Yes, Ben, there is a Santa Clause

If you read my blog diligently (I can count the number of people who read my blog with my fingers and with one hand) you may know there is indeed a Santa Clause as I visited him and did a consultation on him at MGH.
http://doctorjytsai.blogspot.com/2011/12/my-consultation-note-at-mgh-on-santa.html

Ben also spotted Santa peeking in from the window in the early morning of Christmas (Sean must have forgotten cleaning up the chimney) and quickly invited him in.  

 

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.” 

My reindeer Christmas card from Ben

This is my reindeer Christmas card from Ben.  It says,

“This isn’t just a reindeer as you can plainly see.  

I made with my hands which are a part of me.

It comes with lots of love especially to say,

I hope you have a very, Merry Christmas Day!

Ben says: Dinosaurs rule the world

Ben is presently fascinated by dinosaurs; Rex (Tyrannosaurs rex) is a buzz word to him. One day Janice and Brian baby sat Ben and Gabby and they went over many dinosaurs books with Ben. They taught Ben lots of things about Dinosaurs, or so they thought. Ben has already been quite knowledgeable about dinosaurs; I am not sure who taught whom in that reading session.

Ben asked Janice and Brian “did God make dinosaurs?” (I thought he was in the ‘creation’ camp), but he also asked “did we come from dinosaurs?” (This is obviously a school of thought about ‘evolution’). Ben has learned to cover all the bases.

When Joy was home after Christmas we brought her to PPG Place to see the Winter Garden (to see the gingerbread house, life-sized Santa Claus of all countries, ice skating rink and all). With Ben in mind, we took many pictures with the three lovely dinosaurs (permanent display there); oh! How we wish Ben could be there! Next time when Ben comes back to the Steel City; moves over, Phipps Garden, instead we’ll be at Carnegie Museum (of Natural History) to see an army of dinosaurs.

You’ll see lots of photos of Ben sporting his favorite dinosaurs (Rex) pajamas.

A visit to Jo and Sean’s cottage by Lake Huron

Jo and Sean took us to see their cottage by Lake Huron. This was in the deep of the winter; the photos showed we’re actually walking on the surface of the lake. We saw people snow mobiling on the lake. You’ll notice we’re all walking/standing very close together; an instinct to get the body heat against the chilling cold; one cannot hold the camera without gloves. We’ll visit it again when summer comes; it’ll be a totally different view and feel.   (may click the photos to enlarge them)

We’re lucky enough to see the spectacular after glow when the sun set on the lake.

Santa Claus helper came to town visiting Ben and Gabby

The day before Christmas Ben and Gabby were busy making cookies for Santa Claus and his reindeers. They did it with Aunt Janice, who has a cooking skill of a professional chef and Aunt Joy, who says she has a skill of a pastry cook. Santa Clause did come and enjoy the cookies they made. Being considerate, Ben and Gabby also provided a cup of milk.

(may click the photos to enlarge them)

These photos also documented the visit by the Santa Clause helper.

Christmas 2010

We had a treat at Gloria and Tom’s new home on Christmas Eve.  You’ll see Gloria and Tom need a bigger countertop for the so many scrumptious dishes they prepared for us; it was good food and good company.  Gloria’s potato casserole was the best potato I ever had.

Ah-Ma was treasuring this cozy moment with Ben and not watching the cartoon!

Ah-Gong got a treat from Gabby and Papa got a trick; Gabby was pretending giving Papa a gift!

Ben and Ah-Ma are snuggling, having a light moment!

  
Princess Gabby is getting another gift from Nana!

 Merry Christmas!

We played a counting game with Ben who was rewarded with $1 for each number he counted in sequence without making a mistake, i.e. he would get $20 if he counted up to 20, $30 if up to 30, and so on.  He stopped after counting to 50; either he was not too greedy or he didn’t want Ah-Ma and Ah-Gong to go broke.

Gabby is sporting her new earrings.  Also pay particular attention to see what magazine she is reading.

Katy was meeting with a new friend—an almost too friendly Loki.  I initially thought he was Locky and wonder whether he was named after John Locke—the English philosopher and is generally considered the father of liberalism.  But, Jo told me he was named after a god in Norse mythology; may not be more noble, but more mystical than I thought.

The cartoon is as captivating to mom as it is to Ben and Gabby.

黃壬辰 那位大小孩的專注，不輸 Ben 跟 Gabby. (The Big Girl is no less absorbing than Ben and Gabby are.)

This is why I tried not to put “The Big Child” (大小孩) in the picture lest she may steal the show of Ben and Gabby.  But, Jo strategically placed herself in between.

Gong-Fu demonstration! This is why I learn not to mess up with these gals!

Gabby was reading on her Facebook page on her laptop; I think she was sending “be my friend” requests to Ah-Ma and Ah-Gong.

For those who are Taiwanese challenged, Ah-Ma is grandma and Ah-Gong is grandpa (and that happens to be me, NOT papa).  After reading this, Tom will be busy sending a “be my friend” request to Gabby.

What’s on TV that freezed Gabriella’s fingers interrupting her art work?

The three Rockettes were rehearsing for the Christmas Spectacular at the Radio City Music Hall.