The incomparable Steve Jobs

Photo is taken from Isaacson's Steve Jobs

Walter Isaacson said history will place Jobs in the pantheon right next to Edison and Ford.  Many (me included) wouldn’t buy the comparison.  But, what Jobs had accomplished is “insane”, which like “Think Different” is Apple’s advertisement buzzword.

If you admire Jobs you’ll revere him after reading Isaacson’s Steve Jobs.  Some physicians at Sermo argued that Jobs took too much credit saying he was not the man of science or technology; he never invented anything.  But, it is fair to say that without Jobs, there would be no Apple II, Macintosh, Toy Story, iPod, iPhone, iPad, iTune store and Apple store--the things that made Apple the most valuable company on Earth, surpassing Exxon-Mobil.

What is more amazing is that the most creative and innovative products, the likes of iPhone, iPod, and iPad all came out after Jobs first fell ill with a terrible disease (rare pancreatic cancer, liver metastasis, liver transplant and bone metastasis, etc.) in 2003.  iPod first came out in 2001, but has evolved over the years under his watch.  Facing such dreaded disease, almost all mortals cannot function, let alone doing such creative work.

Jobs may not be a man of science/technology, but he sees the beauty of the intersection of artistry and technology or that of humanity and science.  All of his innovative products reflect this philosophy.  Upon his coming back to Apple in 1997, at which time Apple was heading for bankruptcy, he told the employees “The products suck!  There is no sex in them anymore.”   

Steve Jobs and Yo Yo Ma and his wedding

I often write about the book I read, rarely did I preach one to read it, as reading has to be a personal taste and temperament thing.  I will make an exception for Walter Isaacson’s Steve Jobs, the book I just read; I will have many posts (writing or copying) so you may pick it up.

At the end of Chapter 32 (Music Man), there is a paragraph about Yo-Yo Ma; they first met at Aspen in 1981.

“Jobs tended to be deeply moved by artists who displayed purity, and he became a fan [of Ma].  He invited Ma to play at his wedding, but he was out of the country on tour.  He came by the Jobs house a few years later, sat in the living room, pulled out his 1733 Stradivarius cello, and played Bach.  'That is what I would have played for your wedding,' he told them.  Jobs teared up and told him, 'You[r] playing is the best argument I’ve ever heard for the existence of God, because I don’t really believe a human alone can do this.'  On a subsequent visit Ma allowed Job’s daughter Erin to hold the cello while they sat around the kitchen.  By that time Jobs had been struck by cancer, and he made Ma promise to play at his funeral.” And Ma did.

Jobs married Laurence Powell at the Ahwahnee Lodge in Yosemite National Park on March 18, 1991.  It was conducted by his Soto Zen teacher, Kobun Chino, who “shook a stick, struck a gong, lit incense, and chanted in a mumbling manner that most guests [about 50] found incomprehensible.” The wedding cake was in the shape of Half Dome [a landmark at Yosemite].  After the ceremony they all went hiking and Powell’s three brothers launched a snowball fight, and Jobs said to his sister, “Laurence is descended from Joe Namath and we’re descended from John Muir.”   

Six weeks before we went to Yosemite National Park last August, we couldn’t get a reservation in the same hotel (Ahwahnee Lodge).  We did visit the hotel while driving around to find a parking space.  John Muir lamented about too many visitors/tourists that came by horses and buggy in 1880s.  Muir would have passed out if he could have seen that many cars we saw that day.

Last year when he was already terminally ill Jobs went back to the same hotel on their 20^th wedding anniversary.  The hotel was again booked and a nice guy gladly let Jobs take the room.  

So I think I can dance?

Last Saturday we’re invited to attend a party at Murrysville area; good food, good company and good dancing.  We’re the only new comers for a congenial group.  The gracious hostess and her physician husband are well known elegant dancers of professional caliber, just like the couple shown on the cover of this British Medical Journal (BMJ)—see photo.  They opened their hearts and arms to welcome us to their home and their friends.

Their house, nay, mansion, has a spacious dancing studio that allows electric slide or macarena dance for thirty some people without feeling too close for comfort.  The hostess is a terrific dance instructor; she even gave us (Katy and me) individual lesson—she must have found the daunting task most challenging.  A very sympathetic Pitt professor pulled us away from the group, teaching us a few trick steps so that we can get by with all sorts of music and rhythm, in other words, 學了這幾步, 就可以混下去了, so he claimed.

