A composite of my ramblings, ravings, and occasionally, a thought or two.
05 October 2011
Cleavages, Clefts, and Kilos
10 May 2011
Normandy 2011
There is an old saying that "You can't go home again". I believe that is true of most vacations, holidays, etc. of course if it were an infallible truth, I would not live in Switzerland. We just returned from ten days in Normandy that I believe were an exception to that rule also. This may largely be due to Carol and Steve spending six of those days with us, as we all sought things of interest. What follows is what some might call a trip log of our adventures into a time past.
21 April, Thursday
We left home in the early AM, as the dawn was breaking. This trip was to be a first real test of our use of a GPS tracking system, so we listened as our guide, Jill, led us along roads that were at first familiar, but then became unknown. We crossed the Swiss border into France at Basel. As we drove through the Alsatian country, we reached a point where we decided to fore go our point to point instructions to Jill, and let her take us on her own to Saint Quentin. Since we had decided to make this a two day trip to our destination, we had booked a hotel in the city of that name just to be able to say that we had spent a night in Saint Quentin. This was no problem for Jill except for a short stretch just outside of Saint Quentin when some parallel high tension power lines got her a bit bumfuzzled. She recalculated, and we arrived just fine.
Jill, our GPS
The hotel/motel was of interest in itself. It was totally automatic. There was a desk person available for a few hours, but check in, meals ordered, and check out was all done by computer. It wasn't a bad spot for a night.
22 April, Friday.
We were up and away from Saint Quentin after a quickie coffee and croissant breakfast. Jill, our GPS assistant, got us through several rest stops and even more toll booths to Bayeux by noon. The French roads and expressways are very nice. Even though there were places with high volume traffic, the pace rarely slackened. Compared to German autobahns, these were much better in that respect. The tolls seem to be well earned. We arrived at The Dean's Manor on the edge of Bayeux, loaded into our room for the two nights before we can get into the apartment on Sunday, met the Chilcott family members (the colonel, his wife, a son, and several grandchildren who are visiting from England), and then decided to find the Hertz rental location, so we would be familiar with it when Carol and Steve arrive tomorrow afternoon. We went to Arromarche later for a look around. The weather was warm and beautiful, and there were a lot of tourists there.
6th June Restaurant in Arromanches
23 Apr Sat
We were out after a light breakfast at the Manor. We went into the village to meet Elizabeth and Bob Castleman. I had not seen these folks in at least 50 years, and it was by coincidence that our paths crossed at the same time in Normandy. We had a nice two plus hour visit and lunch with them. Then we went to the Bayeux train station to pick up Carol and Steve and went to pick up their rental car. After they got settled in at the manor, we decided to go back to Arromarche, so they could see the lay of the land there. We had dinner there again at the 6 June Restaurant before returning home for the evening.
A bit about Colonel Chilcutt. He was deathly ill in the Caen hospital four years ago when we were here. Today, he says he is better than he has been in years. He is ambulatory, lucid, etc., but I doubt he is as good as before his illness. His demeanor would put some off, but I found him to be very knowledgeable about the D-Day happenings and the logic behind them. He can come over as a demanding host, but if one listens and ignores his bluster, one finds him possessed of a very dry wit. He is 77 years old, and his father landed with the British here on D-Day. He has a map room in a large attic over one of the barns that is packed with wall maps, all sorts of air and beach mockups, and several large picture scrapbooks of D-Day original photos. I hope this collection will find its way to a museum some day.
24 Apr Sun
Out to the Bayeux Cathedral where the other three went to mass, while I cruised the village. The processional at the mass was led by several older men, one of whom carried an American flag. They were obviously WW II veterans. After mass, we had a reservation at La Rapiere. This was a treat and likely, the best meal of the many fine meals on our trip.
At La Rapier
Next, we made our way to the American Cemetery at Omaha Beach. Arriving in mid-afternoon, we saw a long line into the new visitors center. We bypassed that and enjoyed the new entrance walk way to the cemetery. This spot is, for me, just like going to Arlington National Cemetery in the USA. There were mobs of people, but there is a hush over the whole place. People walk the paths and go into the rows looking at the stones. The place is kept in immaculate condition at USA taxpayer’s expense, but one does not resent a single dollar used for this purpose. A majority of these heroic soldiers died well before thirty years of age, and one marvels at the loss of such potential for our country. Of course, if you take over nine thousand young men in a general population, you will have some misfits. Perhaps the war saved them from that, but it extracted an ultimate price. Keeping one’s eyes dry can be very difficult.
After a supper of snacks, we all packed it in for the night.
Markers at American Cemetery
25 Apr Monday
Monday was a French federal holiday. The big LeClerc supermarket was closed. I had seen a notice in a grocery in the middle of the village that said it would be open. I drove down, found it up and running, and stocked up on some items there. I saw some jars of duck fat. The French cook with it, so I will take one back home to Sachseln with me.
Returning home, we unloaded the groceries and took off for lunch in Port en Bessin. This harbor town was a favorite from the trip four years past. We honed in on our favorite restaurant and had a sumptuous lunch.
A Plateau of Seafood
After a post-prandial stroll around this pretty village, we took off for another D-Day site at a spot down the road called Longues sur Mer.
