Wednesday, December 1, 2010

Leaky Week

This leaky week started with WikiLeaks disclosing secret US diplomatic cables. Some meaty revelations, but nothing suggests that you or me cannot handle the truth. After three days of leaks the difference between a cable and an email remains a secret to me.

A-priori my sympathies were not with the leaker. I do like the idea of a Texas hold'em model though, where most of the cards are on the table, and we can call a spade a spade. My mixed feelings cocktail is one part jet-lag two parts cynic. My own Diogenes the cynic would say: If diplomacy is not shameful in private it should not be shameful in public.

The jet-lag is from the trip to Diego's wedding. A week stay is not worth acclimating and risking a second jet-lag upon return. Awake every night facing pharma with her sleeping pill collection against my father's large and growing book collection. Harder to swallow I still go for a book at the top of the stack.

Official Secrets is 1999 research with context for the then released transcripts of WWII German Order Police (ORPO) radio transmissions intercepted by British intelligence. The radio codes were rather rudimentary even by 1940's standards. These intercepted contents were kept secret during the war to avoid tipping the parties off as to their interception. The high price paid for that secrecy surely wins Wikileaks some points in retrospect.

The reasons for secrecy, then and now, are operational. That is the dilemma, plans and methods want to be kept secret while analysis and policy want to be public. Facts, reality, truth, where do they fall?

Wikileaks, with the jet-lag book still fresh in my mind, the most recurring of questions recurs: Where were you then during WWII?

Thursday, November 4, 2010

One Laptop Per Child

In city traffic the 1977 Oldsmobile screamed stay back by a show of size and how little we had to lose...Got respect precisely because it had no value. It also wore the status symbol du-jour: a fake pigtail mobile phone antenna glued to the windshield. Ironically old mobiles were more expensive than Oldsmobiles.

Phones got cheaper than the gas in a Cutlass tank, proving that status symbols do depreciate. Having nothing to lose is still valuable.

Laptops and smart devices also got cheaper and entered our lifestyle outside two groups. Those that cannot afford them, and those deliberately unreachable. No wireless umbilical cord to a job, a boss, a database.

For folks that cannot afford them, there is Negroponte's One Laptop Per Child project. A good cause where internet connected laptops make a positive difference in children lives. A complex project, cheap hardware is just table stakes.

China makes lots of laptops and lots of children. A cynic may note that the One Laptop Per Child project is already at work in China, it is called the One Child China Policy. Just grab a Diet Coke and wait until the numbers of laptops and children cross over.

Don't like Diet Coke or can't wait, then start with less children, may be in Uruguay. Four hundred thousand laptops were deployed there for the largest OLPC experiment. Experts are interpreting the lessons learned, and hopefully come up with less than 400.000 distinct lessons.

Now the One Laptop per Child mantra could apply to the mainstream, re-branded as the Only One Laptop per Child please. Not a simple project, it takes house to house combat, and the arsenal is limited to garage sales and sledge-hammers. Maybe gadgets should come with expiration dates, or somebody finally make the thin client that ends all clients. If it happens I have a pigtail antenna I can glue on it.

Monday, October 25, 2010

Cosmos Ups the Ante

Gabe's academic year started anew, with Friday pickup soccer separating a week of study from a week-end of study. I am there to enforce the separation.

Smarting from a close call in Man vs. Cosmos, I have summoned the muscle stretch to get me through play until dusk. Goodbye cramps.

Cosmos also came ready for the fight: Artificial Lights threaten an endless game. Yet man does not need to outrun the tiger, just outlast some youngsters.

Man lives to play another day, or maybe plays to live another day.

Acutely aware that Cosmos only needs to win once.

Thursday, September 9, 2010

Field Jacket M65

Click picture to enlarge

My M65 field jacket started its third life in 1980 when Gonzalo came to the airport to se me off. He took off his olive green jacket and told me it was mine. Never washed it to preserve Gonzalo's inscription under the lining. It was to be read only after I was gone. And gone I was.

It is not exactly my size, and it has the Army surplus patina, yet I resisted my family's attempts to purge the field jacket from my wardrobe. In it I look like a homeless person to my wife. Vietnam vet reintegration kind of homelessness, reason enough to defy the stigma and wear it. Wear it I did.

I picked up Gabriel once after a party at a fancy Palo Alto hotel. The hosts came out to size up the odd green M65 silhouette roaming outside the ball room...

And wear it Gonzalo did, for he is not a slave to fashion either.

