy mountain road. At the mountain, I picked up my boots and skis. Most of my friends owned their own equipment, and I immediately realized that my rentals were not exactly the top of the line. With every step I took in my boots, it felt like a wild animal was chewing at my ankles. My skis were thick and looked like they had been built in the early days of fiberglass. Instead of the fancy springs on the bottom of the skis that would turn them over if they got loose, mine had frayed, canvas straps that fastened around my ankles.

I ran in place for about five minutes before I learned how to walk in my skis, creating so much friction that it melted away all the snow beneath me until I was standing in the only patch of bare grass within a 10-mile radius. People readily moved out of my way, and I wondered if my outfit had anything to do with it. Once the crowds had parted, I found myself at the red line waiting for the lift to come. But as I turned to ask the assistant for instructions, the metal chair swept me up and sent me up to the top, sprawled out on the seat with my skis pointing skyward as I held on to any piece of metal that I could find.

I had equally little instruction when it came to getting off the lift. I didn’t realize I had to stand up, so I went down the ramp like a catcher in a baseball game until my skis slowly parted and I planted my face down into the snow. With every skier that came after me, I was buried deeper until I became nothing more than a Technicolor streak in the ground. My friend, Andy, dug me out and began explaining how to stop by putting the tips of my skis together. Unfortunately, I was facing with my back to the slope and a stiff wind pushed me slowly to the edge until I finally tilted backwards and began accelerating downwards. “I’m going down!” I declared. Andy looked on in horror. “Wait, Bill, I’m not done yet!”

I remembered him saying something about pointing my skis, so I crossed them, but this sent me spinning like a helicopter across the mountain. Snow was flying everywhere, but I tried to make the best of the situation. I rationalized that some people have to ski for many years before mastering a trick like this. The mountain suddenly dropped out from under me, and in the next moment I found myself surrounded by rubber tubing. I looked up from the hole that I was sharing with the snow machine and saw bright, blue daylight. My skis should have come off under these circumstances, but the antique, and likely rusted, bindings held strong. I took my skis off and tossed them up, one at a time, past the rim of the hole. I scurried up to the surface and made it out just in time to see them sliding all by themselves down the mountain in different directions, the canvas straps whipping behind them. One landed softly in a pile of snow on the other side of the slope, while the other launched about 20 feet in the air and struck a tree, sending it twisting back to the ground with a cracking sound.

I collected my skis, and half an hour later I was getting close to the bottom of the mountain. Some of the time I skied, some of the time I walked, and some of the time I slid. But most of the time I just fell. It was a painful and demoralizing experience. The tears were frozen to my face, and I repeated over and over again that if I ever reached the bottom, I would never go back up again. I took a break from feeling sorry for myself just in time to look up and see a class of small children gathered at the base of the mountain. They didn’t realize that they were in a direct collision course with a multicolored asteroid. I tried to slow myself down the best that I could but, of course, my skis popped off, sending me tumbling over and over down the mountain. My skis were still tethered to me by the strap and they flipped all around me like a helicopter blade as I gathered snow. I skidded to a stop in the middle of the class as the children now realized that I was a skier and not just a large, badly dressed snowball.

I looked up and blew the snow off of my face. All around me were stunned kids with rosy cheeks and mucus dripping from their noses. One little boy stepped forward, wiped his nose with his mitten and said, “Hey mister, you gotta make a pizza wedge!” I thought to myself, “It doesn’t matter, kid. I’m not gonna need the advise anymore.” But on my way back to the rental shop, I hesitated a moment, turned around and ran back to the lift.

_____________________

Last month, I took my wife, my daughter and sons up to Massachusetts to ski. This was only their second year on skis, but they did better that I could have ever hoped and we all had lots of fun. And every time I see them laughing their way down the bunny slope, or ride with them up the lift, I can’t help but smile as I think back to that first time.

Places, Everyone!

2010-01-31T22:56:00.001-05:00

Recently, I had the pleasure of attending a play at my kids’ school. They were sitting next to me because, well, they refused to play a part in the production. I turned to the right and spoke in hushed tones to my middle child, “You know, Matthew, you should be up there.” He popped a couple of Skittles in his mouth and silently shook his head back and forth. I turned left to speak to my oldest daughter (let’s just call her the Queen of Tween) and found myself staring at an empty seat. She found a friend on the other side of the auditorium and escaped without a sound while I was looking the other way. I was annoyed and became determined to find someone who could pay the emotional bill I was quickly running up that evening, so I turned back to Matthew and continued my one-sided conversation with him. “Why don’t you want to join the Drama Club?” My question perturbed him enough that the Skittle he just tossed hit him square in the cheek and rattled through the chair into the abyss of the auditorium floor. He shrugged his shoulders, closed his mouth and pretended to chew on an imaginary candy. Going along with his charade, I continued, “You know, I was in plays when I was your age and I had a great time. In fact, I remember the first time I acted on stage ...”

The year was 1976, the Bicentennial year of our great nation. Disco didn’t suck yet and my entire wardrobe was red, white, blue, and loud plaid. I had leisure suits, but didn’t even know what the word “leisure” meant. I was in the second grade and my teacher informed us that we would be performing the Revolutionary War play, “Sam the Minuteman”, for the entire school. She read us the book, and then handed out the parts. I closed my eyes and prayed, “Please don’t call me. Please don’t call me.” But then Mrs. Scheim was up to the lead role. “... and Sam will be played by Billy Reisacher!” The blood drained from my head, making me look even paler than usual. I was still in shock as I strode to the front of the class to accept the script, which was damp with pungent, blue ink. She must have sensed my apprehension as I took the pages because she leaned down and whispered in my ear, “Don’t worry sweetheart, you’ll do fine.”

When I arrived home that afternoon, I grabbed my pillow and went to lie down on the couch, my only place of refuge when the world was caving in on me. My mother immediately knew something was wrong, but I think I gave it away by watching a TV set that was not turned on. “Billy, what’s wrong?” she said in a soft, soothing voice as she stroked my light blonde hair. I explained the entire predicament to her and, as usual, she had the solution in her back pocket and instantly put my mind at ease. “But Mom, what if I forget my lines?” She picked up the script that I tossed on the carpet next to the couch. “Don’t worry, Billy, we’ll practice every day.”

The night of the play finally arrived and I was as prepared as I possibly could be. I knew my lines backwards and forwards. I was dressed in classic Revolutionary-style clothing, but was most proud of my hat, which was my Dad’s when he was a child. I saw my friend, Marcia, backstage and asked her how she was doing. “I don’t feel so good. I’m really nervous and my Mom is sick at home.” She was a member of the chorus, which sang in the background on stage. I wanted to calm her down, so I tried in vain to make her laugh. “Places, everyone!” Mrs. Scheim frantically called as we assembled in the wings and watched the lights dim. The curtain rose and the spotlight followed me to the center of the stage as the narrator began, “This is Sam ...”

The play was going perfectly. Everyone in the cast was hitting their lines, and the audience was loving it all. At one point in the story, I was supposed to lie down on a cot before waking to hear Paul Revere deliver his famous warning. On my mark, I placed my hat behind the cot and pretended to go to sleep. I had only closed my eyes for a few seconds when a horrible sound emanated from the chorus. It was a guttural, retching noise accompanied by the sound of water pouring from a large pipe. I felt a small splash reach my face and I opened my eyes. To my horror, Marcia had just become violently ill, but my concern for her shifted when I realized that my hat was the sole victim of her stomach malady.

Mrs. Scheim rushed onto the stage and escorted Marcia out of the auditorium. We were now without a director, and both the audience and cast were frozen in stunned silence. I knew that this was my defining moment. I could either rise to the occasion and become bigger than anything the second grade has ever seen, or shrink away forever into the lonely shadows of mediocrity. I stood up and faced the crowd. Staring back at me with wide eyes and open mouths were my parents, sister, friends, teachers, the PTA. Slowly, I looked down at my hat, soiled and deflated on the wooden stage as I thought, “We’re going to need a lot of Ajax for this.” I realized that, just like the foolish ways of childhood, my father’s hat was of no use to me anymore. So I picked it up, carefully balanced it like a bowl of punch as the crowd gasped, and I carried it offstage. Returning to the stage, I took a deep breath and delivered my next line.

The applause were still ringing in my head as I snapped back to the present and realized that the play at my kids’ school was over and the audience was on it’s feet, clapping, screaming and snapping pictures. I jumped up and Matthew reflexively followed, spilling the remainder of his Skittles. He stood up on his seat and spoke to me, but all I could do was read his lips. “Daddy, my stomach hurts.” We stopped off at the bathroom before heading home and conversed through the stall door. “Daddy, maybe I’ll join the Drama Club next year.” I thought about it for a moment and replied, “No need to rush into anything. How about trying the trumpet?”

It's History

2010-01-03T20:10:00.000-05:00

I walked up the front steps of City Hospital and navigated my way through the revolving door. I was wearing my short, white jacket and the overstuffed backpack on my right shoulder almost got stuck as I emerged into the crowded lobby. I stopped at the security desk and explained, “I’m a medical student from Mount Sinai. I’m supposed to meet Dr. Goldstein in room 324.” The security guard motioned me towards an elevator bank, “Make a left on the third floor. It’s on your right.”

Across his large, wooden desk, Ronald Goldstein, an internist, was explaining what I was supposed to do for the day. “Learning to take a good history on your patient and perform a complete physical exam are the most important skills that you will learn in medical school. And this is the first time you’ll get to do this on a real patient ...” He was in his 50’s and the chaotic piles of papers and journals on his desk matched perfectly with his wrinkled clothing, disheveled hair and two day old beard. His monotone voice sent me into a daydream, but I returned just in time to catch the critical details. “Mr. Pal will be your patient for the morning. He’s in room 561. Drop off your history and physical in my office when you’re done.”

I took the elevator to 5 South and followed the rooms, 558 ... 560 ... 562. Across the hall, I located Mr. Pal’s room, straightened my white jacket, took a deep breath and knocked. Hearing nothing from inside, I started knocking harder, but once my knuckles began to throb I decided to push the door open. The room had a stale odor and the sheets on the bed had been hastily pushed to the side, but, so far, no sign of my patient. I knocked tentatively on the bathroom door, but instead of a human voice, the response of a five gallon flush thundered through the door, almost throwing me backwards. Mr. Pal burst triumphantly from the bathroom. He seemed startled to see me right in front of him as he quickly closed his robe and smiled politely, “Hello.”

Mr. Pal was a 40 year old Indian male who was admitted to the hospital for pneumonia. I explained my mission and he was delighted. “Go ahead; ask me anything you’d like.” He leaned in a little closer to me and whispered, “You have no idea how boring it can get in here!” Without hesitation, I began to take a history. With each question, I probed deeper into every aspect of his life from his family history to all the medications he ever took. No stone was left unturned and within a short period of time, I felt like I knew him better than I knew myself. He started answering the questions with long-winded answers, but before long, he was able to trim his responses down to one or two words. He had a hard time with a few of the questions. “Well, I’m not exactly sure how much roughage I get in my diet, but I guess I could ... uh, why exactly is that important?”

I was taking my detailed history of Mr. Pal for approximately one hour, and the reason I knew that was because he pointed it out to me. He kept glancing at his watch, so I added that observation to the twelve pages of notes I had already accumulated, “Patient seems to have a nervous demeanor. Consider ... Neurology consultation.” I assured him that I was about to begin the physical examination, but his eyes began to shift from side to side. “I think I have to go for an X-Ray ... or something.” “Don’t worry, Mr. Pal, we should be able to wrap this up within the next hour.”

I opened up my backpack and began choosing the instruments I would need to perform a complete physical exam. With this vast arsenal of tools, which I had accumulated over the first two years of medical school, I could not only uncover any subtle physical finding, but also fix a variety of appliances. “What are you going to do with that”, Mr. Pal inquired as a pulled out a sewing needle. “I’m going to test the sensation on your legs.” Mr. Pal replied, “I don’t think you need to ... OUCH!” We stared at each other in silence for a few seconds before I looked down and scribbled quickly in my notepad, “Nervous system intact.” For the next hour, I probed and explored every space and surface on Mr. Pal’s body that I could reach and took detailed notes on all my findings. He was watching TV and for some reason, settled on the channel that had a clock ticking. Suddenly a nurse entered and informed Mr. Pal that doctors would be coming soon to perform a spinal tap. Fortunately, the only things left for me to do were palpate his liver and spleen. He perked up and said, “Oh, good ... I mean, OK, if you must.”

I sat at the nurses’ station for the next hour, compiling all of the data I had collected during the morning. When it was finished, I was so proud of what I had accomplished. I tried to staple all the pages together, but the staple wouldn’t go all the way through, so I settled for a paper clip. I went back to Dr. Goldstein’s office and placed Mr. Pal’s history and physical on his desk, but as I turned to leave the office, it slid down one of the piles on his desk and landed on the floor.

Exposure

2009-11-22T23:36:00.001-05:00

1995

I was just starting to doze off on the large, leather couch in the resident lounge when my pager went off. I put down my copy of “The Secrets of General Surgery”, read the number that flashed on the device that was starting to dig into my hip and picked up the phone. “Hey Marie, is the patient in the holding area? OK, I’ll be right there.” I grabbed my white jacket and hustled down the corridor towards the operating room.

I arrived at the preoperative holding area and found Mr. Kingsford lying on a gurney either counting the holes in the ceiling tiles or making his final plea to a higher power. He was a previously healthy man in his 50’s who recently found out that he had a cancerous polyp in his large bowel and was undergoing a lengthy surgery to remove it. “Don’t worry. We’re going to take great care of you. I’ll go out and talk to your wife when you’re in the recovery room.” He forced a smile and I gave his hand a reassuring squeeze.

“Hey, Bill, are you ready to cure cancer?” My Chief Resident smiled at me outside the operating room and I quickly returned the smile and said, “Let’s do it.” When Mr. Kingsford was finally under anesthesia, I went out to the sink to scrub my hands and arms. Returning to the operating room, I prepped his abdomen with an iodine solution and placed sterile drapes over him, leaving an open space for the large vertical incision about to be made down the middle of his belly. The anesthesia machine was beeping along with the patient’s heartbeat and the intense overhead lights made the steel scalpel gleam as it was passed to my Chief Resident.

“Bill, can you pull on that a little harder?” The sweat was pouring down the side of my face and the muscles in my shoulder screamed in pain as I pulled on the retractor in my left hand and moved the small intestine out of the way. We were two hours into the case, and the Attending Surgeon and Chief Resident were close to removing the tumor. As the Junior Resident, my primary job was to provide exposure. That meant holding retractors, suctioning blood and generally making sure that the others could see everything they needed to see. Sometimes it was an impossible task, requiring many more appendages than God gave me, but sometimes retracting was just plain boring. It was not uncommon for a resident to lean back with all of his weight to keep the retractors in position and grab a few winks in a move referred to as “waterskiing”. During a slow point in the case, I found my mind wandering. I just couldn’t escape the feeling that I had been in this situation before...

1978

“Hey, Bill, are you ready to barbeque?” My Dad was standing in the kitchen wearing his New York Giants apron that he got for Christmas the year before as I replied, “Let’s do it.” While my Dad watched the start of the football game, I rolled our circular barbecue to the middle of the patio and wiped off all the cobwebs and leaves. I then dragged a 20 pound bag of charcoal around the side of the house from the garage to the patio. I dumped the briquettes into the grill, which made a sound like hail striking a tin roof, and a cloud of thick, black smoke enveloped me. Once the dust settled, I doused the black squares with lighter fluid and struck a match. Whooosh!! The cicadas made a rattling noise as the flames from the grill punched a tire-sized hole in the ozone layer and the temperature of Earth’s atmosphere rose by a couple of degrees. This maneuver almost cost me my eyebrows on several occasions. My Dad nodded in approval as he arrived with a thick porterhouse steak on a plate and surveyed the glowing coals. His barbeque tools shined in the midday sun as we began to cook.

“Bill, could you push down on the grill a little more?” For my Dad, grilling was both a science and an art. The circular grill was mounted on a central axle, which made it extremely unstable unless there was a perfect balance of food on all parts. I can only assume that the manufacturers of this product never actually tried to grill on it. To make matters worse, my Dad only used one half of the grill, which meant that I had to constantly counterbalance the other side with a long fork to prevent all the food from sliding off. Besides the fact that the fork was never long enough to completely protect me from the searing temperatures, this was no easy task for a couple of other reasons.

First of all, my Dad was constantly adjusting the distance from the coals to the steak using an equation known only to him and Albert Einstein. The muscles in my hands had not yet developed such precise control at that age, but I tried to oblige as he alternated between, “a little higher” and “a little lower”. Secondly, my Dad felt that it was necessary to repeatedly stab the meat until all the juice ran out onto the coals. This meant that I had to constantly anticipate his downward stabs to keep the system in harmony. If I was off by a millisecond, I could potentially launch the meat off the grill and send it to its final resting place in the azalea bushes. When the grilling was finally done, my Dad would point out once again all the physical attributes of a perfectly grilled steak. Inside the house, I iced my medium-well done fingers, wiped the black dust off my face and placed some Ben Gay on my aching shoulder before sitting down at the table to eat.

1995

After five hours, we were finished with the case. Mr. Kingsford was in the recovery room and his wife was relieved that the surgery went well. It was 10 o’clock at night and my Chief Resident and I both collapsed with exhaustion in the locker room. “So Bill, are you hungry?” “Yeah, I’m starving - Where do you want to go?” My Chief thought for a moment. “Hey, there’s a barbeque place right down the street!” My eyes widened and my jaw dropped open. After a few seconds, he said, “Maybe we should just go Chinese.”

What's That Smell?

2009-10-18T15:30:00.000-05:00

I sat in the terminal at Miami International Airport with a cooler tucked under my arm. These were the days before taking off shoes and offensive magnetic wand searches, and I was able to carry the suspicious box through security without the slightest hesitation. The safety officer must have been sound asleep, because the contents of the box would be easy to recognize on X-ray. I looked around nervously as the announcement sounded overhead, “Now boarding all rows to New York.” I grabbed the cooler, making sure that the lid was secure, and headed up the jetway.

The stewardess greeted me with an inviting smile, and I decided to engage her in some small talk. She was tall and pretty with long, blonde hair that was pulled back tightly into a bun. Her well-pressed, navy blue uniform couldn’t hide her shapely figure and her gold nametag said, “Tricia”. “So, Tricia, are we getting any food on this flight?” “Don’t worry, I’ll take good care of you”, she replied and I smiled back. The weight of the cooler was making my shoulder ache, and I worried for a moment that she might want to know what was inside, so I politely excused myself and found my seat.

I immediately felt better once I stowed the cooler in the overhead compartment. I wiped the sweat from my forehead and sat down next to a middle-aged woman who was reading the newspaper. I was a senior in college, but this was only the second airplane flight I had ever taken. My father was not a big fan of flying, so whenever my family took a trip, we would travel by train, boat or car. But I decided to spend my spring break in Key West, so I flew down to Miami and drove down US 1 to the Keys. It was an unbelievably fun trip, but now I was ready to go back to school. And I was traveling with special cargo.

The plane took off and made a gentle bank turn up the coast. The water was a beautiful shade of aqua, and the view of Miami was equally as amazing. Suddenly, the plane jolted and dark smoke began billowing forward from the rear of the aircraft. I turned to the woman next to me and asked, “What’s that smell?” “I believe that one of the engines is burning”, she calmly stated without looking up from her newspaper. I felt the sweat building up on my palms, and when I looked out the window, I saw fuel spraying out from every engine. “They do that to make the plane lighter for emergency landings”, the woman continued. She put her newspaper down and smiled reassuringly, “I’m a pilot’s wife. Don’t worry. It’s not a big deal.”

The plane suddenly made an awkward bank turn back towards the airport. I wasn’t sure if we’d make it back to the airport or have to land on the water, but I was relieved when I saw the ground below me. I closed my eyes and recited every prayer I ever knew. The plane shifted from side to side and bounced down on the runway with enough force to make me rise out of my seat as the lap belt dug into my thighs. Several passengers screamed as black smoke continued to fill the cabin. When the plane came to a stop, we all made our way towards the side doors and slid down the evacuation ramp onto the tarmac.

What followed was a 4 hour layover in Miami. I learned that one of the engines had caught fire, but even more amazing was the fact that we would be getting back on the same plane! I calmed my nerves with a couple of Margaritas in the lounge. When I finally boarded the plane again, the plane was overheated from sitting on the runway for so long. I heard a couple of people behind me complaining that there was still a bad smell in the cabin. Suddenly, I realized that the bad smell was not coming from the vents. It was coming from MY COOLER!

During the flight, more and more people began complaining about the putrid smell in the airplane. I asked Tricia for a blanket, but she gave me a quizzical look because the temperature in the cabin was probably close to 80 degrees. She brought the blanket, but the smell in the area was obviously putting a severe strain on her beautiful smile. I quickly opened the overhead bin and stuffed the blanket around the cooler to mask the odor, but it didn’t help much. All around the plane, passengers were fanning themselves and looking at the people next to them, saying, “I didn’t do it!” When I arrived at JFK, I found a deserted section of the terminal and dumped the contents of the cooler out into the garbage. What a crime.

I drove back to my parents’ house on Long Island. They were naturally concerned about my horrifying experience on the plane. “You see, that’s why I don’t fly”, my father announced triumphantly. I told them about all the good times I had in Key West with my friends. We rented mopeds, hung out on the beach and even went deep sea fishing right off the coast of Cuba. We caught a lot of Mahi Mahi and brought it back to the hotel where we mixed up a beer batter and had a huge fish fry. In fact, we couldn’t even finish all the fish we caught. “So where is all the fish you were going to bring back for us?” my parents inquired. I hesitated and looked down. “Well ... that’s a whole other story.”

Colors

2009-09-21T21:58:00.001-05:00

My sneakers squeaked as I hurried down the hospital’s hallway. A fresh coat of wax had just been applied and I could see my distorted reflection in the shiny, off-white tiles. For a minute, I thought that I looked good in my green scrubs and long, white jacket. I must have walked down that same corridor at least twenty times that day and I knew all the pictures on the wall by heart. The flowers and seascapes in the prints were all faded and I figured that the original painters would be sad to see what had happened to all the vibrant colors they had chosen for their artwork. It made me a little sad too. I passed by the nurses’ station on that floor, waving and smiling at the ladies behind the desk. They were busy writing in their patients’ charts and measuring medications as the sound of heart monitors droned in the background. I stopped by a window near the elevator. The sun was beginning to set and I spotted an architecturally beautiful church nestled in the distant hills. I had seen it many times before. It looked so inviting to me and I often contemplated running there to seek refuge, but then the elevator came and I went inside.

It was my first year of general surgery and I was on night call at one of the hospitals outside of NYC. I was both exhausted and lonely all at the same time. I missed my bed and the softness of my girlfriend’s skin. My days were spent scrubbing into as many surgeries as possible. In between, I would run around the floors performing consults and taking care of the many needs of our floor patients. Yes, it was pretty much like Grey’s Anatomy, but without the sex and commercials. In any given hour, I would unclog a feeding tube, change an abdominal wound dressing, insert an intravenous catheter into someone’s internal jugular vein, deliver blood samples to the lab and write orders for a battery of x-rays and medications.

I tried to be as efficient as possible, but it seemed that every place I had to go was at the opposite end of the Medical Center. To make matters worse, the hospital was a Level 1 Trauma Center, which meant that it accepted the worst accidents. Just when I was getting caught up on my “scut” (that stood for some common, unpleasant task), I might be called to the ER to handle a multivehicle accident with half a dozen casualties. Suddenly, I’d be up to my elbows in blood trying to put a chest tube in and re-inflate a collapsed lung. There were days when I barely had time to change gloves before the next trauma rolled in, and all the while I would be thinking about how behind I was getting on my other work and how my prospects of sleeping that night were dwindling.

During the evening, the hospital transformed from a chaotic madhouse into a quiet, eerie place. The lights became dimmer and all the pain and suffering that was taking place behind each curtain and door took on a more silent character. That night, I was so tired from a sleepless night before that I felt bugs crawling under my skin. My hair was oily and I wasn’t sure when I had last brushed my teeth. I suddenly realized that the gnawing feeling in my stomach was hunger, so I found my favorite vending machine and made a selection. I made sure to vary my diet, so I chose something from a different row than before. I was just about to sneak off to the call room for a nap, when I heard the announcement from overhead, “Surgical Resident to the Medical ICU, STAT!”

I listened to it for a second, and then looked around me. A calm voice inside my head broke the confusion. “Yes, that’s you.” I looked down at my candy bar, stuffed it in my pocket and ran to the MICU which was, yes, at the other end of the medical center. When I arrived there, one room full of light and bustling activity stood out amongst all the others. A nurse ran out of the room and looked at me. She was out of breath as she adjusted her glasses, checked her watch and screamed back into the room, “He’s here!” Walking towards the room, I felt like Alice floating down the hole into Wonderland, but I had no idea where this rabbit was leading me.

I walked into the room and stared at the unconscious man on the bed in front of me. The anesthesiologist was at the head of the bed trying to put a tube down his windpipe to help him breathe. “I can’t get it in, he’s too swollen. He needs a trach!” Somehow, I found myself right beside the bed. My white jacket had been taken from me and in its place was a surgical gown. It all happened in a matter of seconds. Betadine, a skin cleanser, was placed in my right hand and a scalpel was placed in my left. A tracheotomy is a surgical procedure to place a tube through the skin into the windpipe an inch below the voicebox. I had learned about it, and even saw a few done, but I had never done one myself. I knew that if I succeeded, he might live, but if I failed, he would surely die.

My eyes remained fixed on the patient in front of me. I coated his neck in betadine and felt for the location of the incision. I brought the scalpel closer to my patient, but just as the edge of the blade indented his skin, the anesthesiologist screamed, “I got it, the tube is in!” I looked over and saw that air was entering the man’s lungs from a tube in his mouth, called an endotracheal tube. The scalpel made a clanking noise as I dropped in back onto the instrument stand next to me. Part of me was relieved that he was going to be OK, but another part of me was disappointed that this pivotal moment was swept out from under me. “Thanks for coming”, the anesthesiologist said with a smile and patted me on the back. Walking back to my call room, I felt empty and confused. The adrenaline was still pumping through my veins. Consuming the rest of my half-eaten candy bar was my only consolation.

That was one of the toughest rotations of my two years in General Surgery. Before heading home the following morning, I actually had the opportunity to perform an emergent tracheotomy in the ER with my Senior Resident leading me through it. These days, as an ENT, I get to perform these procedures rather frequently, but I always think about the one that got away that night. Walking through the hospital’s parking lot, the sun was shining and I enjoyed the feeling of warmth on my face. The faded paintings in my mind were now replaced by a vibrant, blue sky and the sweet, warm breeze coming off the hills. For now, I was free, but I knew that my escape would be short-lived. As I drove out of town, I passed the church that I saw the night before. The doors in the front were opened wide, as if they were saying, “I’m here when you need me”.

Olé Part III – The End of the Rainbow

2009-08-23T19:16:00.007-05:00

7/25/09
10:30 AM, Veracruz, Mexico

Today is my last day in Mexico. I went for an early morning walk on the beach to snap some last minute pictures, then showered and had breakfast at the hotel. I managed to stuff all my souvenirs into my bags and brought them to the Convention Center. I have one more lecture to go, so I have to go and prepare for this now. I’m looking forward to coming home, but I am also sad to leave this magical place. I am convinced that I experienced almost everything that Veracruz had to offer, but I feel like I took only one spoonful of a huge ice cream sundae. At home, I used to think of Mexico in terms of margaritas and men with large guitars, but now I see that there is so much more to this land. The people here are bound together by their common history and by the love they share for their country. I’m proud to have been a part of it for a few days, and I’m looking forward to returning here very soon.