Longues sur Mer is at a point on the map labeled “Chaos”. It must have been chaotic on D-Day The battery at Longues sur Mer is an impressive group of bunkers that bear testimony that the Germans knew what they were doing when it came to reinforced concrete in their Atlantic Wall. A forward bunker served as a spotting site so the guns behind them could obtain an accurate range. The broad expanse of flat land between that point and the guns surely cost some major casualties to secure.
We left Longues sur Mer and drove a short distance to Pointe du Hoc. This was the site of a fierce battle against the Germans by the rangers of the US Army. Out of about 200 men, 90 were left able to fight after the capture of the area. To see the cliffs that these men negotiated with cables and ladders while being fired upon by the enemy is amazing. The whole area is reminiscent of a golf course with way too many grass bunkers. The “bunkers” are shell craters from the allied bombing and naval fire before and during D-Day. The capture and neutralization of this point eliminated it as a spotter outpost for the German guns firing at both Omaha and Utah Beaches.
26 Apr. Tuesday
Today was exceptional. We drove to Caen about 40 minutes from Bayeux and spent most of the day at the War Memorial Museum. Caen was the scene of some of the heaviest destruction in the Normandy fighting. The city was virtually leveled. This museum has exhibits starting with the end of WW I, going onward to show how the armistice made life intolerable for Germany, and how this led the population to accept Nazi leadership as their only hope for the nation’s survival. The exhibits then go into great detail with WW II, and then even give a good background to the Cold War after the allies defeat of Germany. It was an impressive visit, and even though we thought we were “Museumed out” for the day, we were very close to the Pegasus Bridge. Off we went with our faithful GPS leading.
Pegasus Bridge was the scene of a significant British result at the D-Day landings. It bridged the Caen Canal and was a vital source to protect against German counterattacks. The Brits used glider landings to place troops on the ground there and capture the bridge. The museum at Pegasus is specific to that operation and was a source of interest, since we knew barely anything of this history.
Pegasus Bridge
27 Apr Wed
We had heard that the museum at the new visitor’s center associated with the American Cemetery was not to be missed. The long lines had discouraged us on our initial visit. We tried to be there for the opening and had no problem. The entrance security is much like an airport, hence the line. This site was under construction on our 2007 trip, but I have to say that this is a penultimate museum of which any American can be proud. I am glad we did this in two segments, since the cemetery itself warrants some time in itself.
We then decided to go on a mission to find Brecourt Manor. This was a topic seen best in the Band of Brothers series on TV and DVD. After a bit of convoluted driving, we did find a spot that the GPS said was Brecourt Manor. About all we saw was the barnyard and a bit of the manor. In the barnyard however, we met two young men whose English was better than our French. One guided me across the road, pointed at a pasture with a hedgerow, and said we were welcome to look all we wanted. The pasture was mined, but this time only with cow paddies. We got an up close look at where the men of Easy Company, 506th Parachute Infantry, 101st Airborne knocked out the four big guns shelling Utah Beach. Since our visit, I have learned that there is a monument to Easy Company at Brecourt Manor. We missed this, but I’ll bet we were within a few yards of it.
The Hedgerow at Brecourt Manor
Next, we sought Utah Beach. It was low tide, breezy, and practically empty. Extensive construction is underway at the museum, and it was time to look for lunch. Barbara and I had lunch at a beachside spot near Utah Beach in 2007 on the way from St. Mere Eglise to Utah, so we drove a few kilometers in the opposite direction to find it. The Brasserie Normandie was still there, as it had been four years before. We enjoyed it again.
After lunch we made a quick stop in St Mere Eglise and parted the four of us, so Steve and Carol could see the excellent 101st Airborne Museum there. Barbara and I continued onward to the German War Cemetery near La Cambre where 21,000 soldiers, known and unknown, are buried. This is a beautiful and peaceful spot in contrast to all the mayhem that led these soldiers to be buried here.
German Cemetery at La Cambe
28 Apr Thurs
We explored the map room in the top of a barn at Dean’s manor first. One could easily spend a full day here with all the maps, table mockups, and photo books. Students from military schools over the USA, including West Point used to visit this room for tactical instruction.
The Map Room
After the map room, we made our way to Grandcamp Maisy to explore the German battery there only discovered and opened about five years ago. Though well documented in war records, this site was covered over after the war to use for farming. Aerial Photographs studied by a young Englishman showed its presence and it was rediscovered. Today, it is a work in progress, but in the four years since we first saw it, much has been done.
Maisy Battery
Then, guess what? It was lunch time! We went back into the village proper, and after searching a few menus, found our spot. La Belle Mariniere was a great choice. A small room with two brothers, one the chef, and one the waiter. We had an elegant and tasteful lunch with a reasonable price. certainly a spot worth a return!
A fine Meal
After our lunch, we headed back to the manor so Carol and Steve could pack for their return to Paris the next day.
29 Apr Friday
Today's first order of business was to watch the royal wedding on TV and computers. That social obligation out of the way, I took Steve to turn his rental car in. We went to the station with them to catch the train and saw them off. Although it was somewhat gray and later turned into a drizzle, we decided to head for Juno Beach. Jilly got us to Courseulles sur Mer, the village at Juno Beach It reminded me of Arromanches at Gold Beach. The day was not pretty and after a snack and a look around, we made our way back home.