With our house full of friends, stories, and a round bread denoting the full circle of a new year, we learn that Luis had been a student of Gonzalo's father, Guaymiran, well esteemed Forensic Medicine Professor. Luis now invents molecules, compounds or something like that here in the US, but is not known for inventing stories.

Upon Luis trip to the states in the late 70's, the good professor asked him to bring something, one of those American military jackets Gonzalo always wanted. An XL if possible, Gonzalo already had a large frame. As Luis narrates his purchase of a military jacket in Utah, I walk to the closet and pull my M65 field jacket, the olive green looks familiar to Luis. Yet only when I ask him to remove the lining and read Gonzalo's inscription our full circle closes. That very jacket just trumped anything a round bread can evoke.

Of the jacket's original owner all I have is that red paint inscription. A tall order to go close that circle, but if I keep wearing it who knows...

Monday, August 23, 2010

Before and After

Trips and meals have Before, During, and After epochs. Before is the anticipation phase enjoyed before a vacation or a good meal. Sandra's table here covers both. A great dinner on a vacation trip.

The During part evaporates as fast as the food on her table. The Before and After are longer and seem to bracket the present forever it seems.

The objective benefits of a meal or a vacation take place after, certainly not before the event. Nutrition does not start by thinking about food. Burned out workers have to take actual vacations, not only book them on the web. The cognitive and experiential value of a trip does not kick in until the trip.

But paradoxically we enjoy the Before phase so much more than the After. The picture of Sandra's table is more enticing than after us locust were done eating.

I for one can't enjoy a great meal or vacation if I know it is the last one.

Da Vinci's Jesus seems to enjoy the Last Supper, knowing though it was his last. But then again Jesus had his deity tickets confirmed, an exclusive vacation spot, especially exclusive for monotheistic faiths (triple occupancy rooms max). The last smoke in death row is known to be the last, but folks seldom come back to tell us if they enjoyed it.

An inconclusive trip it was, as I think that we can either double clutch through life by putting things to look forward to behind each other, or learn to live by Vinicius De Moraes lyrics:

E a coisa mais divina Que há no mundo É viver cada segundo Como nunca mais...

Monday, July 5, 2010

The Underdog

Where were you when Uruguay got to the World Cup semifinals?

Well last time, as a child, I was on the apartment balcony in Montevideo. Not sure if the game was broadcast live on TV, but I listened to the game on a transistor radio I just built. A city balcony immerses you in a popular experience. Now it is me and the TV in American suburbia, plus I have become less of a balcony bonding person anyway.

The more things change the more they stay the same. In 1970 Uruguay was the underdog against Russia/USSR, a team from a continent pretty much. This time Uruguay went up against Ghana, the whole continent of Africa behind it.

The common wisdom that Everybody Loves an Underdog rings as false as Newton's physics did to Einstein. The Revised Theory should read:

In the Absence of Bias Everybody Loves an Underdog.

Now, you find me an unbiased person and I will find Einstein's Unified Field Theory.

She has been wearing that #10 celeste way before this World Cup, and far from futility, as the underdog she will always remember where she was that July 2010 when they went to PKs.

Sunday, June 20, 2010

Father's Day

As the poster boy of the "all days are the same" movement, this Father's Day forces me to nuance my position. OK, maybe there should be a distinction between days, but I will not let the holiday or commercial calendar rule my emotional life.

As for birthdays and anniversaries, it would be great if all our days were a celebration. Sounds immature? Yes, but consistent, and a good excuse for us who don't excel at remembering dates, and don't even remember to check.

Now seasons are not all the same. One boy and his suitcases drove back from college, the younger boy sleeps late and works on his juggling instead of some homework. 'Tis the season for our gypsy girl to go travel a bit. June days are long and there is the World Cup on HDTV, which is almost like being there, only better.

Spare me this Father's Day nonsense, I'll take the NorCal summer as "Father's Season", any day.

Monday, April 19, 2010

Man vs. Cosmos

The daily and weekly grind. Life's chores and duties. That is not life, that is just living. Life is the soccer we play, the pickup games we squeeze along the way.

We went back to soccer at UCSD last Friday, pickup games with Gabriel and other students.

After more than 2 hours an imminent face-off between dusk and the right leg cramping. Man vs. Cosmos, an unfair fight for sure. Cosmos wins. Except for soccer, for I can play through pain, but the sun will not stop going down. Or hasn't since the biblical days of Joshua.

Asking how's life risks getting a polite and ambiguous reply. Our calves don't lie and will show the answer.

Monday, March 29, 2010


Human traits are bundled in blocks I am convinced. We know that people that walk a particular way, have a particular look, end up having many other things in common.

