Why Read Moby-Dick?

Call me a contradictory man if you will; I do not leave home without my Kindle Fire or iPad, lest I would be caught without an eBook to read if I happened to have idle 5 or 10 minutes.  And yet I am still a passionate believer to read print book.

This small booklet (Why Read Moby-Dick?) by Nathaniel Philbrick is a good example.  The cover (see photo above) is noble, classy with dignity, in line with the book it reviews.  The author claims he has read Moby-Dick at least 10 times, and has lived at Nantucket since 1986.  After reading Chapter 4 (Nantucket) in this booklet, I went back to read the Chapter 14 (Nantucket) of Moby-Dick again, even though I haven’t finished reading the book yet.  This booklet has only 131 pages and is only about the size of the Kindle Fire (see photo below).

Moby-Dick was first published in 1851 and only sold 3,715 copies when Melville died in 1891.  William Faulkner said “Moby-Dick was the one novel by another author that he wished he had written.”  When Ernest Hemingway was a lion in winter, he wrote to his publisher (Charles Scribner) that “Melville was one of the handful of writers he was still trying to beat.”

Moby-Dick is a novel to read and study and that is why I need to read the book about it.  I bought a paper back, and yet I am reading the eBook version.  Call me a contradictory man if you will.  

My consultation note (at MGH) on Santa Clause

There is a hilarious article of “A Most Unusual Patient at the Massachusetts General Hospital” that was published at the Annals of Surgery, December 2011;254:845–849, reporting the annual admissions of the Santa Clause at MGH for the past sixty years.  The following is my consultation note on Santa.  I have a photo showing the jacket I wore while seeing the Santa at MGH.  When did I work there?  Just give you a hint; Harvey Cushing was operating on the pituitary gland at MGH when I was there.

Present illness: It is my privilege and honor to be called to see this 450-year-old white male, Mr. Claus, also known as Saint Nicholas.  It was not a dark stormy night, it was a silent night when the most unfortunate and unforeseen accident happened; the Santa's reindeers sleigh had a midair collision with Big Bird in the cyberspace.  Santa, Dasher and Donner were brought to the ED of MGH, where Dasher and Donner were treated for minor injury and released.  Santa was found to have multiple contusions, for which he was admitted.  Cardiology service was consulted for fear of Broken Heart Syndrome as he complained of chest pain upon arrival and his troponin was a bit elevated.

Having posted the Broken Heart Syndrome (see the link), I earn a reputation of being the expert of it and landed this honorary consulting job, or shall I say if Santa doesn’t come to me, I go to Santa.

http://doctorjytsai.blogspot.com/2011/12/broken-heart-syndrome.html

Past medical history: is incomplete and legendary, but review of his voluminous medical records at MGH (the past 60 years) reveals he has suffered from all illnesses and traumas imaginable that were related to his noble job.  Thanks to the superb MGH staffs he somehow managed to have full recovery on each and every occasion; some prefer to say it was a miracle.

Social and personal history: He doesn’t smoke, (the only time he smokes is while climbing down through the chimney, it is a secondary smoking, so to speak, nor did he use alcohol; he usually gets drunk with Christmas spirit without a drink.

Allergy: NKA (not to be mistaken as No Known Allergy; it is Naughty Kid Allergy)

Review of system:

-         CVS: There is a history of hypertension, which he claims seasonal at the year end when he was under stress to deliver the cheers to all.  There was no heart failure; it was said his heart can never fail.

-         Pulmonary:  He never had pneumonia despite centuries of delivering cheers from the freezing chills of the North Pole.  No pulmonary function test is needed; judging from his sonorous HO! HO! HO!, he must have a large vital capacity.  It is also a miracle that Santa never had inhalation injury which is an occupation hazard with his job.

-         Gastrointestinal:  He had bariatric surgery (Roux-en-Y gastric bypass) at MGH, so he can continue to do his job by way of the chimney; he is indispensable.

-         Genitourinary:  No urinary hesitancy; he said the stream comes out like Noah’s flood.

-         Mental:  He denies history of depression.  He was once erroneously diagnosed to have bipolar disorder when he wandered to the South Pole after completing his yearly duty because of GPS malfunction.

Physical examination:

A 450-year-old jolly man who appears younger than his stated age.  He was wearing a red coat with white collar and cuffs, red trousers, and black leather belt and boots.

-         Examination of the chest shows no signs of Eskimos (black and blue or ecchymosis), despite coming from the North Pole.