Juno Beach Monument
30 Apr. Sat.
We slept in awhile, then we got the packing underway. We made a last foray into the village to buy some gifts for people back home and had lunch at La Table du Terroir. It was a memorable experience. The last Norman oysters of this trip were as good as always and the absolute best Tripes al mode de Caen that I have ever eaten, bar none. Barbara's appetizer and pollock main dish were much to her pleasure also.
Tripes a la Caen
Now, we have paid our landlady, said our goodbyes to her and the colonel, and plan an early departure for the AM.
02 March 2011
Hoarders
I have long been a fan of the American TV network, A&E, but it has been some months since I looked at any of its material. Now, I find the focus seems to have shifted away from arts, and in my view, it has moved a long way away from entertainment. I was recently exposed to some episodes of "Hoarders". This program can only be described as sad and repulsive. After some time away from the USA, I am at a loss when I see what the public will support and watch.
For those uninitiated in this program, it seems to chronicle the stories of a variety of people afflicted with a disorder causing them to pathologically collect and store a variety of items, both animate and inanimate. The scenes in and about the homes of the people affected are truly spectacular. They are also perverse, disgusting, and filthy. This not a show to watch while eating, or contemplating such. It might serve as a weight control measure, if you watched it enough.
05 February 2011
A few Hours above the "Soup"
This time of year in CH, we can go for days without seeing the sun. Our house on a lake is 500 meters above sea level. Some times, the fog is so dense that we cannot see across the pasture to our neighbor's house. I like these days. They are fine for books, internet, and napping. Driving is not a problem, so we are free to travel.
Some people cannot tolerate days of no sun. They get "Seasonal Affective Disorder", known as "SAD". Some get really depressed and need to go upwards for some sun. This may mean a few hundred meters or even more. That is why one often sees people at ski areas shedding clothes like they were on fire to get the sunshine.
There is a little known spot above Sarnen called Langis. Langis is a well known cross country ski area in the winter with about 40 kilometers of groomed trails. In the summer, it is a fine place to hike, and along a small river, a good spot to cool off and picnic.
Langis is at 1500 meters above sea level. The fog is always below, and on pretty days, the sun is bright. There are two places to enjoy there. The Langis Hotel and a smaller restaurant along one of the trails.
Recently, we spent a few hours for lunch at the hotel. The place becomes more popular each year, and I am told that on weekends, the large parking area is full with a waiting list.
Below is the beginning of the winter walking and cross country trails. The trails are on an honor basis. You just put 5 CHF in the wooden box. There is no control, and you do not have to have a ticket.
Here is the hotel. A postal bus makes the trip up from Sarnen several times a day in the winter. In the summer, there are fewer trips, but at least two daily.
Of course, lunch was a good reason to drive up to Langis. Here you can see what on a lot of menus is called "cheese toast". OK, it is toast and cheese, but it isn't a Kraft slice run under the oven. It is a large slice of Swiss bread, covered with ham, and layered with some wonderful "Bergkaese". Then the whole thing is splashed with a bit of white wine and run under broiler covered to steam. It is not your Momma's cheese toast!!
25 November 2010
A Guest Post
Grieving the death of a stranger on Thanksgiving Eve
08 October 2010
A Trip to the Grimsel Pass
On the way, we paused in Lungern because the Wetterhorn was in fine shape for a picture, as was the nice lake.
We went over the Bruenig Pass and started up the Grimsel road at Innertkirchen. There was a fair amount of road construction in the tunnels on the way, but the drive was as spectacular as ever through the village of Guttanen, past the hotel at Hardeck, the Gelmerbahn valley station, and on above the tree line.
Soon, we were at the Grimsel Pass summit. From the parking lot, I was able to see the highest mountain that I ever climbed. The Sidelhorn is 9028 feet above sea level, and it looked a lot harder than it did twelve years ago. Glad not to do that again today.
Most of the shops, etc. at the pass have already closed, but the one hotel/restaurant that was open had a crowd, as it was noon. We decided to look at the Marmot zoo before lunch.
Then, it was time for nourishment for ourselves. Our server told us that after 24 October, the place shuts down until June.
The top picture is the Walliserteller, a plate of air dried meats and cheese served with typical Wallis style bread, pickles, and pearl onions. This was the small size, so the regular would be a multi-person meal. Barbara had a good looking mushroom soup and then had to help me with the dried meat dish. Foods and tastes are always enhanced by high altitude.
A short ride down from the pass, one comes to the Grimsel Hospiz and the actual Grimsel Dam. There has been an extensive renovation of the Hospiz Hotel, and the power company has added a very nice new visitor's center with a wide variety of exhibits.
In 2001, Barbara and I were hiking a wanderweg along the northern side of the lake formed by the dam when she fell and fractured her ankle, requiring a helicopter rescue by the REGA service. The pictures don't show the path from our vantage, but it parallels the lake shore where the mountain river exits the rocks.