Maybe that is a genetic overload to save space, or maybe it is nature's way of helping us. We can extrapolate character and trust without having to re-discover it for every person we meet.

At work I got to spend some time lately with Ori, including a work trip. Ori shared traits with a friend from elementary school, specially his smiling eyes. We clicked as if he were that childhood friend, and I was looking forward to a lot more.

On Friday I learned that was not meant to be. The only thing I can think of posting for you Ori is Lhasa's cover of Who By Fire.

Sunday, February 28, 2010


The week was perfect and Sunday night we are home for good.

The room was larger this time, facing the Fillmore side, where the walks and the good foods were.

The view had St. Dominics and almost on the same line behind it, Sherith Israel. Beautiful buildings both. Like those who use two different phone carriers, just in case, or enterprises connected to the internet through two providers, just in case, a line of sight to a church and a temple would be another just-in-case. Whatever it was it worked. Time to go back to planning the future.

Tuesday, February 23, 2010

Back in the UCSF

Been away so long I hardly knew the place

Gee, it's good to be back home
Leave it till tomorrow to unpack my case
Honey disconnect the phone
I'm back in the UCSF
You don't know how lucky you are, boy
Back in the UC
Back in the UC
Back in the UCSF

A parody of the Beatles song which is in itself a parody of Beach Boys songs. A parody of a parody is a parody. We are back in the UCSF Mount Zion Hospital.

Yesterday was Day 1 and it went great. Gabriel was walking less than five hours after waking up. Familiar nurses compete to be in charge of him. Igal is here, he was at a conference in Stanford and is staying in San Francisco for a few days. Gabriel and Igal are walking a lot, two tall figures walking and talking about Economics is a first on the 5th floor.

On Day 1 a belly dancer came in to cheer patients up, Gabriel missed her by an hour, but I took a picture. Don't know what language songs she danced to, but ventral motions are a lingua franca, and ventral motions is what it is all about on the 5th floor.

Gabriel pulled-in his second surgery, so we are ahead of other patients we befriended back in December. By now we know some names, one is due in two weeks for his second round. There are though two names from before, probably and sadly still here since December, but these are speculations one makes in the hospital, a bastion of don't ask don't tell.

The best outcome would be to be discharged in 5 days. Why not. If the universe was created in 6 days, we could be done in 5 days. With insurance folks breathing down his neck God would have finished All Creation in 3 days. Not including two weeks of paperwork to get reimbursed. God's insurance covers only his days of creation, nights were a pre-existing condition.

As we close the books on Day 2 it was another great day at UCSF. An assistant surgeon stopped by, a new face for Gabriel who was under anesthesia the first time they "met". All in all the top surgeon and the nurses are the only invariants here. All other doctors changed in these two months. We get to gauge their game all over again. A fresh start can be good, because without anesthesia even doctors only have one chance to make a first impression.

Saturday, February 13, 2010

Seeing the light on 2/22

Things are falling into place for the second planned UCSF work. We can see the light at the end of this saga. A smaller one, just shutting the engine hood and getting Gabriel back on the highway.

Elegant numbers a good omen. This 2nd step will be on 2/22. 2 months after the 12/22 surgery.

We will be at UCSF Mount Sinai for a few days. We'll try to be home faster than in December, but a longer stay means more stories. Feel free to stop by UCSF for a cameo appearance, or who knows, maybe a lead character role in one of the stories.

Thursday, January 21, 2010


Reliability. You can count on something when you need it. Or somebody. Gabriel's car waited in San Diego a full month, and started right up when he returned. Outside of a dog that car is the most loyal thing, inside it is too small to park it. (sorry Groucho).

People have been great, mostly. Judging people metaphorically:
Reliability is finding the car where I expect. Loyalty is you holding the bottom of the ladder while I am up on the top. If you gotta leave, please wait until I get down.

I wish doctors could make us as reliable as Gabe's car, and our guts as pleasant to service as its engine bay. Recovery has Gabriel moving up and down the ladder for a while. Lots of friends have been supporting him, bringing us food, and doing more than I have done for others.

We will make up for anybody that bails out before Gabriel is safely down from the ladder. No problem, just walk the other side of the street I am on.

Tuesday, January 12, 2010

Going Home

Just Discharged! Hitting the road heading south, home.

Sunday, January 10, 2010

Guantanamo vs. Prednisone

Medical information on the internet is a mixed blessing. Access to collective knowledge is useful, but cyberchondria is also real.