We dropped out, or more precisely kicked out, of a dancing studio at Monroeville some years ago.  We took the private lesson once a week; feeling confident after a month we wanted to continue, but the frustrated dance instructor politely said, “I think you’re too busy,” and that was the end of the education of my dancing; my dream of getting on Dancing with the Star evaporated; at stake was his reputation.  It turned out our hostess also has the same dance instructor.

The dance lesson we had last Saturday rekindled our interest; after coming home, we 發奮圖強, unfortunately we have forgotten the electric slide and macarena steps that we’re supposed to practice.

Thanks to the hostess’ instruction, for a short while I think I can dance? It is just an illusion, then I realize 我沒有跳舞的細胞.  Through no fault of my own, my genes and neurons (nerve cells) are to blame.  I even have scientific report to back me up.  The article (“So You Think You Can Dance?: PET Scans Reveal Your Brain’s Inner Choreography”) was in the June 16 2008 issue of Scientific American.  The link allows you to read the first two paragraphs only. This is the neuro science of the dance; this is how I keep my neuro science up-to-date.

http://www.scientificamerican.com/article.cfm?id=the-neuroscience-of-dance

 

Lincoln in 1861

I am not alone in lacking the “dancing neurons”; Abe Lincoln was also a victim.  When Abe and Mary first met in a party in Springfield, Illinois, Abe went to Mary asking for a dance saying he wanted to dance with her “in the worst way” (the way I dance) and he did.

  

On the Inauguration Ball (rightly called Union Ball) on March 4 1861 Mary was whirling in the arms of Stephen Douglas (then a U.S. senator); Lincoln’s heavy heart was far away in the Fort Sumter, South Carolina. The Confederate gun fired on Fort Sumter on 4/12/1861 marked the beginning of the Civil War.

Apple design chief Jony Ive was knighted: Steve Jobs would have been pleased

Today (Jan. 11) WSJ reported that Apple Inc. Senior Vice President London-born Jonathan Ive has received a knighthood for his work in leading the design of many most innovative products, the likes of iMac, iPod, iPhone and iPad.

Steve Jobs would have been very pleased about this news. Ive joined Apple’s design team in 1996, a year before Jobs was called back as iCEO (initially interim CEO, then indefinite CEO).  Their collaboration made Apple the most valuable company in the world pushing past Exxon.

In the 26th Chapter (the photo of Jobs & Ive comes from) of Steve Jobs (Design Principles), Jobs described his respect for Ive,

“The difference that Jony has made, not only at Apple but in the world, is huge.  He is a wickedly intelligent person in all ways. . . If I had a spiritual partner at Apple, it’s Jony.  Jony and I think up most of the products together . . .”

Almost everyday when Jobs was not ill, he would have lunch with Ive and then wander by the design studio in the afternoon.

Steve Jobs: The man of vision and his medical mind

What’s Steve Jobs got to do with Your Medical Mind, the two books that I am reading?  Dr. Jerome Groopman was one of the many (70+) speakers when I attended the meeting in Boston last October.  I read Groopman in the Wall Street Journal or The New Yorker, and always wanted to read his How Doctors Think, but never did.  I am half way through his (and his wife, Dr. Pamela Hartzband’s) Your Medical Mind.

Your Medical Mind talks about the process with which patients make their medical decisions.  I am taken aback by Steve Jobs’ medical mind as much as by his ingenious ‘brain children’, the likes of iPod, iPhone and iPad or even the Apple stores.

I initially had some reservation in reading Steve Jobs, as it may not be a true biography, but an authorized semi-autobiography, judging on the degree of cooperation from Jobs and his family that Walter Isaacson enjoyed.  I felt reassured on reading the chapters (Round One, Round Two and Round Three) about his illness—nothing but honest, even Jobs’ regret about his decision in delaying the needed surgery for nine months was mentioned.

His rare pancreatic cancer (pancreatic neuro-endocrine tumor, still a malignant one—slow growing thought it may be) was discovered serendipitously by a CT scan that was ordered for a kidney stone.  The biopsy was done in the evening of the CT scan and his wife remembered her husband’s doctors “tearing up with joy.  It turned to be an islet cell or pancreatic neuro-endocrine tumor, which is rare but slower growing and thus most likely to be treated successfully.”