EPILOGUE

7/26/09
9:30 AM, Mexico City, Mexico

OK, when I said that I didn’t want to leave Mexico, I didn’t mean that literally. In fact, I was supposed to be boogie boarding in Ocean City, MD with my family at this moment, but I’m not. No, I’m sitting in the airport in Mexico City where, about 17 hours ago, I was doing my imitation of O.J. Simpson (the commercial, not the … other thing).

I arrived at the airport in Veracruz yesterday with lots of time to spare. I had the same driver who originally brought me to the hotel, and we greeted each other like long lost friends. On the first leg of the flight, they naturally served peanuts, but this time I figured out how to use my plastic cup like a gas mask. It worked pretty well! The flight to Mexico City was delayed by 15 minutes and landed in Terminal 1 at 4:15 PM instead of 4:00 PM. My connecting flight to JFK was slated to take off at 4:55 PM from Terminal 2. Here’s how it all went down:

4:18 PM - Ran down the gangway. Found the first person I could find in a uniform and asked him how to get to Terminal 2. He told me I needed to take the air train and he told me to go outside and look for Puerta 5 (gate 5) I found myself in the main part of Terminal 1, but I saw were lettered gates.

4:22 PM - My pace quickened. I assaulted a porter and asked him where the air train was. He pointed up, and for a moment I thought he was signaling that it might help to say a prayer. He sensed my confusion and redirected his finger towards a nearby escalator. I thanked him and charged up the escalator. I was wondering how my checked bag was doing in all of this.

4:30 PM - I found the air train and the electronic sign above the entrance told me that it would arrive in 7 minutes. This is not what I wanted to see. I sat down and began to wallow in my growing despair, when I suddenly heard a tapping sound on the metal roof of the train terminal. The tapping grew louder and more frequent until it became an incessant banging that shook the whole structure. I looked out the window and saw golf ball sized hail coming down in sheets. This was my chance, my glimmer of hope! After all, how could a plane take off in this? My heart sank, however, when I looked out the window again and saw a plane taking off.

4:42 PM - The train to Terminal 2 took another 5 minutes. I was practically in a full sprint towards my gate, hurdling over groups of crying children and sidestepping souvenir stands. I actually thought that I had a chance, but then I turned a corner and was horrified to see a Security Checkpoint! I threw my carry-on bags through the conveyer belt and ran through the metal detector with such speed that even a suit of armor wouldn’t have set it off. I asked the Security Guard to call my plane to tell it not to leave, but I don’t think he understood me.

4:50 PM - Almost there. I was a little disoriented finding my gate number, so I asked an information clerk for the directions. I also pleaded with her to call the gate and tell them I was almost there, but she just told me to hurry up. Did she think I was flushed and sweating because I just waltzed out of the sauna?

4:56 PM - I arrived at my gate. I saw that the door was closed, but I walked casually towards it thinking that everything would just work out fine. The clerk at the desk stopped me and said, “Señor, the plane has already left.” Her lips seemed to move in slow motion and that sentence reverberated several times in the hollow void that used to be my brain. I stared at her in disbelief and my breathing became deep and labored. I managed to get out the words, “You have to tell it to wait. I need to get to New York.” “No, Señor, the doors have already closed.” My mind began swirling with ideas like riding alongside the taxiing plane on the luggage truck and grabbing the axle of the landing wheel in order to gain entry into the plane’s belly. I saw that in a movie once and it looked pretty easy, but then I snapped back to reality. “OK, when is the next plane to New York?” “Not until tomorrow, Señor.” My heart sank deeper into despair. My family was waiting for me back home to start our beach vacation, and here I was, all alone and trapped!

What proceeded for the next 2 hours was the most interesting Spanish language emersion experience of my life. I learned more in those 2 hours than I did in 3 years of Spanish class (Sorry, Señor Rivera). I must have spoken to every employee of that airport twice. I traveled on the air train twice more and passed through a half dozen security checkpoints. In fact, metal was starting to stick to me. I finally found my luggage, which thankfully missed the flight to New York as well. Unfortunately, it was sitting on the tarmac during that bad storm and was a bit on the moist side.

The airline was great in taking care of everything. They put me up free of charge in a nice hotel with meals included and changed my ticket to a flight leaving today at 11 AM. If all goes well, I should be boarding in about an hour. I’ll let you know how things turn out …

7/26/09
7:00 PM, New York, NY

I did it! I’m finally back in NYC! I made it onto the plane successfully after 3 separate security checks and sat next to two young boys from Mexico City. They were cousins who were traveling alone on their way to camp in Connecticut and spoke beautiful English. One of them played video games incessantly and the other had some difficulty controlling his gas, but they were both very friendly. It’s amazing how children feel so free to start conversations and use different languages, but somehow fears of embarrassment and rejection develop as we become adults. Naturally, peanuts were served. I think I’m actually starting to like the smell.

As soon as my plane touched down at JFK, the rain began pouring down so hard that I actually thought they were washing the plane. I immediately made my first cell phone call in 5 days to Cynthia at 4:52 PM to let her know that I was on my way home. After collecting my soggy, souvenir-laden luggage, I had one final obstacle to overcome.

I approached a heavy-set African American woman at the U.S. Customs desk. She looked me up and down and seemed to be able to smell fear in the air. She had a look on her face that told me that she knew I stole a library book in the fourth grade. “Do you have anything to declare?” Trying to soften her expression, I replied, “Besides the fact that I’m really glad to be home?” Not only did her expression not change, but she continued to stare at me and I thought I heard a soft growl. I looked down in shame and gave her a humble, “no”.

Sensing that she had me on the ropes, she asked me, “So why were you in Mexico, business or pleasure?” This was a dilemma for me. Technically, I was on a pleasurable business trip. My mind began to race. What do people who are in the “pleasure” business say to a question like that? I answered “business”, which apparently pleased her enough to show me a slight smile. I swallowed hard as she asked a rapid follow-up question, “What kind of business?” For a split second I thought about giving it all up and answering, “Drug trafficking”, then I came to my senses and said, “Medicine”. Suddenly, I realized that I just did the very thing I was trying not to do. I closed my eyes in regret and opened them to see her smiling the smile of a cat who knew that the mouse was trapped. I knew the next question. “What KIND of medicine?” I thought for a moment, and suddenly a smile broke out on my face because I knew that there was only one answer to that question. Confidently, I replied, “The BEST medicine”.

Driving back to the Upper East Side in a yellow cab, the events of the past several days danced through my mind. The river, the sweet shrimp and the music all seemed so far away now. The sound of hail hitting the roof of the cab brought me back to reality as we crossed the Triboro Bridge. This reminded me of the hail in Mexico City which almost saved me the day before. The FDR drive was a river and the cab moved at the exact same speed as the current. Across the East River, I saw a beautiful rainbow which extended down to the ground. As the cab turned onto 78th Street, the tears welled up in my eyes. My wife and kids were waiting outside, jumping up and down holding a “Welcome Home, Daddy” sign. This is what I have been searching for all along. This was the pot of gold at the end of the rainbow. I’m finally home.

Olé Part II – Billy and the Bull

2009-08-16T19:22:00.020-05:00

7/23/09
7:00 AM, Veracruz, Mexico

I woke up to a beautiful sunrise. My hotel room had a full view of the Gulf of Mexico. The sky was golden and several oil tankers loomed ominously out in the distance.

The hotel was right on the beach, a luxurious building that stood in stark contrast to the less affluent areas around it. The sand was not white or powdery, but dark, with the consistency of loosely packed dirt. I was nervous about putting a towel down on it, but it was great for running. The temperature was already 80° F, but lots of people were out walking on the beach. The waves were small and broke about 100 feet out due to a large sand bar. As I ran, I saw a large tusk of an elephant washed up with flies on it, about 3 ft in length, and wondered how it got there. Saw a Chihuahua peeing into the hollowed-out half of a coconut. Now that was a well-trained dog!

I saw Jorge, one of my hosts, also running on the beach and we stopped to chat. We made plans to go out for a bite to eat after my lectures were over at 1 PM. I read on the internet that Veracruz produced the best coffee in the world, and I will be searching for that perfect cup today. I met some of my American colleagues at the hotel’s breakfast buffet. I was able to communicate with the waiter totally in Spanish and he was comfortable with it. A blackbird perched outside the window, looking towards an island out in the distance. I ate a variety of meats, queso blanco (white cheese) and papaya. The coffee was pretty good, but I’m going to keep looking for that holy grail of caffeine. I almost burned myself shaving this morning. I have to remember that “C” on the faucet stands for caliente (hot), not cold. Right now, I’m getting anxious about giving my lectures today.

7/24/09
1:00 AM, Veracruz, Mexico

I’m so tired. All I want to do is fall asleep, but I want to write this all down before it slips away from me. I’ve been eating and drinking for almost the entire day. My lectures went well. I cracked a couple of jokes in Spanish that were not that funny, but the audience laughed politely anyway. I spoke slowly at the first one, because it was being translated. It sounded so strange to me, and at the end of the lecture, the translator came up to me and said, “For the next one, could you please speak a little slower?”

After the lectures, I met Jorge and his friend Antonio. We changed back at the hotel and went driving with another friend at the wheel. The first stop was a convenience store to buy beer for us and soda for the driver. Apparently, there is no such thing as an open container law here, because the three of us finished a six pack while on the way to the next destination.

We drove out of Veracruz to Boca del Rio (mouth of the river), where we stopped at a local restaurant, which was on the bank of the river. I bought a pearl necklace from a man for 100 pesos (about 9 dollars) after he proved to me it wasn’t plastic by putting a flame underneath it.

Jorge was conversing with the owner and he motioned for me to come out back. The four of us boarded a small boat with an outboard motor and watched as a small boy, about 10 or 11 years old, dove to the bottom of the murky water. After a long, tense 30 seconds, he burst out of the water with a couple of handfuls of large shrimp. I mean, I can’t even get my 10 year old daughter to pick up her own clothes!

They brought the shrimp to the kitchen, boiled them and brought them back out to the boat on a plate with green lemons and salsa picante (spicy sauce) on the side. One thing I learned here is that lemons are green and limes are yellow. Go figure.

To drink, they brought out a tray of toritos, literally translated as “little bulls” because of how strong they are. They were originally created for workers to help them make it through a hard day in the field. My friends told me that when someone asks you a tough question, they are throwing you a torito. It’s made from fermented sugar cane, not refined enough to be rum, and blended with honey, lemon and sometimes another fruit. I had two on the boat made with guanabana, a gelatinous white fruit. As we motored down the river, I pulled the head off of one of the shrimps, peeled and ate it, throwing the uneaten parts overboard. This process repeated many times. It was the sweetest, softest shrimp I had ever tasted.

I was on my second torito as we passed a house on the river called, Casa del Diablo (the house of the devil) because of several ghost sightings in the abandoned dwelling. The air was hot and sticky. The sunlight danced over the water like diamonds, and I reached out my hand, thinking that I could catch a few. I think I could be happy living a pure, simpler life. Our boat trip lasted about a half hour. On the trip, Jorge opened up to me about getting divorced after 13 years of marriage. He had 3 grown children, but was now remarried to a woman named Patty, who had younger children. Antonio had 5 children around the teenage years and could not understand Jorge’s desire not to have any more children.

After the first restaurant, we drove to a bar for, you guessed it, more toritos. The bar seemed to be a cave cut out of a large rock. This time, I had a coconut and mango which were much more potent than the first two I had. With each torito, my Spanish got a little better, while Jorge and Antonio’s Spanish got a little worse until it finally became one beautiful, perfectly fluent language. We shared common interests and family situations. There was mutual respect as well. Antonio spoke only Spanish to me in the beginning, but as he became more comfortable with me, he decided to practice his English, which I could understand very well.

In the next restaurant we stopped in, we feasted on spicy shrimp soup with lobster claws, local fish and fried fish eggs wrapped up in a tortilla with salsa and vegetables. The waitress asked me what I would like to drink, and when I ordered water, she and my guests had a similar look of dismay on their faces. I quickly changed my order to cerveza (beer) and everything continued normally.

At this point, I was so tired and buzzed from the food and alcohol that, at least in my head, the line between English and Spanish became very blurry. I made it back to the hotel at 6:30 PM, slept for one hour and opened my eyes at 7:20 PM. I had to be in the lobby by 7:30 PM to board a bus taking us to the reception for visiting professors. I watched a traditional dancing show near El Centro, the center of the old town of Veracruz, and was called onto the stage to receive a certificate from the Congress along with several bottles of alcohol and local coffee. The reception was held in the central courtyard of a beautiful, old museum that used to be a hospital. It was a night full of good music, good food and good conversation. I drank paloma (dove), a white drink made of tequila and grapefruit extract. Not bad. With dinner, I had red wine and, yes, another glass of tequila to finish off the night. I hope my liver survives this trip. I’m going to bed.

2:00 AM, Veracruz, Mexico

A storm rolled in from the Gulf along with lots of wind, rain, thunder and lightening. One bolt shook my room. It must have struck the building, but I’m still here. I wish I had Cynthia next to me.

8:00 AM, Veracruz, Mexico

The storm lasted all night, and sleep was intermittent. I went running this morning. The rain knocked the temperature back about 5 degrees, but did nothing for the humidity. The dirt on the beach was even springier, but had lots of debris washed ashore. I ran even further today, all the way to a jetty of large rocks. I saw some grey crabs on the rocks, about 6 inches across. They didn’t look particularly aggressive, but I didn’t get too close. Out in the distance was Isla de Sacrificios (Island of Sacrifices), the island I spotted yesterday morning at breakfast. I’m going to try to find out today why it is named that.

On the way back, I saw a man rowing in the ocean with his son sitting at the front. He was rowing with a long oar that had a fork-like device on the other end, presumably for catching fish. To me, this represents the entire meaning of life – do good things in the world and then teach your children how to do the same. I hope I can accomplish that in my life. I’m meeting Jorge in an hour and going to breakfast. I told him about my coffee quest, and I’m excited about the possibility that I might soon be sipping the best cup of coffee in the world.

7:00 PM, Veracruz, Mexico

I’ve been to the top of the mountain and I saw the other side! I had my caffeinated epiphany today at last. Breakfast is forever ruined for me and I refuse to walk into another Starbucks again. Jorge and I drove to downtown Veracruz and stopped at the Gran Café de la Parroquia, or La Parroquia (parish) for short. It is named for the church that it used to be next to before the café was moved to its present location in 1976. We waited about a half hour until a table opened up, and dove to occupy it, as their was no waiting list. The waiter who took our order told us that he has worked there for 52 years. The first thing we ordered was café lechero, or coffee with milk. It came as a couple of shots of espresso in a large glass. To call over the “milk guy”, I was instructed to bang my spoon on the inside of my glass until he came, a maneuver referred to as “tinkling”. For me, that’s usually what I have to do AFTER the coffee. So I tinkled, but was afraid someone was going to make me give a speech or random couples were going to begin kissing.

When he came, he poured the steaming milk from about 2 feet in the air, transforming the espresso from a black puddle into a bubbling, sea of mocha colored waves and white, swirling foam. The milk he used was freshly milked from a cow without pasteurization or homogenization, and thus it contained stringy and gelatinous elements that I didn’t even mind. It was moderately sweet by itself, but I added a small amount of sugar. I wrapped the hot glass in a napkin and brought it slowly to my lips. As soon as I took my first swallow, I felt my whole body go numb. I closed my eyes and all the rough edges in my life suddenly smoothed out. I felt the pride, beauty and sweat of 500 years of Mexican heritage enter every cell of my body and I could do nothing but bow my head in respect and quietly mutter, “Olé”. Needless to say, that was one slammin’ cup of joe!

Next, I ordered huevos tirados, or eggs with frijoles (beans). Jorge, still amused by my reaction to the coffee, ordered gorda (a pastry made from frijoles) and picada (a tortilla with cheese and hot sauce). On the side we had fresh breads and bomba, a baked pastry with a slightly gooey, sweet center and a thick, crumbly cheese crust covering the outside. OK, let’s just call it a Danish. Dipping that in the coffee further intensified the magical transformation that was going on inside my body.

The café was crowded, but not unruly. People walked around selling newspapers and shining shoes. Jarochos (Ha-ro-chos), something like a Mariachi band, played for different sections of the café and a beautiful woman wearing a traditional Spanish dress came around with a hat for tips.

After we finished paying, we headed out to the marketplace for little shopping. Music played from every doorway, alternating between modern music with a heavy beat to soft, traditional folksongs. Many women, some with their children beside them, sat outside the stores selling items that they had obviously made themselves, but I did not encounter one person begging for money. There was a military presence, many with assault rifles by their sides. In fact, the night before, we were warned not to wander in the town because of the “dangers”.

Jorge showed me all the historical sites in the downtown area, which is where he spent a great deal of his childhood. I asked him to tell me the story behind the Island of Sacrifices. His face became very serious as he explained that when the Spanish settled Veracruz, they discovered that the indigenous people there had used that island for regular human sacrifices to appease their Gods. The island is reputed to be haunted by the spirits of all those who lost their lives there. I guess I won’t be going over there any time soon.

I made it back to the hotel with minutes to spare before I had to go over to the Convention Center and give my next lecture. It went OK, but it’s strange telling a joke through a translator, only to have the audience laugh 30 seconds later. I’m starting to realize that I’m really going to miss this place. I decided to relax for the afternoon and spent four hours baking in the sun, feasting on quesadillas and margaritas by the pool. The pool was a winding, sprawling network of smaller pools linked by waterfalls and hot tubs. I didn’t want to leave.

I showered, rested and went down in the lobby to meet Sergio, who was assembling a group of people for a farewell dinner. I also saw Jorge in the lobby and finally had the chance to meet Patty, who was very pretty and charming. I excused myself and proceeded with Sergio and friends to a local seafood restaurant nearby. I had ceviche, spicy crab soup and flan for dessert. Several Dos Equis washed it all down. A group of us then went out to a bar and had a round of drinks called toros (bulls). These were different from the rustic toritos I had the day before. This concoction consisted of tequila, whisky, brandy, rum, beer and honey. It tasted a bit like a Long Island ice tea.

Next week, read about the final leg of my trip, and find out why it’s not as easy to leave Mexico as it sounds!

Olé - The Extranjero

2009-08-09T18:49:00.006-05:00

Prologue

A couple of months ago, I was invited to speak as a guest Professor at the 59th annual meeting of the Mexican Society of Otorhinolaryngology (Ear, Nose and Throat), Head and Neck Surgery. The meeting was supposed to take place in the spring, but because of the swine flu outbreak, it was rescheduled for the end of July. I was asked to give five lectures on a variety of ENT and allergy topics over a four day period. The meeting was to take place in Veracruz, a city in Mexico on the Gulf Coast which I had no idea even existed before this invitation. I accepted the honor, but was filled with a mix of emotions. On one hand, I was excited to explore new places, but on the other hand, I was nervous about leaving my family and traveling alone outside the country. I kept a detailed journal of my adventures while I was in Mexico and I took a lot of pictures. It was an exciting journey, and I think you’ll be surprised at how it ends. As you read each of the three parts, you’ll surely taste the sting of tequila on your tongue and hear the sweet folksongs as they float past you on the warm, afternoon breeze.

7/22/09
7:00 PM, Veracruz, Mexico

I woke up at 5:30 this morning, got ready and caught a cab to JFK. It’s always sad to say goodbye to Cynthia and the kids. As soon as I got on the line for AeroMexico, I felt like I was in another country. There were about a dozen people before me in a line which wasn’t moving at all. I suddenly became aware that I looked different from everyone else, and a few people around me probably thought I was in the wrong line. After about 15 minutes, the entire line cleared out, and I realized that there was only one family in front of me. The plane took off uneventfully and I drifted off to sleep. Suddenly, I awoke to the flight attendant saying, “Pan francais?” I was still in a daze, and thought for a moment that I died and was reincarnated as French bread. She then continued, a bit annoyed that I was making her struggle through English. “Would you like French toast or omelet?” I asked for the French toast and my next door neighbor got the eggs. I was so shocked that I received real food that I quickly gobbled it down before someone noticed and took it away.

I didn’t make much conversation with the guy next to me, and he didn’t really say much to me either. He was probably afraid that I would assault him with the English language, but I was actually looking forward to using my Spanish, which I think I’m pretty good at. I use a lot of Spanish in my office with patients, but if you’re not suffering from an earache or a sinus infection, a conversation with me in that language might be a bit tedious. Suddenly, my heart quickened as the guy two seats down leaned over and asked me to borrow a pen. Unfortunately, he spoke fast and used the word for pen that I wasn’t familiar with, so we had to convert to charades. Señor Rivera, my Spanish teacher from Junior High School, would have been so ashamed of me.

I’m having the exact opposite problem that I had when I went to Germany last year. When I was in Germany, everyone spoke to me in German because of my appearance, and they wouldn’t give me a break, even when I answered them in English. I have a small, working knowledge of German. I learned most of it from my Grandmother, who spoke fluent English, but would only converse with me in German once her Alzheimer’s disease got worse. Unfortunately, you can only say “turn on the light” and “what’s your name?” so many times before you have to move on to another topic.

I really wanted to impress the guy next to me, so I planned on asking him how his eggs were. However, I realized just as the words were about to leave my mouth that the phrase, “Como estan sus huevos?” can also be interpreted as, “How are your balls?” I knew that mine were feeling a bit cramped, but I really wasn’t interested in how his were doing, so I stayed quiet. Silence dominated the rest of the flight, until a person with an extremely productive cough woke up and began expectorating one of his lungs. I voted for pushing him out with a parachute, but I think they just took him to the ICU right from the airplane. I almost needed an ICU myself when they passed out roasted peanuts as the snack. Some of you may remember that I am severely allergic to peanuts. I managed to hold my breath for a record-setting 30 minutes until the smell cleared, but once the oxygen finally returned to my brain, I still felt horrible.

We flew into Mexico City, which looked like Brooklyn from the air. When I landed, I had to fill out a questionnaire asking if I had any symptoms such as cough, fever, runny nose, body aches, etc. I imagined all the horrible things that could happen to me in a Mexican hospital, so I quickly ran a line down the “no” column. I went through customs, where I always feel guilty even though I have nothing to hide. I was now officially an extranjero (foreigner). My connecting flight was a tiny, cramped jet which served peanuts again. I guess they were trying to finish me off. I got off the airplane in Veracruz, still clutching my Epipen, and surveyed my surroundings. The glare of the noon sun reflected off the tarmac, and the air was heavy and still. The heated exhaust from the plane’s engines made it difficult to breath, but as I walked farther away from the plane, the air quality didn’t improve. I trudged into the air-conditioned terminal and was relieved to see a young man smiling and holding a sign with my last name on it.

On the way to the hotel, I spoke to Alex, my driver, in Spanish. He must have been about 18 years old and seemed to understand everything I was saying. He told me that he dreamed about going to NYC to come and see the Yankees play, but had not been able to get a travel visa. I met some of my hosts at the hotel and we went out to eat at a place which overlooked the Gulf of Mexico. I ate rice, plantains and some of the best shrimp I ever had while enjoying a beautiful view of the water. They asked me if I wanted something to drink, and before I could answer, the waiter placed a beer and a glass full of tequila in front of me.

As I sipped tequila, my new friends told me a bit about the history of Veracruz. It was actually the first city settled by the Spanish back in the 1500’s and for a while, the city was larger than the country’s capital, Mexico City. The city was founded in 1519 on the Friday before Easter Sunday, which is known as Good Friday or the day of the True Cross (Vera Cruz). Over the past several centuries, Veracruz has not only been an important commerce port on the Gulf of Mexico, but is also an agriculturally blessed region with a rich culture and tourism base. The song “La Bamba” was written about Veracruz as well. You’ll have to take me out for a beer to hear the true story behind the song.

7/23/09
1:30 AM, Veracruz, Mexico

After lunch, I went back to my room, showered and slept off some of the tequila. I took a bus to the opening ceremonies at the Convention Center, and the Governor from this part of Mexico was there. I was immediately escorted to the front row. There was a color guard procession, which was followed by a chorus of blaring trumpets that almost sent me under my seat. Suddenly a group of photographers kneeled in front of me and the other American doctors I was sitting next to. I tried to duck out of their way until they motioned to me that I was the subject of the photos. Every time I laughed or applauded, the cameras swung from the Governor back to me as another round of flashes fired. I felt just like Paris Hilton and preyed that there was nothing stuck in my teeth. I was really not used to this kind of attention, but it felt nice.

After the ceremony, there was a show. There was a band and dancers called “jarochos” doing something similar to the “River Dance”. The theme was old world meeting new world. The music was intense. The rhythms were distinctly Indian, but the costumes and music were classic Spanish. During the reception which followed, tapas were served along with tamarind margaritas coated with flakes of chili pepper and salt around the rim. Every time I put down an empty glass, it was mysteriously refilled. I never actually saw it happen. It was like some little Mexican margarita fairy was flying around the place. I lost track of how many I actually drank, but I eventually boarded a van going back to the hotel at around 1 AM. Despite the current humming noise inside my head, I am determined to get up early and go running. My first lectures are also tomorrow if I can survive that long.

Independence Day

2009-07-20T23:04:00.002-05:00

I sat at my desk, drumming my pencil on the test paper in front of me. I looked up at the clock, which told me that I had 15 minutes left until noon recess. I looked back down at my paper and checked my answers once again. The test was on the American Revolution, a subject which we seemed to cover endlessly in the fourth grade. I knew the information so well, that I was practically on a first name basis with most of the Founding Fathers. When my teacher announced that those who were done could leave, I sprang out of my seat and launched the paper towards her desk so carelessly that it almost landed on the floor. My teacher cleared her throat and I knew that the sound was intended for me. “Billy, you forgot the date”, she said in a hushed tone and slid the paper towards me. I scribbled, “April 22, 1978” at the top and raced out of the room.

Walking down the hallway towards the cafeteria, I was filled with excitement and nerves. My friend, Bruce, came up behind me and I almost jumped out of my skin. “Ready to go?” he asked and I nodded. In retrospect, I was agreeing to abandon the life that I knew before and open a brand knew chapter from which there would be no return. As we passed the library, my feet were beginning to feel like cement. Bruce and I entered the cafeteria, but instead of taking a seat at our assigned table, we tossed out our brown bags containing wilted bologna sandwiches and carrot sticks and headed out the cafeteria door into the short, dark passageway that led to the playground.

“Where do you think you guys are going?” a voice boomed from the darkness. A mop blocked our path as Frank, the janitor, stepped into the light. He had a muscular build and a military haircut. Despite some loose skin, thick glasses and a stomach which hung over his belt, he was still a figure to be feared in his dark, green jumpsuit. Bruce thought quickly and blurted out, “We left something on the playground.” I though our plan was surely doomed, but a smile suddenly broke out on Frank’s face as he returned the mop to its bucket and began to laugh, “Yeah, right!” Without looking back, we burst open the outer door and the light of the midday sun made us squint. It felt strange to be alone on the playground, but we weren’t in the clear yet. We stayed close to the fence so that the staff in the Principal’s office would not see us. Passing the monkey bars and the swing set with all of the broken swings, we made it to the corner of the playground and out onto the sidewalk.

As we walked down the street, my nervous, short steps turned into a relaxed stride, even a cool swagger. I realized for the first time in my life that nobody, except Bruce, knew where I was. I was truly UNSUPERVISED! This experience alone would have been enough to last me many years into the future, but we continued further down the street to the pizza place. Dano’s was a classic establishment that produced some of the best Italian food that I have ever tasted. My family had ordered pizza from them many times, and as we entered the shop, I panicked for a moment thinking that someone in there might recognize me. I looked down as I ordered a plain slice and a coke from the man behind the counter. He was sweating as the heat radiated out from the ovens behind him.