-         His heart rate is rhythmic with the season, galloping with joy, a grade 2/5 halo-systolic murmur is best heard at the apex.  He has a big and tender heart, not to be mistaken as cardiomegaly.

-         Auscultation of the lungs reveals a few scattered musical wheezes with Christmas melody.

-         Abdomen is obese and protuberant, not tender (tender is in his heart), no liver or spleen palpable, a well healed, candy cane-shaped (like an upside down 'L', nay, No 'L') vertical surgical scar from previous bariatric surgery was seen.

Chest X ray shows a characteristic heart shape in a most romantic way, known to have a big heart notwithstanding.  Abdominal CT scan shows signs of love, joy and peace.  EKG shows sinus rhythm with no characteristic Saint Thomas (as we know he is Saint Nicholas, not Saint Thomas) segment elevation.

The abnormal Lab includes a non-fasting blood sugar of 150, troponin 0.07, and a CREATinine of 1.5.

Assessment:  Even though the sudden stress from motor vehicular accident or sleight accident is known to precipitate the Broken Heart syndrome, aka stress cardiomyopathy.  It is highly unlikely that it can occur on this ageless, jolly old man whose heart is filled with cheer and hope, which is unbreakable.  The marginal elevation of troponin is most likely related to his slightly impaired renal function that goes along with his age.  The chest pain was the result of the direct hit over the ends of the elves, as a light touch in his heart elicits tenderness.  A cardiac catheterization is unwarranted.  The drug of choice for the elves contusion is Eleves (the O-T-C equivalent of Aleves) which is an NSAID (Non Saint Anti-Infedel Drug).  A tincture of faith, coupled with prayer t.i.d. will put him back on the road to deliver joy to the world in no time.                               

Thank you for giving me this God-send opportunity to participate in the care for this man for all ages.  Such a sweet man with a blood sugar of 150 may suggest diabetes mellitus.  I have taken the liberty to ask for an endocrinology consultation, paging Dr. Joy Tsai.

merrily yours,

Jer-Yuan Tsai, M.D.

(After reading the above consultation note, Harry sent me the following email, of course, from the lawyer’s perspective.  Harry is obviously very familiar with the DSM (Diagnostic and Statistical Manual of Mental Disorders) and its Axes.  Axis I is clinical mental disorder, Axis II is developmental and personality disorder, Axis III is medical & physical disorder, Axis IV is psychosocial stressor, Axis V is not applicable here.)

“I understand that he has a past history of mental health treatment in New York City where his DSM diagnosis included Axis I Schizophrenia Axis II Personality Disorder and delusions of grandeur Axis III (You have covered in your report) Axis IV Institutional adjustment and workplace problems at Macy's department store. It will be hard to find these records due to the efforts of a lawyer who defended him in a civil commitment proceeding in the Supreme Court of New York.  The Bellevue Hospital records have been sealed.  Many years ago there was a documentary movie about the episode produced which frequently is replayed on television this time of year.” 

Happy Anniversary to us!

In the “Grow old with me! The best is yet to be” post, I mentioned our recent wedding anniversary, I might as well put some photos here.  It is very nice that one of the most hospitable couples in Taiwanese/Chinese community, our good friends, were able to join us for the anniversary dinner; good food, good ‘spirit’ and good company.  They also introduced us to a nice restaurant (Capstone Grill) that we’ll for sure patronize again; it is just a stone throw away from our friends’ house.  The clam chowder rivals that we indulged in the Oyster House at Boston or the sea shore restaurant where the New England clam chowder was born and where Janice took us some years ago.

Grow old with me! The best is yet to be.

Two unique Christmas gifts in history (1864) and in medicine (2011)

Today (Dec. 22) in 1864 Union General William T. Sherman (see photo--taken in May 1865 after Lincoln was assassinated) arrived at Savannah, Georgia and sent Lincoln a message, “I beg to present you as a Christmas gift, the city of Savannah, . .”, to which Lincoln replied the day after Christmas, “Many, many thanks for your Christmas gift, the capture of Savannah. . . “

The fall of Savannah virtually cut the Confederacy (the seceded states) into two, it is known as Sherman’s March to the Sea. A marvelous military strategy and success though it might be, the way Sherman conducted the war, so called total war, led to the harsh criticism of some historians.  His earth-scorching tactic, taking the war directly to the civilians, aiming to break the will and morale of the South to continue to fight, wiping out every thing in its path.  Lincoln obviously condoned it.  I find it difficult to defend Lincoln in this case.