Some may say that Jobs blew it by refusing the surgery that was obviously recommended; instead he looked for the alternative medicine by following strict vegan diet, organic herbs and “other treats found on internet, frequent bowel cleansing, hydrotherapy or even the psychic.”  None of the best doctors at Stanford and his loved ones could convince him of the need of the surgery until nine months later when the tumor (cancer) had spread to the liver.

Arthur Levinson, a close friend of Jobs and Genentech chairman (former CEO), who has a background of cancer biology.  Levinson “pleaded every day” and “the fight almost ruined their friendship.”  Andy Grove (the Intel co-founder and former CEO) is Jobs's neighbor, who came to stay with Jobs for two hours when the cancer was first diagnosed.  Grove also failed to persuade Jobs to have surgery.

Malignant neuroendocrine tumor is a complicated one, behavior of which is still elusive, on no can be sure whether Jobs could have a cure had he consented to the surgery in October 2003, instead of July 2004.  After reading Groopman’s book, it is still beyond me to understand the health literacy of one who is a ‘genius’ in the line of his work and a man of vision.

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.  

 

Eight CEOs from Shanghai IT companies visited Pittsburgh

(Katy’s dispatch to the World Journal, 世界日報 reporting Shanghai’s IT promotional and networking reception was published on January 6.  The reception was held at LeMont Restaurant, Pittsburgh on January 3.  You may read directly the online version,
http://www.worldjournal.com/view/wjnjpanews/17004514/article-8%E4%B8%8A%E6%B5%B7IT%E7%94%A2%E6%A5%AD%E4%B8%BB%E7%AE%A1-%E8%A8%AA%E5%95%8F%E5%8C%B9%E8%8C%B2%E5%A0%A1?instance=panews 

The eight members from Shanghai IT Enterprises and Shanghai Entrepreneur Business Promotion (上海創業環境推介會) visited Pittsburgh by way of California.  The main purpose of the visit was to recruit the overseas Chinese IT talents and entrepreneurs to Shanghai to work or invest.  Shanghai is presently planning the reduction of business tax for IT industry.

The director of Shanghai Information Service Outsourcing Development Center (iiSO or 上海市信息服務外包發展中心), 徐龍章, introduced the entrepreneur business environment in Shanghai.  There is an urgent need for the overseas Chinese high tech IT talents to participate.  It is estimated that there have been more than 23,800 people setting up business in Shanghai.

上海市軟件信息產業及上海創業環境推介會3日在匹茲堡舉行。右起：涂子沛、徐龍章、蔣瑋琪等彼此交流資訊

In addition to 徐龍章, there were relevant government department heads and CEOs from the eight major companies in Shanghai: 吳衛平 (President of  Shanghai Huateng Software Co.), 迮曉昕 (Vice President of Neusoft, Shanghai), 潘恩林 (CEO of Shanghai Interactive Entertainment Limited), 葉劍 (Vice President of Shanghai Tri-d Information Industry Co.), 周懌 (President of Shanghai SEARI Intelligent System Co.), 蔣瑋琪 (Director, Europe-American Dept., Shanghai Hyron Software Co.), 邊瀅 (Vice President of 靈臻 Venture Capital Invest Co.)

The group invited the overseas IT talents and entrepreneur enterprises to enquire.  They would be very glad to provide the relevant information regarding the investments environment in Shanghai, the government high-level recruit policy that encourages the students study abroad to return to China.

The president of Chinese Association for Science and Technology, Pittsburgh Chapter (CAST-P), 涂子沛, introduced Pittsburgh to the group, he pointed out that Pittsburgh has been selected as the Most Livable City in U.S.A. many times.  Pittsburgh has since evolved from the Steel industry to the IT high tech and advanced healthcare center.  It is a logical and worthy consideration for the major Shanghai companies to set up a branch office in Pittsburgh.