With every bite of pizza, I was enjoying the sweet taste of freedom. I was ready for my independence and I knew exactly how the Founding Fathers must have felt at that crucial moment. I searched my pockets and realized that I only had another $1.25 to fund my revolution. One quarter went to playing the video game in the corner, which would actually shake when the racing car crashed. With the last dollar, I bought Italian ices and we enjoyed them thoroughly as we headed back to school.

Recess was just coming to a close as I joined my class lining up on the playground. I was dying to share the secret of what I had done with the others, but I kept it to myself. I didn’t say a word, fearing that the cherry red coloration of my tongue would give me away. What I had committed that day was nothing short of high treason. But there was no escaping the fact that I had been liberated and there was no turning back. It was a brand knew world and I was a brand new person, ready to take on all the challenges that were in front of me ... as long as my parents didn’t find out.
______________________________________

This story describes one of my earliest adventures as an independent creature roaming this planet. From these humble beginnings, my thirst for excitement has never fully been quenched. This week, I will be heading south of the border. For those of you with your minds in the gutter, I am referring to Mexico. I can already see the bewildered facial expressions on the unsuspecting locals as I unleash my own brand of Spanglish on them. Of course, I will be writing down every single detail of this journey for the sole purpose of your amusement. Keep an eye on “The Best Medicine” and see if a white boy from the Upper East Side with a weak stomach and delicate skin can survive the hot deserts and tropical rain forests of Mexico, not to mention the tequila.

Oink!

2009-06-28T22:24:00.001-05:00

Walking through my High School lobby was one of the most stressful activities of sophomore year. I never knew where to look, so I usually just looked down at the floor. By graduation, I think I memorized the location of every crack and piece of gum all the way from Hall B to the cafeteria. It felt like everyone was staring at me, but I knew that it was all in my head along with all the other crazy thoughts: “Why did I pick these clothes today? ... Are these pimples ever going away? ... I think I’m getting fatter by the second!” I quickly glanced to the right and saw a table of football players all standing around in their team jackets. They were smiling and laughing as if they didn’t have a care in the world, and I wished I could be more like them. On the other side of the lobby, Dawn and Michelle were sitting by the window applying lip gloss. They were arguably the hottest girls in the class. The sun illuminated their feathered-back hair, and I wondered if I’d ever get to say anything to them besides, “Excuse me”. I was so relieved to finally make it through the lobby. I approached a large, metal blue door with crooked, painted yellow letters that read, “WKWZ”, and pulled it open with all my strength. It squeaked shut as I disappeared into the dark hallway and was finally free.

There was barely enough light to see, but I knew exactly where I was going. I let out a deep breath and descended down about 50 concrete stairs. With each step, my heart rate slowed, my breathing became easier and I think my skin actually started clearing. The air was cool and my steps echoed in the darkness. As I got to the bottom, the sound of Elvis Costello’s music and the smell of cigarette smoke welcomed me immediately. I pushed the door of the radio station open and Agnes’ face brightened as soon as I walked in. She was a woman in her 50’s who was more like a really cool aunt than a secretary. She pushed a cigarette into the coffee cup in front of her on the desk and lit another. “Important day, Billy, nervous?” “I’ll be fine”, I replied with a smile, and headed towards the back of the station. On the way, I ran into Judd, a junior who was generally regarded as a class comedian. He worked as a DJ and an engineer at the station. He also knew my older sister, who worked at the radio station and convinced me to join when I first came to High School. “So the little Reisacher wants to be a newscaster just like his sister?” he said with a devilish grin. I laughed silently at the joke and continued on to the Associated Press machine.

The AP machine looked something like a military weapon used by the Germans in World War II. It was a hulking mass of grey metal which made the sound of repeating artillery as it belched out reams of thick, tan paper with the latest news typed like telegraph messages. I ripped off some “copy” and arranged a 15 minute newscast that included international, national, state and local news along with sports, weather and a 30 second public service announcement. This was going to be my audition for the news department. I wanted desperately to go on the air. I walked into the studio, arranged my papers on the desk in front of me and placed the headphones on my head. I swung the microphone in front of me and tilted it into the perfect position. I looked up into the engineering booth and saw Judd smiling at me through the glass. He fiddled with some controls and slowly tilted his finger towards me. The red light in the studio began to glow.

My voice was strong and I felt really good about the newscast. I kept telling myself to slow down, pronounce every syllable and avoid saying, “umm”. I made it through international news and was covering some U.S. stories when a heard a strange sound in my headphones. I paused, thinking it was feedback, but then the noise repeated. It could only be described as the mating call of a chimpanzee, although I’m not really an expert on this topic. I decided to move on to local news, but when I said “news”, the sound, “moooo!” played instead. In horror, I paused once again and looked up. Although I couldn’t hear any sound from behind the glass, Judd was obviously laughing his head off. He caught himself from falling backwards on his chair and sat up, putting on a serious face that didn’t convince me. I made it all the way to sports, but then the sound effects returned just as I was giving the scores for women’s field hockey. “Oink, oink, oink!” I practically felt the porky breath of a trough-full of muddy swines right in my ear. Amidst the cacophony of squeals and grunts, I tried to choke back the laughter. Trying not to lose bladder control, I cleared my throat, turned the volume knob on my headphones down and finished the newscast.

Although it may sound unbelievable, I was accepted into the news department and went into regular rotation on the air. I covered evening news and eventually became the News Director of the station. I also hosted a weekly health show called, “No Preservatives”, probably one of the earliest signs of my interest in medicine. Throughout my high school years, the radio station was a place where I could go and just be myself. Everybody who worked there was a little different or strange in their own way, but down in that basement, we accepted each other and had a blast both on and off the air. Judd went on to do pretty well for himself. On that day, I didn’t find his joke very amusing, but as I watched his movies, “Knocked Up” and “The 40-Year-Old Virgin”, I’ve come to appreciate the humor of Judd Apatow. Thanks, my friend, wherever you are.

The Music

2009-05-31T19:17:00.000-05:00

For as far back as I can remember, the music has always been there. It’s like a movie soundtrack inside my head that never stops playing. I’m not exactly sure why it’s there, but all these notes and rhythms weave their way into my dreams and keep me company while I’m in the operating room, eating lunch or playing with the kids. Sometimes the music is low and in the background, while other times it becomes louder and more melodic. Occasionally, I hear words as well. Over time, I learned that the only way to control the music in my head was to somehow play it. It’s not surprising that I decided to take up a musical instrument.

I started with the clarinet in the 4th grade, but eventually grew frustrated with playing single notes and marching up and down Main Street, so I turned to the piano. On the piano’s keyboard, I could play any combination of notes to produce all the complex and colorful sounds that I needed. All throughout high school, I studied the sheet music for classical and popular songs and taught myself how to play them. But my mind would always wander and I would end up changing the music in some crazy way. Eventually, I just started writing my own songs, and that process has continued to this very day. Creating music and lyrics at the piano can be a deeply frustrating task. The chords and melodies both haunt me and heal me at the same time. But in College, I discovered that this skill had another very important function ...

The year was 1987. I was a sophomore in College. A couple of my friends had just joined a fraternity, so I dropped by one of their parties to see the house. The fraternity house was a 100 year old stone structure with large, sweeping spaces that made it seem more like a castle. After getting the royal tour and meeting all the brothers, I poured myself a beer from the keg and headed out to the dance floor. “The One I Love”, by R.E.M., was blaring from the speakers. The windows were open and the cool breeze from outside became laced with the smell of perfume, sweat and musty wood. I saw a girl that I knew from class who I really wanted to dance with. She smiled and waved at me, but she was dancing with one of the brothers. Feeling a little sorry for myself, I retreated to the next room, refilled my beer and started thinking about the midterm I should have been studying for. That’s when I saw it in the corner of the room.

It was covered with a heavy canvas and seemed to be as lonely as I was feeling at that moment. I uncovered it, pulled out the bench, sat down and lifted up the lid. I pressed down on one of the worn, ivory keys and the action was smooth. I had to strain to hear, but the tones were deep and rich. Both of my hands settled in and I began to play a ballad that I had been working on. I could barely hear it above the party noise, but I knew my fingers were doing the right thing. All of a sudden, the girl from before came over and smiled. “What are you playing?” I smiled back and tried to answer her while continuing to play, “It doesn’t have a name yet!” I’m not sure if she heard me, but she sat down next to me and said, “I love it!” Captivated by her pretty face and confused by what was unfolding, I began to lose my focus. My hands were now playing something completely foreign to me, but she did not seem to notice at all. All of a sudden, another girl came over and leaned on the piano, then another, and another.

Soon, I had a crowd of women all standing around the piano. By this time, I had no idea whatsoever what I was playing. I couldn’t hear anything, but neither could they. They kept drinking and requesting different songs. Some tunes I knew, but most of them I had no idea how to play. So I kept on playing the same improvisational nonsense and they kept on laughing and giving me complements. I stared at one girl in disbelief when she actually began singing along with my random, never-ending song. A couple of girls stuffed dollar bills into a glass on the piano, and that is when I knew that I had officially entered “The Twilight Zone”. My fingers were starting to cramp up, but every time I stopped, the girls would protest and encourage me to play on. The fraternity brothers were standing by the side with a mixture of anger and disbelief on their faces. I gave them a sheepish smile and shrugged my shoulders as I launched into the next verse of ... well, whatever you call it.

You might be surprised at this, but I walked home all alone that night. It seemed that when I finally stopped playing, the spell was broken. Most of the women whom I had entertained earlier had either staggered on to the next party or had passed out on one of the couches in the fraternity house. In the following year, I went to many parties at that house, and it became something of a legend that, late into the night, I would sit down at the piano and serenade anyone who needed their spirits lifted. As I passed over the bridge leading back to my dorm, I heard the rush of water from the gorge below. This soon gave way to the silence of the night. I paused for a moment, confused by this silence. Then the music in my head began once again. I smiled and continued my walk home.

Summergirl

2009-05-10T23:09:00.001-05:00

I drove down the dirt road that took me to the rear entrance of the camp. The worn tires of my ’71 Chevy Nova crackled as they rolled over gravel in the staff parking lot and came to a stop with a cloud of dust. I grabbed the backpack on the front seat, my orange juice and half-eaten cream cheese bagel and headed inside to the lifeguard station. The morning sun was low in the sky. There was moisture on the grass, but the air was hot and dry. Inside, the Lieutenant was checking his clipboard, but he stopped to look up at me. “Late night?” he asked. I smiled and nodded as I shoved my clothes into the locker. He returned the smile and added, “You got beginners today”. Standing by my locker, I covered my nose with zinc oxide and took one more bite of my bagel. The sunscreen on my shoulders began to burn, which reminded me that I didn’t put enough on the day before. I hid my bloodshot eyes behind dark sunglasses, grabbed my whistle and headed out to the pool deck.

When I was in school I worked during each of my summers. Besides a very brief stint as a supermarket cashier and one as a painter’s apprentice in the Hamptons, I spent all my summers since high school as a lifeguard and swim instructor on Long Island. This was the summer after my first year of medical school and the last of my “free” summers. I had endured Gross Anatomy, but nothing I learned in that class could help me as I approached my class of 6 and 7 year-olds. About a dozen of them huddled together for safety, clutching their towels like they were life-preservers. I gave them a big smile and dove into the pool. Emerging from the peace and quiet of my underwater sanctuary, I blew the water out of my whistle and said, “OK, who’s coming in with me?”

I was working with each of them on their back float, supporting them under the water with one hand and encouraging them to arch their backs. Then, something caught my attention across the pool. Out of the hazy, morning sun, she appeared. Her wavy, brown hair with reddish highlights bounced as she moved. On her wrists, she wore multiple, hand-made bracelets. She smiled and laughed with the freedom of a warm breeze and her face glowed with the radiance of the sun. I was immediately intrigued by this Summergirl, but a splash of water and the sting of a small hand smacking by sunburned chest broke me out of the moment. “How was that, Mister?” “Good, Jimmy”, I encouraged. “Let’s try it again.” I looked up once again, but she was no longer there.

That was a summer I will never forget. During the day, I would walk around the camp and find Summergirl making friendship bracelets or eating lunch with her group. I’d catch her eye and smile, pretending that the encounter was just an accident. My heart would always beat faster when she returned the smile. Those were magical, innocent times, when my entire paycheck would go towards rides and funnel cakes at St. Rocco’s. There seemed to be a different party every night with friends from work or high school. The cool air was always filled with music and felt good against my warm, tanned skin. We would dance for hours while sipping from large cups filled with Coke and Malibu Rum. I feasted on frozen yogurt and scrambled eggs from the diner at midnight. Days off were usually spent at the beach and my hair was as blonde as ever. I spend a lot of time with Summergirl. She was so full of life and energy, and I just wanted to be a part of that. We talked and laughed and flirted with each other. Life was so simple and easy for us then, and I convinced myself that those days could last forever.

But soon, the days began to grow shorter and Labor Day was quickly approaching. I was starting to prepare for the tough school year ahead of me. I kept looking for Summergirl, but it was becoming harder to find her. One night, as I was standing at the waterline overlooking the Harbor, I felt a hand on my shoulder. I turned quickly and she was there. I was so excited to see Summergirl once again. Our eyes met instantly, but for the first time, I saw a trace of sadness in her smile. I held her in my arms and kissed her soft lips, but just like the sand, she slipped through my hands and faded away right in front of my eyes. Deep down, I knew that this was the price I had to pay for getting so close to an angel.

These days, summer is kind of like winter, only hotter. Now, my paycheck goes to Con Edison and Time Warner Cable instead of the ring-toss guy at the carnival. My days of contemplating life’s mysteries at the diner have now been replaced with begging my kids to eat their chicken fingers. Are the best years of my life really behind me? I’ll admit that sometimes I want to go back to those days, but in the end I realize that in order to get where I want to be, I have to move forwards. I think that the best time in anyone’s life is the present because this is where all the opportunities exist. This is the only point in time when you can actually make a change in who you are and what you do. Unfortunately, it’s impossible to appreciate the magic of your life until time edits out the painful parts and leaves you with a soft, warm memory of it.

When that summer of innocence finally came to an end, so did my relationship with Summergirl. I never saw her again, but I’ll always carry a part of her inside of me. There are moments when I hear her laughter as I’m walking down the street or riding the subway, but when I turn, there is nobody there. Sometimes, when I’m alone, I feel that she is still watching over me, just like she did almost 20 years ago. She is timeless in my mind, a free spirit that goes wherever the wind takes her. Wherever you are, Summergirl, I want to thank you for being a part of my life, and I hope you always remain happy and free.

The Rocket

2009-04-26T18:51:00.000-05:00

There it stood, maybe 100 feet tall or more. Its metal cage arched gracefully towards the sky and I had to shield my eyes and squint just to get a look at the top. The year was 1973 and, like many other 5 year olds, my goal for the summer was to make it to the top of the Rocket. It was the centerpiece of the playground at the Community Pool that I went to on Long Island. Looking back, there was not a single safety requirement that this monster would satisfy today, but at the time safety was the farthest thing from my mind. For those lucky enough to make it to the top, the rewards were bragging rights and a view that was beyond compare. From the top, you were higher than the lifeguard stands, the highest diving board and even many of the tall pines that surrounded the picnic area.

My palms were sweaty, so I wiped them off on the sides of my blue bathing suit with the white whales all over it. I kept my hands by my sides as I marched through the sand that lead up to the rocket’s entrance. The larger sand particles and stones filled my sandals, but I disregarded the pain and remained focused on my mission. The sun beat down mercilessly as I approached the ladder that lead into the Rocket. There was no plastic coating or rubber mats anywhere to be found, only steel and the strength of my own conviction. I grabbed the ladder, but the searing heat of the metal sent me flying backwards. It was as if the Rocket was saying, “Did you think I was going to make it that easy?”

After a trip to the water fountain to cool down my second degree burns, I made another attempt. First, I licked my hands. Then I scampered up the ladder and through the porthole that lead to the first level. For the first time in my life, I was on the inside of the bars looking out. The smaller children on the playground were looking at me with admiration in their eyes, and for the first time I felt like I fit into the social order. I was assuming my rightful place in society and nobody was going to get in my way. I had three more levels to go until I reached the top. I grabbed the next ladder, but the combination of fear and burning flesh made a tight grip impossible.

The Rocket levels were small, only accommodating three or four children comfortably around a central pole. The levels were accessed through small portholes that could only fit one child at a time. A few times, I successfully shimmied up the ladder, only to be knocked back down by a larger kid coming down from the top. Stories existed of kids who were near the top and got knocked all the way back to the sand. The Rocket was an unforgiving beast. As I reached the level below the top, I felt the natural sway of the Rocket, which was exaggerated by older kids grabbing the bars and shaking back and forth. I looked up the final porthole and saw the sun beaming through it. I caught a glimpse of steering wheel.

I was literally on top of the world. I grabbed the metal steering wheel and the steel levers next to it that did absolutely nothing except produce a sick, squeaking sound. I looked out over the world which now appeared very different to me. For that moment on, the world would be all mine. Life seemed limitless and I felt invincible. Even to this day, I always keep a small part of that feeling with me, and I call upon it whenever it is needed. Sometimes it’s during surgery or when I have to get up and speak to an audience, or sometimes it’s when I’m all alone and unsure of what to do next. It’s been many years since the Rocket was taken down, but I will never forget the lesson that it taught me that day. The strength is inside all of us, and if we only face our fears, anyone can touch the sky.

________________________________________

Come see Dr. Reisacher perform his standup routine. He will be at The Comic Strip, 2nd Avenue, between 81st and 82nd street on Thursday, April 30th from 5:30-7:30. Tickets are $30, 2 drink minimum. Proceeds will benefit the enrichment programs of P.S. 158. Hope to see you there!

Bull's Eye!

2009-04-06T22:21:00.001-05:00

I squirmed nervously on my seat while my eyes remained frozen on the floor. The metal of the chair squeaked with every twitch of my muscles. Across the table, Detective Harris pounded his cigarette into the ashtray and, with a sigh, blew a cloud of smoke in my direction. He had a square chin, which he was rubbing thoughtfully, and his rough voice cut the silence like a chainsaw. “This is the point where I’m supposed to put you in handcuffs and formally charge you.” I looked up at him, but did not make eye contact. He answered my unspoken question. “Second degree assault and battery.”

After a few moments, he continued. “What year are you, son?”

“I’m a Freshman.” My voice cracked so badly I wasn’t sure he understood me.

“What are your plans after you graduate from college?”

“I want to go to Medical School.”

“Well, do you realize that something like this on your record could seriously jeopardize your chances of doing that?”

I remained silent. His rhetorical question rang inside my head and I tasted the acid in the back of my throat. How could things have come to this? My mind drifted back to the same time last night when I was safe in my dorm room, studying for my Economics midterm ...

______________________________

Pete burst into my room as I was sitting at my desk. “Hey, Bill, what are you doing?”

“I’m trying to figure out what the hell a negatively sloping demand curve is”, I replied.

“Oh, that’s a bummer.” He took a sip from his Diet Coke. “Come down to the lounge when you get a chance. I’ve got something to show you.”

I tried to concentrate, but it was no use. The graphs on the page began to swirl and the heat from my desk lamp was causing beads of perspiration to emerge on my forehead. My skin began to crawl and I realized the iced tea I had been drinking over the past hour finally filled my bladder. It felt good to get up and walk around. On my way to the bathroom at the end of the hall, I passed by the lounge. Pete and Mike were sitting on the couch, examining something that I had never seen before.

“What’s that?” I inquired.

Proudly, Pete held it up and exclaimed, “It’s a Funnellator!”

He proceeded to demonstrate the device to me and Mike. Basically, it was a huge slingshot made out of canvas and surgical rubber tubing. Two men, called stanchions, would each hold one end of the tubing, while the wingadoro would pull the canvas pouch and its contents backwards before letting it rip.

“Let’s give it a try!”, Mike said as he jumped to his feet. “I’ve got some balloons.” We all got caught up in the excitement and began filling up our arsenal in the bathroom. I finally had a chance to pee.

Our target was the dorm across the way. We ran down to the other end of the hall and took our positions. Mike and I were the stanchions, while Pete was the wingadoro. The first few attempts were clumsy, but soon we could nail the side of the building with surgical precision. The water balloon struck the bricks and burst into a shower for the unsuspecting students on the path below, who believed that it came from our rival dorm. We were having a wonderful time, laughing and reloading, when all of a sudden the unthinkable occurred.

Pete pulled back on a balloon that was under-filled. It took an unexpectedly low trajectory and struck the window of the dorm directly across from us and broke the window. The sound of glass shattering echoed in the courtyard below as we looked on in horror. Through the broken glass we saw a male student holding his arm. He had been standing next to the window and a piece of glass had cut his arm and there was blood running down towards his hand. Instinctively, we raced from the window and stashed the Funnellator under Pete’s bed. I sat back down at my desk, but was overwhelmed with feelings of remorse and fear.

This is the point in the story where things turn from bad to worse. Apparently, the floor where we launched our assault was inhabited by several members of the football team who conducted a quick investigation and concluded that the missile came from our floor. An angry mob assembled across the courtyard, armed with bats and letterman jackets instead of torches and pitchforks, and promptly marched towards our dorm. One of our dorm windows was broken as they stormed up to our floor. It was a standoff. They were thirsty for revenge and we all hid behind a thin veil of innocence.

The conflict was about to escalate when the Campus Police arrived, alerted by the reports of glass breaking. With clubs out and hands on their revolvers, they separated the two groups and took a full report from each. They assembled all the students on our floor into the lounge and issued an ultimatum. “Whoever is responsible for this, you know who you are. And we’re not going to give up until we find out. Someone was injured, so the town police had to be notified. If you don’t turn yourselves in to them by 5 PM tomorrow, the entire dorm is going to suffer because of you.” Pete, Mike and I exchanged glances. We knew what we had to do.

______________________________

“Is he OK?”

Detective Harris pulled another cigarette out of the wrinkled pack in his shirt pocket, lit it and took a long, slow drag that he did not expel until he responded to me. “He’ll be fine, but it took a few stitches. You should be grateful – he agreed not to press charges.”

I was. “So can I go?”

“Not yet, kid. It’s out of our hands now, but you’ll have to face J-R.”

“J-R?”

“Judicial Review. It’s judge and jury all in one. They’ll decide your punishment. Go on, get out of here.”

______________________________

The three of us went separately to Judicial Review. In retrospect, we didn’t suffer nearly enough for our carelessness. I was sentenced to work as a cook for a semester, flipping burgers and preparing food for a variety of campus functions. This skill served me well when I moved off campus the following year and cooking remains a passion for me to this day. I earned a B in Economics and never took another class in that department again. As for the three of us, we did not exactly retire the Funnellator. The following year, we entered the slingshot event at a fraternity competition, requiring us to launch water balloons into the football stadium portholes from the 50 yard line. Needless to say, we took first place. Proving that violence only leads to more violence, our prize was a dartboard.

Orgasmic

2009-03-15T16:27:00.001-05:00

The other day a woman came into my office complaining of a burning sensation in the back of her throat. After examining her, I informed her that she was most likely suffering from acid reflux. I then went on to explain that the treatment for this condition was medication along with dietary changes. “Dietary changes?” she exclaimed, “My diet is just fine. Everything I eat is orgasmic!” After fighting back the urge to invite myself over for dinner, I went on to explain that eating organic foods is not a guarantee against developing illness and disease. This encounter made me realize two things: First of all, many people have unrealistic expectations about the benefits of organic foods and, secondly, some of us have no idea what organic actually means.

The dictionary is always a good place to start, so that is where I began my search. (Translation for the younger generation - the “dictionary” is a thick, heavy version of Google with lots of paper pages that you can actually turn.) The first definition of “organic” that this book offered was “a chemical compound that contains carbon.” I’ll have to admit, that does describe most of the food that I prepare, but I don’t think this is what they mean. The second definition was, “related to an organ.” That didn’t seem to apply here. I don’t remember the last time I saw a pancreas on the shelf of my local organic food store, or hearing cathedral music at the checkout counter, for that matter. I knew that I struck gold with the last definition, “grown without the use of chemicals or pesticides.”

The USDA states that organic food is grown by farmers who use renewable resources and emphasize the conservation of soil and water. Over 70% of organic food produced in the U.S. is fruits and vegetables. They are produced without conventional pesticides, synthetic fertilizers, bioengineering or ionizing radiation. Organic meat, poultry, eggs and dairy products come from animals that are not given antibiotics or growth hormones. To meet organic standards, farms are certified by Government-approved inspectors. To be labeled “organic”, at least 95% of the requirements must be met, but if all the requirements are met, the food may be stamped, “100% organic.” Organic foods do not have to be labeled as such, and many non-organic foods are labeled as “all-natural” or “hormone-free” to enhance their marketability. In general, organic foods are more expensive than their non-organic counterparts.

I don’t think anyone will disagree with the statement that our bodies are flooded with chemicals. They enter our bodies through the air we breathe, the food and water we eat and drink, and the creams, soaps and cosmetics we place on our skin every day. All of these chemicals are either broken down by our body or stored in our cells, and this not only consumes a tremendous amount of our energy, but may also lead to cell damage and certain diseases. Organically produced foods help us a great deal in this battle, but they also help promote good farming practices and environmental conservation. The danger comes when we accept an “organic” diet as a substitute for striking a balance in our lives. We all need a balanced, varied diet. Just whip the good, the bad and the ugly into a medium-sized shake and enjoy! Get out there and move your body safely in any way possible, try to love someone or something and, please, don’t forget to laugh! And if you’re still a bit confused by all this, don’t worry, because you’re not alone. I’m still wondering if I’d rather eat the pesticides or the pests!

Be Free!

2009-02-08T23:33:00.000-05:00

Along the steep and curvy road towards the medical profession, many obstacles stood in my way. Some were speed bumps, some were hills and some were deep canyons that I had to race towards at top speed and hurdle myself blindly into the air, hoping that I landed safely on the other side. For me, Genetics was one of those canyons. It was a pre-med requirement in college and what many referred to as a “cut-throat” class. At first I thought that meant that if I failed the class, I would essentially be cutting my own throat by ruining my chances of getting into medical school. But by the end, I was pretty sure it meant that any other students in the class would gladly cut my throat if it improved their chances of doing well in the class. Either way, it was not a subject that I was going to enjoy, so I just wanted to survive it.

I entered the lecture hall on the morning of the first day of class. This large room was constructed almost entirely of wood and approximately 500 folded theater-type seats lined up like soldiers preparing for battle. The musty air was soaked with the odor of chalk dust and the audible tension in the voices of the students who were beginning to file in. I took a seat towards the front and smiled at the girl sitting next to me. “Don’t you just love Genetics?” she said with an inappropriately large smile on her face that caused mine to quickly fade. “Love is kind of a ... strong word”, I replied as I covered my neck and sat back in my seat. The Professor began speaking as the lights dimmed. He was a thin man in his 50’s who looked like he hadn’t smiled since Nixon was in office. His face almost cracked as he spoke, “This afternoon, you will begin your fruit fly experiment in lab. It counts for half your grade. Midterms are in 6 weeks. Shall we begin?” Suddenly, he smiled.

My footsteps echoed in the empty hallway as I approached Genetics Lab. I looked in one of the classrooms along the way and saw a group of students sitting around a table staring at a green, foam block in the center trying to figure out how to arrange the colorful flowers piled up along the side. I longed to join them, but forced my feet to continue all the way to the double doors at the end of the hall. A pungent odor stung my nostrils the moment I opened the door. I saw the girl from the lecture, but managed to avoid getting sucked into the gravitational pull of her smile and took a seat at an empty lab bench. I stared at the jar of fruit flies in front of me as the instructor explained how we would be raising generations of flies over the next 2 months and recording traits such as patterns on their wings and eye color in each fly. The final goal was to tell which chromosome the gene for each trait was on and where it was located on the chromosome. This is referred to as gene mapping. Smiling girl was beaming brighter than ever.