While were at Hospiz, we toured the visitor's center, noted the rates at the hotel (very reasonable and open year-round), and watched a working helicopter moving equipment from a project on the dam. Not cheap at about 90 CHF per minute!
This trip can be done without a car using the great Swiss Postal Bus System too.
Then it was time to head for home. Wonderful weather, good lunch, and a chance to see what man and nature can do.
09 September 2010
It's Football Time!
Early observations:
Arm garters are still a big thing. All I could find out last year was that they were some kind of "fashion statement". If that's the case, they probably aren't the stupidest thing that ever got that term. I can't help but wonder if there isn't another reason. If the blood return from the lower arms and hands is impeded by these rubber bands (I guess they are rubber), do the fingers swell enough so the hands are bigger to catch the ball or another player?
This season there seems to be a proliferation of intricate and ornate tattoos on many upper arms. Some of these guys look like a character in "The Girl with the Dragon Tattoo". Are these supposed to frighten the opposition?
Has anyone done a survey on how many players have first names that start with a "T"? There is a whole gaggle of them.
Somethings do not change. The quarterbacks still don't even scratch without a signal from a coach. The cocktail waitresses and waiters still carry around drinks to the players. I suppose that is to prevent fights and gossip at the water cooler.
Evidently, college football players don't spit. Maybe they drool a lot, but one cannot see that on TV.
The season has just begun, so there will a lot more to come. I am looking forward to it!
28 May 2010
An Old Mistress of Mine

I first met her way back in 1974. We were both much younger and had a bit of a wild streak in us. Little did I know then that our lives would be intertwined for over twenty years. My wife and children knew about her from the very first but rarely interacted with her. This was good because I loved her dearly and would have been heartbroken if I had been made to give her up. A lot of my friends were jealous of our union. My business partner gazed at her and simply said, "She is a real sex machine". She and I both had a penchant for traveling, and we went many places together with great pleasure. It was a rare occasion when we were apart for more than a few hours. Her upkeep was not cheap, but the joy she gave me was well worth more than mere money. Sometimes, I felt as if I had waited my whole life for her to come to me. As she aged, she became like a fine wine; more precious than ever. She watched my children grow up, and even a second wife was tolerated. Her health remained good until the very end. When I had to give up up, she was still a daily delight in my life. I know that she has found another liaison, but I have not seen her in many years. I do keep her picture with me and often look at it with a certain longing in my heart. She has become more and more valuable as the years have passed.
A 911 Porsche Targa. In 1974, she cost 13,500.00 brand new, and in 1994, she fetched 9,800.00 on departure.
14 May 2010
Dummie
I suspect that Dummie did yard work for some people, but I never saw him except when he was walking in the street by our house. He always had a big grin on his face and would give a wave. Shortly after I began school, Dummie seemed not to be around anymore. One can hope that maybe he went to The Tennessee School for the Deaf, but I doubt it. In this day and time, his life would have been very different.
19 April 2010
Gigli Eats a Bit of Crow
It was a source of conflict for me when two of my grandchildren wanted to come to Paris on their spring break and requested that Barbara and I meet them for a week in The City of Light. Without a believable way to cop out, I agreed, and off we went. The TGV ride from Basel to Paris was like greased lightening. We had booked a hotel around the corner from what was to be our apartment for a week, so we could meet the USA contingent there the next morning. In past French visits, my severely deficient French had always served me well. It was true in all of Paris, that if one opened a conversation with a bit of their language, they were happy to speak with you in yours, if they could.
I found the service in the stores and restaurants at least comparable with that in any tourist mecca. That was never more evident in the many open markets that Paris has. On more than one occasion, a person waiting with us would also offer their assistance in translating. The same was true on the streets when looking at a map, etc.
I was surprised to hear and see German both written and occasionally spoken in Paris, once occupied by the Nazis. I frequented a small bakery close to the apartment and usually used a French word or gesture to communicate. On one day, I misspoke a few words of German. To my surprise, the young lady clerk spoke back to me in German! She spoke both German and English but was better at English.
We enjoyed the usual tourist spots such as the Eiffel Tower, The Lourve, and other attractions. These would be a shame to miss, but for the most part are best seen once in my opinion. Everyone should do these things, but many such as the tower are best enjoyed from a distance. The Champs Elysees was a favorite for people watching and widow shopping, but since the rents are over 100,000 dollars a month, the prices are a bit high for my tastes. The avenue does make Zurich's Bahnhofstrasse look a bit small time.
Would I go back to Paris? Sure I would if given the same circumstances. One must understand that I was with some of the people who are treasures of my life. If not, then I still might go back, but only after some other things on my list. Another trip to Normandy, another trip to Berlin, more of Austria and Bavaria, and last but not least, Ireland. If I went back to Paris, I likely wouldn't do so much of the tourist thing. I would spend more time in the side streets and by-ways.
Anyway, I hope crow will BBQ well, since I have the grill fired up.
