When Life Gives You Lemons

When I was about ten years old, swimming on a Texas swim team, I remember hearing that the child of one of the local coaches had been diagnosed with leukemia.  The idea of a kid dying of an untreatable disease was so foreign to me that I am sure that I have blocked out most of the details.  I do know that the child died, and it didn’t take very long.  In the fifty years since, the landscape of childhood cancer has changed dramatically for the better.  Today, most children diagnosed with acute lymphocytic leukemia—the most common type—survive.  But in the past, we oncologists significantly underestimated the cost of that survival.

For the last six months, I have been taking care of one of the earliest survivors of childhood leukemia.  In her late forties now, she was treated with life-saving combination chemotherapy when she was six years old.  A couple of years later, she relapsed with leukemic cells in her brain and spinal cord, and received cranio-spinal irradiation—radiation therapy to her entire brain and spinal cord, a toxic treatment associated with short stature due to reduced growth of the spine, lowered IQ, and a depressed immune system.  Again she survived, and grew up to be a teacher of disabled children—the ultimate in “giving back.”

In 2005, she was diagnosed with breast cancer, likely a consequence of the radiation exposure she had as a child.  She underwent a mastectomy, and then did well until last fall when she noted a lump in the medial aspect of her breast reconstruction.  A staging work up revealed a benign appearing brain tumor which, again, was likely a late effect of her brain irradiation.  Since she had no symptoms from her brain tumor, her medical oncologist forged ahead with chemotherapy for the breast cancer, followed by removal of her reconstructed breast and its residual cancer, followed by radiation to her chest wall and lymph nodes given by me.  All of this she bore without question, without complaint.

I saw her in follow up on Friday and she was doing well, but she knew she needed to undergo more testing for an enlarged and nodular thyroid—possibly a thyroid cancer, also radiation induced.  She also needed to have a follow up MRI for her brain tumor, to be sure that it is not growing rapidly.  She was matter of fact about the inconvenience, not to mention the anxiety, of having multiple additional tests and procedures over the next few weeks and months.

I am continuously amazed by her grace and equanimity.  I said to her, “You are my hero.  How do you just keep going, day after day, month after month, year after year, dealing with cancer, one cancer after another?”  She said, “When I was a child, dying was NOT an option.  My parents never even mentioned the possibility, so I was never afraid.  I just did what I had to do.  Now it’s the same thing—I know that this is the price I have paid for the wonderful life I have led.  I just keep putting one foot in front of the other, one day at a time.  I know that I will be okay.”

Here’s the thing about oncology folks:  It puts everything else into perspective.  If this brave woman can take the lemons life has given her and make lemonade, so can you and I.   This is the crux of the matter; this is what has kept me going in this field for over thirty years.  If this woman considers herself lucky, so should we all.

A Rancho Santa Fe Moment

I’ve never been good at snappy comebacks and witty one-liners.  I always think of what I wished I had said about two hours after the opportunity has vanished.  But today I did okay.

I was in the local grocery store known as Harvest Ranch Market.  It’s an expensive little place, but known in the community for its superb selection of fresh fish and meats. I imagine if Julia Child had lived in my community she would have shopped here. The butcher is a cancer survivor himself—he calls me “Princess” and saves the best raw bones for the deerhounds.  And sometimes, when he’s run out of the cheap hamburger meat, he gives me the good stuff but charges me the lower price.  Shhhssssh—don’t tell anyone!  I guess you could say I’m a regular.

So today I was in the store, and I noticed a very beautiful woman, first standing at the meat counter, then later in the vegetable section.  She was tall and elegant and dressed in a lovely coral colored dress, low cut and sleeveless, and to quote Warren Zevon—“Her hair was PERFECT!”  She wore towering heels and her sparkly jewelry matched her dress—at 5 pm on a warm Saturday afternoon.  As it turned out, she hit the check-out line right in front of me.  I couldn’t help myself—I said to her, “You look so lovely!  I hope that you’re going someplace nice this evening.”  She looked down at me and said, “No, I’m on my way home—from a party on our yacht” and strolled out the door.