I had to work very hard over those 2 months, partly because the information was challenging for me, but mostly because I was afraid of bugs. I managed to overcome both of these shortcomings, but events took a dramatic turn for the worse one Saturday morning. The experiment was drawing to a close and I was on my forth or fifth generation of flies. To count them, I had to place ether over the jar until they fell asleep, then dump them out and examine them one by one under the microscope. I frequently wondered how this was going to help me as a doctor, but one day several years later as a surgical intern, I was picking small pieces of glass from a broken beer bottle out of the scalp of a drunken man and finally understood.

The only other person in the lab that morning with me was smiling girl, who I finally learned would only smile when people who handed down grades were in the room. From the look on her face, she was as hung-over as I was. When I arrived at the lab, I started consuming large amounts of water to help dull my throbbing headache, and soon my bladder was throbbing as well. I had just spread my anesthetized flies out on the counting sheet. I quickly weighed my options and dashed down the hallway to the bathroom. I barely made it in time, and I had to brace myself in the stall for fear of being thrown backwards by the force of the stream.

I immediately knew something was wrong when I returned to the lab and saw smiling girl smiling again. I went over to my desk and a wave of nausea washed over me. Where my generation of about two hundred flies once lay sleeping, now only a couple of drunken flies remained, staggering towards the edge of the desk. My entire experiment was soon hovering silently in the air around me, darting to and fro as I comically tried to grab them in my fists. Soon, I was swatting at them with my textbook. I was determined to take them either dead or alive. They, however, had other things in mind as they promptly headed towards the window I had foolishly opened when I first arrived. In desperation, I began searching the lab for any dead creatures that had wings.

Somehow, I managed to squeak a passing grade out of Genetics. I excelled on the written exams, but my fruit fly experiment left the Professor scratching his head. Clearly, I could not map my flies’ traits to the correct chromosome, nor could I even tell how many chromosomes the poor creatures had. In fact, some of the faculty thought that I actually discovered a brand new species. But in the end, only I and smiling girl knew the truth about what happened that morning. And to this very day, every time I see a fruit fly, I wonder what color eyes it has and if it might be a descendent of my lost generation.

When You Gotta Go ...

2009-01-01T22:16:00.002-05:00

Do you remember what you were thinking when the ball dropped last night? “Who am I going to kiss?” “Which party should I go to next?” “How much more champagne can I possibly consume without passing out?” “Where, exactly, are my children?” Before midnight, I spent some time trying to plan how I would become a better person this year. Unfortunately, this reflective moment was interrupted by the sounds of my stomach trying to digest the overpriced, overindulgent PreFix dinner I had just enjoyed with my wife. I accepted some cabernet from my father-in-law, but my assumption that more wine would help settle my stomach proved to be overly optimistic. After glancing up at the TV, I put my thoughts on pause, grabbed a bottle of champagne from the refrigerator and began unscrewing the cage.

Happy New Year!

Working on my third glass of champagne, my thoughts shifted to how I was going to get back to the person I was an hour ago. With that many bubbles on board, the lyrics to “Auld Lang Syne” actually started making sense to me. Sitting on the couch of my in-law’s apartment, I began making resolutions uncontrollably as the emotions of hope, fear, love, joy and regret all blended up inside my head like a huge cerebral smoothie. At that very moment, a neighbor of my in-laws sat down next to me. She was in her 50’s, tan-skinned, holding a half-filled glass of champagne as she proceeded to tell me a story about, well, when you gotta go ...

“I was walking around Times Square this afternoon before the barricades went up. I hadn’t been there in probably 30 years. But I was so cold that I had to go to the bathroom. So I went into a local bar to warm up and use the bathroom. I usually don’t drink more than wine, but while I was there, I sat at the bar and asked the bartender to give me the strongest drink he had. He poured me a shot of whiskey, and after two more of those, I headed back outside. As I was looking up at the big tree, I suddenly realized that I had to go even worse than before! I crossed my legs and concentrated as hard as I could until the feeling passed. I managed to make it to 5th Avenue where I found myself in front of Saks Fifth Avenue, so I went inside. Luckily for me, there was a bathroom right by the entrance, so I used it. But while I was there, I felt bad for using their bathroom, so I decided to do some shopping. I found a nice, fur wrap which I bought before heading home. I only made it half way home before the urge to go came back again. I looked around for a bathroom, but the only place I saw was a pizza shop. They were nice enough to let me use their bathroom. I wasn’t really hungry, but when I came out I ordered a pizza. I brought the pizza home, opened up a bottle of champagne and here I am.”

She smiled, sat back and took a sip from her champagne as the story still rang in my head. I looked down at my champagne glass and realized that I had to answer the call of my own bladder. I thanked her and excused myself. On the way to the bathroom, I thought about how nice it was to leave my world for a while and spend a few moments in someone else’s. She came to me at the perfect moment, just when I was becoming lost in my own head. I decided that I would focus on two resolutions this year: The first is to pay more attention to the feelings of others around me, and the second is to always bring an empty bottle with me on long trips in the cold weather.

Pass the Syrup

2008-11-28T22:21:00.001-05:00

I woke up this morning, still feeling the effects of several helpings of turkey and a few too many margaritas during yesterday’s Thanksgiving celebration. I shuffled to the living room to find my boys lounging on the couch watching a cartoon they had seen so many times that even I knew how it ended. I smiled at them and they smiled at me. Not a word needed to be said, because we all had the same thing on our minds. They jumped off the couch and raced me to the kitchen. I dragged out the griddle pan and the boys began putting the flour, sugar, baking powder, salt, milk, chocolate chips and vanilla extract into a stainless steel bowl. They knew exactly how much of each ingredient to use, because I have spent every weekend over the last two years training them how to make the perfect pancakes.

A half hour later, with only minimal amounts of flour on their faces and pajamas, my sons and I brought our steamy little creations to the table, where my wife and daughter were eagerly awaiting them. As usual, a fight ensued about who could have the syrup first. All attention was focused on a jug of 100% pure maple syrup. I watched it go back and forth like a tennis ball during the U.S. Open until it was finally my turn. I opened the cap and the odor permeated my nose and lifted my spirits. As I watched the dark amber elixir cascade down my stack, I began to think back to the time when this obsession began ...

The year was 1988. I was a sophomore at Cornell University, majoring in Biology in the college of Agriculture and Life Sciences, originally designed to educate farmers in the 19th century. I was premed, so most of my courses were related to biology, chemistry and physics, but I had to take a certain amount of credits in the Agriculture Department. As I looked through the course book, Maple Syrup Production struck my eye. It seemed like an easy four credits, so I signed up. In the class, we learned about how sap flows and how scientists have never been able to reproduce the special sugars in maple syrup that are believed to produce its unique flavor. But the real fun began when it was time for our first laboratory.

Our professor drove the entire class across the Finger Lakes region in a van, pointing out wild turkeys and other forms of wildlife on the way. Soon we arrived at the Arnot Forest, Cornell’s maple research facility. I stepped out of the van and the crisp, February air hit my face as my clean, white Reebok high-tops crunched on the snow beneath me. What could be easier than tasting some syrup and tapping some trees? I was now sure that I had made the perfect course choice, but this conclusion was only short-lived.

Dan, the maple farmer, took me and a couple of the others up the mountain to tap some trees. When we reached a grove of trees, I jumped off the tractor and Dan tossed a heavy canvas harness at me. I wasn’t sure whether to catch it or jump out of its way. “Go ahead, put it on.” I buckled everything as tight as I could, trying to remember the techniques I learned in a book on Houdini I used to read as a boy. “You can never tap a tree in the same place”, Dan explained. “Each year we have to go higher up on the tree.” Dan’s attention moved from my face down to my feet, and his facial expression sank in clear disapproval of the footwear I had chosen for the day. I looked around at all the Timberland boots around me and my face sank as well.

I quickly came to terms with the fact that I was heading up the tree. The rope which was pulling me was meant to assist me in my climbing, but instead my body just scraped its way up the tree as my arms flailed meaninglessly to the sides. If the wood on the tree was polished with colored lines, I would have been fine. The rope stopped with a jerk and I shamelessly hugged the mighty Sugar Maple. Dan scaled the tree in a fraction of the time to hand me my equipment. I was expecting a mallet and a bucket, but instead Dan handed me a hardhat and safety goggles. This was not a good sign.

Suddenly, Dan placed a machine in my hands which was the size of a lawn mower. The rope tensed and made a squeaking sound that told me it would break soon. “Are you sure this is safe?” I asked Dan, but in the middle of my sentence, he pulled the ripcord and the monster roared to life. I could only read Dan’s lips now. He mouthed, “Just screw it straight in”, but in my mind I thought he said, “You’re screwed, stranger.” I felt my cheeks vibrate as the drill bit made contact with the pulp of the tree. Soon, my entire body was vibrating as the bit sank further in and then bounced out. Dan gave me a thumbs-up sign as I hammered the tap into the hole I had just made.

Back in the sugar house, I was starting to regain sensation in my feet and hands, which were frozen and still vibrating. The sap was slowly being boiled down to produce syrup and the steam provided not only warmth, but also that intoxicating aroma I still remember today. Dan poured us each a small paper cup of hot syrup which was so delicious that I waited as long as possible before swallowing it. I felt both proud and humbled as I returned to campus that day, excited about my next visit to the mountain ...

After we cleaned up breakfast, the kids and I decided to go to John Jay Park for some bike riding. Today was a cold, but beautifully sunny day. After showering, I got dressed, put on my Timberland boots and headed out the door.

Boo!

2008-11-01T22:13:00.000-05:00

Last night I was walking down First Avenue with Spiderman and a Special Forces agent by my side. Sure, they were each only about 3 feet tall and occasionally forced me to carry their bags of candy, but it was still an honor I will never forget. Spiderman coughed from under the mask which apparently obscured his view of the curbs, and my Special Forces agent spent the night battling an aggressive enemy wedgie. I encouraged them to go into every store possible to add to their loot, but my pleading repeatedly met with a chorus of “Nah”s. Finally, as we stood outside a Japanese restaurant, I knelt down, put my arms around them and said, “Look boys, the people are not going to come out of the stores and give it to you.” The moment the words escaped my lips, a man from the restaurant leapt onto the sidewalk in full karate apparel with two fistfuls of candy, saying, “Hiya!” Before he could deposit his candy, the bags fell to the sidewalk. The blood drained from the heads of my superheroes and they froze in place. “Maybe I’m wrong”, I thought to myself, as I thanked him and bowed instinctively.

Later that night, as I watched my kids trading candy pieces on the dinner table like it was a high-stakes poker game, I thought about my own Halloweens when I was their age. Some things never change. I remember picking through the pennies and fruit to get to the gum and chocolate. Urban legend said that someone was going around putting razor blades into apples, so my parents sorted through the contents of my plastic pumpkin and made sure that no bombs had been planted in my UNICEF box. To make matters worse, I was allergic to peanuts, so by the time my candy had gone through interrogation, I was lucky to be holding a single box of Good-N-Plenty.

Costumes seem to be much more comfortable these days than when I was a youth. All modern costumes are so full of lycra and padding that my kids have actually fallen asleep in them. When I was young, my parents took me to the drug store and I had to choose between 6 costumes: Batman, Superman, WonderWoman, Lone Ranger, Princess or the Bionic Man. All of them came in a shirt-sized cardboard box with a small, cellophane window that was so shiny that you had to hold it in a certain light just to see what you were getting. When I took it out of the box, I had to warm up the industrial vinyl costume for at least an hour before it would fully unfold. It was one-size-fits-nobody and never looked good with my Buster Brown shoes. I did enjoy the contact high I obtained from the pungent odor coming from the outfit, just like I enjoyed the smell from the wet, purple ink on papers I received in school (younger generations, ask your parents about that reference).

Once I was able to don my chemical-laden outfit, the cherry on the top of this sundae was the mask. It was thin, stiff plastic with a flimsy rubber band in the back which was secured with a single staple. And strangely enough, the mask was always adult-sized. I think the manufacturers went out of their way to make sure that sharp edges on the plastic were not filed down. There are still some areas on my face where facial hair will not grow. To make matters worse, they put tiny holes in the regions of my face where I guess they thought I would be breathing out of, but my nose and mouth had other ideas. The warm condensation on my face would then freeze when I took my mask off and exposed my skin to the cold, October wind. One year, I got so used to breathing my own carbon dioxide that I wore my Batman mask until the following Easter (If you don’t believe me, ask my mother!).

But no matter how things have changed over the last 30 years, the magic of Halloween night never changes. For one night out of the year, you can put on a mask and be somebody else for a while. You can paint your face with white makeup and fake blood and see what it feels like to live in the world of the dead (or nearly dead). Who among us does not want to satisfy that curiosity? There is a special chill and an eerie silence in the air. Suddenly, the wind makes a strange, sad sound as it moves through the trees, as if the ghosts who have been summoned are announcing their arrival. And as you pass by the cemetery on your way home from the Halloween party, you’re going to walk a little bit faster. Your heart will pound its way right up into your throat and your eyes will become as wide as the moon which lights your path home. Your mind convinces you that you didn’t see that spooky figure in between the headstones, but just in case, you’re not going to look over your shoulders.

Flu ... Who Knew?

2008-10-06T22:57:00.002-05:00

Think back. Do you remember sneezing so hard that you thought you might lose your memory? Have you ever felt that your body’s internal temperature was directly linked to the stock market? If you’ve ever been so miserable that you just wanted to dive into a pool of Advil, then you know how terrible the flu can be. But what exactly is the flu?

Flu stands for influenza, a virus that is present at highest levels during the fall and winter, reaching its peak in January. This contagious illness generally lasts under one week and commonly produces fever, sore throat, chills, fatigue, cough, headache and muscle aches. However, more serious cases can lead to high fever, pneumonia, diarrhea and even seizures. Almost a quarter of a million people have to be hospitalized each year for influenza and 36,000 people die from it each year, mostly the elderly. While antibiotics are not effective in treating influenza, vaccination can prevent the illness. You’ve probably seen all the ads on TV or heard about co-workers who have been vaccinated, so I’d like to hit some of the high points in case you have any questions:

Who should be vaccinated?

1. Children from 6 months through 18 years of age
2. Adults 50 years of age or older
3. Women who will be pregnant during the flu season
4. People with long-term health problems, such as heart disease, diabetes or asthma
5. People with weakened immune systems, such as people with HIV/AIDS, long-term steroid treatment or currently undergoing cancer treatments.
6. Nursing home or residents of chronic care facilities
7. People living with or caring for people who are chronically ill or elderly
8. People living in dormitories or working in crowded conditions
9. Anyone who wishes to decrease their chances of becoming ill or spreading the disease to others

Who should not be vaccinated?

1. People with a severe egg allergy
2. Anyone who has had a severe adverse reaction to the flu vaccine
3. Children less than 6 months of age
4. People who are currently ill with a fever (They may be vaccinated when they feel better)

How is the vaccine given?

The vaccine is given as an injection of the killed virus in the arm. Most people require only one injection, but children under 9 years of age or those getting the injection for the first time should have two injections. A live, weakened flu virus vaccine is also available in nasal spray form, but this is only available for non-pregnant people between 2 and 49 years old.

What are the side effects from the vaccine?

Most of the side effects from the flu vaccine are mild and occur soon after receiving it. Soreness at the injection site, low-grade fever or body aches are commonly seen and last only a couple of days. Side effects from the nasal spray include runny nose, headache, sore throat and cough. You cannot get the flu from the vaccine, but there have been rare reports of people who received the nasal spray vaccine transmitting the virus to others. Severe allergic reactions are rare, and if you feel that you have been injured by a flu shot, a claim may be filed for compensation from the National Vaccine Injury Compensation Program. (http://www.hrsa.gov/osp/vicp/)

I hope this clears up some of the confusion. As always, the best advice is to eat properly, exercise regularly and devote enough time to sleep. Oh, and remember to laugh for at least 15 minutes every day. Don’t worry – I’ll help with that.

That's My Home

2008-09-07T23:38:00.001-05:00

I had a little time to kill. I wasn’t expected at dinner until 7 PM and it was only 5 in the afternoon, so I walked around the streets of downtown Denver for a while. To be truthful, I wasn’t really looking forward to dinner. I was in town for the annual meeting of Ear, Nose and Throat specialists and representatives from the drug companies often took us out for decadent steak dinners. The food was always great, but the conversation was always a bit forced until about the third or fourth glass of wine. A few blocks away from my hotel, I saw a green sign with an arrow which said, “World Trade Center Parking”. I was impressed that other cities besides New York had a World Trade Center, but it made me a bit homesick at the same time. My wife, daughter and 6 month old son were back in New York, and this was the first time I was away from them for an entire week. I found myself standing next to the Hard Rock Bookstore and Café, so I took off my sunglasses and traded the bright afternoon sun for the dark, air-conditioned cafe.

I scanned down the row of large coffee table books for something that interested me. I picked out one on the history of the Rolling Stones and flipped through the pages. Then, out of the corner of my eye, I spotted a black and white book on Skyscrapers of New York City. I stared at images of the Empire State Building and the Twin Towers for the next 15 minutes. I looked at my watch and realized that I had to get back to my room and take a shower before finding the restaurant. I bought bottled water at the counter and glanced at the newspaper on the rack. “September 10, 2001” was the date at the top.

Sitting at the table with a half-devoured, medium-rare filet mignon on my plate, I found myself staring at the photos on the wall. The group consisted of two reps and about half a dozen physicians. I swirled the red wine in my oversized glass and tried to seem interested in the conversation. It moved awkwardly from the stock market to football to President Bush to the current healthcare crisis. I laughed on cue. Finally, the topic shifted to terrorism and one of the reps commented that the world is just not as safe as it used to be. I agreed, and on that note, the group disbanded. I tried to shovel in the rest of my New York cheesecake, but was forced to leave some behind.

Lost in thought, I walked back to the hotel. As I got ready for bed, I stared at the gift basket I received from the hotel after my room was not ready the first night I was there. It was filled with nuts (which I am allergic to) and some strange pink grapefruit sucking candies. I didn’t have to get up early the next day, and I had a pretty light meeting schedule. I went to sleep that night thinking that tomorrow would be one of the easiest days for me in a long time.

†

I was awakened by the telephone at around 7:30 AM, a full hour before my alarm was supposed to go off. It was my wife and her voice was telling me to turn on the TV. “The World Trade Center has got a hole in it”, she explained. “They’re on fire. They interrupted Sesame Street.” I stumbled to the TV and didn’t have to turn any channels to find the images that would later become burned into my memory. I watched the flames engulf the buildings as my mind flashed back to all the times I had been there. I visited often as a child because my father worked around the corned on Church St. I took my wife there when we dated. I stayed in the Millennium Hotel after by bachelor party and woke up staring at the blurry Twin Towers. “That’s my home”, is all I could think as tears welled up in my eyes. These tears began to stream down my face and I held my breath when the South Tower collapsed. I ran to the shower, but could not feel the water hit my skin. The water hitting the curtain drowned out my audible sobs. Twenty minutes later, I returned to the TV, and a few moments after that, I saw the antenna of the North Tower tilt and then fall into a cloud of soot. Suddenly, my tears stopped. I wiped my eyes and focused my energy on one thought and one thought only: I have to get back home!

I knew instinctively that all planes would be grounded. I called several car rental agencies and discovered that nothing was available. In desperation, I tried to rent a moving truck, but was informed that no trucks were being rented considering the current situation. Cell towers were flooded with calls. All I could think about was my family. I quickly packed my suitcase, ripped the grapefruit sucking candies out of the basket, and ran out of the room.

Still in a daze, I hurried to the Conference Center and tried to gather a group of friends from New York to make a plan and get home. Some thought that flights would be available the next day. Some were just unsure about what to do. Lectures were cancelled. All of the monitors in the Center were playing the collapse over and over again. Then I heard of a few doctors from New York who had a bus and were meeting at a certain corner downtown, but spaces were limited. I didn’t hesitate in making it over there. A husband and wife were willing to drive there tour bus across the country for $150 per person. I recognized one of the organizers as someone I knew from my training, and he agreed to give me a seat on the bus when it arrived. Many of the doctors who were waiting changed their minds when they found out that the bus did not have a bathroom, and after waiting 2 hours, I was beginning to think about making other plans as well. Then it arrived. I shoved my luggage in the overhead rack, sat down and popped a grapefruit candy in my mouth. Glancing down the city streets, I saw the beautiful, snow-capped mountains in the distance as the bus pulled out of town.

We stopped somewhere for dinner at a family restaurant. I overheard a group of people watching the news in the bar as I ate. They were saying how bad they felt for people who lived in New York. As afternoon turned to evening, the bus fell silent. The sound of President Bush giving his address to the nation played quietly in the background, interrupted by frequent static. My head throbbed and my mind was racing. I looked out the window and saw a bright, quarter moon in the sky. I tilted my head, remembering the time when my daughter pointed out how much it looked like a smile. I had never thought about it that way before. I smiled for the first time since the night before, but I was more homesick than ever. I closed my eyes, but didn’t sleep.

The sun rose on the first day, and my eyes stung from all the tears from the last day. I looked out and saw the St. Louis arch, suddenly wishing that I was better at geography. When enough people on the bus complained that they had to go to the bathroom or were hungry, the drivers stopped at a Cracker Barrel. At each of these restaurants, there was a gift shop by the exit. On the way out of one, I bought a small, pink stuffed poodle for my daughter, and for my son I found a children’s guide book on how to be a good American.

The hours dragged on. I finished the last of the grapefruit candies. Each one started out sweet, but then turned sour in the end. My cell phone signal was inconsistent, but I called my wife whenever I could. I was amazed how long we could drive without seeing a house, or even another person. For most of the time, I didn’t even know where I was. I tried to see the license plates as they whizzed by. We stopped at a gas station, so I got out to stretch my legs and buy something to drink. A young girl with plump, rosy cheeks and a beaming smile was at the counter. “What state is this?” I asked. Her smile faded for a moment, then reappeared as bright as ever. “Why, you’re in Indiana!”

Once again, evening fell and I felt that we were getting close. I began to recognize the meadowlands of New Jersey and then as we turned north. I strained my eyes to see as Lower Manhattan came into view. Over the last 35 hours, I did a good job convincing myself that the Twin Towers were still standing, but now I saw it with my own eyes. “Ground Zero” glowed like a bonfire and a cloud of smoke rose in a straight line up to the sky. My tears suddenly began again, partly out of sorrow and partly out of joy that I would see my family soon.

When I opened my front door, I dropped my bag and fell into my wife’s arms. I couldn’t verbalize all the things that I wanted to say, and she understood that. All of a sudden, my own home seemed like such a strange place. The whole world was different, and tomorrow I would have to begin learning how to live in it. The kids were asleep, but I placed the pink poodle on my daughter’s bed and kissed her goodnight.

Again, why are you here today?

2008-08-07T21:16:00.001-05:00

Welcome to the second installment of the game I like to call, “Why are you here today?” Just to review, this is the first question on a questionnaire that every patient fills out when they come into my office for the first time. While I take every single complaint very seriously, I have to admit that some responses … how shall I say it … are more colorful than others. Here are some that I thought you might enjoy.

The first category includes those individuals who are a bit challenged in the spelling department:

“Clocked right ear”
“HOH”
“Have a lam under the chan”
“Have a bad sore throat, can’t talk long, hard to breeze”
“Growth on thort”

Did you get them all? Well, here are the answers:

Clogged right ear
Hard of hearing (This was an 85 year old woman and one of the original users of text messaging)
I have a lump under my chin
I have a bad sore throat. I can’t speak for very long and it’s hard to breathe.
I have a growth on my throat

The next category goes under the title, “Dazed and Confused”:

“Nose and hear”
“Appointment on my ear”
“He bleed from noise”
“Terrible noise in left hand”
“Loss of hearing in eye because of infection”

And, finally, one of my favorites of all time:

“Allergic breakdown”

I hope these put a smile on your face. I’d like to thank all the patients who unknowingly gave me these little nuggets of joy. You’ll have to believe me that none of the responses were altered in any way, shape or form. After all, I could never make up anything this good!

Bottled Up

2008-07-12T22:33:00.000-05:00

Prior to beginning my ENT residency program, I spent two years as a General Surgery resident in the West Village, where I learned some interesting skills like taking out an appendix and repairing an intestine that was pierced by a knife after a wild night on the town. The first year of General Surgery was spent on the hospital floors and in the Operating Room with the other General Surgery residents. The second year, however, I found myself spending more and more time in the Emergency Room. Everyone knew that I was moving on to greener pastures the following year, so I naturally assumed that they stuck me down there so I could stay out of trouble. At least that’s what they thought …

Being the General Surgery resident down in the ER was a grueling task. Basically, anything that wasn’t a heart attack or a stroke came to me. I learned that if the patients came out of the ambulance sitting upright, I was safe. If the patient was lying down with a cervical collar on and a trail of blood following the gurney, I was screwed. The hours I worked were particularly punishing. One week was days and the next week was nights, 12 hours on and 12 hours off. I have collected a countless number of stories from those days, but as I am sitting down enjoying a fine imported bottle of beer on this hot, summer night, one story in particular comes to mind.

It was the summer of 1994, on a night where the heaviness of the air felt almost identical to today. I woke up around 6 PM, showered and made it to the hospital 15 minutes before my 8 PM shift officially began to take report on the patients already there. The time from 8 PM to 2 AM was always the busiest. This is when all the traumas and hot gallbladders came rolling in and there was hardly a chance to breathe. When things began to slow down around 3 AM, I would take a stroll across the street and buy a honey turkey sandwich from the deli. The meat was piled about 2 inches high and I never figured out how they got the honey flavor in there. After devouring my sandwich, I’d usually stitch up a couple of lacerations that were lingering in the hallway before heading off to the room where pelvic exams were done to take a nap. It was the only place I could acutally put my feet up. Usually I could get an hour or two of sleep in before the first morning stabbings came in, but on that day, I was in for a surprise.

My eyes widened as a man rolled in on all fours. He was on his hands and knees, staring straight ahead like a hunting dog that had just spotted a rabbit. He didn’t have a cervical collar on and there didn’t seem to be any blood around him. It was as if the homecoming queen in a medical parade had just arrived in my town. The EMS driver looked at me sheepishly and said, “He’s got a bottle up his ass.” At this point I will purposely refrain from any social commentary on how or why the bottle got there. Let’s just accept the fact that it was up there and move on from this point, shall we?

The nurses looked at me and I looked back at them with the same expression. As I stared at the poor man’s behind, he turned his head and inquired, “How’s it going back there?” I tapped on the bottom of the glass with a hemostat forceps to make him think I was making progress, “Clink … Clank … Clunk”. It didn’t budge, but I almost had “Jingle Bells” figured out. The problem was that the bottle had formed a vacuum, and any attempts to grab it and pull it out were solidly in vain. However, I remembered enough about physics to know what my next move was. I picked up the phone and called the operator, “This is Dr. Reisacher down in the ER. Could you please connect me with the Engineering Department?”

Patrick was a proud, Irish man in his early 50’s. He had worked in the Engineering Department of the Hospital for the past 20 years in order to put his three kids through college. He spent some time in the Navy and his muscular frame was covered with tattoos and course, auburn hair that contrasted well with his dark, green uniform. He was a man’s man, but that night would challenge every value that he held dear in his heart. Without reservations, he accepted his assignment and got to work.