10 February 2010
NO NO (Norah)

I got the idea for this blog from a book that I have almost finished. "The Help" by Kathryn Stockett, could almost be a biography of my early years. Some of you know that I was born and grew up in the South (Tennessee). Hitler invaded Poland when I was 6 months old. The Civil War had been over for 75 years, but there were remnants of segregation all over the USA (not limited to the South). Because of that, black people were at the bottom of the job chain. A lot of black women found work as maids. Maids came in two categories, day and full time. Full time meant that they lived on site. Full time maids wore white uniforms, as a rule, at least out in public. A white uniform on a black woman with a white child in tow would get her into a lot of places that she would not ordinarily go.
Exactly when NO NO came to live with us is beyond my memory, but I expect it was while I was still a baby in arms. Our house was separated by about 10 yards from "the little house", a two room affair attached to our single garage. The small house was fitted with gas heat and electricity. It was NO NO's home. During the day, she took care of our house, and mostly she was my nanny. I was her full time charge, but my mother took care of a lot of the household duties. I never recall NO NO cooking or serving meals. She did wash and iron clothes, but I think she had me as her main duty. The rest was secondary.
Why NO NO? It was all I could get out of my mouth in early talking efforts, and it stuck. In effect, I renamed Norah. I know that she had at least a sister, but I recall no history of a marriage or children for NO NO. She had a family name, but I have forgotten this and likely never heard it more than once or twice. She was such a great part of my daily life that I always considered her as family. Unlike some in "The Help", my parents treated her as a valuable member of the household. I have no clue as to her salary, but she had a place to live, which I learned later was a nicer spot than a lot of her friend's. She had at least a Sunday off, and her schedule could be flexible. She worked only nights when my parents were gone. I learned a lot about many things from NO NO. Early on, she taught me about race. The "N" word was not used in our household. She was called by her name, and others were called "colored". I remember being in a car somewhere with my mother and NO NO, and for some reason race came up. NO NO explained me that God made all people but some were different colors. She always preferred to think of her self as a Negro. That was a lot for a 3 or so year old to soak up, but it was the first word that I learned to spell. I knew that her skin was black but she was still NO NO to me.
On occasion, we would travel down into Alabama or to Memphis to see grandparents. NO NO was always with us. I wish that I could know where she slept, bathed, or went to the bathroom at those places. My grandmothers both had maids but not full time. I can only imagine that NO NO stayed with these women. Once, in Memphis, NO NO took me to the municipal swimming pool not far from my grandmother's house. I strolled off and jumped into the deep end of the pool. NO NO began to scream for help, as I sunk. Not being happy with the response from onlookers, she jumped into the pool, white uniform and all, to fish me out. Now, a black woman in Memphis, Tennessee in the 1940s, jumping into a whites only public pool was out of the ordinary. Years later, she would pull up her skirt to show her knees. "See them white scars on my black skin? That is from pulling you out of that water". Regardless, I am here to tell the tale. My first nickname was also a thing from NO NO. While in Alabama at my other grandmother's house, I came out the back door one morning crunching on something. NO NO was already in the yard and thought I had a piece of toast in there. UNTIL, she saw two legs slip through my lips. She fished out a June bug, and for her, I always answered to "June Bug".
As I mentioned, NO NO had at least one sister. The first time that I remember her was in her house which was also some sort of black woman's beauty parlor. For a small child, the view of a black woman having her hair done with a curling iron heated to sizzling over a coal stove was impressive. NO NO's sister had a boy my age named Robert. Sometimes, Robert would come to see her, and we would explore the small world of our back yard and vacant lot. When it came time for Robert and I to go to school, our ways parted. That was the way it was then. I wonder what happened to Robert? In later years, NO NO went to live in retirement with her sister. Even when in college, it was a Christmas time visit yearly that we took NO NO her gift there. Usually, a 10$ bill. Often that would buy her a ton of coal for her winter. One of those years, my mom told me that this year we would not go. NO NO had died. How old? I do not know, but I remember her gray hair. My mother never had across word to or about NO NO.They were partners more than employer-employee.
Random memories: I can remember that it was a joke in our house that NO NO would rock me to sleep even after I was almost tall enough to drag the floor with my feet. I remember NO NO as a snuff user. Did you know that a finger in her mouth with it applied to a bee sting is curative? As in the book, there was a network of maids who cared for children together. I remember my sandpile sweetheart from down the street had a nanny named Jessie. NO NO taught me by listening to speak in "Dialy" (dialect). This stood me well when in the 5th grade, my teacher (whose father had been in the KKK) praised my recitation of an Uncle Remus story in class
There is no doubt in my mind that NO NO loved me, as if I was her own. Our skins were different, but I don't think for a minute that we thought about that. Times change. Sometimes for the best. I do think that I had something that others will never have. Right or wrong, it was good for me, and I think it was good for NO NO.
I loved "The Help". The author's web site is informative also.
07 February 2010
Pathology Reports
I think that reports need to be addressed, both biopsy and surgical pathology reports. As a medical student, I was fortunate to spend a 3 month lay-out quarter working in a hospital pathology department. Since it was in the nation's largest privately owned hospital with about 1200 beds, we had plenty to do back in the 60s. I was also lucky to work with four very nice pathologists who were interested in teaching. Other than a dozen autopsies (also very instructive), I spent all my days cutting surgicals. For whatever reason, surgical pathology was not stressed in our general pathology courses, so my mind was a fertile field to plow.