At this moment, the guy at the cash register says to me, “Will that be paper or plastic?”  I said to him, “If you please, Sir, I’ll carry my meager groceries in whatever the lady with the yacht was using.”  The couple behind me in line snickered.   Aspen’s got nothing on Rancho Santa Fe.

Get Along Little Doggies

Lately, I’ve been carrying around a couple of cowboys in my car.  One of them is riding a bay horse and leading a buckskin against the backdrop of the Southwest sky.  The other one is moving a small herd of Hereford cattle across a stream, cigarette dangling from his mouth.  A real Marlboro man.  They’re not real cowboys of course—they are the subjects of two large oil paintings by Western artist Karin Hollebeke that belong to my father.  The Marlboro man was painted in 1973—by then he should have known better, but depicting smokers in art and film was not as “non-PC” as it is now.  The two paintings have been riding around in the back of the old Suburban for about a week now—they don’t fit in my father’s new place, and I am not quite ready to admit that I love them.  My walls are decorated with Victorian etchings of dogs and children and beautiful women in flowing dresses holding parasols and looking wistfully over their shoulders.  I must have been quite the Victorian lady in my past life.

Art collecting seems to run in my family.  My paternal grandfather bought an oil painting by a British artist back in the 1920’s that hangs in my hallway now.  When my father did his stint in the Navy just after World War II, others may have had a girl in every port, but from the looks of his collection he spent most of his shore time buying paintings—oil paintings of Italian street scenes and water colors of Venice and Rome.  He says that the artists would line up their canvasses like ducks in a row, and move from painting to painting, one color palette at a time—first the water, then the boats, then the people, then the sky.  Then they would sell them to the sailors, five dollars a piece, and my Dad, arms laden with freshly painted treasures, would carry them halfway across the world, and more recently halfway across the country.  These paintings from the post war years, with their boats and colors and eager roustabouts are a reminder of a Europe recovering from the wreckage.

When our family moved to Texas, the art and artists of the old West, real or imagined, became the focus of Dad’s acquisitive instincts.  The canvasses were as big as the state we were living in, and Comanche’s in full war paint shared wall space with winter clad cowboys shooting wolves from the back of their saddles, and stagecoaches paused briefly to rest under mining city gas lamps before moving on to their destinations.  Hill country scenes ripe with bluebonnets bloomed in the bedrooms, and over the fireplaces.  These big ornately framed oils are the cargo my friend and I carried back to San Diego two weeks ago.

I used to make fun of Dad’s cowboys and Indians, spectacular though they were—especially during my Boston years when I strolled Newbury Street like a new sophisticate and bought colorful abstract lithographs and framed black and white posters from important art exhibits.  But then, one day nearly twenty years ago, lightning struck.  I was at Wind River Gallery in Colorado and in front of me was a magnificent bronze, aptly named Tatonka, by an artist named Buck Mahaney.  A bison bull, in full flight, had leapt into the air as an Indian brave on his buffalo pony bore down on him, his legs clenched tightly around the horse as he drew his bow and arrow and took aim at the animal’s heart.  In Native American lore, the animal must agree to give up his spirit to the sky and his body to the hunter and the bull’s leap symbolized his spirit that was leaving the earth, at that last moment between life and death.  I was smitten, and the proprietor recognized that the only way to get me out of his gallery was to agree to take payments.  A year later, the bronze was mine.

I am giving in to the Western Art gene, and my older son seems to have inherited it.  A couple of years ago he strolled casually through the house, running his hand over the bronze, and he said, “When you die, I want THIS!”  I said, “I’m not dead yet.”  But when I go, I suspect that my Dad’s art, Tatonka, and the cowboys in the back of the Suburban will find a good home with the kid, now grown up and working for the State Department who wore his boots and Stetson in his high school graduation photo.  Even if they have to travel half way around the world.