A huge disservice is all the research papers accessible only to paid subscribers.  Patients many times fall back to knowledge disseminated by other patients on bulletin boards. 

It is hard to extrapolate from our singular experience, but there is one topic Graciela felt we had to share.  I have not used the well known Prednisone cortisone myself, but I saw it in action. The mental image of what I saw is darkness

I will use a strong dose of sarcasm to complement the picture. If the war on terror decision makers knew how this substance messes up your mind and breaks your will, they would have not bothered with waterboarding. They would have shipped Prednisone pills to Guantanamo. That is all I can and will say, in case somebody else is traveling the same road.

Still planning on going home tomorrow Monday with Gabe, and put the darkness behind. 


Saturday, January 9, 2010

UCSF Nights

Day 18 and Gabe is eager to get out, we may leave the day after tomorrow.

Nights at UCSF Mount Zion are slow. We took turns with Graciela, one sleeping in the hospital room, and the other in a nearby studio.

In the room when the patient goes to the restroom or a nurse comes for vitals you also wake up,  disassemble the couch, and clear the way. A Spanish Inquisition couch you may say. Au contraire, it is a clever apparatus for bonding with the patient. Our rythms and discomforts are so synchronized that patient and visitor have been known to trade places after a fortnight, as we did on occasion.

Quiet nights on the 5th floor. Exempt from the day time chores of feeding parking meters, and moving the car every 2 hours. In the room Gabe likes podcasts and on-line lectures, some Abstract Algebra on a white board, and often evaluating permutations of the finite set of pain medications nurses can offer.

The streets around UCSF have their own feel late into the night. I crossed paths with a large frame male staff person requesting a security escort for his 40 meter walk to the car. Reminiscent of the Karate competition days in Queens, NY where the streets around the event were more threatening than the sparring inside. Now the streets around UCSF feel less scary than what can happen inside a hospital.

Many youngsters visited Gabe, four of them came from Berkeley the very surgery night.  4 to 6 a day on average, with some days in double digits. They ate Gabe's jello and played board games for hours. This place ain't Rick's Cafe and MD residents are no Bogarts, so there really was no gambling in the house. As for alcohol I hid a bottle for one of the nurses. Nurses do twelve hour shifts of demanding and caring duty. I thought she could use a Spanish Jerez after work. She found the bottle while looking for supplies and gave Gabriel a complicit reprimand.  

The studio was a retreat for a warm shower, sleeping on a bed, and waking up to a view of Golden Gate Park. We didn't spend time there, but we somehow prompted written noise complaints from the downstairs tenants. Heck, I can't fly, I must walk.

We just learned from Paul Ekman's segment about emotions here that restraining locomotion generates anger, and I was ready to vent my anger to that neighbor. I was restrained, the studio sublet was "informal" and pursuing that matter could get my host in trouble. This was a compound case of restraining locution about locomotion. I need to ask Ekman if it creates exponential anger. I am too busy for anger, I just keep a mental list of people that better cross to the other side of the street when they see me. The downstairs tenant is on the list.

Ben joined today back from Uruguay. We spirited Gabe out with Ben for a secret walk to Fillmore street, showed them the streets and foods around UCSF. "Captain Burger" met us for sangria and turkish coffee. It may be that liter of sangria, but on the way back it seemed like most people walked on the other side of the street.

Friday, January 8, 2010

Walk man walk

We are on day 17 of Gabe's UCSF hospital stay when most patients names on the board have changed but Gabe's is still there. Name persistence is proportional to how sick you are, nobody wants that.

We meet other patients walking the hospital walk, we share stories. To feed the illusion that we are getting out really soon we don't use names.

Take Sonoma man, tall, determined, and strong. 30 days and two surgeries. He was told that walking was key to recovery and discharge. He walked the 5th floor day and night like the energizer bunny. The only names we have for him are Sonoma man and energizer bunny. It worked, three days ago he was all smiles being discharged. After walking for miles every day the mindless hospital rules had him pushed in a wheelchair to the street. Oh well. Good luck man! Did you walk 60 miles to Sonoma?

The ultimate anonymous patient has armed guards at his door. We call him the convict, his door only has a prisoner number, just like Jean Valjean in Les Miserables. We haven't spoken to the convict but Gabe has seen him walk with his IV column and ankle chains, and says you hear him coming.

Christmas and New Year at UCSF Mount Zion hospital, the holiday spirit is low. Patients don't want to be there at any time, and staff doesn't want to be there during the holidays. The only one happy to be there is the convict, Mount Zion is better than jail.