Each day, I was given specimens removed at surgery to describe grossly into a dictaphone, cut sections (I was taught where to cut on a given specimen), and then read with a double microscope the microscopic slides from those that I had cut two days before. The pathologist was on the other side of the double scope to teach me. It was one of the most rewarding periods in my medical education. With this lengthy preamble, I will now try to get to the point.
We saw a lot of prostate specimens, both whole and chips from trans-urethral resections (TUR). I would guess maybe 20-30 specimens per week. Most of these specimens were sent to us because men had prostatism (BPH) and not cancer. In those days, there was no PSA test, and a man with PC usually came to surgery because of a nodule on DRE. The TURs were the majority unless a man with a so-called "median bar" required open prostatectomy, which was treated with complete removal rather than a TUR.
When examined microscopically, often the chips or the sections of the whole prostate would reveal malignant cell structures. These were usually considered as incidental findings and reported to the surgeon. CT scans were unknown, bone scans were so primitive as to be nearly worthless, and the urologist had to watch for new evidence of recurrence. If bone metastasis showed up on x-rays, then an orchiectomy (testicle removal) was done. Biopsies may have been done back then, but I recall seeing none.
OK. Now to the REAL point of this message, When a pathologist looks at sections of prostate tissue with cancer evident, there is not a little sign there down in the tissue that says "Gleason 4+3, 4+4, or some such". This determination is an ESTIMATE, not an absolute, and it is based on cell appearance. Give the same slides to another pathologist and, you may get a different grading, up or down. The same goes with estimates of per cent of the prostate involved. Of course this is a good reason for multiple readings of slides. I suppose one could send slides to a hundred pathologists, and then take the majority opinion as gospel, but that is ridiculous. In our department, it was standard procedure for more than one doc to look at anything questionable. Disputes were judged by the head man. Gleason was yet to set out his system, so the grades were I-IV, with IV being what is now a Gleason 10.
If you are disturbed by your Gleason score or other micro findings remember the doc is looking at a tiny portion of your prostate on biopsy. In a whole specimen, as a rule, the look is not a lot greater (sometimes our guys would tell us to make more slides of other areas to see further cells). Those scores are not written in stone by any means.
01 February 2010
The New American Football, Page Two
I like ESPN, but I wonder if they realize that their announcers and "color commentators" are often afflicted with the terminal "blathertosis". These guys are constantly yapping about something and not always about football either. I really do not care about which restaurant at which they ate last night. They often digress, and frequently sound like pitchmen for a given player or coach to the NFL. I wonder if they get a commission? Another thing; what is the deal with all these girls(mostly) running around on the sidelines with green bottles like cocktail waitresses? I understand the need for good hydration, but what happened to the table with cups of liquids on it? These players are big boys who ought to be able to get their own drinks. On another note,each broadcast team seems to have at least one female member who is on the sidelines. Now, I am all for equality in the workplace, but if I was a coach in a tight game, I would likely be unkind when one of these babes stuck a microphone in my face to ask an asinine question about how I felt.
I guess the modern locker room looks like a hospital now with x-ray machines, CT scanners, etc. Won't be long before there will an OR in it, so that arthroscopy can be done on shoulders and knees. Sometimes, the coaches look like they are going to stroke out also, so CT scans might be helpful for them.
Just a few last thoughts for this year....
01 December 2009
A Little Snip and a Little Snip There
One of the things about having a RALP in a foreign country is being confronted with different cultural experiences. My surgery was done in a large hospital (800 beds?) in Luzern, Switzerland. The nursing staff was multilingual, as is the norm in Switzerland, and highly competent in my opinion. I do know good nurses from bad. In any event, the second day out of the OR, a nice Indian nursing instructor came in and asked in very good English, if she and a student could give me a bed bath as a teaching exercise. Now, I have spent 30 years or so in a teaching hospital environment, and I was fine with her request.
Before long I was lying on my back having each leg washed and dried. As I think we all know, pelvic modesty at this point in time is way out the window if you have had prostate cancer, so I had no compunction about these two ladies giving me a perineal wash. The student's English was limited to non-existent, so the instructor was doing a bilingual session. I became aware that the attention being paid to my penis was taking some time. I have to say that I have nothing in the way of a show-stopper in the penis department (John Holmes, I am not). Of course seeing a catheter was not unusual for both these women. What was unusual was that neither of them had ever seen a circumcised penis. When I inquired if there was a problem, the instructor said that they understood the importance of cleansing the foreskin of the penis, but they could not find one on me.
Thereafter, I gave a short history of circumcision, including the religious and social aspects of this procedure. The ladies were rapt with academic interest and spent some time discussing this in a Swiss dialect. This was accompanied with no small amount of manipulation, and at this point, I realized that indeed, the usual activity resulting from female manipulation was lacking in "the man". I also found it amusing and began to hope that my wife would not choose to make an entrance at this time. I thought that she would understand, but who can say? The ladies finished there explorations with newly acquired knowledge, finished my bath, thanked me nicely, and I did not see them again. I can tell you that I think the other students in the class got a new discussion of this pearl of nursing education at their next class. My wife took my news of this event with mixed emotions and was glad that she had missed the instructive events.