One of the Original Articles of today (Dec. 22, 2011) issue of New England Journal of Medicine (NEJM) is “Adenovirus-associated virus vector-mediated gene transfer in Hemophilia B”.  It reported (from England) the successful gene therapy (the FIT gene is carried by the innocuous adenovirus) for Hemophilia B, which is also known as Christmas disease, named after the first patient in 1952. (Hemophilia A is due to deficiency of factor VIII, whereas Hemophilia B factor IX (FIX).  Both show X-linked inheritance.  Queen Victoria was the most famous carrier of Hemophilia B gene.

This leads to an Editorial (see photo) in the same issue of NEJM, “Merry Christmas for patients with Hemophilia B”.  The good timing of the published report makes the catching headine of the editorial befitting the season well.  Merry Christmas to all the patients with Christmas disease, Merry Christmas to all!

The Path Between the Seas: the Creation of the Panama Canal 1870-1914

After reading David McCullough’s The Path Between The Seas: The Creation of the Panama Canal 1870-1914, John recommended me to read earlier this year.  I promised to return the book “next” time John and Tuner came back to Waynesburg, after several “next” times, I finally finished it yesterday.

McCullough made the seemingly boring story of the creation of Panama Canal a fascinating one.  So many pivotal people involved came alive in his book.  It spanned three Presidents: Theodore Roosevelt, William Taft, and Woodrow Wilson.  It is fair to say that without Teddy Roosevelt, the “rough rider”, there will be no Panama Canal.  He earned a place in Mount Rushmore rightfully for he was the President that made the American might and power known in the international community.  And being a naturalist and a conservationist, he had great impacts in the shaping of wildlife refuges and conservation that we can take pride to say “This is America!”

Theodore Roosevelt visited the Panama Canal once at its very early stage (see photo; he was actually operating the big, 95-ton machine for more than 20 minutes, truly enjoyed it); he never saw it after its completion.  The passage of the American Pacific Fleet through the Canal when they returned from WWI in 1919 took place seven months after his death.  This is the scene he envisioned and would love to see.

It was also a story of the conquest of the disease in the jungle, such as malaria and yellow fever, a remarkable story of Dr. William Goethals, who later served as the head of the Army Medical Service during WWI and died of stroke in London in 1920.  King George visited and knighted him in the hospital before his passing.

Many persons were in charge of the project on site, George Goethals (a West Pointer) impressed me the most.  He was buried at West Point Academy in 1928, I’ll look for his grave next we visit West Point.

David McCullough is my favorite historian, a prolific one.  Jo gave me his Truman many years ago.  His John Adams is one of the best books I read about Adams (I bought one after reading the library copy).  His In the Dark Street Shineth: A 1941 Christmas Eve Story is my favorite story of Churchill and FDR.  His recent book, The Greater Journey: Americans in Paris, which unfortunately covers the Americans in Paris in 19th century only, the likes of Oliver Wendell Holmes, Samuel Morse, and Charles Sumner (I know him well through reading Lincoln; he accompanied Lincolns on their last visit to General Grant in early April 1865.  Mary respected him and got along well with him.)  The 20th century American expatriates, such as Gertrude Stein, Hemingway, and F. Scott Fitzgerald are not covered for a good reason though, as the theme of the book is about how France/Paris created/influenced the creation of America as we know her.

Grow old with me! The best is yet to be

The other day Jo called to say Happy Anniversary to Katy and asked how many years we have been married.  After hearing Katy said “xx” years (Katy gave me no permission to reveal the top secret), Jo let out a big exclamation repeating and emphasizing that “xx” years!

One shouldn’t ask a woman of her age, nor her years of anniversary, which invariably tells her age more or less.  One doesn’t ask a man, he doesn’t remember any way.  Oscar Wilde said this in his A Woman of No Importance, “One should never trust a woman who tells one her real age. A woman who would tell one that, would tell one anything.”  Katy is not quite like Lady Astor, otherwise, she is going to say “I refuse to admit that I am more than 52, even if that makes my daughters illegitimate.”

The same is also true that one doesn’t ask one’s lovely wife (老婆, 老伴兒) “How many Christmas have we spent together?”  (see the today’s Pickles comic strip at Observer-Reporter)  Fortunately the number of our years together is not quite “mind boggling”.  Merry Christmas to all, and to Katy, let me borrow from Robert Browning,

Grow old with me!

The best is yet to be.