And Always at My Back I Hear

I used to read a lot of books.  But then the Internet, and Facebook, and eBay took over, and these days I am lucky if I have time to read a magazine.  I find that there are two great places for magazine reading—on an airplane, and at the hairdressers.  From an experiential standpoint, these two places have a lot in common:  you’re in a limited space where you don’t particularly want to be, for a limited period of time which you don’t have, chit-chatting with strangers you don’t really want to talk to, and when it’s over, you can’t wait to get out of there.  Perfect for magazine reading.  Today it was the beauty salon, where I picked up Vanity Fair while having the gray colored away.

I have always been obsessed with time.  My friends will tell you that I am always late.  No matter when or where I start my day, I am never where I need to be when I need to be there.  Apparently this is at least partially genetic—my mother was congenitally late, and I think that my sister and daughter might have inherited a dilute form of the gene.  But for me, it’s full blown.  I own at least twenty watches, and have never been on time for anything—never—not even once. I read recently that being late is a “control issue”.  That the late person is making a “statement” about their priorities, which means that if a person is late to your meeting, or affair, they don’t really want to be there.  I think that’s a load of hogwash.  I think some people are just late.  But hope springs eternal that if I could just get the right kind of watch, I would improve, be reformed, be ON TIME.

Back to the magazine—in the latest issue of Vanity Fair I came across a full page ad for a brand of watch I had never heard of:  Shinola Watches, made right here in Detroit, USA.  The watch pictured was beautiful—functional and utilitarian, with large numbers, a sweep second hand and a date display.  Just the kind of watch a chronically late person would want.  I came home; I looked up the Shinola watch company on the internet.  It appears that a lot of people think the same way I do—that a new watch will improve their punctuality.  I put myself on the waiting list for two watches, both in a lovely plated rose gold.   I am bad at being on time, but very good at waiting for things that I want.  I will wait for my new Shinola watch.

I must confess here, that my fascination with the new watch company out of Detroit, comes from a distant memory dredged up by that ad—my parents, born in 1925 and 1932 respectively—used that old expression to designate when a person, usually me,  demonstrated a complete lack of common sense:  They would say, “You don’t know shit from Shinola!”  I hope that the Shinola watch company will be so successful that its name becomes a synonym for class, and elegance, and functionality, and for being on time.

In the meantime, Andrew Marvell said it best:  “And always at my back I hear, Time’s winged chariot hurrying near.”  Our time is short, and forever running out.  Let’s use it well, or at the very least, as best we can.

Who We Really Are

When I was a resident in radiation oncology, I thought I already knew a lot about medicine.  After all, I had just completed an internal medicine residency, and had taken and passed my boards.  Needless to say, I was more than a little bit irritated the first time a patient “coded” in the radiation therapy department and I was shoved out of the way by the intern on the code team.  After all, he was an internal medicine intern at the World’s Greatest Hospital, and I was a lowly radiation oncology resident. My protestations of “I can HANDLE THIS!” were lost in the general hubbub of excitement and confusion surrounding a cardiac arrest.  The patient survived, despite my bruised ego.

I found out very quickly that I didn’t know much at all—in fact, I didn’t know how to write a proper history and physical.  On my first rotation, my attending corrected my very first sentence, stating emphatically that “Mr. So and So is NOT just an 86 year old Caucasian male who presents with lung cancer. He is an 86 year old retired firefighter and grandfather of eight who presents with lung cancer.  There is a big difference.  You will see!”  From that point on, I was charged with adding descriptors beyond the age, sex and race of my patient so that I would know that patient as a PERSON, and not just as a disease.

My daughter is going through her internal medicine residency right now.  I remember how easy it was to de-humanize a patient by calling her “the myocardial infarct in ER bed 8”, or the “renal failure in 222”, or the “nursing home placement on the 9th floor”.   If we call them by their disease, they cease to be the living breathing mother of high school age twins, or the father of a disabled son, or the principle of the local school for the deaf.  They’re just diseases, to be treated and discharged, or “buffed and turfed” in the old House of God parlance.  It’s much easier to be detached from a disease, than from a human being that one might just have something in common with.