27 November 2009
The Robot and Me
I slept well but was awake when Barbara arrived shortly after 6 AM. Anyone who knows Barbara will be assured that she loves me if she rose at such an hour. Shortly afterward, I left to go to the pre-op room. I had not received any pre-op meds until that point. An IV was started, and the anesthesia doc told me that he was going to put in an arterial line. Evidently, somebody turned out the lights then, because I knew nothing until about 8 hours later when I awoke in the post-anesthesia recovery room. The first thing that I did was to run my hand over my abdomen to see what sort of dressing I had. Any robotic procedure can be aborted and converted to an open procedure if conditions require this. I only had five band aid type dressings, so I knew that the robot had done its deed. I then became quite aware of a significant pain in my right hip and thigh. I had no other pain at all, but this was a real dilly. I had a pain pump hooked up to me that did a fine job, and because of the hip and leg, it got a pretty good workout. I stayed in this area almost 24 hours. It was not Heaven, but the nurses were angels that helped me turn and every so often rubbed my back with ice cold towels. That may not sound great, but it was just what I needed. I remember the doctor coming in. He later told me that he had been worried about me because I took so long to wake up. Truth be told, I had been awake but zonked out on the pain meds. The hip and thigh were the problem, and no one seemed to get the big picture. I went back to my room about 24 hours after awakening but stayed fogged out because I was pushing that little button on the pain pump every two hours.
Of course, I had a catheter in, but that didn't seem to bother me like a lot of others had reported. I was drinking as much water as they asked, and other than the first day, I saw no blood in the bag.. They stopped the pain pump the next day, and all of a sudden, I was hungry. One must be aware that the food in this hospital was good! Each day, I got a choice for breakfast that included any thing one could wish.For lunch and dinner, one got three menus from which to choose each time. By Friday morning, I was up and ready to eat. It was a shock when I sat up on the side of the bed to eat. My right leg shot up like a chorus girl kicks. I could not bend my knee because all those muscles were out. I had not noted this while lying down, but unless I took the left leg and held it down against the right, the leg stood straight out. The doctor was in at least daily, and when he saw this, he got the PT folks up to see me. In the meantime, I was up to sit in a chair a lot. Walking was another matter, as my right knee was not very stable. I made my own diagnosis of neurpraxia and all agreed that this seemed to be the case. The PT brought me a walker with which I could manage quite well. I knew that neurpraxia is usually a benign injury, and time would be my best friend. Later that day, I walked in the hall a bit. The Dr. Mattei came in and spoke in detail to Barbara and I about the surgery, what was done, and why it took about twice as long as the usual. He was to be off for the weekend, and asked if I would like to go home until Monday. Sweeter words I had not heard in some time, so I grabbed at the chance. I would have to come back on Monday to have a cystogram, and if it looked good, the catheter could come out. The nurses outfitted me with bags, etc. for the catheter, gave me instructions, and urged me to call if I had a problem.
One must understand that no matter how nice the hospital, home looks great. It did! There were no problems other than a leaky catheter bag which was replaced by my local urologist on a Saturday afternoon. Monday was to be the big day for the catheter removal. That was OK with me. Catheters can be downright convenient though. Looking for a bathroom is mostly only for a place to empty the bag. Nevertheless, I was looking forward to Monday.
We were there early on, a resident took me back, did the cysto, saw no leak, removed the catheter, and I was ready to go to the floor for one more night. Apparently, a lot of men have trouble with frequency that first night, so they are asked to stay close. Dr. Mattei came around that evening and was amazed that I had had no problems of any sort, was voiding normally, and met him in the hall. We had a chat, and he asked when I would like to go home. I told him "right now". I called Barbara to come and get me. He signed me out, gave some meds, and I was on my way. Other than the rare complication of the neurpraxia (which was rapidly improving), the robot was a piece of cake.
21 November 2009
Prostates, modesty, and other things-part one
It so happened that an old partner of mine has a son who is an urologist in the USA. We had been together earlier in the year when I was in the USA, and he had related that the son was doing a new procedure on the prostate using robotics. Now my experience doing open prostatectomies in past years had led me to believe that open prostatectomies were brutal and bloody. The fact that robotics had taken all that away was interesting, and it became even more interesting when I found out that I had PC. The doctors all went over my treatment options with me, but I knew that the robotic way was going to be what I wanted. The mentality of a surgeon is to cut it out, if it is cancer. Enter here the Internet. An unbelievable amount of information is available about PC there, and I began to research robotic assisted laproscopic prostatectomies (RALP). I also decided that I would feel more at home in a Swiss hospital than back in the USA, so I went on the hunt for one close to me. A little less than a year before I got the diagnosis, the Luzernerkantonsspital in Luzern had added a new man to their urology staff who was trained in RALP. I checked him and his credentials out on the Internet and even read some of his papers which he had published. He looked like the guy for me, so the local urologist called and set me up with an appointment with this doctor. Dr. Mattei turned out to be a super nice guy who answered most of my questions before I could ask them. He didn't mind telling me the straight scoop about his training, number of procedures done, good and not so good points about the operation, etc.