Give the gift of knowledge

The other day I saw a greeting card displayed on the check out counter at Waynesburg University Eberly Library saying “Give the gift of knowledge”; the most precious gift, after the gift of life.

And this is the gift I received today; I received two books sent from Amazon.  One is Churchill by Himself edited by Richard Langworth; the other is Farnsworth’s Classical English Rhetoric.  I checked out these two books October from the two local libraries and I've been allowed to renew repeatedly since no one requested for them.  I told Janice I began to feel guilty in keeping the renewal.

The two books come with two gift notes from Janice (see photo).  Daughter knows father the best.  In the first 10 years of my coming to America, all I read was medicine or science, and then I began to read scientists who can write, the likes of E.O. Wilson, James Watson, and Richard Hawkins.  It was Lincoln and Churchill that led me to discover the beauty of English language.  I have been reading these two literary giants for almost 30 years and am still reading; reading them or about them.  Churchill is a Nobel laureate in literature, Lincoln would deserve it had he lived after 1900, the year the Nobel Prize began.

In the book (inside) cover of Farnsworth’s rhetoric, one read “Masters of language can turn unassuming words into phrases that are convincing, effective, and memorably beautiful.  Lincoln and Churchill had this power; . . .” I immediately know this is my type of book.

I am reading “366 Days in Abraham Lincoln’s Presidency”—a free online eBook (published in 2010) loaned from Amazon through my Prime membership.  I have read “tons” of books by Lincoln and about Lincoln, and I still discover something new every month, if not ever day.  When Lincoln made the unprepared farewell address at Springfield railroad depot that began his 12-day inaugural train journey to D.C.  Mary Lincoln was not there.  She did join Lincoln at Indianapolis.   I never knew why.  I even read one book saying Mary threw a tantrum and refused to go with Abe that morning.  I read “Mary was shopping in St. Louis and joined him at Indianapolis.” in this “366 days” book  This shows how Mary was treated unfairly in history.  Mary also went to NY City with Robert (eldest son, the future Harvard man) for a shopping spree for two weeks to make sure she had the First Lady dress and accessories and returned to Springfield two days late.  The poor Abe went to the train station and came home alone two days in a row.

Steelers are playing for pride, revenge and control, not for the playoff berth, tonight

Yesterday was a good day, a victorious day for the Steelers, and they didn’t even play.  All the teams that are supposed to lose lost.  Steelers clinched the AFC playoff berth because Oakland, Tennessee, Denver and New York Jets all lost.  And better yet, with the Baltimore Ravens lost at San Diego last night, Steelers were propelled to the AFC North Division champ.

Taking advantage of this situation, the ankle-sprained Roethlisberger may play tonight to ensure a win, as Pouncey was out and Harrison is being suspended for one game.  This is not a Must Win game, but it is a game for pride, revenge and control.  Two of the three losses the Steelers suffered this season were at the hands of John Harbaugh’s Ravins.  And Steelers are to play Jim Harbaugh’s (John Harbaugh’s younger brother) San Francesco 49ers tonight.  If you cannot beat that Harbaugh (John), you got to beat this one (Jim).

The Big Ben should play or not tonight; to play or not to play, that is the question.  Mike Tomlin got paid to make this kind of tough decision.

PSA prostate cancer screening controversy: to do it or not to do it, that is the question

FDA approved PSA to be used to screen for prostate cancer in 1994, although it has been so used for many years prior (probably around 1986).  But, to screen or not to screen, that is the question (with no definite answer!)  To illustrate the complexity of the controversy I’ll first mention the most vocal opponent against using PSA to screen for prostate cancer is Dr. Richard Ablin (see photo, left), who discovered PSA in 1970.  He wrote an op-ed at NY Times (3/9/2010) “The Great Prostate Mistake”, in which he chastised the American Urological Association (AUA) for still recommending PSA screening ‘shamefully’.  He also wrote, “If the biopsy showed any signs of cancer, the patient was almost always pushed into surgery, intensive radiation or other damaging treatments”.

Patients are “pushed into surgery” for the “damaging treatments”, that is to say “shame on you, you urologists!”  Drug companies are not spared, he wrote, “Drug companies continue peddling the tests and advocacy groups push 'prostate cancer awareness' by encouraging men to get screened.”  To say ‘peddling’ is equivalent to “咱們的跑江湖賣膏藥的「王樂阿仙」”

Dr. Ablin concluded by saying “I never dreamt that my discovery 4 decades ago would lead to such a profit-driven public health disaster.”