Because of my first radiation oncology attending, to whom I will be forever grateful, I’ve made a point to pay attention to the person, and not just the disease.  I teach my medical students the same thing—that it’s not enough to just copy and paste the social history—the history of whether the patient is married, has a profession, has children, smokes or drinks alcohol or takes her religion seriously.  I try to learn about the person, and when I do, and convey that to my entire team of physicists, therapists, nurses and front office, I know that the patient gets better care.  It’s just human nature to empathize, and sympathize, if we truly know the human being behind the diagnosis. And it’s especially true for the difficult patients, the mean and angry ones, the ones we would prefer to dismiss.

But sometimes I slip up.  Recently I treated an elderly man postoperatively for rectal cancer.  He was a quiet elderly gentleman, but his son, a tech writer, made everyone in the department miserable with his demands for his father.  I never asked the man what he used to do, before he was eighty six with rectal cancer.  But another one of my patients was a little more curious.  He and the old man were side by side in the waiting room day after day of treatment until finally, the younger man asked me, “Where is Mr. __ from?  I can’t place his accent.”  I said, “I don’t know—I suspect he might be German but I never asked.”  So I did ask.  And was surprised to find out that my elderly patient was Israeli, born in 1925 in what was then Palestine. A true “sabra.”  He grew up in the Holy Land to become one of Israel’s foremost songwriters.  In fact, they still play his songs in Israel and recordings are available on YouTube. And I would never have known that if another patient had not cared enough to ask.

When you and I get sick, as we almost certainly will, we should all hope that our histories state who we really are, and that our admitting interns and residents care enough to ask.  They will be better doctors if they do, and we will get better care.

Mel’s Posh Junk

With apologies to any of the really nice people who live in Aspen, Colorado

I admit it—I have a little bit of an eBay habit.  May I be permitted to say that cruising eBay helps me relax after a long day at the office?  I have all my favorite searches set to notify me if one of my desired tchotchkes suddenly comes up for sale, and I have my favorite sellers marked.  One of them, a dealer from the UK, calls himself “Mel’s Posh Junk.”  I love that, since both my father and my stepdaughter are named Mel.  I’ve bought more than a few items from Mel’s junkyard, which seems to be a jewelry shop specializing in Victorian and Edwardian costume jewelry. Queen Victoria had nothing on me when it comes to gaudy brooches from the Scottish hinterlands.

This past weekend, I was tasked with traveling back to Colorado to make a disposition on the contents of my father’s townhome in Snowmass.  I love Aspen and Snowmass in the summer, when the lupines and Indian paintbrush dot the hills in front of the Maroon Bells.  I can remember some lovely trail rides from the T Lazy 7 Ranch and Brush Creek Outfitters.  I also remember taking a summer ride in the high speed gondola up Aspen Mountain, affectionately known as Ajax.  I was so dizzy from the added height and movement of the gondola up over 11,000 feet that I insisted on crawling down the mountain.  Literally crawling, on my hands and knees, all the way down.  I do not like heights.  Or icy cold.  Or falling down.  Hence, I am not nor will I ever be a skier. But that is another story.

Dad is here in San Diego now, and the sale of the condo closes in two weeks, and it was time to decide what was going where.  He decided to buy new furniture here, scaled to his smaller apartment rather than move the grander furnishings of the place there.  My chief mission was to get his art moved.  An artist himself, he has been a collector all his life, and the paintings that hung on the walls in Colorado are his most treasured possessions.  But what to do with the furniture, and the rather impressive contents of my mother’s closet?  I called ahead to several consignment shops in the area.  The first woman, from Aspen proper, came through with the realtor days before I got there.  With one dismissive wave of her well-manicured hand, she declared, “I can’t use ANY of this.  It’s SO very DATED.”  I decided to move “down valley”, as the natives say.  I figured that surely the good people of El Jebel, Basalt and Carbondale could use a living room and two bedrooms full of high end furniture.  I figured wrong.  The lady from Basalt was equally dismissive.  She walked the floors solemnly, proclaiming that no, she couldn’t sell this, or that, or even those.  Until she stopped at the table where I had placed my mother’s silver and antique Limoges for safe packing.  She said, “I’ll take THOSE.”  I said, “No, I don’t think so.”