Our fearful leaders are arguing in Washington over a health care public option. Little do they know the public option already exists, unlimited tax payer funded health care, anybody can get it, regardless of preexisting conditions. The convict has it. All you do is a crime and you are covered. Next time we run into the convict I can ask about his copay, maybe his is better than my plan.

Three days ago a newbie went through Gabe's surgery and was brought to the floor. No names exchanged but resembles an adult Harry Potter, so that is what we call him. Gabe is his recovery mentor, and of course my wife Graciela who is everybody's mentor on the 5th floor. Well except for the convict she has shown care and advice to everybody. Not because she wouldn't, the guards don't let anybody close to him.

A silent Asian teenager crashes in the relaxation area computer. He is not ill, unless you think video game addiction is a disease. He has been there for weeks playing computer games, and reconfiguring the browser for chinese language and the baidu home page. We pitty him thinking his only adult relative is in recovery, but then again he may have no relatives in the hospital and discovered the public option of PC games and internet access. Just walk into the hospital and play for free.

It has been a long stay but Gabe was always a long distance runner, the longer the race the better he did, and he is walking fast and straight on the 5th floor. Walk Gabe Walk, don't let Harry Potter (or the convict) catch up with you.

Thursday, January 7, 2010

Who am I?

Discovering one's identity in a time of crisis is so kitschy I leave it to Hollywood. Walking the streets around the UCSF Hospital for more that two weeks I found something better than my identity.

I found a method for finding who you are, no DNA test involved. Think those lame official questionnaires with race and ethnicity questions, shoehorned answers that don't fit.

You walk into an ethnic Deli, grab a few items, you stay mum, not a word, approach the counter with confidence, pull the wallet as if ready to pay, not a word, and wait until they address you. If they speak to you in their language, that is your identity, if they speak to you in English you try the next Deli.

Really simple, the mirror lies. We are not who we think we are, we are not who we say we are, and in spite of the tired Hollywood line we may not be anything we want to be.
We are what others think we are. If to the locals I am one of them, then I am. If am not, there is no use in pretending.

We are telling Gabe about all the good eateries we are lining up for him the moment his ordeal is over, anything is better than hospital food, specially some good Armenian, Peruvian, French, Italian, Argentinean, Jordanian, and Russian places around here...

I found who I am, and the picture has the answer.

Wednesday, January 6, 2010

The last mile in Healthcare

This is not a medical blog, but Gabe is recovering from surgery and two weeks with him at the UCSF Hospital brewed much that has to be said. Jonathan is Gabe's doctor. Harold is my mechanic. They are both so good that I will not share their names. Paraphrasing Ben, get your own.

Medicine pooh poohs knowledge acquired without controlled experiments as "anecdotal". Harold can fix any car. Harold has never conducted a random controlled double blind experiment, and unlike doctors he never said that I imagine wheel bearing noises, nor put a placebo in my engine.

The last two weeks I saw that hospital practice is flexible and doctors do admit using trial and error, just like in Harold's shop. Good. Now if doctors were as accessible as Harold's shop... I mean in Who, how, and when to contact for medical help.

That is the last mile of health care, and Jonathan has solved it. Some doctors call you back within a week, or have a nurse call you back in a week, or put you through their answering service Q&A, that is fine if you have a skin rash but not a good thing for chronic or accute care. Jonathan put Al Gore and Steve Jobs together by using the Internet and an iPhone for patient communications, and the outcome is timely, direct, and precise.

Email is not a billable event for profit minded practicioners and insurers, but that thinking is so pre-iTunes, it is vinyl record mentality. Remember the medical equipment telemedicine commercials? Those with doctor-to-doctor sessions and a grateful smiling patient in the background? Get real, patients in pain don't smile, and the only telecommunication that matters in real life is patient-to-doctor, like Jonathan does.

Healthcare change is slow, sick people face the system alone, at a time of weakness, so how can they drive change in the last mile. Answer: Laughing.

That loud sarcastic laughter I use on ridiculous people and ridiculous arguments. Laugh at any doctor unwilling to use the internet to help you. Laugh so loud until it is uncomfortable for the laugher and the laughee. Ridicule them, shame them into retirement until we get a crop of smart multi-taskers like Jonathan. If a browser is good enough to manage their portfolios it should be good enough to ask a question and request a prescription. If Skype is good enough to connect with their college children, it is good enough for a patient followup.

Gabe is recovering and hopefully will be home in a few days, thanks for asking. But fear not, there is pent up laughter and sarcasm waiting to be posted right here, stay tuned.