Current U.S. Preventive Services Task Force does not recommend PSA screening for patients of any age.  What’s wrong with PSA screening?  I used it as one of the examples of “sensitivity and specificity” concept in interpreting the Lab tests during my talk at the Taiwanese Bible Study last month.

PSA (prostate specific antigen) is produced by the epithelial cells (上皮細胞) of prostate and is released to the blood stream.  PSA increases in the presence of prostate cancer as its production increases, as does the leakage into the blood stream.  And better yet 90% of prostate cancer detected by PSA screening show the cancers are confined to prostate or regional spread (no distant metastasis); the 5-year survival is almost 100%.  Prostate cancer diagnosed after patients become symptomatic (i.e. without PSA screening) are almost always too late.

This makes PSA screening much desirable and medically advisable.  No wonder 90% of US men (50 yr-old or older) have at least one PSA test.  However, the advantages stop here.

Vicious attack on AUA and drug companies notwithstanding, Dr. Ablin also made many sensible and legitimate comments, such as “American men have a 16% lifetime chance of receiving a diagnosis of prostate cancer, but only a 3% [2.9% to be exact] chance of dying from it. That’s because the majority of prostate cancers grow slowly. In other words, men lucky enough to reach old age are much more likely to die with prostate cancer than to die of it.”

An autopsy study shows two thirds of  men (of 80 years of age or older) died of any illness other than prostate cancer have prostate cancer; these people “die with prostate cancer than to die of it.”

If you read the Lab report you would see PSA of 4 is the upper normal limit.  But, in realty no one knows what is the normal upper limit of it.

In a 7-year study of 18,882 patients, 9,459 patients have annual PSA and digital rectal examination (DRE), 2,950 patients have prostate biopsy at the end of 7 years and 449 (ages 62-91) turn out to have prostate cancer.

  

The number of PSA among these prostate cancer patients spread all over from below 0.5 to way above 4.

            PSA                 0 - 5                             6.6%

                                    0.6 – 1.0                      10.1%

                                    1.1 – 2.0                      17.0%

                                    2.1 – 3.0                      23.9%

                                    3.1 – 4.0                      26.9%

                                    ---------------------------------------------

                                                                        74.5% (with PSA less than 4.0)

                                    greater than 4.0           25.5%

If 100 patients known to have prostate cancer and do PSA test, only about 25 (1 in 4) have PSA ≥ 4.0, that is to say that PSA test has 25% sensitivity.

A high sensitivity test is good to rule out disease.  For example, D-dimer test (elevated in cases of deep venous thrombosis or DVT) has nearly 100% sensitivity, that is to say if one has normal D-dimer, one doesn’t have DVT.  But PSA has such a low sensitivity (about 25% in this study), one has ‘normal’ (i.e. <4.0) PSA still doesn’t guarantee no prostate cancer.

Setting PSA 4.0 as a cutoff value, sensitivity is about 21-25%, setting PSA 3.0 as a cutoff value, sensitivity is 32%, so lower the number, increases sensitivity, but what about specificity?

A high specificity test is good to rule in disease.  If PSA test has a specificity of 100%, then if one has a PSA>4.0, then one has prostate cancer.  However, using PSA 4.0 as a cutoff value, its specificity is 91%, i.e. 9% of patients with a PSA>4.0 will turn out not to have prostate cancer.  Using PSA 3.0 as a cutoff value, the specificity is down to 85%.

I mention this dry statistical stuff to make a point that there is no such a thing as to what is “normal” PSA; setting PSA 4.0 as a cutoff is a “compromised” trade off between sensitivity and specificity. 

                       

Why is it so? the answer lies in the fact that there are many other conditions that will raise PSA, most commonly benign prostate hyperplasia; the list is as long as your arm, like Dr. Albin wrote, “Infections, over-the-counter drugs like ibuprofen, and benign swelling of the prostate can all elevate a man’s P.S.A. levels.”

Not all prostate cancer behave the same way; most are slow growing, but some can be aggressive.  One wrote in a letter-to-the-editor in NY Times claimed “roughly 30-40% of all prostate cancers are aggressive.” (see photo below).  I am not sure all urologists would agree with the number of 30-40%, though.  Unfortunately, PSA screening cannot differentiate between indolent and lethal [aggressive] prostate cancer.” 

The urologists have many tools at their disposal in predicting which will be more aggressive and treated accordingly; these evaluations are helpful, but by no means perfect.