The scene that followed is burned so thoroughly into my memory, that I can sometimes still see it when I close my eyes at night. As I flipped the curtain back, I heard the man with the bottle squeal, “Oh my!” This was followed by a familiar mechanical sound, “Wheeeee”. The patient was lying down with his backside high in the air as Patrick, his large head only inches away, was drilling a hole in the bottom of the bottle. Once completed, Patrick removed the safety goggles from his beet-red face and calmly stated, “I think that’ll do it”. We exchanged positions and with a healthy dose of Vaseline and a gentle twisting motion, the vacuum was released and the bottle slid easily out. The patient turned over on his back and smiled from ear to ear, “Boy, what a relief that is!”

I never did get back to sleep that shift. The morning traumas just didn’t seem to affect me as much as they usually did, and the honey turkey never tasted the same either from that point on. I saw Patrick in the halls from time to time, and although we smiled half-heartedly at each other, our relationship was never quite the same. I think a part of each of us died that night. It might have helped if we would have spoken about it, but instead we chose to keep it bottled up inside.

Counting Backwards

2008-06-15T22:12:00.001-05:00

I walked down the long corridor to the operating room. I glanced at the empty scrub sinks, but was keenly aware of the fact that I would not be using them today. Inside the OR, the anesthesiologist and circulating nurse both greeted me warmly. At the nurse’s request, I loosened the gown I was wearing which gave new meaning to the abbreviation, “ICU”. She checked the ID band on my wrist and the intravenous line in my arm felt stiff and cumbersome. I “hopped up” on the narrow OR table and the cool linen sheets felt good against my skin, which was beginning to perspire with nervous anticipation. A familiar, clear plastic mask descended over my face. “It’s just oxygen”, the upside-down anesthesiologist calmly stated. My arm began to sting as he continued, “Just count backwards from ten.”

“Ten … nine … eight … theven … fix …sive … fo … t … thu ...

Eyes closed

Music plays

Instruments clank

I lay in a dreamless sleep

The surgeon’s beeper goes off

The nurse gets relieved to go to lunch

I can’t move, breathe or think

The anesthesia monitor beeps

The last stitches are tied in place

"BRING ME BACK, BRING ME BACK!"

The next thing I know, I was being wheeled into the recovery room. My eyes were cloudy from the ointment in my eyes and the room seemed to be spinning. Completely against my nature, I surrendered to the fact that I was not in control here. As a surgeon, I have witnessed over a thousand patients go to sleep and wake up, but this was the first time I experienced it myself. Last year, I decided to have an inguinal hernia repaired, which had been giving me pain for the past 5 years. You could say that I’m a bit stubborn.

I felt like my head was not attached to my body. I was afraid that if I looked under the sheets, I might not see anything at all. But suddenly a wave of intense pain pulsed across my abdomen and into my groin and this reassured me that at least something was there. “How’s the pain”, my nurse asked. Later on, I was told that I responded, “It sucks”. Apparently, my sense of humor was the first thing to wake up. I gained a new appreciation for morphine that day.

I just managed to squirm into a semi-upright position, when my surgeon came in. “How are we doing?” he said with a bright smile and soothing voice. I was about to say, “Well, in your nice suit, you seem to be doing fine, while I, on the other hand, feel like I was just trampled by a mentally deranged farm animal!” But instead, I just said, “Great, thanks.” After a few more doses of morphine, I felt like jumping off the bed and heading up to the floor to see patients, but just then the nurse brought me back to reality. “Slow down, Doc. In order to leave, you first have to fill this.”

I stared at the urinal for a few moments before working up the nerve to use it. I felt like I was refueling my car. After finally negotiating everything into position, I smiled and calmly waited for the fireworks to begin, but after a few moments all I heard was a lot of nothing. Thinking that the urinal must be malfunctioning, I examined it carefully, just like I stare at the uneven sidewalk after I trip. After confirming the integrity of the plastic, I repositioned it and used all my available willpower to make the pee magic happen, but I soon realized that I would have to think outside the bladder.

Now, I usually stand up during this task, so that’s just what I did next. Fighting back the pain, I began to feel some pressure down there, but no luck. I imagined cool mountain streams and giant waterfalls, but the urinal remained dry. Sensing my growing anxiety, the nurse brought in some apple juice. “Why don’t you try this? Maybe it’ll help.” As I began to sip the juice, I thought for one devious moment how easy it would be to just dump the juice into the urinal and call it a day, but I didn’t think I could endure the embarrassment if I got caught.

After the juice, the nurse walked me to the bathroom. She reluctantly let me shut the door, and as I leaned against the wall over the toilet, I prayed as hard as I could, “Please let my urine flow!” All of a sudden, a few drops fell, then a few more, and then a full-fledged trickle. I wasn’t sure the volume of the splash would be satisfactory for my nurse, so I supplemented this meager flow with some water from the sink that I collected in my juice cup and poured from high above my head. I walked out of the bathroom with the look of pride on my face, but the suspicious smile on my nurse’s face told me that she knew I was up to something.

Nevertheless, I did manage to go home that night. I wheeled out the front doors with my wife at my side, clutching my prescription for narcotic pain medication like it was a newborn baby. I think of this experience every time I recommend surgery to a patient, and, of course, every time I use the bathroom. It’s unusual for doctors to have the opportunity to spend time in our patients’ hospital slippers, but maybe this should become a part of our training. At least for me, I think it helped me become a more compassionate physician and a more humble person. Now, when my patients can’t make it all the way when counting backwards from ten, I take a moment and finish it for them.

A New World

2008-05-18T22:08:00.001-05:00

The bus rumbled along the City streets on its way to the VA Hospital. This was the first day of my medical school psychiatry rotation and I was filled with apprehension. Up until now, I had mastered the art of drawing blood and examining the abdomen, but now the rules were going to change. Now I would have to use my words rather than my hands to probe the deepest recesses of my patients’ lives. In order to help them I would have to talk about sensitive issues and open wounds that would probably best be left closed. To some degree, I would be forced to bring myself into their world, while maintaining enough distance to prevent myself from being consumed by the fires that burned within their minds.

The bus bounced in and out of a pothole as it entered the driveway of the hospital. With rounded windows and an aluminum facade, it felt like I was about to be swallowed up by a large spaceship. Indeed, I was about to enter a completely new world. In the lobby, I was greeted by my supervisor, Dr. Morehaus, a middle aged woman with wavy black hair and intense, green eyes that could probably pierce right through the thick fabric of my short, white jacket. On the way up to the floor, she revealed to me that her area of expertise was the sociopathic personality disorder. As she handed me my orientation booklet, she went on to explain that sociopaths are the same as psychopaths. The different terms reflects different opinions on whether the person’s defect, or pathology, came from society’s influence or the inherent derangement of their mind, or psyche.

After a brief orientation meeting, Dr. Morehaus walked me up to the floor. It was a locked unit, but the grey, metal entrance door with a small window of reinforced glass snapped welcomingly when she waved her ID in front of the scanner. We pushed through the heavy door into a quiet, dimly lit hallway. The drab color on the walls matched the drab color of the floors, which looked like they were recently shined. We passed a recreation room on the left, where two middle aged men with disheveled hair played checkers in their bathrobes. An old piano, which looked like it hadn’t been tuned in years, stood quietly in the corner. As I passed by, one of the men looked up from his game and stared me down. I quickly looked away. “That’s Jim”, my supervisor explained, sensing my discomfort. “He just came back from the Gulf War. Paranoid schizophrenia with suicidal ideations. He’s really a sweetheart when you get to know him.”

The noise in the hallway grew louder as we approached the nursing station. It was nine o’clock and all the patients were lining up for their morning meds, which they received in small, white paper cups. Most patients tossed them back dry, but some stopped at the water fountain to help swallow the array of brightly colored pills. Dr. Morehaus took me into the staff lounge for some final advice. “Now when you go into the room, don’t close the door behind you. And remember never to position the patient between you and the door. You need to have a way out … in case.” Her voice trailed off, and then quickly returned. “You have a very nice tie on, but take it off and don’t wear one again. Nothing should be around your neck. Oh, and while you’re at it, take the pen out of your front pocket. Your patient today is in room 215, just down the hall. Good luck.”

When I reached the room, I couldn’t help but think how easy it would have been to just turn around and head downstairs for some coffee. At first I knocked so lightly that I could barely hear it myself, so I decided to give it an authoritative double knock. I was relieved that nobody answered, but just as I turned around, a stern voice replied, “Yeah, who is it?” Lieutenant Colonel Robert “Bobby” Woods was a thin, unshaven man in his 40’s, wearing striped pajama pants and an off-white tank top undershirt. He was also a paranoid schizophrenic who had served in the Vietnam War and suffered from PTSD (post traumatic stress disorder). I managed to introduce myself without letting my voice crack, but he continued to stare ahead into the distance. From the stockpile of food in the corner and military bumper stickers on the bed and walls, it appeared that he had been here for a while. “Sit down”, he ordered and I quickly occupied the only available seat in the room. With the agility of a panther, he pulled his chair in front of mine, and suddenly I realized that he was positioned between me and the door.

Bobby stared out the window with a wild, vacant look in his eyes and seemed to be completely immune to my questions, which now seemed utterly irrelevant. “So Mr. Woods, how has your appetite been lately?” He completely ignored the question as he began to drift back into his past. “You know, Doc, when I’m driving in the car, I can see them weaving in and out of the trees by the side of the road.” “Who?” I asked, relieved that he considered me worthy of conversation. He finally looked me straight in the eyes and squinted disbelievingly, “The Vietcong. They’re real sneaky, you know.” While I was thinking of a response, he moved on. “I see little people running around the room. They’re here right now.” “Where are they”, I asked, finally feeling like a psychiatrist. “They’re behind your chair and they’re telling me things”, he stated in a serious tone and looked down. I eased the pen out of my front pocket and dropped it nonchalantly into the side pocket. With trepidation, I asked, “What are they saying?”

“They want me to hurt you.”

These words echoed through my head so loudly that I doubted for a moment that there was a brain in there at all. The next minute or so is blurry in my memory, but I quickly excused myself by pretending I was paged or claiming to be late for a meeting or something. Either way, I was out of that room so fast that I practically left my blank notepad still suspended in mid air. On the way out, I heard Bobby say, “See you soon, Doc.”

I emerged from the hospital later that day, still alive and sipping a cup of coffee at last. The victory would have seemed sweeter if I didn’t know that I would be returning the next day. The bus picked me up to bring me back to my own hospital. With the setting sun in my eyes, I stared out the window and tried to catch the trees as they whizzed past me. Once, when I found myself looking more closely in between the trees, I squeezed my eyes shut tightly and drifted off to sleep for the rest of the ride home.

36,000 Feet

2008-04-27T22:28:00.001-05:00

Life is all about timing and opportunity. Depending on the situation, you may consider it being in the right place at the right time or being in the wrong place at the wrong time. A few weeks ago, I had the wonderful experience of traveling to Austria and delivering some lectures to physicians from countries formally under Communist control. Following this, I took a train from Austria to Germany to visit my relatives. It was a golden opportunity to reconnect to members of my family whom I had not seen in years, and I had the time of my life. Finally, it was time to fly from Frankfurt back to JFK and this is where the excitement began …

I boarded the plane and quickly made it to my seat. After stowing my carry-on bag in the overhead bin, I sat back in my seat, reclined it to the max and closed my eyes. An American couple soon broke the sanctity of my row as I opened my eyes halfway, politely smiled and nodded in their direction. Before the plane took off, an attractive flight attendant came over to me and politely fired a round of German words in my direction. I know many German words and can hold my own in a very superficial exchange, but I am far from fluent. However, because of my appearance, most people in Germany and Austria assumed I spoke the language. I have to confess that I enjoyed playing that role for as long as possible.

I didn’t get every word that the flight attendant said, but I got the idea that she wanted me to put my seat up for takeoff, so I complied. “Dankeschön (thank you)”, she said with a sweet smile. “Bitteschön (your welcome)”, I replied, relieved that she did not have any other requests. After takeoff, she returned with a cart full of beverages. “Ich möchte ein Bier (I would like a beer)”, I explained, and before long I was sipping a cold brew and reading my book as the plane inched closer and closer to NYC. When the English-speaking couple next to me wanted to communicate with me, they did so by using gestures and I devilishly responded with only a smile.

About halfway through the flight, I began to doze off, but was suddenly awakened by an English announcement overhead, “If there is any medical personnel on the aircraft, please make yourself known to the flight attendants at the front of the cabin. We have an emergency.” My eyes opened wide and my jaw clenched. This is a situation I think about every time I get on a flight, but I didn’t know how I would feel until that very moment. A split-second of terror gave way to focused determination. I jumped up from my seat, frightening the couple next to me, and hurried up the aisle.

When I drew the curtain aside, I saw a German-speaking women in her 60’s, pale and sweating, slumped down on the floor between the seats assigned to the flight attendants. The attendants began firing information to me in German and I knew my game was over. “Please tell me as much as you can in English and I’m going to need you to translate.” I had the attendants tell her that I was going to examine her and take her vitals, and as I began this task, they told me that she had a history of heart problems and was feeling shortness of breath and pain radiating down her left arm. Her eyes were darting nervously back and forth and I noticed that she had a list of medications clutched tightly in her fist. She spoke to the attendants, who then looked up at me and said, “Her doctor told her not to fly.”

I put her on oxygen and gave her some nitroglycerine under her tongue. I was concerned that she might be having a heart attack, but her vitals remained stable and she started to breathe easier over the next half hour. I was impressed with the medical equipment that I had at my disposal and the knowledge that the crew had of the supplies. I ordered an ambulance to be ready at the gate when we landed. After about an hour, she sat up in a seat and I sat next to her, holding the oxygen tank which she was still attached to. Just when I began to close my eyes, one of the attendants came over to me and whispered in my ear, “Doctor, we have another situation.”

In disbelief, I left my patient to the observation of one of the attendants as I headed up to the first class section. A middle-aged Caucasian woman was vomiting repeatedly in the bathroom. When she came out, I began collecting information from her and performing a focused exam. She spoke English and relayed that she had come from Romania and took a pain killer containing codeine on an empty stomach. I recommended starting an intravenous (IV) line to replace her fluids, but the crew cautioned me that the plane would begin descending shortly. I gave her seltzer water to drink slowly, and she eventually held it down.

I finally made it back to my seat, just in time for the final approach to New York. I began chatting to the couple next to me and they looked at me in disbelief. Only then did I remember that they didn’t think I spoke English. With both of my patients stabilized, the plane landed safely at JFK. On the way out of the plane, I thanked the crew for hosting the most interesting flight of my life. They thanked me in both German and English and gave me a bottle of wine for all my troubles, which I knew I would need later. On the jetway, I encountered my first patient being taken away in a wheelchair. “Vielen Dank (thank you very much)”, she said with a smile that broke all language barriers. Seeing my family at the gate, the tears welled up in my eyes and thought about all the events which put me on that flight that day and brought me home to them.

_____________________________________

Come see Dr. Reisacher perform live stand-up!
Thursday May 1, 2008
“The Comic Strip”
1568 2nd Avenue, between 81st and 82nd
6:30 – 8:30 PM
$30 at the door, 2 drink minimum
Proceeds will go towards PS 158's enrichment programs

The Ghost

2008-04-06T23:14:00.001-05:00

As I walked through the streets of Collegetown, I could hardly believe my eyes. Some of the bars where my friends and I used to drink beer and sing Jimmy Buffett songs at the top of our lungs were now occupied by Sushi bars and boutique coffee houses. The house where I once lived had been repainted, and the porch swing swayed gently in the cold, March wind as if a ghost trying to rekindle a distant memory was aboard. I thought about all the events in my life that occurred in the two decades since I last haunted these streets, and for a moment I wondered if those events could have all just been a dream. I was a man suddenly cast adrift on the ocean of time, trapped between two familiar worlds and feeling lost in both. I was relieved when people looked at me because this proved that I was, indeed, visible.

I didn’t need to look down because my feet knew every crack and step along the streets. The muscles in my legs fired in the precise order that they had so long ago and my eyes could see what was ahead even before I turned the corners. My heart began to beat faster and with every breath I drew the spirit of this sacred place deeper and deeper into my soul. I could smell the familiar odors of my social and intellectual birthplace, and I knew instinctively that I was home.

As I crossed the stone footbridge that connected Collegetown to the central campus of Cornell University, I noticed that most of the students walked quickly over the bridge without taking the time to appreciate the beauty of the water cascading down the gorge towards Lake Cayuga. I realized two things at this point. The first was that I probably acted the same way when I was a student here, and the second was that most of the students I saw that day were just learning how to walk when I attended Cornell. I wanted to scream some cosmic warning to the students whizzing by me, just like the Ghost of Christmas Future in “A Christmas Carol”, but it was too early in the day to get escorted off the campus.

I never thought that my journey through life would lead me back to Ithaca, New York. I have been working on a research project with the Biomedical Engineering Department and I needed to meet with some colleagues and spend a day in the lab at the campus up there. The lab was located in Olin Hall, a huge stone fortress with few windows and many exhaust pipes in the roof to release the toxic fumes generated within its walls. I pushed the doors open and the rattle from the metal doors echoed loudly through the dimly lit hallways. Along the walls were pictures of scientists and engineers from the past who seemed to be staring at me with disapproving eyes because I had now entered their hallowed sanctuary.

The laboratory was in stark contrast to the hallways that brought me there. The lab was quiet and brightly lit, but every square inch seemed to be alive and buzzing with activity. The PhD student I was working with maintained a good sense of humor as she took me through the experiments we had planned for the day. I kept up with her efficient pace as best as possible, taking copious notes and frequently asking her to rephrase things in a language closer to my own. Overall, the day was a success and I left the lab feeling both energized and inspired.

Driving out of Ithaca, I could not wait to get back to NYC and continue the progress that I had made that day up at Cornell. I felt a renewed sense of good fortune and was reminded once again of all the reasons I went into my profession in the first place. I am truly blessed to be able to see patients. They trust me with their lives at their weakest and most vulnerable moments, and in return I owe them compassion and the best care possible. It is a thrill and an honor to be able to push the envelope of medical knowledge beyond its existing limits and challenge the laws of science in order to discover a better way of life for someone who needs help. I gained so much from my experience that day. In this place, I had established a tangible link that would not only connect me with my past, but also provide me a bridge that would lead me into the future. I no longer felt like a ghost.

Why Are You Here Today?

2008-03-19T22:16:00.001-05:00

When patients come to my office, I ask each of them to fill out a questionnaire concerning their past medical history, prior surgeries, current medications, allergies and other pertinent tidbits about their social life. This is a pretty standard practice for any medical office. Generally, I take note of the information provided and move on with my day. But over the years, I have been surprised by some of the interesting and amusing answers to the very first and most basic question on the form, “Why are you here today?” I have decided to share 10 of my favorites with you, and I promise that these responses were not edited in any way … seriously!

1. “My ears are amplified”
2. “New York”
3. “Emergency speech therapy”
4. “Clocked right ear”
5. “Trouble hearing due to hear infection”
6. “Tested for strip troat”
7. “Living at Clue I” (don’t ask me! I was never able to figure this one out.)

The next two earned an NC-17 rating, so please hide you child’s eyes at this point:

8. “Nose bleeds when blown”
9. “Get ears blown” (I had to inform him that I was not that kind of doctor.)

And, finally, the crown jewel of the list:

10. “Swallowed mold remover thinking it was green tea”

I’ll admit that there were times when I wondered whether or not I really wanted to walk through the door of my exam room and face the people who made these remarks. However, I’m proud to report that they all received quality medical care and walked out of my office satisfied (except for the guy in #9). I owe them each a debt of gratitude for giving me these tiny, humorous gifts which I can unwrap from time to time when I need to smile. I hope they made you smile as well!

Coming Home

2008-02-25T23:44:00.002-05:00

This is the conclusion of last week’s post, “Aloha!” …

2/18/08

What a day! What an adventure! I’m not even sure where to begin. I finally made it back to the hotel room and I’m so tired I can barely see my laptop screen in front of me. But if I don’t write this down now, I may wake up tomorrow and think that it was all a dream …

We woke up at the crack of dawn to reach the volcano before the heat of the midday sun made the journey unbearable. Even in the slight cool of the morning, I could tell by the cloudless sky and motionless air that this would be a brutally hot day. We jumped in a cab to get there fast and I tried to make small talk with my barely English-speaking driver. He drove an older model Cadillac and the crushed velvet seats felt good on the back of my thighs. The air-conditioning vents were blowing cool air across my face, but little did I know that this would be the most comfortable moment of the entire day.

We arrived at Diamond Head Crater in a half hour. The cab took us through a tunnel right into the center of the crater. The volcano had last erupted 300,000 years ago and the rock and ash that was thrown into the air formed the walls of the crater when it came back to the ground. It was an awesome sight. We were surrounded by a complete wall of rock and our task for the morning was to hike up to the highest point on that wall. As my family and I began our journey, I was convinced that this would be an easy climb.

The trail began as a level concrete path, but it quickly became a steep slab of irregular rock and dirt that wound back and fourth around the base of the crater. The sun had fully risen and the heat was beginning to become more intense. About halfway up the crater wall, we passed a middle aged Irish couple with distressed faces that were plump, moist and red. The woman caught her breath, handed a flashlight to my daughter and said, “Here, take this. You’ll need it. We didn’t make it!” With that, her and her husband stumbled back down the path back to the bottom, leaving my wife and I to stare at each other in disbelief. Glancing over at my three small kids, who were dressed in their beach attire and all fighting over the flashlight, I thought to myself, “We’re in trouble now.”

It took about an hour, but we finally made it to the top. Many of the spaces that we had to crawl through were tight, and my kids actually had the advantage at times. The panoramic view from the top was breathtaking. The entire island of Oahu was visible, and as I stared into the crater, I could image the explosion that occurred so many years ago. The temperature had risen to a boil by this time and I looked over towards Waikiki Beach, wishing I was back there now. The trip down the volcano was easy in comparison and we rewarded ourselves at the floor of the crater with shave ice.

We proceeded up the coast to Hanauma Bay, a nature preserve that was actually formed in the same way that Diamond Head was, but the sea broke through one side of the crater and flooded it, forming a bay. The water was filled with coral reefs that were teeming with tropical fish and turtles. We descended down the face of the crater and claimed our plot of sand. The sun was punishing at this point, but the air was dry and pleasant and the water was cool and refreshing. The kids played mostly by the water line, but I explored the reefs and followed some brightly colored fish which didn’t seem to mind my intrusion at all. Back on the sand, we snacked on turkey sandwiches and cabbage that we bought on the road and stayed the rest of the afternoon.

Burned and weary, we packed up our blankets and caught a bus back to Waikiki. Once back in town, we realized how hungry we were, so we stopped at a cheeseburger shack and devoured all they had to offer. Because I was already tired and dehydrated, the local brew that accompanied by cheeseburger packed quite a punch. We only had a few more blocks to walk in order to reach the hotel, but we stopped along the way and bought Hawaiian shirts and dresses for the entire family. Finally back at the hotel, we bathed the kids and watched some TV. In the time that I’ve written this account of the day, everyone has fallen asleep. I won’t be far behind them. Isn’t it funny that sometimes the moments when you are totally exhausted are also the moments when you feel most alive?

2/19/08

I woke up with the sobering thought that this was the last day of the trip. Thoughts of projects I needed to do next week at work began creeping into my consciousness, but I forced them out just as fast. I showered and headed over to the conference room for some early morning lectures. This was the same room where, only one day before, David Beckham was giving his press conference for the Pan-Pacific Soccer Championships. For the afternoon, we hung out at the beach one final time. I knew that my kids were getting used to this island when my son gave me the “hang loose” hand sign before diving head first into a wave. We walked around town after the beach to get some dinner and do some last minute shopping before heading back to the room to pack up and prepare for the day of travel that was waiting for us in the morning.

I can’t decide whether the vacation went fast or slow. In a way I am longing for the smell of the East River in my nostrils, but in another way I’ll have a hard time letting go of this place. Yes, I’ve finally found my aloha on this island. I found peace of mind, body and spirit, but most importantly I discovered a new perspective which is lost in the daily routine we all find ourselves in. I found some time to think and reflect on my priorities in life. The family had a wonderful time this week and I’m glad that we had this opportunity to grow even closer to each other. We made new friends, learned about new places and shared experiences that we will be talking about for a long time. Hopefully, we can bring back some of the spirit of this island back to our own small island. I’m not looking forward to the cold weather, or the plane ride back, but I am looking forward to coming home and I’m ready for all the challenges ahead. I’ll see you all soon …

Aloha!

2008-02-18T01:50:00.002-05:00

2/14/08

Greetings from a tiny volcano in the middle of the Pacific. More specifically, I’m in the bathroom of my ocean view room at the Hilton on Waikiki Beach. My kids and wife are asleep, so this has become my office. I like spaces that have multiple functions. We arrived here yesterday. It’s the middle of the night here, but I’m still operating on New York time so I’m all full of creative energy. Be prepared … this post is more like a postcard!

I know I’ve said that laughter is the best medicine, but surely vacation comes in a close second. Yes, it’s time for the doctor to get some R&R. And what could be more relaxing than a grueling, 11 hour flight with my kids beating me at every board game imaginable? I think that watching everyone around me on the plane float away into a blissful, vodka-induced slumber actually prevented me from sleeping. Several strong cups of coffee probably didn’t help. I did get some “pretend sleep”, where you close your eyes, think crazy thoughts and fool yourself into thinking that it was a dream.

When we arrived in Hololulu, I was surprised to find that everyone looked pretty much the same as they do on the mainland. I think I was expecting that all the people would be running around wearing grass skirts and coconut shells over their privates, but seeing the abundance of fast food and retail chains gave me the clear indication that I was still in the USA. Most of the people here speak clear English, with the exception of my cab driver who only knew how to say, “Four dollar extra for heavy bag.” Conversations are sprinkled with odd phrases like “mahalo” (thank you) and “aloha” (hello/goodbye/would you like to buy a souvenir?) Aloha is a vague salutation used similar to “Shalom” at a Jewish wedding. I’m afraid to use the local phrases as that may clearly identify me as a tourist. Oh, who am I kidding – I don’t blend well here. I wonder if they have bagels?

2/15/08

I upgraded my office. Now I’m sitting on my balcony overlooking the harbor and beach below. The family and I started the day off right with brunch in the resort, but almost lost our appetites when we saw the prices. A bagel with cream cheese costs $15 (no, I didn’t buy it) and a hot dog will set you back about 8 ½ bucks. This place makes Manhattan seem like a bargain! The best value was the buffet, and we each went back about 5 times. It was some consolation knowing that my hard-earned money was going to help support Paris’ extravagant lifestyle. After brunch, we watched a heron pick a fish right out of the coi pond and swallow it while it was still thrashing back and forth.

We then spent the day lounging on Waikiki Beach, trying to expend as few calories as possible so that we did not get hungry again. None of the newscasts here carry the weather because it is always the same … perfect. The sky was clear and cloudless, the water was 20 different shades of blue and a light breeze was blowing. As each wave crashed up on the white sand, my worries and stresses began slipping further away just like the sand that was being carried out to sea. The sun was toasting my skin and I could feel each muscle in my body slowly releasing its anxious grip. The beads of sweat that were forming on my stomach glistened like diamonds in the sun. One by one, they slowly trickled down the creases created by my abdominal muscles and landed on the towel. As I tightened those muscles, my mind traveled back to my days as a lifeguard and I wondered if I still looked as good now as I did then.