On Saturday, my friend who had met me in Snowmass with her cargo van to transport the art, and I painstakingly went through my mother’s clothing.  She was a petite woman, barely 100 pounds.  Unfortunately for me, I cannot wear a size 4.  But she had exquisite taste, and a penchant for fancy labels.  We loaded the truck full of Burberry, and Ralph Lauren, and St. Johns, and cashmeres from Sak’s Fifth Avenue and leather jackets custom made in Italy.  We drove to the second hand store in Basalt where the proprietor could not be bothered to even direct us where to park, or help us unload the van. She took one disdainful look at the offerings, and said, “Most of this stuff will go directly to charity.”

My friend and I made the 960 mile drive back safely from Colorado in 16 hours on Sunday.  We did not want to stay overnight on the road with our precious cargo of Dad’s art, and Mom’s antiques. On Monday, Hector from Habitat for Humanity will pick up the contents of my parents’ 3000 square foot condominium.  I am quite certain that Habitat will find folk who are thrilled to have down stuffed couches in perfect condition, and sleeper sofas, and beautiful lamps, and my father’s custom made walnut desk and file cabinets. I am happy about that, because I want people who appreciate quality and construction to have the furniture.  I guess that Mel’s posh junk just wasn’t posh enough for Aspen.  Oh well!

An Exercise in Futility

I am working at home today.  And no, that’s not the exercise in futility, although it could be.  I have paperwork to complete, treatment summaries to write– odds and ends that don’t involve patient care. I am working at home because today, the carpet layers are putting in my brand new wall to wall carpet.  A month ago, when the painters were putting in my brand new wall to wall paint, I found myself relieved of a camera, an iPad, a Nook reader, my grandmother’s diamond necklace and $200 cash hidden, obviously, in an underwear drawer.  “Fool me once, shame on you.  Fool me twice—you can’t get fooled again” as George Bush famously said.  My new plastic bathroom is being installed today too.

The exercise in futility, as my fellow pet lovers will readily attest to, is the new carpet.  When we moved into this house fifteen years ago, the carpet was already worn and stained by the treasured and precious (aren’t they all?) beasts of the former owners.  No amount of cleaning or convincing could persuade the current inhabitants that my living room was not to be used as a toilet.  Especially the little dog, Jack.  There is most definitely an inverse correlation between dog size and ego, with ego proportionate to the compulsion to mark territory.  I was in luck, however.  The prior owners had considered the possibility that accidents do happen, and their choice of color was the sadly dated, but tremendously camouflaging “Harvest Gold”.  Circa 1970.  Yes, you read that right.

When I went to choose new carpet, I had only two absolute criteria:  That the color have not a HINT of yellow or gold, and that it be treated with Stainmaster to the max.  Actually I chose a wonderful distressed walnut hardwood, just the right amount of roughing up to disguise the toenail marks of the deerhounds as they chase each other around the house.  But my pocketbook chose otherwise.  So today I watch, as the carpet guys install a beautiful pale taupe ultra Stainmaster synthetic, with a subtle criss cross pattern, ever so tasteful and elegant.  And as I watch, I wonder, who will be the first to despoil my unbesmirched and freshly non-fragrant footing.

I leave for Colorado on Friday morning to transport my father’s art work to San Diego.  My husband is in charge of the animals. If I come home to a urine stain on my new carpet, or the contents of the unfortunate cat’s stomach, I swear, there will be a bloodbath.  And I’m not sure who—the guardian or the ward—will go first.  I’ll let you know what happens.