^  Gleason score (after prostate biopsy)

^  PSA velocity (rate of increase)

^  ratio of free over bound PSA

^  PSA density (PSA divided by volume of prostate)

^  age

^  comorbidity

^  life expectancy

There are two major trials study the impact of treatment outcome of PSA screening.  One is from Europe: ERSPC (European Randomized Study of Screening for Prostate Cancer), the other from the U.S.: PLCO (prostate, lung, colo-rectal & ovary trial).  The ERSPC involves 182,000 patients in 7 European countries over 9 years period, whereas the PLCO involves 76,693 patients at 10 U.S. centers over 7-10 years period.  Both studies were published in the same issue (3/26/2009) of New England Journal of Medicine (NEJM).

The result is not favorable in pursuing PSA screening.  The ERSPC shows small absolute survival benefit after 9 years follow up.  Although there is 20% decrease in prostate cancer mortality in the group of ages 55-69, the absolute survival benefit is very small (a decrease in 0.7 death per 1,000 patients after 9 years follow up), and 1,410 patients have to be screened and 48 patients have to be diagnosed to have prostate cancer to prevent one death.

The “over diagnosed” issue comes into play.  If one’s prostate cancer never would have caused any problem during his life time, and it is picked up because of doing PSA tests and is therefore subject to surgery (radical prostatectomy) or radiation therapy, resulting in complication or undesirable consequence, such as erectile disorder (20-70%) or urine incontinence (15-50%), then this is “over diagnosed”.  Over diagnosed may lead to unnecessary treatment and the potential complications.

The PLCO study shows no mortality benefit from annual PSA screening in 7-10 years of follow up.

This is what led the U.S. Preventive Services Task Force to recommend no PSA screening.  However, American Cancer Society still recommends the PSA screening begins at age of 50, while AUA at age of 40 (see photo below). 

PSA is very good in monitoring the progress of prostate cancer treatment or recurrence; there is no controversy about it.

The way Dr. Ablin criticizes the AUA is not fair.  The urologists are the ones seeing all the troubles, complications and suffering of prostate cancer patients.  This is not 飯碗的問題 (not a matter of making a living); in fact, the urologists end up making more money in taking care of complicated prostate cancer patients.

Keep in mind that Dr. Ablin is a Ph.D., not an M.D., let alone an urologist.  A super scientist though he may be, he may lack the knowledge and understanding of the relevant clinical problems and idiosyncrasy of individual patient.

USPSTF is supposed to be a government (federal) agency; one may wonder their stand and recommendation put more weight on the cost than the benefit of individual patient.  They caused an uproar two years ago when they announced the mammogram can be done every two years, instead of every year, and begins at age of 50, instead of 40.  Is this the Obama Care to come?

One thing for sure is that a PSA test shouldn’t be requested (by patients) or ordered (by doctors) without a through counseling, which will be a daunting task.  The photo is the cover of the British Medical Journal illustrating the importance of physician patient partnership.  It is not as graceful as the image implies.

上醫醫未病之病

中醫醫將病之病

下醫醫已病之病

This is from 黃帝內經.   Prevention is not as easy as it seems.  It is not easy to be a 上醫.  The issue of PSA screening also demonstrates the wisdom of 黃帝內經.

This writing is to help you understand the complexity and dilemma of a medical controversy.  Is a PSA test right for you?  Only you and your doctor can make the decision.  The last slide of my talk quoted what Enrico Fermi said in 1938,

 “Before I came here I was confused about this subject, but now having heard your lecture I am still confused, but at a higher level.”

After reading this, if you’re still confused, hopefully at a higher level, then the purpose of this writing is served.

Speaking of PSA, I have to mention a very popular book in Taiwan (Family Medicine series) “攝護腺肥大: 小 Case” (see photo) written by an urologist Dr. Chung Cheng Wang (王炯珵).  It is a well written, comprehensive and informative book, every thing you need to know about prostate gland; a must read book by men as well as by women for their loved ones.   

Dr. Wang (王炯珵) was a research fellow at UPMC about six years ago.  When he came to attend the annual American Urology Association meeting at Washington, D.C. this past May, he made a side trip to Mount Vernon with us—a fond memory.  The photo shows Dr. Wang and Katy at the back yard of George Washington’s House at Mt. Vernon, overlooking the majestic Potomac River in Northern Virginia.
 