Following the beach, it was time for a “shave ice” (NYC translation: sno cone) by the pool and a much needed nap in the shade. Dinner consisted of a turkey and lettuce on white bread from a local convenience store. Back at the pool, there was a show honoring David Kalakaua, the last King of Hawaii who ruled over 100 years ago. Finally, I saw the grass skirts, hula dancing and twirling fire that I had expected. I was politely corrected by a local when I referred to this event as a luau. “Luaus have food”, she said with a smile that spoke otherwise. I guess she did not consider alcohol food. For the record, a mai tai is very similar to a Long Island iced tea.

2/16/08

I didn’t sleep well last night. I couldn’t tell if it was the mai tais or the fact that sleeping next to my two young boys left me with only a sliver of bed space and less room for movement than a Manhattan studio. We took a submarine down to the sea bottom today and watched a variety of sea creatures frolic through the wrecks of airplanes and sunken fishing ships. Once back on the beach, I borrowed my son’s goggles and swam out about 100 yards to a coral reef and back. This counted as my exercise for the day and I rewarded myself with a nap on the sand.

With my eyes closed, I could hear the faint sound of music rising above the white noise produced by the rolling surf. The song sounded so familiar, but all I could make out was the sound of the bass guitar. I picked up a handful of sand and enjoyed the feeling of the granules shifting around my fingers. Like so many things in life, the harder you try to hold it, the more difficult it is to control. I finally identified the song as “Brown-Eyed Girl” and smiled triumphantly. Watching my kids and wife play by the waterline, I was reminded once again how precious time is and how readily it can slip away, just like the sand that had just streamed out of my now-empty fist.

My stomach reminded me that it was actually later than I thought it was. I ran my fingers through my dark blonde hair, but the salt water and sand had made it stiff and sticky. On the way back to the room to take a shower, I paused for about 10 minutes at the coi pond and watched the heron stalk his next meal, but he didn’t seem to be having any luck. For dinner, I feasted on prime rib and crabs legs under the tiki torch lamps that lined the walk along the beach.

2/17/08

I woke up early today. While in Hawaii, I signed up for one of those courses doctors take to keep themselves sharp. It’s called continuing medical education and if I don’t get enough of it, they take my little black bag away from me. With a cup of high octane coffee as my only friend, I sat in the conference hall at the crack of dawn listening to another ENT brag about all the miracles he performs. The slides at the front of the room began to blur and my mind kept drifting back to Waikiki Beach. As soon as the lecture was over, I threw on my bathing suit and headed out to meet my family.

Many of you may wonder if I carry a pager while on vacation. Well, the answer is yes. When I’m away, there are other doctors who cover day to day questions and problems, but I’m always available if the need arises. It’s a reciprocal deal and I cover for other doctors when they are away. One thing that I had to adjust to when I became a doctor was the fact that I was responsible for my patients. Just like a parent should never leave their children unattended, I must be there for my patients when they need me.

In the evening, we headed into the city of Waikiki and did some shopping before dinner. One interesting fact that I learned was that it is illegal to honk in Hawaii for any reason. They must have a lot of pent up frustration. The cool evening breeze felt good against my sunburned skin and as we walked along the beach, I saw the light of the moon reflecting in the eyes of my wife and kids. I can’t believe how far away from the Upper East Side I am.

Anyway, I’ll bring this post to an end for now, but there is still more to come. Tomorrow, we will be heading up the mouth of a volcano. Check back in one week to see if I make it to the top and find out how I find my way back home …

Med Students Who Cheat

2008-01-27T23:06:00.000-05:00

The sound of my heartbeat was in perfect synchronization with the crunch of my running shoes on the loose dirt beneath me. I was rounding the northern border of The Reservoir in Central Park as I took a long, deep breath to make sure both of my lungs were fully inflated. I was surprised at the extent to which Fall had robbed the trees of their bright, green foliage. To my left was a chain link fence, and beyond that was the calm, blue-green water that provided me with the peace I so desperately sought. That afternoon was my first Gross Anatomy exam and I was running off all the stress I had built up over the past two weeks of preparation for this landmark event.

I was running through all the branches of the external carotid artery in my mind when I noticed a man running towards me. He was an older man with sparse, white hair and an athletic body which indicated that he probably embarked on this form of exercise while I was still in diapers. But as he grew closer, I lost my breath when I noticed that he bore a striking resemblance to my cadaver, the body I had been dissecting over the past couple of months. How could this be? Have I finally cracked under the pressure? I quickly looked away and hurried back to my apartment to shower and change into my lucky T-shirt.

I arrived at the lecture hall in plenty of time. The written portion of the test was first, and I breezed through this in under an hour. I was much more worried about the next part, the practical portion where I had to answer questions while examining actual dissected bodies. My fellow Med Students and I began milling about outside the anatomy lab in nervous anticipation. Some were smiling and making jokes with each other. Others were sitting quietly or reviewing some notes, while others were just rocking back and forth while talking to themselves. Suddenly, the course director opened the doors of the lab. With an uncharacteristically serious look on his face, he brought his index finger up to his lips to quiet us down and said, “You may enter now.”

I entered the lab with the same reverence I felt whenever I walked into a funeral parlor. The cool, formalin-soaked air felt good on my perspiring skin as I glanced around at the twenty or so dead bodies that were scattered throughout the lab. I tried hard, but because many of the heads were shrouded I could not tell which one was mine. I would spend exactly 2 minutes at each station and would have to answer 3 questions during that time. After that, I could not go back. Because there were more students than bodies, the potential for looking over someone’s shoulder was tangible. At the front of the room stood a blackboard on wheels, on which was written in bold, yellow chalk, “MED STUDENTS WHO CHEAT MAKE DOCTORS WHO KILL!!”

I stood at the first station as the proctor said, “You may begin.” I peered deep into the body’s abdominal cavity and my heart surged when I realized that I did not know what the flagged pin was pointing to. I closed my eyes and took a deep breath which allowed all the memories from the class and images from the textbook diagrams to come rushing back into my head. I answered the first two questions, but was stuck on the third. Was that the ovarian artery or the ureter? Perched awkwardly on a cold, metal stool, I knew that time was running out. I though for a moment that the cadaver might have some personal insight which she could perhaps whisper to me, and I debated with myself whether this would actually constitute cheating. Focused and frozen with indecision, I was defenseless when the loud buzzer suddenly shattered the silence and sent a shock wave to every cell of my body. I jumped up in the air, and when I came down, the stool was no longer beneath me. Sitting on the cold, gray concrete floor, I retrieved my pencil from under the gurney, marked an answer and moved on.

I remained on my feet for the remainder of the exam. As I went along I became more comfortable with the frantic pace, and in the end it all paid off with a passing grade. The next day was Saturday, and I headed back to The Reservoir to overcome the headache that resulted from the party the night before celebrating the end of the Gross Anatomy exam. Sluggish and dehydrated, I stopped along the way to take a long drink from my water bottle. Suddenly, I looked up and my eyes widened as I saw my cadaver look-alike from the day before running towards me. When he passed, he looked me straight in the eye, gave me a knowing smile and nodded as if to say, “Good job.”

Dr. Hasty

2008-01-06T22:57:00.000-05:00

“Dr. Hasty, please come to 3 North,” I heard from the overhead speaker in my on-call room. During my General Surgery years, I spent some time at a community hospital in the suburbs. The relaxed atmosphere I experienced in this hospital could not have been farther from the frantic pace I was accustomed to in the City hospitals. Here, two or three nurses stood by the bedside when I saw a patient, each of them searching for a way to make my life easier. In the City, nurses covered many more patients and had little extra time to assist Attending doctors, no less cocky Residents. Here, I was treated like a King and I felt like I was witnessing Medicine for the first time as it should be.

Naturally, all the other Residents and I referred to this rotation as “The Country Club”. However, membership in this club came with a price. Because this was not a “teaching hospital”, none of the Attendings spent the night in the hospital. When I was on call, I was the only physician in the hospital besides the ER docs, so when something emergent happened on the floors, I was called. However, the tradition of the hospital was not scare people by announcing “CODE BLUE” or “SLAVE LABOR, GET YOUR ASS TO THE ICU” over the speakers. No, in this hospital, a calm, slightly nasal voice would gently summon an imaginary physician named Dr. Hasty to the place he was immediately needed. Sometimes the call meant someone had gone into cardiac arrest. Sometimes it was a severe allergic reaction. But on that night, it meant something altogether different.

I heard the announcement from a very light stage of sleep. The starched hospital sheets haphazardly tucked around a retired hospital mattress never felt quite like home. My beeper went off simultaneously with the announcement and, as I opened my eyes, I noticed that my portable alarm clock read 11:45 PM. I threw my heavy, white coat over my scrubs and headed out the door. On the way out I paused for a moment to contemplate brushing my teeth with the tan hospital toothbrush sitting next to a half-filled glass of water, but I quickly proceeded out the door.

Three North was a unit with many elderly patients. As I arrived, a young vivacious nurse behind the counter smiled as if she knew me and said, “Room 315 … She died about a half hour ago. She’s in bed A.” As I soon learned, one of my regular tasks being the only available physician on the floors was to pronounce patients dead who were … well, dead. Interestingly enough, nobody ever taught me how to pronounce someone dead in medical school. I mean, I knew that pupils being fixed and dilated, no heartbeat and no breathing were not indicative of a promising future, but I suddenly felt the weight of what I had to do. Was there some ceremonial chant I needed to say? What if I was WRONG!!

I developed a cold sweat as I entered room 315. It was dark and there was an eerie chill to the air. Shutting off the air conditioner, I proceeded over to bed A. But wait, which one was bed A? Was it the one closest to the door, or closest to the window? I could never remember that. No problem, the answer should be obvious. I glanced from bed to bed. Elderly women with flowing white hair were present in both beds, and both women were completely motionless. Pale, waxy skin covered both skeletonized faces. Their open mouths were both shaped in an “O” and were pointing straight to the ceiling. Under the covers, I could not tell whose chest was rising and falling.

My clammy hands could barely hold on to the rubber stethoscope as I headed to the bed by the window. I figured the heartbeat would be the easiest way to tell which one was currently standing at the Pearly Gates. But just as I was about to place the bell of the stethoscope over her bony ribcage, I hesitated. If she was alive, she might suddenly jump up in bed. The fright of such an incident might just kill her, not to mention what it would do to me. No, this was not the way to go.

My pupils must have been as wide as saucers as I tried to use every bit of available light in the room to help me decide what to do next. Then I reached in my pocket and pulled out a small mirror that I received from a pharmaceutical representative the week before. Carefully, I placed the mirror over the mouth of window lady. I brought the mirror close to my face and, with my penlight, saw that it was covered with fog! Bingo. But just to be sure, I went over to door lady and repeated the procedure. To my dismay, there was fog on the mirror once again. Replaying the past 5 minutes in my mind I realized that my deep breathing had fogged up the mirror each time. Back to the drawing board.

In the dim light of the room, I could tell that it was now 12:30 AM. All I could think about was the deceased women looking down on me saying, “I’m dead, you schmuck! Can’t you tell? What are you waiting for?” “I’m trying”, I whispered impatiently towards the ceiling. With a decisive motion I drove my hip into the bed by the door, causing it to shift over a good two inches and to send a wave of pain screaming down my right leg. I watched the lady in the bed carefully, but she did not stir. So I proceeded over to the window bed and made a similar move with my left hip. Now I had matching pains in both legs. All of a sudden, the lady in the window bed made a chewing motion with her mouth and shifted her shoulders about. This was all the information I needed. I threw the sheets over the lady in the door bed and Dr. Hasty was back in his own bed before long.

Weather Denial

2007-12-09T20:53:00.000-05:00

On my usual morning walk down York Avenue, as I headed towards my hospital, I spotted a tanker rolling gracefully down the East River. The sun was making its way over Roosevelt Island and the palate of purple and gold that was beginning to splash the 59th Street Bridge made me wish that I was standing on the Esplanade with a French beret on my head and a canvas in front of me. And with all this beauty and tranquility surrounding me, I could not help but think to myself, “I’m freezing my butt off!”

Trying to ignore the stinging sensation in my face, I headed into my favorite coffee shop. The man at the counter engaged me in some pleasant conversation, but feeling like I was still under dental anesthesia, my mouth produced a sound that even I couldn’t understand. I walked out of the store, leaving the man with a quizzical look on his face, as the coffee began thawing out my frozen lips. My agony was only augmented by the images of sandy beaches flashing through my mind as I longed to smell the coconut-scented sunscreen basting my warm, tan skin.

Does any of this sound familiar to you? Are you still lining up outside the pool at John Jay Park in your bathing suit hoping they’ll fill it once more just for you? Is that favorite jean jacket of yours not cutting the mustard anymore? Yes, summer has turned to winter in a matter of two weeks and what you’re suffering from is a bad case of weather denial. I know that they say suffering is good for the soul, but icicles hanging from your freshly-washed hair are just not cool. Your mother knows what you’re wearing; that’s why she keeps asking you about it. “Are you dressing warmly? Do you have a scarf?” You try and reassure her as convincingly as possible as your open windbreaker flaps like a sail in a regatta, but the truth is that the only scarf in your life is what you just did to breakfast.

So for all of you out there who think gloves are for wimps, I put together a few helpful bits of information about hypothermia, which can be a life-threatening problem. Hypothermia occurs when your core body temperature drops below the normal 98.6°F. If it goes down past 95°F, the condition moves from mild hypothermia to moderate hypothermia. If it gets down to 90°F, then we’re looking at severe hypothermia. Below that, well let’s face it, you’re a popsicle! So how does this happen? Well, the body is constantly using energy to generate heat to make up for the heat that is lost. Heat is lost through direct contact with colder objects, through cold air passing over the skin, through evaporation of sweat on the skin and by the exhalation of warm, humid air from the lungs (also known as respiration).

Probably the most important thing you can do to prevent this problem is to dress with enough layers to keep you warm and try to cover all exposed skin surfaces. Wearing a hat may ruin your perfect hair day, but on a frigid day up to 70% of your heat can be lost through your head. Keeping the clothing dry is important and synthetic fibers will not retain sweat and moisture for as long as cotton will. If your clothes get very wet, change them! Just like in the summertime, hydration with 6-8 glasses of water is very important, particularly if you are exercising. Eating ice and snow may actually worsen hypothermia.

Try to stay out of high wind conditions, which will speed the loss of heat from your body. The same holds true of sitting on cold rocks or metal. One of the worst situations I can remember is when I was sitting on the metal bleachers for two hours at a football game on a windy day in the dead of winter. Brrrrrr! The one thing that saved me was frequent trips to the snack bar. Food is important to give your body the proper fuel it needs to generate heat. Alcohol impairs that ability as well as your ability to realize that something is wrong. Save the Bailey’s for sitting around a crackling fireplace.

Your body will tell you if you are doing a good job. Shivering is the body’s last ditch effort to generate heat for itself. Oh, and the last point. If you take a sip of your coffee and find that it has turned into a block of ice, get your frozen butt inside!

Have Mercy

2007-11-11T22:40:00.000-05:00

Morris was a boy who was hard to control, and everybody knew it. Even though he was only 12 years old, his reputation was well-known in the community. Parents, teachers and kids alike all knew that Morris had problems following directions and did not respect authority the way he should. Wherever he went, trouble was not too far behind. It was not that he was lacking in the intelligence department; nothing was farther from the truth. He could grasp concepts and memorize facts with ease. This is possibly the only reason that teachers did not request his immediate transfer from their classes. On the outside, he looked like every other kid in school. It was something on the inside, something that no one else could see, that made him very different.

Morris’ parents moved here from Australia back in the 70’s, when his father’s job relocated. They came with their two young children, who are now grown and out of the house. One is working as a nurse and the other is in the hospitality industry. Morris came into the picture many years later as a “happy accident”, and some have speculated that the subtle resentment his parents developed upon his arrival was the reason for his behavioral peculiarity. Others stated that he ate too much sugar. Some believed that he was just born that way.

While Morris was indeed special, he was not unique. There were a handful of kids in the school who demonstrated personalities similar to Morris, both boys and girls, and they had a magical kinship with each other. Just like twins, they shared a special and unspoken bond which drew them towards each other. Morris seemed to be the leader of this clan, and all the others followed his lead. And when they all got together behind the same cause, it struck fear into the hearts of every teacher and administrator. This group was not exclusive, though. They all had many other friends and were generally all well-liked. They were not bullies. In fact, the multitude of kids in the school kept these highly spirited kids in line, convincing them to follow the rules and even ganging up on them when their antics were threatening to get everyone in trouble.

Morris never liked to follow the crowd and, therefore, he never ate the school lunch. He and his soul mates would ceremoniously toss their brown bags in the trash at the beginning of the day. As they mocked the school lunch and the ladies with hair nets who made it, they found their nourishment in the bank of vending machines lined up outside the lunchroom. One day, as Morris and his group were triumphantly dining on cheesy corn chips and iridescent-colored soda, they noticed that some of the other kids were running out of the lunchroom towards the nurse’s office. To their amazement, they saw almost the entire student body evacuating the lunchroom, most with nauseous expressions on their green faces. The lucky ones actually made it to the bathroom.

The days and weeks that followed tested the strength of both the school and the community. Ultimately, the illness was traced back to a tainted batch of lima beans. Most of the kids who became ill were out of school for a few weeks while their stomachs recovered. But the most amazing thing was happening in their absence. Without the other kids to keep them under control, Morris and the rest of the no-lima-bean crowd became more powerful than ever. Teachers were lecturing to handfuls of students and activities like Student Government and Drama Club were in dire need of participants. Morris and his gang easily filled the void and in no time, they ruled the school. They made their own rules and would not listen to any of the teachers or administrators. They even wanted to rename the school “something cooler”. In the midst of all this chaos, the police had to be called to reestablish order. Morris and his gang were removed from the school and their fate was placed in the hands of the Board of Education.

Once the sick children came back to school, things slowly returned to normal. On his first day back, Tommy, a straight-A student, who had always followed everything his teachers said, was sitting at his desk. “OK, class”, the teacher began. “Today we are going to begin our study of Ancient Greece.” Tommy whispered to his friend at the next desk, loudly enough for everyone to hear, “Who cares about a bunch of crusty, old statues!” As his bewildered friend tried to quiet him down, the teacher said, “Tommy, do you have something to share with the class?” Tommy made a farting noise with his mouth, pushed his desk aside and stormed out of the class. As he arrived at the lunchroom, he put a dollar into the vending machine and smiled.
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The story above demonstrates the role of Methicillin-resistant Staph aureus (MRSA) in our bodies. The school represents the human body. The kids represent all the bacteria in the body. Staph aureus is plentiful on our skin, in our mouths and in our noses, and is actually helpful in keeping our bodies in balance. The teachers represent the immune system, which helps defend our bodies and keeps bacteria under careful control. Some of these bacteria, unfortunately, are resistant to certain antibiotics (Morris and friends). This happens naturally over time, but is sped up by the indiscriminate use of antibiotics. The non-resistant bacteria help keep more aggressive bugs from gaining control, but antibiotics (represented by the lima beans in the story) only kill off the protective bacteria, leaving the resistant bacteria to overpopulate the body. When subsequent infections occur (Morris and friends in the Student Body and Drama Club), the body’s natural defenses fail and more aggressive antibiotics (police) must be brought into play.

A large number of people have MRSA on their bodies and will never know it’s there. Anyone who has spent time in a hospital (healthcare workers included), has these bugs somewhere on the body, but it is now prevalent in the general population as well. Proper hygiene is as important as ever, but the overuse of antibiotics and anti-bacterial products on the skin is detrimental to the individual and to society. Medical science is working feverishly to develop new antibiotics which can fool the “educated” bugs we are growing on our bodies, but whether or not the race will be won by us or our microscopic friends has yet to be determined. We must remember that bacteria have been on the planet for millions of years before human beings arrived, and they will likely be here for millions of years more after we have departed.

Sweet Papa

2007-10-21T21:11:00.000-05:00

It was a cold, rainy Friday afternoon in November as I headed over to the West side in a cab. I was trying to drink my Snapple, but every pothole sent more Mango Madness shooting up my nostrils towards my brain. You would think that after my experiences on the ambulance, I would have given up trying to feed myself in moving vehicles, but I was late for my first session in the Nursing Home. I volunteered to devote one afternoon each month to seeing “clients” in the facility who could not obtain the services of an ENT doctor elsewhere. I was excited about the new adventure and nervous at the same time, but both emotions soon became overpowered by the sensation of nausea as my cab weaved between a few pedestrians and came to a sudden halt in front of the Nursing Home.

As I entered the lobby, I was surprised by the well-appointed room I was in. There were hardwood floors, a piano and the type of furniture you were almost afraid to sit in for fear of depreciating someone’s investment. This was not a big issue because I soon learned that everyone here took there seats with them. The only other person in the room who was not sitting down was a thin, elderly man with a cane who scuttled past me towards the front door, which was still partially open. He had a determined look in his eyes, further accentuated by the thickness of his eyeglasses. “There he goes, get him!” said the Front Desk Official as two burly attendants went barreling after him. To me, it seemed like an unfair fight. They should have at least given him a one block head start or used potato sacks to hop after him. I shrugged and freshened up the smile on my face as I approached the front desk and explained why I was there.

I followed the instructions towards the elevator and was met by a sea of wheelchairs, all waiting for a car that was stuck on the fifth floor. Apparently, lunch had just let out and everyone was anxious to get back to … well, somewhere else. The overcoming smell of mashed potatoes and talcum powder stung my eyes and burned my nose, even worse than the Mango Madness. I imagined the horror scene that would develop as soon as the elevator doors opened, as it appeared that many wheelchairs bore the scars of previous battles. I felt like a giant among them, and suddenly I realized that I possessed a distinct advantage over them.

I found the stairwell down to the basement and quickly located my small clinic room. My nurse was a hearty, Eastern European woman named Lila who promptly showed me the ropes. My first patient was Mr. C, a former accountant and current octogenarian who was coming in for impacted earwax. The overwhelming majority of patients came to me for either this complaint or to obtain a hearing aid. His wheelchair was oversized and when it finally squeezed into my modest space, it left little room for any maneuvering. “What can I do for you?” I said in my cheeriest tone. He looked at me with a vacant stare and his lips quivered as if he was trying to explain something to me. I flipped through his chart and saw the standard picture they took of all clients. Sitting in front of me, dressed in his plaid shirt and tan pants, he looked like he could almost get up and walk out of here, but the picture of him, gowned and in bed, spoke of disorientation, depression and the longing for a life he used to be comfortable with.

In between patients I was trying to make a call to my office. I was on hold with the Nursing Home operator and was listening to a recording advertising all the luxurious benefits of the facility when suddenly I saw a large cockroach scamper across the floor in a zigzag pattern. Instinctively, I tossed a chart on top of it, and since each chart weighted at least 20 pounds, it didn’t leave much evidence to clean up. While on the floor, I saw a pair of fur-lined bootie slippers with thin, black, scaly legs come shuffling into the room and sit down. Quickly sitting upright, I was greeting by Sadie, a thin, elderly black woman with long, gray braids down each side of her head and a sly smile. As I attempted to examine her ears, her demeanor shifted and she became agitated, “You ain’t touching me, sweet papa!” I paused, a bit confused, and looked up. “Did you just call me sweet papa?” I said indignantly. “Nobody has ever called me that.” “Oh, don’t be that way, sweet papa”, she replied, and suddenly I wanted to know who her ‘sweet papa’ was. Father? Husband? Lover? Son? Maybe he died long before I was even born.

I never did get to examine Sadie’s ears, but time was up and Lila whisked her out of the room. The afternoon went along very smoothly, but was very circus-like in atmosphere. The patients wheeled in, I tried to examine them while skillfully dodging their slow right hooks, and then Lila wheeled them back out, sometimes while they were still yelling at me to cut their toenails or call their son. While looking at the chart of one woman, I realized that it was her birthday. “Happy birthday”, I said almost in a signing tone and she quietly thanked me. “Are you going to do anything special for your day?” I asked. “No just the same old thing”, she replied. There were no balloons around her wheelchair or cards taped to the side. Was I the only person who acknowledged the occasion?

Four hours after I arrived, I walked out of the Nursing Home and caught a cross town bus, not sure whether I felt good or bad. As my umbrella dripped onto the floor of my seat, I stared at all the people on the street that didn’t seem to care that they were getting wet. When we see patients in a Nursing Home, or even the hospital, it is easy to forget that these people all have lives and have gone through amazing journeys. They lived, loved, laughed, learned, hoped, dreamed and lost. They all had a childhood and their eyes witnessed 70 or 80 years of the best and worst that the world had to offer them. All of that collective knowledge is still inside each of them, although now clouded by cataracts and dementia. Spending time with medically incarcerated people creates mixed feelings. On the one hand, there is fear that we will become like them at some time in our own lives. On the other hand, it gives us a good feeling that we took their minds off the fact that, like the crowd at the elevator, they would all rather be somewhere else. I suppose that it all comes down to balancing these two sides in our lives, and who couldn’t use a little more balance?

On the Fence

2007-09-30T21:17:00.000-05:00

During the last two years of Medical School, free time was a commodity which was in very short supply. This meant that mundane activities were often juxtaposed with life-altering events. After a while, moving back and forth between seemingly unrelated activities became second nature and the transitions became seamless. Only years later would I look back with disbelief at this phenomenon, but at the time I hardly thought twice. During the same hour, I might find myself both studying the chemical composition of proteins and draining an abscess. One moment I might be eating a tuna fish sandwich, while 15 minutes later, I might be in the Operating Room removing someone’s appendix.

Such was the case one night during my last year of Medical School. I was working the night shift in the ER at a hospital in one of the outer boroughs. The air was cold and the wind was biting as I waited for the bus that took me there. I stood there, leaning up against the fence, keenly aware of the pain at the top of my ears and the tip of my nose. Since I was now an “insider” in the medical community, I must have figured that injuries and diseases no longer applied to me, and frostbite was apparently on that list.

Finally arriving at the hospital at 7 PM, I stopped at the deli in the lobby to get a sandwich. My shift lasted until 7 AM and I would eat the equivalent of “lunch” at around 1 AM. I usually went for honey turkey with Swiss cheese on a roll, but that night I just couldn’t seem to make up my mind. The maple ham looked good, but the mountain of tuna with a sliced red pepper at the peak seemed to call my name that night. I went with tuna and tomato on a Kaiser roll with soda and spicy plantain chips. Cradling my food under my arm just like a football, I hustled down the hall towards the ER.

No sooner did I hide my brown paper bag and stash my jacket, when my Chief Resident popped her head in and said, “Trauma in Room A. Move it!” I stumbled towards the trauma room with nervous excitement as I tried to straighten by ID. What I saw as I entered the room will forever be etched in my memory. A frail, elderly woman had apparently tripped as she went down the front stairs outside her apartment earlier that evening and became impaled on the gate below. She was awake, but calm and motionless as she stared at the ceiling. Lying on her back, she was clutching the 2 feet by 2 feet portion of gate with both hands like a prisoner longing for freedom. The Fire Department had welded off this segment, and one of the dagger-shaped decorative elements at the top was still deeply embedded in the side of her neck.

My job was to hold the gate motionless as the trauma team worked furiously. If it had entered a major blood vessel, then the slightest movement could lead to life-threatening blood loss. I was on top of the gurney, straddling her and trying to reassure her as best as I could with my facial expressions as the cacophony of noise in the trauma room roared on. I commanded my muscles to remain motionless, but after about 15 minutes they began to twitch and shake as I searched for ways to support my arms.

In another 15 minutes, the sweat began to pour down my flushed face. The IV was in and a few brave residents began exploring the wound. They finally concluded that she would have to go up to the operating room to have the gate safely removed. I was left alone with the woman for the moment as the residents and nurses went off to make phone calls and other preparations. I turned around to check the clock on the wall behind me, but when I turned back around I was in for the shock of a lifetime. I was only holding the gate … with nobody attached!