I signed on to meet the robot with him as soon as it could be done. That turned out to be a good 5 weeks later. The interval is needed because after biopsies are done, the prostate must return to normal before the robotic surgery can be done safely. The month of June and first week of July went slowly, but the time gave me a chance to study more on what was going to happen. I found some well done podcasts on the Internet to watch the operation, and I read about patients that had had this done. The RALP is truly a fascinating method of removing a prostate and its associated structures. The patient is under anesthesia on an operating table. The robotic machine is fixed in position over him, five or six arms of the robot are inserted into the abdomen through small openings (band aid size), and the surgeon sits across the room at a computer console. The surgeon uses movements with two fingers of each hand to manipulate the arms of the robot. The computer dampens down his movements so they are far more precise that with a human hand. The whole thing is seen through a 3-D camera with a great light source and 10x magnification. Watch a podcast if you want to see more. After the surgery, a catheter remains in the bladder for 3-4 days, but the patient often leaves the hospital the next day. Two or three ounces of blood loss is the average opposed to 8-10 times that with open prostatectomies.
When the big day on 8 July arrived, I was more than ready. The Luzern hospital is less than 30 minutes drive from home, so we were there in plenty of time on the day of admission. More will follow.
20 November 2009
The New American Football
I know this sounds like an old man, but I am an old man. Growing up in high school and college, as well as 25 years living in the USA, I watched a lot of football live and on TV. The quarterback was the smartest guy on the team. He knew all the plays and led the squad. Each team member depended on him to tell them the upcoming plays, so they knew what they were to do. Today, it seems that the game is run by the assistant coaches and the head man. Most of this done while the assistants are sitting in the boxes high above the stadium talking into radio headsets to the head coach down on the sideline. He keeps a paper of some sort in front of his face so the lip readers in the area cannot tell what he is saying. Guys along the sideline with him then give all sorts of hand signals to different members of the team on the field. Before the ball is snapped, the team all stops and turns to the sideline to get instructions.
Football equipment has steadily changed over the years much to the well being of the players. Helmet design is a lot safer, as are the other pieces of equipment that players wear. Shoulder and hip pads were long time standards. Today, a lot of players look like they are in full body armor. They even wear gloves. They still seem to have a lot of injuries. I wonder if this isn't because they are so well padded that they can hit each other much harder. When an injury happens, it usually isn't terrible, but there are a lot of bad knees and shoulders in these player's futures. If your CAT scan and/or MRI scan looks OK, then you will likely be in the next game's lineup.
It took me a few views before I realized that some of the players did not have a real shag carpet hanging out from under their helmets. Some of these players are immense and yet still very quick on their feet. In my day, a lot of the team weighed at or near 200 pounds. Today, that is considered light unless you play quarterback or kicker. Three hundred pounds and 6-plus feet tall are the rule. Frequently, I feel like a spectator watching in the amphitheater, as the gladiators duke it out.
Maybe, I have this all wrong. Football is still a great sport, but I fear that the culture has left me a bit out of date.
28 June 2009
Mr. Jones
Oh My!! Was that a treat or what? It was a combination of several things, excitement, fear, and a treat too. The steam engines of the day were hot, noisy, hissing, and lots of other things that awed a four year old. We sat on the left of the boiler with a firebox underneath. The fireman, who in those days was as far as a black made in the rail business, was constantly shoveling coal from the coal car into the hellish firebox to keep the steam up. There were a variety of valves, wheels, etc. that had to be manipulated too. Then there was the whistle! It seemed about to blow me out of the cab, but Mr. Jones would let me pull the lever. We made the trip to the yard and back as often as my dad could take me, and I have never forgotten the smell of that burning coal.
One day close to the time that Mr. Jones was to retire, he came through town on The City of Miami which had become diesel powered. He pushed me up into the cab. It was clean and cool. The horn sounded like a horn and not a whistle. I didn't know that I was seeing the end of an era. Had it not ended, I wonder if I would not have been an engineer like Mr. Jones.
01 June 2009
A Light Extinguished
Her life began in Norway but ended after 40+ years in Switzerland. She and her husband, "A" produced three children that I often called "Stepford" children. They in turn, had grandchidren that are superlative. These gave her great grandchildren before she died. I have no idea how any step children there are to count. Numerous kids from Switzerland, the Balkans, and elsewhere lived for varying periods in her home. To this day, they all remember her. I am certain that more will turn up at her memorial service.
Then, there are the "step adults" who were fortunate enough to become her charges while vacationing in Switzerland. These people and their activities would fill a sizable book, and they all remembered the lady with a smile who could seemingly make things gone wrong OK again. The stories that she could tell about American tourists were many and always showed the fun she had with them. One of her cures for a kranky American was to invite that person to sit and have some Congnac. A lot of fussy folks have left her house feeling much better than they entered. She and "A" always planned a weekend excursion with the Americans in a car, so they go places that were not always reached eaisily by public transport. These along with frequent dinners helped make her a favorite with all her guests and resulted in many repeat visits. These Americans reciprocated when she traveled to the USA. People actually got mad when she and "A" were not able to visit just them. Everyone always considered them "their" friends. They certainly had more friends in the USA than I did.
