涂子沛

Shanghai IT Enterprises and CAST-P signed the cooperation agreement.  Opportunity of face-to-face communication and net-working was provided at the end of the dinner meeting.  It is hoped that the trip will bear fruit in recruiting the overseas IT talents and entrepreneurs by offering the incentive and the preferential taxing policy.  (Katy Tsai)

(The following is Katy’s dispatch)

8上海IT產業主管 訪問匹茲堡

【賓州匹茲堡訊】 世界新聞網 北美華文新聞、華商資訊

January 06, 2012 06:00 AM

上海市軟件信息產業及上海創業環境推介會八位團員，3日由加州轉到匹茲堡訪問，此次活動主要是尋求海外華人有意到上海工作或創業者，上海目前正研究減免軟件企業的營業稅.

周懌（上海電科智能系統股份有限公司人力資源部經理）簡介所屬公司

上海市信息服務外包發展中心主任徐龍章向與會人士簡介上海創業環境。現在急盼更多海外高級人才參與合作。據統計，迄今已有2.38萬人在上海創業.

徐 龍章一行包括上海創業和就業政策相關政府部門負責人及各大公司總裁CEO等八位主管。除徐龍章外，還有吳衛平（上海互聯網軟件有限公司董事長）、迮曉昕 （東軟集團上海有限公司副總經理）、潘恩林（上海盛大網絡發展有限公司盛大旗下邊鋒集團CEO）、葉劍（上海眾達信息產業有限公司副總經理）、周懌（上海 電科智能系統股份有限公司人力資源部經理）、蔣瑋琪（上海海隆軟件股份有限公司歐美事業部部長）、邊瀅（靈臻投資管理有限公司副總經理.)

上海市信息服務外包發展中心主任徐龍章

他們表示歡迎海外人才及創業團體洽詢，樂意提供上海投資參考資料、國內政策鼓勵海外留學生的高層次人才招才計畫.

中國旅美科技協會匹茲堡分會主席涂子沛3日也在會上簡介匹茲堡。他認為匹茲堡多次被選為全美最宜居住的城市，匹茲堡早已由鋼鐵轉型為IT科技及醫療產業的重要城鎮。他說中國國內企業可以考慮到匹茲堡開創分公司.

上海市信息服務外包發展中心和匹茲堡旅美科技協會在會上簽定合作協議。最後讓大家面對面交流上海創業機遇和引進海外人才的優惠政策，以及與上海頂尖高科技公司的高級主管交流招聘和就業機會，希望此行到匹茲堡有好成果。（張瓊月)  

秦新喜，(業務主任，Management Science Association,Inc.)簡介MSA公司

   
        

How many books should one read a year?

Some years ago Janice said she read about 40 books a year; we talked about it again last week and I said I try to read 100 books a year.  Two books a week! It is not realistic, she said.  I am always of the opinion that one doesn’t need to read a book page to page to get benefit or to enjoy it.  It is practical and reasonable to set the goal of reading 40-50 books a year (page-to-page or at least 90-95% of it), and have your hands on another 40-50 books that you may read part of it.

I finished reading Billy Graham’s Nearing Home in two days this week (at age of 92, hopefully this won’t be the last of his many books).  Rarely did I read spiritual books.  Graham can quote the Scripture alright; one cannot read a paragraph without a quote or two, all very relevant.

Not all the books I read are serious; I am reading Bill Maher’s New Rules.  It is a good-for-nothing book that many would trash.  The subtitle of the book is “Polite Musing from a timid observer”—he is every thing but polite or timid; he can be rude and outrageous, his language is not for the faint hearted.  But, he is obviously talented and has an opinion of his own, and some of them make sense or get on one's nerve.  He was a favorite guest of Larry King’s show.  He always emphasizes he is a comedian and should be treated as such.

I mention these two books to show one can read several books a week.  It’ll take “forever’ to read Moby-Dick, though. One can also read this booklet, Why read Moby-Dick, in one day, especially if one has read Moby-Dick.

 

I mention these two books to show one can read several books a week.  It'll take 'forever' to read Moby-Dick or Middlemarch, though—the two novels I am determined to tackle this year.  One can also read this booklet, Why Read Moby-Dick, in one day.

 

Katy’s report at 世界日報: Tom Chen’s lecture series and fashion show

(Katy’s dispatch to the World Journal (世界日報) reporting Tom Chen’s lecture series and fashion show was published on December 14.)

Tom Chen (陳世瑞), the successful industrial entrepreneur in Pittsburgh, had his “Blissful Life” lecture series (幸福人生講座) for the Chinese community the other day.  He brought down the full house of one hundred guests, talking about the secret of happy marriage and marital harmony.  Chen’s wife, 王麗華, was in charge of the fashion show—included in the program for the first time.