The only factor tempering the terror that gripped me was the relief my muscles felt as my entire body went numb. The patient and I both stared at each other like twin deer caught in headlights. The hole remained in her neck, but a quick check of my jacket reassured me that it was still dirty white and not crimson. A sudden rush of adrenaline allowed me to hoist the gate above my head and scream, “It’s out!”

After another painstaking moment of silence, the residents put down their phones, the nurses stopped documenting and the entire team descending on us. The remaining Fire Department EMS workers removed the gate from the area, but since my hands were still fused to it, I went along for the ride. I wound up in a corner of the room where I could no longer see my patient in the sea of white jackets and scrubs. They tell me the patient did fine.

Later that night, I bundled up and headed up to the building’s roof to eat my sandwich in peace. Sitting up against the fence, I marveled at how the gate could have missed every major artery in the neck. She escaped with a small operation and stitches. I wondered how I would have reacted if it had happened to me and suddenly I didn’t feel so immune to injury anymore. Then, just as quickly, I dismissed that thought and began thinking about my plans for the weekend.

The Bear Facts

2007-09-03T20:13:00.000-05:00

Nora and Bobby have been married for 6 months, no kids yet. She works out of the home and her husband is a police officer. Bobby drives about an hour each day to and from his job in the city, and recently he switched from days to nights.

It’s ten o’clock in the morning. Bobby came home a little over an hour ago, had breakfast and went to bed. Nora is working downstairs on the computer when she hears a strange sound coming from her bedroom. It sounds a bit like a Harley-Davidson while it is idling, but she doesn’t recall purchasing one and placing it in her bedroom. Alarmed, she slowly climbs the stairs to the second floor of their house. She pauses for a moment before dismissing the fear that a bear from the surrounding woods snuck into the house and is roaming about on the second floor of their center hall colonial.

Nora quickly moves down the hallway and storms into her bedroom using the technique her husband had taught her once while they were dating. All her suspicions are confirmed when she finds Bobby sprawled out on the bed. He is lying on his back with his mouth open, making the most awful sounds she has ever heard. She recalls him snoring from time to time after drinking a few too many beers, but this cacophony takes sawing wood to a new level. She inches closer to the bed and tries to push him over to his side, but suddenly he makes a snorting sound and all airflow ceases. She jumps back and stares at his chest. This pause lasts less than 10 seconds, but to Nora it seems like several minutes. “Oh my God, he’s dead!” she thinks, but just at that moment, he snorts again and the snoring resumes, just as if someone has pulled a cork from a bottle.

This breathing pattern continues over the next few weeks and Nora makes an appointment for her and Bobby to see Dr. Brown, an Ear, Nose and Throat specialist. “Bobby, I’m glad you brought Nora with you to the visit today, because she can provide valuable information that you’ve been sleeping through! Snoring is a very common problem and is the most common symptom of a more serious condition known as sleep apnea. When your body is sleeping, all of your muscles are relaxed, including the muscles around your throat. If those muscles are too relaxed or extra tissue is in the way, then the walls of your throat will vibrate and cause the sound of snoring.”

The doctor continues, “Apnea is caused by the airway being completely obstructed. The body will fix this problem by waking you up enough to take a breath, but this may occur hundreds of times per night. It’s a bit like sleep deprivation and it has been estimated that up to 18 million adult Americans suffer from sleep apnea. Approximately 2-4 % of kids suffer from this problem as well. And because you are not fully waking up, you won’t remember anything. Bobby, you mentioned to me that you have been feeling drowsy when driving to work or when you take breaks, and this is a common feature. Your sleep schedule has also changed, and the combination of not being able to exercise and eating fast food has caused you to gain about 20 pounds over the past year, making the problem worse. Many people don’t realize that the increased work the body has to do while it is breathing against an obstruction can place a great deal of strain on the heart and lungs, leading to high blood pressure and irregular beats of the heart. Not to mention the strain this problem places on the person’s partner!”

“Bobby, I’m going to do a complete physical examination today to try and determine where this obstruction is coming from. I will use an endoscope, a small, flexible camera, but it only takes a minute and is not painful. Then, I’m going to send you to see a Pulmonologist, a lung specialist, who sub-specializes in sleep medicine. He will perform a sleep study, where you will spend a night or part of a night in a sleep lab. In the sleep lab, which looks like a hotel room with wires, technicians will measure your breathing pattern, heart rate, oxygen level, muscle movements and brain waves as you sleep and dream. They will be able to determine whether or not you have sleep apnea and differentiate between mild apnea and a more severe case.”

“In the meantime, try and devote enough time to sleep. Regulate your sleep schedule by going to bed and waking up at the same time each day. Avoid taking anything sedating like sleeping pills or alcoholic drinks within about 3 hours of bedtime. It is easier to solve this problem if you don’t smoke. Weight loss is always beneficial, but I know you can’t do this quickly. Start by trying to eat right and devoting a little time to regular exercise. Sleeping on your side is usually better than being on your back. Sewing a tennis ball into the back of the shirt you sleep in is a simple trick that can sometimes help a great deal. The sleep specialist will discuss some of the non-invasive ways of treating the problem, but there are also procedures that I can do both in the office and in the operating room which can help treat the problem. Any questions so far …?”

A few months later, Bobby is back on the day shift and is cruising around the city streets in his patrol car. He has followed all of Dr. Brown’s recommendations and is feeling better, mostly because Nora is feeling better. He underwent the sleep study, which discovered a mild sleep apnea. He is stopping for a salad a few times a week instead of grabbing a bacon cheeseburger, and he makes it to the gym twice a week. His snoring continued to the point where Nora kicked him out of the bed and he was sleeping on the couch. Dr. Brown then performed a simple procedure under local anesthesia in his office which helped prevent the roof of Bobby’s mouth from blocking his airway, and soon he was back in the bed. Unfortunately, one night when Bobby rolled over on his back, the tennis ball that Nora had sewn into his T-shirt became dislodged, shooting out to the side and striking Nora in the eye. Now he is back on the couch.

Just a Little Off the Top

2007-08-11T00:06:00.000-05:00

“Bubble gum or a shave?” This is what Fred the barber would ask me every time I walked into his shop with my father. I was only six at the time, and I didn’t chew bubble gum yet, but I sure as heck knew that I didn’t want anything shaved off of me, so I always chose the gum. Fred was a stocky man who wore thick-rimmed eyeglasses. He spoke English in a heavy Italian accent and hummed songs from the Old Country as I sat on his heavy, leather booster chair, reading my Bazooka Joe comic. His strong hand would gently guide my head into different positions, but out of the corner of my eyes I could see the reflections of the other customers in the mirror. Fred always wore a light blue smock with large pockets that were filled with silver scissors and black combs, just like the ones standing up in the glass jar with blue liquid on the counter. At the time, my hair was so blonde that it was practically white, and as the scissors snipped and crunched through my bangs, it seemed like a Christmas snow was falling all around me.

Outside of Fred’s shop, I would stand mesmerized by his swirling red and white barber pole. Only later on during my surgical training did I understand the significance of the barber pole. A long time ago, medical doctors were reluctant to perform invasive procedures on their patients. If something needed to be removed, they called upon the person with the sharpest instruments, the barber. This is why, in Europe, surgeons are referred to as “Sir” instead of “Doctor”. A common practice for a barber was to perform bloodletting to release the evil humors in the body thought to cause illness. He would have a patient hold a stick as he cut open a large vein in the patient’s arm. The blood then trickled down the arm, spiraled down the stick and was collected in a pan on the floor. The appearance of the stick as it was placed outside the barber’s shop to dry gave rise to the barber pole we know today with its red stripe perpetually swirling around.

Throughout my life, I have always had a special relationship with both my hair and the people who have cut it. When I first experimented with a “hairdresser” to try a different style, I felt pangs of guilt when I came back to Fred. I was almost to the point where I was going to choose a shave instead of the gum, but I felt as though I had cheated on him. He smiled as he always did, but I wondered if he was somehow thinking, “These are not my cut lines. Someone else has been here!” As the years have gone by, there have been many people who assumed Fred’s role, but when I look up in the mirror, I always see his face and hear his humming.

It is strange how hair is so important to me, considering that I cannot even see it without the benefit of reflection. The configuration of my hair always seems to fit my mood and outlook for the day. Sometimes it is slick. Sometimes it gets twisted. Other times it stands straight up in defiance and then there are times when it just sits there as if it saying, “Well, what do you think we should do now?” But through it all, my hair and I have always been friends and so I have worked hard to hang onto it. I know all the information about good genes and nutrition, but I feel that it is important to demonstrate to your hair that you still need it. I rarely wear a hat and only wear a helmet when my life is in immediate jeopardy. I haven’t used a blow drier in 20 years and I keep sprays and gels to a minimum. Hair is human in many ways, so I have made a point of giving it the freedom it deserves.

If you have hair, give it a loving rub today and thank it for being there through the thick and thin. If you have lost your hair, take a moment of silence and pay tribute to a fallen hero. And most of all, thank your barber or stylist for keeping the two of you together. If you need someone good, stop by Hair’s Castle on 78th and York and let Pamela work her magic for you. She cuts a mean head of hair. Now if she only had bubble gum …

Sex-Ed

2007-07-29T21:24:00.000-05:00

So when did you first get, you know, the conversation? It’s one of those special occasions in our lives, but for some reason, nobody reaches for the video camera or sends a Hallmark card. Few people can even give the topic a precise name, so it is simply referred to as “the birds and the bees”. Most people know exactly when they got it and who gave it to them, but when exactly is the best time? This question has taken front and center over the past couple of weeks among the Presidential candidates. Is it right for schools to start introducing the topic of human sexuality in kindergarten, long before many parents have mustered up the courage to approach the topic? And how exactly should it be introduced?

As usual, to help me work through these tough questions, I looked back into my own childhood memories. Before my official “birds and bees” conversation with my father, my sister sat me down and asked me to guess how babies were made. I’m estimating that this was about the third or fourth grade for me. After about an hour of incorrect guesses, and drenched in perspiration, I finally got it right. A few years after that, my father gave me the “official” talk. He was an amazingly clear thinker and an eloquent speaker, but on that day he seemed somehow to be at a loss for words. This frightened me and I cringed as he wound up and began to speak. It was an anticlimactic finish as he quickly posed a question to me which was not really a question after all. “So Bill, you know how to use a condom, right?” Delicately, I replied, “Sure”, knowing in the back of my mind that he was probably not referring to filling it up with water and tossing it over the neighbor’s fence.

In junior high school, the topic of human sexuality was mentioned briefly in something called “health class”, buried in between detailed discussions about single-celled organisms and vegetables. However, extra help was on the way from the playground to the bathrooms, where the topic was so badly misrepresented that it occupied a position somewhere in between myth and voodoo. Everybody had a story about an older brother or sister who did this and said that. I couldn’t tell what was true, so during the lunch period I would sneak into the library and pull some books off the shelf dealing with the subject. Even before all the text made sense to me, the pictures spoke volumes. How messed up was that? Human sexuality became a self-instruction tutorial for me!

There are many places where human sexuality is taught at the kindergarten level. In the South of China, children are introduced to the topic at the tender age of 5 for the purpose of lowering rates of HIV/AIDS and teenage pregnancy. A law was recently signed in California which authorizes schools to provide sexual health education to all children, even those in kindergarten, without permission from their parents. However, it is possible for parents to submit a general opt-out letter at the beginning of the school year in programs that have Federal funding.

Democratic candidate Barack Obama and Republican candidate Mitt Romney represent opposite ends of the spectrum, but the debate underscores the importance of active parental involvement in education. Parents need to work with teachers to develop a curriculum that will both protect and nurture students in the classroom. The age-appropriateness of the content may differ depending on the child’s level of maturity and family cultural values and everyone must be sensitive to this. And most important of all, parents should not rely entirely on the school system to educate their children, particularly about human sexuality. Children should be engaged early on about the subject and reassured that it is OK to talk about things that they do not understand. When a good example is set, children will certainly follow.

Surf's Up!

2007-07-08T21:13:00.000-05:00

From up in my chair at the diving section, I saw a middle-aged man approaching the one meter board. I recognized him immediately as the head of the family which we all knew as “the human paperweights.” None of them possessed the buoyancy to stay above the surface for more than 10 seconds, but their deep devotion to summer recreation kept them coming back for more. Many of the guards had plucked various members of the family out of the water and we all pleaded unsuccessfully with them to enroll in swimming lessons.

The man smiled and waved at me as if to say, “I hope you had your Wheaties today”, but behind my dark sunglasses I maintained a cold, steely expression. The Acme Thunderer whistle at the end of my lanyard did not even stop twirling. With the smile still on his face, he bounced awkwardly towards the end of the board and did a full revolution in the air with his index finger on the top of his head before splashing face first into 12 feet of water.

Suddenly, my whistle stopped spinning and I held my breath for the next few seconds. The water above where he entered went calm and I removed my sunglasses. Then a hand appeared from the depths, followed by his head and torso. I breathed a sigh of relief as he smiled and gave me a thumbs-up sign, but just as quickly, the smile and thumb both disappeared under the water again. I blew one long whistle and dove into the water. I reached him quickly, tucked him under my arm and dragged him to the side. Slightly winded, but still smiling, he thanked me and ran off to rejoin the other boulders.

During the summers of my College and Medical School years, I worked at a local pool. In addition to life guarding, I coached the youth swim team and taught lessons to swimmers of all ages and skill levels. I truly love the water and was constantly amazed that I could earn money doing what I was doing. In the process, I also gained a tremendous respect for the water and the dangers that can ruin even the sunniest of days.

As a lifeguard, I constantly had to deal with the question, “So how many people did you save?” And whenever I answered, “Not many”, I had to handle the embarrassing follow-up, “So then I guess you let a lot of people die!” But the truth is that my job was more preventative than people realized. I stopped swimmers from doing dangerous things before they got into trouble. The story I told above is a notable exception which illustrates the three most important points of water safety:

1. Always swim in areas that are supervised by lifeguards. Follow the rules that they post. They will alert you if you are going into an area that is dangerous or diving in a section that is not suitable for diving. They are also looking out for approaching storms and will clear the water when thunder or lightening is in the area.

2. Know your limitations and don’t try anything that seems risky or that you have had problems with in the past. Avoid mixing alcohol and swimming because this can impair your judgment, skills and your body’s ability to regulate its temperature.

3. Learn how to swim! This is the most important thing you can do for water safety. Courses are available for all ages and skill levels from The Red Cross, schools, health clubs and swim clubs. I know how expensive that can be, particularly in the City, but it will be the best investment you ever make. Also, you should never go swimming alone!

Parents, if you use artificial flotation devices or garments for your children, make sure they are closely supervised. This is particularly important if you inflated those devices with air, because they may give you a false sense of security. I have seen many children get into trouble as their “swimmy” began to deflate on them. Parents, you should also learn CPR and encourage all others who care for your children to enroll in a course as well. You will be surprised how simple and easy it is. Also, if you have a pool at home, make sure it is securely fenced in.

The water can be a wonderful opportunity for exercise, fun and relaxation. I encourage you all to keep these safety tips in mind and have a wonderful time this summer!

Hold On!

2007-06-24T20:25:00.000-05:00

The excitement was passing through my body like electricity. It was the first day of my second year Medical Student elective where I would be riding in an ambulance. Oh, the glory of it all! Maybe I would get to work the siren and say things like, “10-4” and “I’m on it”. Maybe I would finally get a chance to treat living patients who weren’t in a position to refuse my help. The possibilities seemed limitless, and so I did my best to prepare for the experience. I wore comfortable clothing and brought my cheap-o stethoscope instead of the nice one which I refused to use for fear of getting it scuffed. I made a heaping tuna fish sandwich on white bread to bring with me because I didn’t know where my next meal was going to come from.

I arrived at 6 o’clock PM at the hospital to meet my ambulance crew in the parking lot. Jose and Frank were jovial, rather portly middle-aged men who happily showed me around the rig. Everything in the back was carefully arranged and neatly stacked. “OK, this is where you’re going to sit”, they informed me, and I was pretty disappointed when I learned that I wasn’t going to ride up front. I was about to take the first bite of my sandwich when the small window connecting the cab to the back cabin slid open. “Ready?” they asked, but before I had a chance to answer, the rig roared to life and lurched forwards. I hastily wrapped my sandwich up again and stashed it on the shelf, just as a couple of boxes of gauze pads slid off and hit me on the head.

I was in the middle of trying to guess what exciting situation we were called to when the rig screeched to a halt. I jumped out of the back, grabbed the defibrillator and stormed into the building, only to find that it was a Little Caesar’s pizza place. “What the hell are you doing?” asked Frank as Jose chimed in with a “Holy shit!” As I was re-packing and straightening up the rig, the guys came bouncing out of the pizza place with their arms full of calzones and cheesy parmesan sticks. They passed me my share, which was more than I would usually eat in an entire day, but I ate it all, feeling like I had just betrayed my tuna fish sandwich.

Suddenly, the window slid open again and the simple warning came from the front, “Hold on!” I barely got a chance to wipe the last traces of dipping sauce from my lips when the siren flipped on and red lights circled about the cabin. The rig accelerated, sending me and a significant portion of the supplies downward towards the rear door. Crawling along the floor, I began to grapple my way back towards the front as IV bags and rolls of ace bandages continued to pelt me on the forehead. I tried to grab my tuna fish sandwich as it rolled around the floor, but a sudden right turn sent it flying to the other side of the rig. By the time we stopped, the cabin looked like a tornado had just passed through it. I looked around and finally noticed the grab bar which I was supposed to hold on to!

I knew that I was in trouble when I exited the rig and noticed that the trees had graffiti spray-painted on them. “So this is the Bronx”, I thought. The call was for a lady having chest pain, so we walked up the stairs to her apartment. She lived on the 11th floor and unfortunately for everyone involved, her elevator was not working. This might be considered good exercise except for the fact that she weighed approximately 300 pounds. We medicated her, strapped her to the chair and began the tedious climb down 11 flights of stairs with her unending protests passing through my ears like dental floss and echoing into the steamy stairwell. At last I thought I understood why those guys needed to eat so much food.

Once we dropped our patient off at the hospital and stole a new set of white sheets for the gurney, it was on to the next stop. You guessed it, Kentucky Fried Chicken. Two buckets of crispy chicken strips later, we got the next call and Frank put the petal down to the floor once again. I thought I would be smart this time and grab onto the bar, but as the ambulance soared mercilessly over a steep hill on the street, my feet and the medical supplies all became a bit airborne. From my suspended horizontal position, I saw my distorted tuna fish sandwich floating past me as if we were both on a mission in outer space. After returning to full gravity, and feeling like my chicken strips were somewhere in the region of my brain, I opened the back doors of the ambulance, unaware of the danger that was waiting.

We charged into the lobby of a building where a young man had just been shot, execution style, in the head. Normally, the police were the first ones on the scene to secure it for emergency crews, but for some reason we were the only ones there! We all looked at each other, not believing the situation we had just gotten ourselves into. If we went to examine the man, we might be shot ourselves if the assailant was still present, but if we ran out of the lobby, the man would surely die and we still might be killed. I couldn’t believe that my last meal was going to be KFC. After a tense few seconds, Jose and Frank approached the victim, while I was assigned the slightly less glamorous role of lookout. The police arrived within the next few minutes, but unfortunately the man was already dead.

The rest of that 12-hour shift is just a blur to me now. All I remember is a deli, McDonalds and a Dunkin Donuts shop. I was emotionally drained, but at least 10 pounds heavier. Back at the hospital, I opened the back door of the rig with a creak as I saw the first pink hue of sun rising over the East River. I looked down at my feet and saw my tuna fish sandwich which, like me, was almost unrecognizable from its original state. I noticed that the mayonnaise had soaked through the wrapper as I tossed it into the garbage can in the parking lot. “See you next week, Bill”, my new friends said with wide grins. I thought to myself, “I can’t wait.”

It's a Boy!

2007-06-10T21:28:00.000-05:00

My first clinical rotation in the third year of Medical School was Obstetrics and Gynecology. This was a big deal. From this point on, I would feel more like a doctor than a student. And as I strolled onto the wards that first day, I was truly a sight to behold! The only thing whiter than my crisp lab coat was my brand new pair of Reebok sneakers. A good pair of sneakers turned out to be quite an asset considering that the bulk of my job consisted of running samples of blood and urine from the floor to the Lab and transporting patients down to Radiology. The pockets of my lab coat were stuffed to capacity with every medical gadget I could find (and most of which I had no clue how to use).

The goofy smile on my Medical Student ID fell in stark contrast to the look of nauseated nervousness that controlled my face the first few weeks of my rotation. Nevertheless, I was a good soldier and tried to scoop up every pearl of wisdom that rolled my way. My coat and I hustled down the hall whenever the Chief Resident beckoned, sometimes leaving a debris field of tongue depressors and my highlighted copy of “Medicine for Dummies” in our wake.

The Holy Grail for this particular rotation was delivering a baby. My quest began by watching a few dozen deliveries. I would stand in the room, pretending to have some critical role in the process. Sometimes, I would pretend to be making some imaginary note on the chart, but most of the time I was just trying not to look so amazed. Eventually I graduated to assisting the doctor and delivering the placenta after the baby was born. I was grateful for being given this important job, but nobody takes pictures of the placenta or tries to tickle it under the chin. There were many nights after delivering yet another placenta where I was tempted to name it, swaddle it, place it in the nursery and start saving for college.

I was growing more frustrated as time went on. Every time I came close to delivering an actual baby, something got in the way. I would step out of the room for a minute to go to the bathroom or grab a snack and suddenly I would hear the familiar sounds of delighted cries and cheers coming from inside. I have heard it said that a baby is born at the exact time it is conceived, so I would routinely stay up all night. My piles of blood and urine samples were beginning to stack up, but I continued watching my patients like a lion stalking his prey, and with the slightest twitch of uterine muscle or leakage of amniotic fluid, I was ready to pounce!

Suddenly, all my waiting paid off! My patient was in labor for several hours and was ready to deliver. The moment had finally arrived. Outside the room, the Attending Physician gave me some last words of advice, “OK, Bill, the baby is going to be slippery. When it comes out, flip it and pull it in towards your chest … just like a football. Just remember not to spike the ball!” I really didn't appreciate the last part of his remark.

Inside the room, chaos had commenced. Drapes were being set up, instrument trays were clanging open and my patient was screaming like she was being murdered. As I took my place by the end that wasn’t actually screaming, she looked up from between her legs and asked, “Have you ever done this?” Before I had a chance to answer, she continued, “Oh, who the hell cares - just get this thing out of me!”

As it was customary, a small wastebasket was positioned between me and the bed to catch any body fluids or medical waste that might be produced. My patient’s water had broken, but on the first couple of pushes, a second gush of bloody water passed directly over the bucket and landed right on my new sneakers. Undaunted, I continued to feel for the baby’s head. One shoulder came out and then the other. The baby felt like pasta when it comes right out of the water. I flipped him and pulled him towards me. I suctioned out his mouth and he began to cry. But then … the unthinkable occurred.

As I was getting ready to cut the umbilical cord and hand him over to Mom, he slipped out of my hands and dropped right into the wastebasket! It was a soft landing as it was filled with gauze pads and towels, but the event was terrifying nonetheless. As I was busy peeling off the wrappers that were stuck to his skin, I said, “Congratulations, it’s a boy!” Mom looks up in amazement and said, “Isn’t that clever – you have something to catch him in.” With a sheepish grin, I handed the baby off to her and they began bonding.

Later that night, I was lying down in my call room thinking about the events of the night. As I stared at my soiled sneakers, I smiled and drifted off to sleep …

Besides your name and the fact that you are about 14 years old now, I don’t know much about you, young man. But from these humble beginnings, I hope your life has been blessed and that you and your Mom have been happy together. It is sad, in a way, that we will likely never know each other, nor will you ever come to know the profound impact you had on my life.

Be Wise - Prioritize!

2007-05-28T22:06:00.000-05:00

For those of you wondering how my initiation into the world of standup comedy went, it was a bit like the first time I delivered a baby – messy, but very satisfying in the end. The audience was kind and, mercifully, a bit drunk. No major networks have contacted me yet, but I still feel that it was a success and I am currently working on some new material and looking forward to the next time!

I hope all of you had a great Memorial Day weekend and spent some time thinking about the people who have given their lives for our country. As we all enter the summer season, it is easy to get stressed out about things we meant to do but never got a chance: planning summer vacations, spring cleaning and filing our taxes are just a few. At the start of the academic calendar on July 1st, I begin thinking about all my new projects, while at the same time trying to wrap up projects from the past year. Many parents become stressed out as they plan activities for their children who are free for the summer. Between work and home demands, the list of thing to do can become overwhelming.

For all of these reasons, I would like to share with you some of my thoughts on setting priorities. Now, I can hear some of you saying, “What does this have to do with health and medicine? It must be a slow week in the medical world!” Well, for your information, it has always been my firm belief that a person’s emotional health is directly tied to their physical health. Research has shown over and over again that mental stress can impede the healing process. Truly good health requires a balance between physical, mental and spiritual strength. Remember, laughter is the best medicine, not penicillin!

The first step in setting priorities is making a list of ALL the projects you have become involved with and all the jobs you are trying to accomplish in the upcoming weeks and months. You may think that your memory will suffice, but most people have an average of 50 projects on their list. Include high-priority items such as a presentation at work and planning your son’s birthday party as well as low-priority projects like cleaning out a closet, so that none are forgotten. Many people keep a work list and a home list, but it is important to combine them. If you are afraid that a combined list will be too long, then it is possible that you have spread yourself too thin!

The next step is to examine your list and place the items into categories, just like army medics must triage mass casualties wounded in the battlefield. The first category includes the items that are absolutely required or things that have been promised to someone else. These items must stay on the list. The second category includes the projects which you feel are important in the advancement of your career or life. This is the most nebulous category, because some things may not actually belong or remain their after careful consideration. The final category includes the projects which could be postponed and those which you are merely interested in accomplishing. This category may be bumped to a future list in order to keep the current one from reaching the floor.

As you enter your week, create a short list of projects for the week and keep it handy. At the beginning of each day, write down no more than five tasks that must be accomplished in order to bring you closer to completing your projects for the week, and at least one of those tasks must be related to a high-priority project. Set a goal to accomplish one of your daily tasks prior to checking your inbox, voicemail and Email. Most of our days are actually consumed doing mundane tasks like brushing your teeth, buying lunch or checking Email, so limit the amount of time you devote to these routine jobs.

Nothing is more satisfying than completing a project on time. Keep track of deadlines, but don’t wait until the night before, only to realize that you have underestimated the time required to finish the task. No two people work the same and soon you will find which organizational strategy works best for you. But once you’ve decided what to do, you may be wondering how exactly to execute the plan. That, my friends, is a project I must leave for a future list.

Love Thy Skin

2007-05-15T00:00:00.000-05:00

First of all, I would like to thank those of you who have sent in comments and questions. I encourage all of you to send in your questions and if you have a topic you would like me to write about, please let me know. This is as much your blog as it is mine!

It is very comfortable to sit at my computer and write funny things, but this week I will be venturing out of my warm, cozy apartment to unleash my quirky sense of humor on a live audience. This Friday, May 18th, I will be performing stand-up at The Comic Strip as part of a “fun-raiser” for P.S. 158. The club is located at 1568 2nd Avenue between 81st and 82nd Street. Doors open at 6 p.m. and the show will run till around 8 p.m. Don’t miss it!

As some of you may have heard, May is National Skin Cancer Prevention Month, and so I thought it would be appropriate to discuss our beloved skin. Whether it is soft, wrinkly, sweaty or hairy, it is our first line of defense and I’d like to give you some words of advice on how to protect and maintain it.