Let Me Call It In For You

These days they have navigators for everything.  When we got lost back in the day, we used to consult a map, or lacking a map, we would pull in to the nearest “filling station” (what we used to call gas pumps) and ask for directions from the friendly young man who would appear to wash our windshield, check the oil and the tire pressures, and of course, pump the gas.  Not anymore. These days we type the address we are seeking into our smart phones, and a nice man with a somewhat generic British accent directs us to “turn left in 0.3 miles.”  No intervention—no human interaction required. Medicine has taken navigation one step further—now it is quite fashionable to have “cancer navigators”, usually registered nurses, who help a patient from the shocking time of diagnosis, to the myriad choices for treatment, to coping with survivorship.  But so far, I have never heard of emergency room navigators, and to the best of my knowledge, this is an area ripe for harvest.

In medical school, a great deal of time is spent teaching students to take a relevant history, called the “history of present illness.”  This would seem like a simple thing, but in reality it is quite complicated.  Each patient perceives and gives weight to a different aspect of her symptoms, and the events leading up to her appearance in the emergency room at 10 pm on a Saturday night.  What takes us four years to learn in medical school often eludes patients—the pertinent parts of the history and physical symptoms which may lead to an appropriate hospital admission, or conversely a waste of a good hospital bed, or even worse an inappropriate discharge resulting in the death of a patient.  The fact is, that if a patient cannot put together a concise cogent account of the events just prior to showing up in the ER, the attending physician is disadvantaged to the point of making a serious and sometimes grave error.

A case in point—a few weeks ago a good friend of mine in another state had a skin cancer removed from her neck.  A few days after her surgery, she was feeling poorly and noticed that the incision site was reddened and tender.  I urged her to go back to the surgeon, but he had been abrupt with her and she was more comfortable going to her primary care doctor.  The primary was not used to evaluating surgical wounds, but sensing my friend’s discomfort, she prescribed a course of antibiotics to cover typical skin infections such as staph and strep.  My friend began the medicine but that evening she experienced a bone shaking chill followed by a temperature spike, and her incision opened up, allowing drainage.  She called me, barely able to speak, and I directed her to go to her nearest emergency room at once.  I offered to “call it in for her”—to speak to the triage nurse or the ER doctor.  She said she would let me know where they were going.  But she did not.

When she appeared in the emergency room, she told the ER doctor that her chief symptom was a severe headache in the posterior occipital region. It was the worst headache she had ever had.  My friend ending up getting a noncontrast CT scan, which thank goodness was negative for a brain hemorrhage or stroke.  She was given Valium and Demerol and Compazine, and then Vicodin “to go” and was told she had a bad migraine headache.  As best I can tell, no one ever looked at the surgical incision on her neck.  My friend survived, but only because she continued to take the Bactrim DS, two tablets twice a day, that her primary care MD had prescribed empirically.  She did enjoy the Vicodin and the Valium.

The moral to this story is:  when you’re sick and your fever spikes to 103 and your doctor friend offers to “call it in for you”—that is, speak to the triage nurse or the emergency room doctor—take her up on it.  It might just be a migraine, or a tension headache, or a virus.  But it might be a life threatening disease or infection.  Doctors spend years learning to decipher symptoms and to dissect out the relevant parts of a history.  We speak the same language.  Let us help you.

What’s For Lunch?

These days, Thursdays are my busiest day of the week.  It’s the day I see all of my on treatment patients.  Currently there are thirty one of them—a busy load for a radiation oncologist.  Nonetheless, I have instructed my therapists that they must leave me time for lunch, and so they schedule the patients so that during a brief period during the noon hour, my nurse and I can retreat to the quiet of our offices and grab a bite to eat.  Food having always been of major importance to me—it’s the high point of my day on a busy day like today. Since we have no cafeteria or vendors in our building, I usually bring something easy, like a salad, or perhaps some cottage cheese and tomatoes.  I don’t usually hit the Milky Ways and peanut M and M’s until late at night, but that’s for a different story.  When I do break for lunch, I can usually be found at my computer, catching up with emails, surfing Facebook, and yes, checking to see if anyone is actually reading this blog.