Chen has been very active in public affair with a philanthropic spirit.  His living philosophy advocates how to be “Straight A” parents and how to raise “Straight A” children in his talks.  He also traveled, as his reputation did, to Ohio, such as Columbus, to deliver “the chicken soup of the soul and mind” (心靈雞湯) lectures.

Studied and trained as a chemist, Chen is well read, mastering Confucianism, Buddhism and Taoism.  He practices what he preaches in the pursuit of blissful life, exemplary to his friends and families.

In his talk, Chen encourage every one to have a life goal of being a sage,  The word, sage (聖) is composed of a king (王), who uses the ears (耳) to hear and instruct with the mouth (口).  It takes the coordinated effort and to be in the right time and the right place, to be a sage.  What is the happiness?  It all depends on individual’s perception.  One must have a feeling of happiness to be happy; one should learn that happiness can be within your reach easily.  There are four steps in pursuing happiness:  “no know, nor feel” (不知不覺), “know, but not feel” (知而不覺), “feel, but do not know” (覺而不知), “both know and feel” (有知有覺).  One will have a noble and enlightened life once one has a grasp of what is the happiness.

He reminded the husbands of the road to a happy marriage is being thoughtful and generous to ones’ spouses.  One needs to apply the teachings of our ancient sages to one’s life experience; to learn from Liu Bei (劉備), “Do not think any virtue trivial, and so neglect it; do not think any vice trivial, and so practice it.”  (莫以善小而不為，勿以惡小而為之).

Chen pointed out that once husband and wife, hand in hand, heart to heart; walk to the marital harmony, happiness will come your way.

Chen’s better half, 王麗華, was in charge of the fashion show that followed his lecture.  Many Chinese beauties, the likes of 易泰安、易泰基、孟憲寧、賈敏儒、李淑貞、鄭文錦、吳海鳴, etc. were invited to be the models, each wore her most splendid and eye-catching dresses.  Many of the clothing’s and gowns were provided by 宇風尚, a newly opened fashion store in Taipei that quickly becomes the vogue of simplistic and elegant design.  The stylish hand made leather flower accessories attracted attention of all the ladies who felt that that is a MUST HAVE item.

  (The following is Katy’s dispatch)

陳世瑞 現身說法全A婚姻

匹茲堡成功企業家陳世瑞，日前在匹茲堡市為當地華人舉辦「幸福人生講座」，現身說法講解幸福婚姻和夫妻和諧之道，贏得上百嘉賓滿堂采。講座中並首次舉辦服裝表演，由陳世瑞妻子王麗華主持.

陳世瑞一向熱心公益，常現身說法宣傳如何做全A父母，如何培養全A子女。夫婦倆有時還開幾小時車到俄亥俄州哥倫布市等地，為大家送去「心靈雞湯」.

讀「化學」出身的陳世瑞，博覽群書，對儒、釋、道哲學融會貫通，除自己運用在追求幸福的生活中，進而身體力行推廣給眾親友.

陳 世瑞在演講中提到，大家一生「學做聖人」。「聖」字是王上用耳聽加口述而成聖，需要天時地利人和協調一致，才能成聖。至於什麼是幸福？他說因人而異。主要 是人對幸福有沒有感覺，如何學習「幸福就在你左右」。他認為人追求幸福有四階段：不知不覺、知而不覺、覺而不知、有知有覺。明白何為幸福？人生才會「正大 光明」.

他提醒丈夫要對太太體貼大方，才會有幸福婚姻。要學習把聖賢古訓運用到生活中，學劉備「莫以善小而不為，勿以惡小而為之」.

陳世瑞指出，夫妻生活講求和諧，只要夫妻同心協力向前走，幸福就會跟著來.

陳世瑞演講完後，他的另一半王麗華首次在講座中舉辦服裝表演，邀請易泰安、易泰基、孟憲寧、賈敏儒、李淑貞、鄭文錦、吳海鳴等華裔佳麗當模特兒，每人穿上自己最吸睛美麗的衣服亮相，配以台北「宇風尚」提供的服飾，倍顯高雅俏麗，尤以手工皮製胸花獲佳評。（張瓊月)      

 

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.