When I was a child growing up in the 70’s, I’m not even sure sunscreen was available. A can of Crisco, a sheet of aluminum foil and a can of Tab was all I needed for a hot summer day. After a long day at the beach, I would lay down in bed only to discover that when the lights were out, my body glowed like a nuclear reactor on fire. Society sends us mixed signals by referring to that rosy hue our skin has after being in the sun as a “healthy glow”, when it’s actually a first degree burn.

The best time to start protecting yourself from the sun is when you are young. 80% of skin damage from the sun occurs before the age of 20. The sun is strongest between 10 a.m. and 4 p.m., so limit direct sun exposure during this time. Use a hat to protect your neck, face and ears. Sunglasses should protect against both UVA and UVB rays. Sun damage can occur at any time of the year, but summer is the most dangerous because more skin is exposed during this time. On top of this, sand and water can reflect up to 85% of the sun’s rays.

Sunscreen should definitely be a part of the battle plan. Ideally, sunscreen should be applied every day, even on cloudy days. Use sunscreen with a sun protection factor (SPF) of at least 30 and reapply several times throughout the day, particularly after exercise or swimming. Apply sunscreen before going outside and make sure to cover your ears, nose, lips and the tops of your feet.

If you have burned in the past, or if you have very light skin, you are in a high-risk group for skin cancer. The American Cancer Society estimates that nearly half of all cancers are related to the skin and most of these cancers, if detected early, have a cure rate of up to 95%. Keep an eye on your skin and look it over on a regular basis. Any moles that have asymmetry, irregular or poorly defined borders, uneven color, large size (over 6mm) or increasing size should be evaluated by a Dermatologist. Having worked as a lifeguard for several years, I go for a total body skin exam once a year. This is an easy and painless exam which takes less than 15 minutes.

If you feel that you might be at risk for skin cancer, make this the year to get yourself checked out. On Friday, May 25th, The Department of Dermatology at Weill Cornell Medical College is hosting a free skin cancer screening from 1 – 5 p.m. at 1305 York Avenue, 9th floor. No appointment is necessary!

I’ll see you all around the pool!

Bee Safe!

2007-05-01T00:27:00.000-05:00

Jennifer wakes up at 7AM to a bright and sunny day. She takes a shower and styles her flowing blonde hair, using multiple aerosol cans in the process. Checking the sky outside, she applies sunscreen and just a dab of perfume on each side of her neck. She puts on the new bathing suit she just purchased and a loose, floral cover-up. After a quick phone call to her friend, she grabs a can of diet soda and her sunglasses and heads out the door.

Later that day, Jennifer is seated on a blanket with her friends in Central Park. One of them points out to her that she has a bee on her shoulder. After a moment of silent terror, Jennifer lets out a loud scream and begins to run circles around the blanket, swinging her arms wildly. All of a sudden, she feels an intense pain as though someone just punched her in the shoulder. She looks and sees a red, swollen area with a black dot in the center.

What did she do wrong and what should she do now?

Springtime is all about being outside, and while you’re searching for that elusive peace and quiet, it is important to keep in mind that you are sharing nature with many other creatures. Most people retain vivid memories of the moment when they were stung by a bee. The good news is that most bee stings produce nothing more than local pain and swelling for a few hours. However 1% of the population can develop a more severe reaction and about 100 deaths from bee stings are reported each year in the United States.

The key is not to be attractive to a bee. Avoid perfumes or heavily-scented lotions. Bees are attracted by shiny jewelry and brightly-colored floral prints. Try and wear well-fitting, lightly-colored clothing rather than dark, baggy garments. Wear a hat and shoes in areas that are likely to have bees, such as a field.

Bees go for the food. Dispose of your partially eaten picnic items as soon as you are through with them. Even a small amount of spilled fruit juice on a child’s clothing can attract a bee. Soda cans should always be watched and covered whenever possible to avoid bees from climbing inside and stinging you on the lip when you take the next sip.

If a bee flies near you or lands on you, try not to frighten it. Hold still or walk very slowly away. Blowing on it gently may encourage it to fly away. Overall, bees are not very aggressive and will only sting when they feel threatened. If a bee flies into a moving car, slowly pull to the shoulder and open the windows. Very rarely will a bee sting the occupants of the vehicle.

If you do get stung, check to see if the stinger is still in your skin. If you see a black dot, try and scrape it out with the edge of a credit card or blunt knife as quickly as possible. Avoid squeezing it with your fingers or tweezers, because this may result in the injection of more venom. Apply ice to the area for about half an hour. Other medications that are helpful are antihistamines, topical steroid creams and pain medication such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil). Calamine lotion or a paste made from baking soda and water may also sooth the region.

Small local reactions will usually be painful for a couple of hours, but the swelling may persist until the next day. If the initial reaction is more than a few inches in diameter, the swelling may persist for up to a week. You should seek immediate medical attention if you were stung more than 10 times, if you were stung inside the nose or mouth, or if you experience difficulty breathing, dizziness, hoarseness, vomiting or any hives in other areas of the body besides the sting. If you do experience a severe reaction from a bee sting, it is advisable to carry injectable epinephrine with you at all times in case you are stung again. Talk to an allergist about the possibility for desensitization therapy.

Keep this advice handy for the next time Jennifer comes with you to the park.

Facing Up

2007-04-15T17:19:00.000-05:00

One of the most wonderful periods in my life was the four years I spent in Medical School here in NYC. Without a doubt, my favorite class was Gross Anatomy, one of the first classes in the curriculum where groups of 3 or 4 students would dissect a human cadaver. In this case, “gross” refers to the anatomy which is large enough to identify by regular sight, rather than just … well, GROSS! Many of the stories I have to share with you are drawn from my experiences as both a student and instructor in this class, but the most exciting moment of this class actually occurred the night before it began…

It was a warm evening in August. I was alone on the 12th floor, flipping through the heavy textbooks which were opened at my desk. All of a sudden, I heard footsteps approaching. “Hey, Bill, what are you doing?” It was Fred, my colleague, friend and roommate. I just looked up a smiled, unsure if his question really required an answer. “I’ve got an idea”, he continued. “Do you want to go and check out the anatomy lab?” A slick smile broke out on both of our faces as I abandoned my books and followed him.

The anatomy lab was just down the hall. “I’m sure they’ve got it locked, and, anyway, they always keep the cadavers in the fridge”, I explained to Fred. As soon as the words left my mouth, he clicked the latch open and we proceeded inside the lab. It was dark, except for the eerie glow of moonlight coming through the windows, and much colder than I recalled from when I came here during my interviews. The gurneys cast haphazard shadows all around the room as the heavy door slammed shut behind us. Fred fumbled for the light switch, and when he flipped it on I could hardly believe what I saw.

On each carefully spaced gurney was a motionless body shrouded in a white, plastic sheet. It looked like a bizarre dormitory, where at any moment its inhabitants might wake up, jump to the floor and go about their day. I suddenly felt as though my sneakers were glued to the floor and I became aware of every breath I took. “Let’s take a closer look”, Fred said in a more tentative voice. As we approached one of the gurneys, each step of our sneakers made such a deafening squeak on the newly waxed floor, I thought for sure that any one of the cadavers would begin to stir. The air seemed thick and I could feel my heartbeat pounding in my ears. The smell of formaldehyde pierced my nose and burned my eyes. Fred motioned for me to lower the shroud.

I grabbed the sheet around the area of the cadaver’s forehead and it made a crinkling sound as I carefully pulled on it, making sure not to lean on his nose. It was stuck underneath, but as I worked it free and began moving it downward, I saw thin, white hair in a random distribution and a leathery forehead began to take form. I closed my eyes and gave the sheet a tug, strong enough to get it down to the neck. When I opened my eyes again, I expected to see the peaceful face of someone who appeared to be sleeping, but I was not prepared for what I saw.

Although he was very well preserved, rigor mortis (the sustained contraction of muscles after death) had caused his eyes to open widely. The muscles of his head twisted and contorted in such a way to cause the combined expressions of anger, terror and surprise to remain frozen on his face for all eternity. His mouth was open, but no scream came out. Instead, Fred and I both faced each other and began to make the sound the cadaver might have made if he were able. I felt a tingle shoot up my spine and we both used each other’s body to swing around and push off towards the door. I’m pretty sure you could still hear us screaming as we continued running down the street.

So what exactly did I learn from this? Well … when you see your future for the first time, it can be a very frightening experience.

Spring into Action!

2007-03-29T07:32:00.000-05:00

During a recent run of warm weather, I was walking down York Avenue with a friend. Coming towards us was an attractive young woman who was rubbing her nose so hard I thought a genie might pop right out of one of her nostrils and offer up three wishes. Suddenly, she paused and let out a sneeze so loud that a cab came to a screeching halt right beside her. “Boy, that must be music to your ears”, my friend said. This troubled me. I mean, sure I take care of many people with allergies, but did he think that I was that shallow? Did he think that I was so self-involved that I could gaze into the bloodshot eyes of my suffering countrymen and wonder what they could do for me? Did he think the sound, “A-CHOO”, actually sounded like “CHA-CHING” in my brain? “Yeah, she’s playing my song”, I replied.

The springtime brings mixed emotions for many people who have allergies. All around us there is beauty. The flowers are bursting forth with glorious colors. The trees, lifeless for so many months, begin their annual mating ritual as well. Sap, the life blood of these wooden soldiers, takes its annual journey from the roots all the way up to the tips of the branches. Suddenly buds appear, and from these tiny factories come millions of particles called pollen that will be carried for miles on the wind, searching for fertile soil that will insure the propagation of the species. Talk about speed dating! And as we take in the beauty of the season, the only thought that comes to many people’s minds is, “I am #$*@% miserable!”

Allergies affect approximately a quarter to a third of all people in the United States. If you have allergies, what this means is that your body is trying to become immune to common and harmless things in the environment. You may contact these things from particles carried on the air you breathe, in foods placed inside the body or even from things that contact the skin directly such as latex gloves. The body will react to these perceived invaders as violently as if it there were viruses or cancers getting into the system. Often times, this allergic potential is passed down by the family genes, similar to eye color or the tendency to yell at people in other cars.

In general, the most common treatment for allergies is medication. Joe K. writes in asking about which medicine he should use. He states that he gets all side effects and no relief from any of the ones he’s tried. This is a very common dilemma. Your physician is a good resource to help you sort out all the different types to find out which one will target your symptoms best. There are plenty of options, and, sometimes, combinations work better. If nothing works, it probably means that your exposure to the offending pollen is too high. Read on, Joe, and thanks for the question!

Desensitization (allergy shots or drops) is another form of treatment, usually reserved for the more severe allergies lasting for a majority of the year. Consult with a qualified ENT Allergist or General Allergist if you’d like to learn more about this. I will also be discussing this topic in more detail in the near future. But there is a third category of allergy management that always seems to get overlooked …

Avoidance.

No, I did not say “A boy dance”. Get the wax out of your ears. I said, AVOIDANCE. There’s no avoiding it, either. Call them environmental control strategies or call them whatever else you’d like. If you don’t take meaningful steps to try and separate your body from the things that are ticking it off, you’ll be fighting an uphill battle. Most people cringe when I start talking about avoidance, saying things like, “Are you going to make me throw out Mr. Fluffy?” or “Shall I go move into my bubble now?” While either of these measures might be effective, avoidance, in order to be successful, must be practical.

If you suffer from springtime allergies, you should know that tree pollen levels are at their highest from 5 AM to 10 AM. Fight the urge to open your windows in the early morning to get some “fresh” air in. Keep them shut and put your AC on. Even those basic filters will keep the large pollen particles outside where they belong and this goes for the car as well. If you can shift morning activities like gardening or running to the afternoon or evening, when pollen counts are lower, this might help as well.

You can’t eliminate pollen from the outside air, but you can prevent it from becoming an indoor allergen. Create a save haven for yourself in the bedroom. When you come in from the great outdoors, change your clothes and take a shower, but DON’T throw the clothes on your bed. Keep them in the closet and consider changing into “safe” clothing that does not go outside. Pollen can also be brought into the house on your pets, so just try to keep Mr. Fluffy off your bed. Also, wash your hands before touching your eyes.

Finally, if you do happen to find out that you are allergic to, say, maple trees, please don’t grab your hatchet and go crazy on all the maple trees around your block. The pollen that is irritating you is very lightweight and could have reached you from several miles away. This is why you feel worse on windy days. Rain may take the pollen out of the air, but the relief is only short-lived.

So rise up, countrymen! “Spring” into action! Pick up your travel tissue packets and come out of your bubbles! Take control of your allergies before they start controlling you. I hope some of these suggestions will help you enjoy the beauty of the season. See you around the neighborhood!

The First Time

2007-03-08T23:15:00.000-05:00

Life is full of important firsts. The first day at school, the first kiss and the first time you drive a car solo, just to name a few. In medical school there seems to be an amazing first at every turn in the road, but one of the most memorable ones is the first day in the Operating Room. For the first two years of medical school I was limited to the classrooms and labs, but all I could think about was getting into the O.R. It was a mystical place, like the girls room, full of mystery and forbidden secrets. Reaching the O.R. made me feel like I was back in Junior High School sneaking into my first R-rated movie, as every rebellious, buttery kernel of popcorn I tasted propelled me further towards the next stage of development. It really didn’t matter what kind of operation was going on, because I just wanted to be there. Brain surgery – not a problem. Hammer toe repair – sign me up!

The first day I walked into the O.R., I felt like the tin man in green pajamas finally prancing into Oz singing, “If I only had a scalpel.” Actually, it took me half the day just to find the locker room, so I sang very slowly. I also have to publicly thank the orderly who showed me where to find my booties, hat and mask. Finally, I made it to the Operating Room I was assigned to and immediately came face to face with Nurse Mueller. She was an older gal of ample proportion with curly, silver hair and bright red lipstick that was imprinted on the inside of her mask. Watching her bound towards the door gave me added respect for the adhesive strips holding her disposable gown together. As she glared at me, like I was the only thing standing between her and a plate of lamb chops, I understood right away that this was her O.R.

“You must scrub first”, she said, looking me up and down and pointing towards the scrub sink. “First clean under the nails, and then scrub the fingers, hands and arms up to the elbows. Ten passes on each surface. Scrub for at least ten minutes”, she warned, “and you must keep your hands up!” As I began working up a chemical lather at the sink, I couldn’t stop thinking about my mother telling me, “Billy, wash your hands before dinner.” Once I was done, I triumphantly tossed the scrub brush into the garbage and crashed backwards through the O.R. doors into the flowing arms of Nurse Mueller. “Your hands are below your elbows!” she reprimanded. I thought they belonged there, but apparently this could allow tiny germs from my elbows to swim down my water-logged arms. “Go outside and try it again, young doctor!”

The surgery had already begun as I hurried up and scrubbed another layer of skin off. Charging back into the room, Nurse Mueller met me like a defensive tackle at the door. With the first smile that I saw on her face so far, she pointed to the clock and explained, “That was only eight minutes.” Once again, I found myself banished to the bank of stainless steel sinks. Other surgeons were starting to look at me strangely as I was muttering under my breath something about the Great and Powerful Oz. My scrubs were now soaked in all the wrong places and my hands were starting to throb as I tried this time to sneak into the O.R. I made it to the instrument stand as the surgery was well underway, when I brushed the stand. Out of nowhere, Nurse Mueller bellowed, “You just violated my sterile field!” In silent protest, I thought, “I’m not that kind of man … and what’s a sterile field?”

Back at the sinks, as my weary hands were completing their next lap of the scrub-a-thon, I heard noises from inside the O.R., indicating that the operation was finished, the instruments were being collected and the patient was being awakened from general anesthesia. Moments later, a couple of my fellow students came out of the operating room, chatting with excitement as they reminisced about their adventures inside. They looked over in my direction and said, “Hey Bill, wash your hands and let’s get some dinner!”

Give it to me straight, Doc!

2007-02-24T23:43:00.000-05:00

I overheard a woman speaking with her friend the other day over coffee. With equal parts of anger and frustration, she asked, “Why can’t doctors just say what they mean?” I don’t think she was actually expecting an answer, but I began to wonder whether or not one existed. After all, the vast majority of doctors want to be good communicators, but maybe we’re not as good as we think. I’m sure that, on occasion, my patients must have wondered if I wanted any syrup with my waffle. So what exactly is preventing doctors and patients from operating on the same wavelength? Is it all that technical terminology? Laziness? Indecision? Fear? Incompetence? Stress? None of the above? All of the above? Maybe we should just resurrect the conspiracy theory and call it a day!

Ever since entering the medical field almost 20 years ago, I have been fascinated by the way doctors talk to their patients, and many of my patterns of communication were forged from experiences during my training. As a medical student, I remember huddling like a football player with my friends around a creaky, metal bed as my senior physicians grilled me about the patient hopelessly tangled up in the sheets before me. Preoccupied with trying to prove my worthiness, I spoke about my patients as if they were on a different planet, which is probably exactly where they wanted to be at that moment. “So, Dr. Reisacher, what do you think about Mrs. Jones’ neck mass?” This was known as the “guess-what-I’m-thinking” game, so to increase my odds of hitting the nail on the head, my answer may have sounded something like, “Well, from the looks of it, the mass has definitely been around for some time. It could either require surgery or just improve with medicine, but in any event, further investigation will certainly be necessary.”

Running around the hospital with my fellow residents like a pack of hungry wolves during my training lead me to realize that there was safety in numbers. This is a very powerful source of comfort and is not abandoned easily. Have you ever noticed that your doctor refers to himself or herself as “we”? Just the other week in my office, a patient asked me why her throat was sore, to which I replied, “We think you might have an infection.” Besides the patient, I was the only one in the room, so who exactly was I referring to? My imaginary assistant? The Network? Part of me expected her to dart her head nervously from side to side or search the closets for the absent members of my entourage, but the mistake went completely unnoticed. Nowadays, as long as I catch myself in time, I try to make a quick pronoun adjustment.

It is also possible that doctors use language that is less than direct in order to avoid, or delay, delivering bad news to a patient, thereby sparing the patient (and hence, themselves) emotional distress. But it never seems to work out that way. As an Otolaryngologist, I frequently perform procedures in the office that are uncomfortable for my patients. Early on in my practice, I would try to calm a patient down by saying, “I’m almost done”, but when I found myself saying that over and over for the better part of 15 minutes, I began wondering if I was saying that for the patient’s benefit or just to settle my own nerves.

Most doctors want exact answers just like patients do, but medicine is sometimes more like a form of art than an exact science. It is filled with shades of grey, ranges, opinions, options and a list of possibilities that are referred to as the differential diagnosis. Finding the exact answer is often like figuring out the plot of a movie based on a few still-frames. Many doctors are unaware that the language they are using is evasive, vague or overly-technical, and it is important for you, the patient, to stop nodding and ask all the silly questions when the waters get murky. Effective communication is a two-way street and takes many years of hard work to improve upon, but it is possible. In my own practice, what it ultimately comes down to is looking each patient in the eye and speaking from the heart. All patients deserve and appreciate total honesty. And they know when it’s real.

The Key

2007-02-10T21:48:00.000-05:00

This is a true story. Honestly. The other day, I was riding on the 6 train and across from me were two older gentlemen with shaggy, salt and pepper beards and leathered skin. One of the men reached into his pocket and pulled out a set of keys. Analyzing each one individually, he finally found the one he was looking for and proceeded to place it into his ear. Was this the only key that would unlock his ear? Anyway, as he twisted this key deeper and deeper inside his ear canal, his eyes were rolling back and forth as if they were searching for something lost long ago in the deep recesses of his brain.

Suddenly, he struck pay dirt and pulled out a nugget of wax that resembled a baked potato in both size and color. Following a brief moment of disbelief, a satisfied grin spread like wildfire across his face as he displayed his trophy to his friend. From the joy on their faces, you would think that they just married off their last child. In fact, I got so caught up in the thrill of the moment that I had to hold myself back from jumping up and screaming, “L’CHAIM!” If the field of ENT had a police force, the moments that followed would have surely gotten both of them a free ride to Central Booking. After the man cleaned off his key, he passed it over to his friend who then began a mining expedition in his own ear. WITH THE SAME KEY!

Many people who come through my office whisper in my ear, “Hey Doc, what’s the best way to clean out my ears?”, as if it was a closely guarded secret. I think the whole problem comes from the fact that our ears do not come with an instruction manual. Perhaps our mothers were hiding it underneath the TV guide, because they always had a definite idea on how to keep our ears “clean”. Some used the cotton swab as a plunger, while some preferred a more twisting motion. “It’s all in the wrist, son!” Or maybe your mom was part of the anti-establishment movement that would only use a washcloth. As you matured, you may have stuck with these time-honored traditions, or you may have graduated to more advanced paraphernalia such as pen caps or the stylet from your latest electronic gadget.

Truth be told, I’ve never seen a “dirty” ear in all my 12 years as an ENT doctor. Maybe this whole issue could be avoided if we could just make wax clear instead of brown. But wax is actually a valuable part of the maintenance of our ear canals. It coats the skin on the outer part of the canal and makes it waterproof, just like wax on our cars. This is why using a cotton swab after the shower is unnecessary and can actually cause the ears to get dry and itchy. Wax also acts like a natural antibiotic, keeping bacteria from contacting the skin and gaining entry into the body.

Wax naturally drops out of the ear along with the dead skin exfoliated from our ear canals. When you see a little boulder at the opening of your husband or child’s ear, DO NOTHING! Even large amounts of wax at the opening of the ear rarely cause problems, while small amounts pushed close to the eardrum can have devastating results on our hearing and comfort level. It’s like they say in real estate … location, location, location! And if you do get into a “jam”, where the wax has muffled half of your world, try an over-the-counter wax removal drop (usually a combination of oil and peroxide) or a trip to your friendly neighborhood ENT if this doesn’t help.
What a cruel joke nature would have played on us by requiring us to clean such a small, inaccessible hole in our body. So why do we do it? Well, after talking to thousands of patient, I have come to the conclusion that IT JUST FEELS GREAT. Actually, there is some science behind this. Our ear canal contains several nerves that feed directly into the pleasure centers of our brain. There is a well-known actress currently in films who can reportedly reach climax simply from using a cotton swab. Heck, they cost less than batteries! But everyone should know that placing anything in the ears is both unnecessary and potentially dangerous. In terms of taking care of your ears, this is the key.

Go With The Flow

2007-02-01T23:20:00.000-05:00

You know when it’s going to happen. Perhaps it’s in the board room during an important meeting. Or maybe it’s during final exams. Any parent who has peeked in on their sleeping child and suddenly began wondering if they live in the Amityville Horror house knows the anguish associated with nosebleeds. Even the word “nosebleed” stirs up horrible images, which is probably why doctors call it epistaxis. If you really need to know, just start off with a short “e” and follow it up with “piss” and “taxes.”

Call it whatever you’d like, but nosebleeds are a very common and disturbing problem. You probably get a feeling when it’s about to happen, even before the Sea of Sangria has broken through the dam. Then you touch your finger to your nose, only to confirm your initial suspicion that the third grade is steadily leaking out of your head. And don’t bother trying to find a tissue because you know that box is going to be empty anyway. You might just as well tear off the sleeve from your freshly laundered white shirt and pack away.

The first lesson in controlling a nosebleed is not to panic. This can raise your blood pressure and make matters worse. In fact, high blood pressure is one of the most common medical conditions associated with adult nosebleeds. Blood thinners, such as aspirin or Coumadin, taken by many people with heart disease, tend to make nosebleeds more difficult to stop. In childhood, digital manipulation (translation: nose-picking) commonly precedes an episode. Overall, I see many more nosebleeds during the wintertime, when colds and dry, indoor air create a hostile nasal environment.

The next step in controlling a nosebleed would fly in the face of everything you learned from your school nurse, who promptly forced you to look up at the ceiling when you ran into her office. This maneuver saved her from cleaning up her floor, but did absolutely nothing for you. In fact, swallowing blood can severely irritate the stomach. I recommend keeping the head level or tilting it a bit forward. Since most of the bleeding actually occurs in the front of the nose, put firm pressure on the soft part of the nose with your thumb and forefinger. Try adjusting your finger position until it slows down or stops the flow and then HOLD IT. Ten minutes by the clock should do it, and remember, NO PEEKING.

An ice pack or a bag of frozen vegetables (I like sweet corn best) can be placed on the bridge of the nose to help shrink down the blood vessels. I’ve heard many people say than they put ice on the back of the neck, but I’ve never found this to help. If the episode has not passed in the first 10 minutes, you may repeat this step twice. If your nose is still flowing like the River Nile after 30 minutes, proceed to the nearest Emergency Room. Many people report that blowing out a clot heralds the end of the episode, but don’t feel compelled to blow your nose.

If the nosebleed is very severe, or occurring on a regular basis, you should be evaluated by a doctor. If you find yourself in this predicament, be good to your nose. Limit the amount of bending, straining and heavy lifting. If you exercise, focus on lighter, aerobic activities rather than strenuous crunches or bench presses. When you lift, stick to lighter objects and exhale through your mouth. Open your mouth if you sneeze, and the only thing you should pick up off the floor is the winning Lottery ticket. Try not to pack anything into your nose (leave that to the pros) and this includes your finger. Nasal saline mist or gel is helpful to combat a dry nose, and these products are available at most drug stores or supermarkets.

It is a good idea to check with your primary care physician to make sure your blood pressure is under control. Often times, an ENT doctor can cauterize, or heat-seal, a blood vessel which is giving you grief. Armed with a bit of information and a cool head, you will be able to do more than just “go with the flow”, and avoid such comments as, “My, what an interesting red shirt … You must tell me who your designer is!”

The First Dose

2007-01-30T22:15:00.000-05:00

Welcome to my first blog. My name is Dr. William Reisacher, but if you’d like to call me Dr. Bill, that works just fine. I’m 38 years old, and I live, work and play on the Upper East Side with my wife and three children. I am what is known as an Otolaryngologist. I bet you never knew all those letters could be put together like that, but I’m not making this stuff up. If you prefer, you can just call me an ENT doctor, which many people think stands for Emergency … Nedical Technician. Oh boy, we’re getting off to a bad start.

What I do is take care of problems relating to the ears, nose and throat - anything north of the collarbones and south of the eyebrows. I pick noses and get money to buy CDs and stuff. (And to think my teachers said that such a disgusting habit would not serve me well in life!) That’s not to say that I don’t care about the rest of the body. Neglecting a patient’s overall health and lifestyle is a big no-no in my industry. It’s just the way the medical field works these days – doctors pick their little niches and then spend insane amounts of time trying to become the best in that area. For example, I specialize in ENT and sub-specialize in allergy. Maybe someday, I will sub-sub-specialize in allergies to maple trees. I have heard it said that doctors are learning more and more about less and less until finally we will know everything about nothing!

Having spent the last 15 years of my life in the healthcare industry, I’ve seen many changes which have disturbed me, and this is part of the reason I’ve magically drifted into your living room. The costs of maintaining a practice keep going up, while reimbursement from insurance companies keeps going down. You don’t need an MBA to see where this formula leads you. In order to make ends meet, doctors are forced to cram as many patients as possible into schedules that are already bursting at the seams. Consider yourself lucky if your doctor lays a hand on you at all, and after waiting one hour for a five minute visit, you come out the other end feeling like something that just popped off a fast food assembly line.

This blog is all about bringing the human touch back to medicine. I’m here to help explain what your doctor didn’t have time to cover. I want you to know that it’s OK to have doubts and to ask lots of questions. And I’d also like to give you a glimpse into the unbelievable highs and desperate lows that shape a doctor’s life. You will learn a lot about me, just like I will learn a lot about you. I want to answer all of your questions and hear all of your concerns and I don’t want you to hold back. I may also try to make you laugh because, after all, that is … the best medicine.