Katy’s report to 日報: National Taiwan University Alumni Luncheon at Pittsburgh

Katy’s dispatch to the World Journal (世界日報) reporting the National Taiwan University (NTU) Alumni Holiday Luncheon was published today (Dec. 15).  It was held at Monroeville City Buffet on December 11.  The initially scheduled speaker was 許倬雲, the faculty member (院士) of Academia Sinica (中央研究院), who was unfortunately not at his best health and unable to attend the luncheon that day.  The arrangement was made to obtain a new speaker, Charlie Chian (簡豐源), who is a NTU alumnus with a Bachelor of Arts in Law degree.

(You may read directly online)

http://www.worldjournal.com/view/wjnjpanews/16789888/article-%E5%8C%B9%E8%8C%B2%E5%A0%A1%E5%8F%B0%E5%A4%A7%E6%A0%A1%E5%8F%8B%E6%9C%83%E8%81%9A%E9%A4%90?instance=nj2

 

Chen’s topic is about the Long Term Care Insurance.  He pointed out many things worthy of attention and emphasized that the insurance company selected has to be state-approved.  He jokingly said that thing would be simple and easy if one is poor; the state will take care of the poor as long as one’s asset or bank deposit is less than $2,000, otherwise one would have to pay all the expenses.

He reminds every one of the importance of designating beneficiaries for the pension and life insurance.  It has to be clear and exact, such as writing the specific names, instead of “children”.  He suggested asking for POD (payable-on-death) for bank accounts and TOD (transfer-on-death) for stocks and brokerage accounts as well as joint tenancy with right of survivorship.

Living trust is more complicated.  Each individual can give $13,000 to each of his or her children or even relatives or friends.  It is not advisable to give away the money too soon.  Chen mentioned an example.  Mr. so and so gave money to his married daughter who died in a car accident; the money went to the surviving son-in-law, who remarried and also met his accidental death.  The money went to his widow; the result is none of the grand children of Mr. so and so will get any money.  Setting trust would be the solution, the more trustees the better.

NTU is a national university, its tuition is traditionally lower than that of private universities.  In order to fund the scholarship and keep the world class teaching faculty, the university has been fund raising asking each alumnus to donate $100 every year to 「台大永續基金」。「百元美金，台大躍進。三千細水，台大長流」is the fund raising slogan.  This effort will propel NTU into the World Top 100 Universities.

In order to promote and strengthen the contact between the university and alumni, the university encourages the alumni to apply for Alumni Card (台大校友證), with which the alumni can enjoy the resource and various benefits of the university.  For further information, please visit http://www.ntu.edu.tw . (Katy Tsai, 張瓊月)

(the following is Katy’s dispatch)

匹茲堡台大校友會聚餐

【賓州匹茲堡訊】 世界新聞網 北美華文新聞、華商資訊

December 15, 2011 06:00 AM 

匹茲堡台灣大學校友會日前在夢諾維爾的市區饗廳（Monroville City Buffet）聚餐。原計畫邀請中央研究院院士許倬雲演講「國際風雲」，由於高齡80的許倬雲身體違和，不克出席，臨時改由台灣大學法律系校友簡豐源演講。

簡豐源演講主題是「購買美國老人的長期照顧保險注意事項」。他指出，最主要的是不管買那一家的保險，都必須注意是向該州有認證旳保險公司購買。如果沒有錢，反而簡單，如果銀行存款只有2000元，政府將補助長期照顧。如果有錢就只要自己付費。

他 提醒大家注意退休金、人壽保險的受益人，要清楚註明，避免日後被清算付稅。他建議可到銀行把存款帳號免費做 POD（payable-on-death），還有股票帳號做 TOD（transfer-on-death）。兩人聯名的帳戶，如果一方死亡，就直接全部歸屬另一人。

簡 豐源說生存信託（living trust）就比較複雜。每人每年可以給子女或親友1萬3000元，但必須報所得稅時有紀錄才行。不要太早把錢分給子女。他舉例，某人把錢分給女兒，女兒 意外死亡變成女婿的錢，女婿再婚後又出意外，錢財落到遺孀手上，親外孫反而拿不到錢。所以他提議最好為可能喪偶的家人或小孩預先設立信託基金，多找幾位信 託人。

目前因為台大是公立大學，向學生收取學費比其他私立大學低廉很多。為確保能多發獎學金及保持世界一流教學品質，希望校友響應每人每年「百元美金，台大躍進。三千細水，台大長流」，支持台大進入世界百大，捐款贊助「台大永續基金」。