So there I was minding my own business, the door to my office wide open to compensate for the fact that maintenance has never succeeded in making the room cool enough to ward off my hot flashes, when a man walks into my office and says, “Is there a doctor around here?”  I have not met this man before, but I assume he is one of the patients belonging to one of my colleagues who have been covering one day a week since my partner went out sick.  I look around hopefully for my nurse who is nowhere in sight, and then own up.  “Yes sir, I am the doctor here. I am Dr. Fielding.  May I help you?”  He said, “Yes, I need you to look at my rectum.  I think there’s something there.”  I am hoping that he has lung cancer, since I do not want to look at his rectum, or his anus during lunch.  I say, “Sir, since we haven’t met, what are we treating you for?”  He said, definitively, “Rectal cancer.”  I see now that, as they say, the only way out is through.

So I ceremoniously put down my fork, pick up my napkin and dab at my lips, and say, “Follow me.”  In we go to the exam room next door, where he drops his drawers and I have a look.  It’s a hemorrhoid, plain and simple, and swollen from the irritation caused by the radiation.  I say, “Sir, it’s not the cancer.  It’s a hemorrhoid. I can prescribe some medicine for it.”  There is an audible sigh of relief.  He follows me back into my office, where the sad tomatoes and mozzarella are looking a bit waterlogged by their balsalmic vinegar.  I write the prescription and he thanks me profusely and goes on his way, and I go back to my lunch.  A day in the life….

Reflecting on this later, I thought to myself, “Well, at least he wasn’t an asshole when he asked me to look at his asshole during lunch.”  Always happy to be of service!

Thirty Years Later

From my husband, a guest blog today:

 

When I travel on business, it’s hard on everyone.  I just flew back from a trip to China in a coach seat wedged between two very outsized men who not only snored loudly during the 14 hour flight, but had an annoying habit of invading my “personal space” with their various body parts.  Even a strong dose of my favorite sleeping med, Ambien, failed to blot out the annoyance.

 

When I return after such an experience, I quickly realize how much of a hardship my travel has also been for my wife, Miranda.  In addition to managing her oncology practice, she has to take care of the dogs, the sick cat, the horse, various contractors remodeling our house and fix the things which increasing break around our old home.  So, in recognition of Miranda’s hardship, I decided to give her a night off from writing her blog by describing a truly remarkable trip to China.

 

This was not my first visit.  When I was a young doctor, I toured China as part of a delegation of pulmonary specialists interested in learning more about Chinese respiratory care.  We visited a number of large cities and their medical schools.  We saw lots of air pollution and very little in the way of modern medical care.  Back in the 1980’s China was very much a developing nation, with many of the problems of a developed country (pollution, urban poverty, traffic jams, etc.).

 

Thirty years later China has emerged as a full fledge developed country, but still has the same developed country problems, particularly the air pollution and population crowding.   But so much else has changed!   The cities I visited were modern, clean, orderly and prosperous.  I saw many more BMW’s on the roads around Beijing than you see in Southern California.  The scale is hard to comprehend.  I visited Guangzhou, which is a city of 24 million. The largest city I bet you’ve never heard of One night my host invited me for a drink at the bar of the Four Seasons Hotel.  It was on the 99th floor with distant views across the South China Sea to Hong Kong.   My vertigo notwithstanding, it was quite an experience.

 

But what most impressed me was my interaction with healthcare and business professionals.  These 40-something people were really bullish on China.  They didn’t complain about the ruling Communist Party, but rather indicated how government was a prime factor in the growth of business and providing a better standard of living for everyone.  For instance, 95% of Chinese citizens now receive healthcare under a government sponsored national program.  

 

If you are a 40-something professional in China you are shooting for the stars.   You have never experienced an economic downturn and have only experienced continued economic growth and prosperity.  A far cry from the China I saw 30 years ago, and a far cry from America circa 2013.     If it can be said that the global economy is a competition, then one might conclude that the Chinese are winning or have already won.  We Americans just don’t know it yet.