另外為了加強學校與畢業校友之間的連絡，方便校友共享學校資源，台大歡迎辦理台大校友證，憑證可享受各種優惠。詳情可上網查詢 http://www.ntu.edu.tw。（張瓊月)

Fredericksburg, VA was a slaughter-pen today (Dec. 13) in 1862

Lincoln in 1862

Union army suffered a major defeat in Fredericksburg, VA (George Washington’s boyhood home) today, December 13, 1862.  Union casualties were 12,650 and Confederate losses 5,300.  Watching the carnage, Robert Lee said, “it is well that war is so terrible, or we should grow too fond of it.”  Andrew Curtin, Pennsylvania Governor, returned from Fredericksburg battlefield and visited Lincoln around midnight.  Lincoln asked, “Well, Governor, so you have been down to the battlefield?”, to which the Governor responded, “Battlefield? Slaughter-pen!  It was a terrible slaughter, Mr. President”

The above is from “366 Days in Abraham Lincoln’s Presidency” by Stephen Wynalda (published in 2010).  I am reading it online free, thanks to my Amazon Prime membership through my purchase of Kindle Fire.

In Carl Sandburg’s Lincoln, we read the PA Governor said, “Mr. President, it was not a battle, it was a butchery.”

General Burnside

Lincoln’s general was Burnside (photo credit: “A. Lincoln: A Biography” by Ronald White, Jr.), who was charismatic and honest, but lacked intelligence and confidence to be a great general.  It was said he possessed “ten times as much heart as he has head.”  The political ramification following this defeat and disaster really depressed Lincoln more than any event of his life.

No wonder Linclon aged in his four-year Presidency.  This picture of Lincoln was taken by Mathew Brady in 1862 (credit to “Team of Rivals: The Political Genius of Abraham Lincoln” by Doris Kearns Goodwin).

士林夜市小吃 (Shih-Lin Night Market snacks) and tones of Chinese language

Mae Hwang sent us this YouTube of士林夜市小吃.  This may make some of you home sick.  This also reminds me of a story that happened in 1993 when Janice was sent to a summer camp at Taipei by the Overseas Chinese Affairs (僑委會).  One day she called saying she went to a Shih-Lin “Yes” market (士林夜市); it took me a long while before figuring out she was not talking about Yes or No, it is Yes (夜市, night market)—both has 4^th tone, not “Yes” that has 3^rd and 1^st tone.

 

The four pitched tones of Mandarin Chinese make the learning of it by Americans all the more difficult and confusing.  Someone told me there are nine tones or more in Taiwanese; I am not aware of it.  If one has to learn the tones of a language then that language is not his or her native tongue.

http://www.youtube.com/watch?v=5O7_0rTX-WQ&feature=youtube_gdata_player 

Yamamoto: the man behind the Pearl Harbor Attack on December 7, 1941—A date of infamy

Seventy years ago today (Dec. 7), which as FDR said, has lived in infamy.  Admiral Isoroku Yamamoto (山本 五十六) masterminded the sneaky Pearl Harbor attack.  Ironically if Yamamoto had his way, this wouldn’t have happened.  Not only was he against the Tripartite pack (Rome-Berlin-Tokyo), he was also opposed fighting with America.  Not that he was pro-America; he knew very well that Japan couldn’t win the war with America in the long run.  He said, “I shall run wild considerably for the first six months or a year but I have utterly no confidence for the second and third year.”  He was prophetically correct as the Battle of Midway (June 4-7, 1942) proved the turning point of the war in favor of America.

I always wonder what would have happened to Yamamoto on the post-war war criminal trial had he survived the war.  His aeroplane was shot down over Solomon Islands on April 18, 1943 after a Japanese message was decrypted by the American Pacific Fleet’s Radio Unit.  America couldn’t rejoice and celebrate in public, lest Japan would suspect their secret code was broken.  This is the ultimate revenge for the Pearl Harbor attack.

Yamamoto spent two years studying at Harvard (1919-1921), exactly the same time when Lin Yutang (林語堂) was at Harvard (Lin entered Harvard in 1919 and left for France then University of Leipzig in Germany in 1921, where he obtained his Ph.D.) I wonder whether Yamamoto and Lin met during their stay at Harvard.  It was said that Yamamoto read all books about modern naval warfare in Harvard libraries.  Lin Yutang also said it was at Harvard Widener Library where he “first found himself and first came alive.”  I visited Widener many times, but never had time to stay long enough to experience exhilarating feeling as Lin did.