And Speaking of Plastic Surgery

I have a new favorite doctor show, “The Knick” on Cinemax, airing on Friday nights.   The show stars Clive Owen as the charismatic cocaine addicted Chief of Surgery Dr. John Thackery at a fictitious New York City hospital called The Kickerbocker at a time when surgery was one foot out of the barbershop.  The tagline is, as they say, priceless– “Modern medicine had to start somewhere.”  On the third episode, last Friday night, Dr. Thackery performs a pedicle skin graft from the upper arm to cover a gaping hole in a woman’s face where her nose used to be, before she got syphilis.   Back in those days, this was a marvelous feat.  Real progress in what we now know as reconstructive surgery didn’t come until the end of World War I, when Sir Harold Gillies, a New Zealand otolaryngologist later known as the “father of plastic surgery,” established the first hospital ward for the facially wounded in Queen Mary’s Hospital in Kent.

For over fifty years, I have been a bystander to the evolution of plastic surgery.  As a teenager I remember the heady early days of microvascular surgery—my father, Dr. Melvin Spira reattaching the scalp of a man whose hair got caught in machinery, then the tales of sewing back severed fingers and ultimately entire limbs with gradually improving functional results.  In the 1970’s the great French surgeon Dr. Paul Tessier, pioneer in techniques for cranio-facial surgery to correct birth defects came to the United States to teach, and I remember a Saturday morning clinic at my father’s office, where mothers whose children’s facial deformities were so severe that these kids had, literally, never seen the light of day waited in line to be seen by the great surgeon who could give them back a normal appearance, and thus a life.

Plastic surgery, like my own specialty of Radiation Oncology, has become one of the “lifestyle” specialties to which medical students aspire, particularly those with an artistic bent and good hands, and for good reason.  Cosmetic procedures are highly reimbursed, and are done during “regular” working hours. Walking around here in San Diego and Los Angeles, surely two of the plastic surgery capitals of the world, it’s easy to spot who has had “a little work” done.  Having one face lift might be a good thing (I wouldn’t know because, as I’ve covered in previous blog pieces, my imagination runs wild with the possibilities of complications and I am far too chicken for elective surgery), but have three and you become one of “Our Ladies of Perpetual Surprise”, eyebrows at the hairline.  Same goes for breasts—it is not normal for the “girls” to be rigidly immobile as their owner pounds away at the Stairmaster.

Last year I mentored a medical student who had started his medical education thinking that he wanted to become a plastic surgeon.  After a beloved aunt developed breast cancer and needed radiation, he started to think that perhaps he would rather become a radiation oncologist because he enjoyed dealing with cancer patients.  He was an outstanding student, and I was quite sure that he would be accepted, and do well in either specialty.  I assured him that with his gifts, and his compassion, he could combine his interest in helping cancer patients with his interest in reconstructive and restorative surgery. Residency interviewers for plastic surgery residencies have a difficult job these days: all of the applicants SAY they want to do reconstructive surgery, but most end up doing cosmetic work.  Apparently my student was convincing when he said he wanted to do plastic surgery to help cancer patients.  He started his plastic surgery residency at Stanford last month.  Dr. John Thackery of “The Knick” may be fictional, but I hope that my student leads the way in new innovations in reconstructive surgery.  My cancer patients may depend on it.

In Pursuit of Perfection

“Upon what instrument are we two spanned, and what musician holds us in his hands?”

Rainer Maria Rilke

This past week was a very busy yet very interesting time for me.  Early in the week, I had a visit from an old medical school classmate who is now one of our nation’s leading researchers in diabetes and other endocrine diseases.  Although most of his time is spent in the lab, he still prides himself on being an outstanding clinician, and I can attest to that.  I would choose him for my own personal physician any day, were he not based at Duke in Durham, NC.  He told me the following story:  a few months ago he was the attending physician on the endocrine consultation service.  The fellow on duty was called for a consult on a middle aged man who needed an amputation for vascular complications related to his diabetes, and the surgeon needed to make sure his blood sugars were under control before taking him for surgery.  The endocrinology fellow assessed the patient’s insulin requirements, and also mentioned that the man was complaining of some mild upper back pain, which seemed insignificant at the time. The case was presented to my friend, was assessed to be routine, and the patient went to surgery.  Shortly after the operation, the man suffered a cardiac arrest due to a myocardial infarction in the posterior circulation.  He did not survive.  My friend, whose job was NOT to assess the patient’s cardiac status, but rather his diabetic control, is still beating himself up about the patient’s death, many months later.  He insists that he should have asked the surgeon for a cardiac work up prior to the surgery.

On Thursday, I flew to Kalispell, MT to attend my nephew’s graduation from Montana Academy, a boarding school dedicated both to academic excellence, and the therapeutic mission of helping teenagers with problems learn to cope in positive ways. At the graduation ceremony, I was moved to tears several times, first by the headmaster’s recounting of the tale of Odysseus and the Cyclops as an analogy for the importance of finding and declaring one’s true identity, and later by the speeches of some of the parents whose children had benefited from this school, set in the green pastures and foothills of Montana. Finally, and even more importantly, some of the students themselves spoke, hesitating at first and stumbling over their words, but gaining strength from the support of the gathered crowd as well as their teachers, counselors and the founders of the school sitting behind them.  The students spoke of the failures which led them to the academy, each small but increasingly significant success they met there, and their hopes and dreams for the future.  These students were articulate and impressively intelligent. The last student who spoke was particularly moving, when she said, “Here I discovered that I am worthy of love, and that I DESERVE to love and be loved in return.”

We all strive for perfection, and yet for most of us it is our failures which teach us the meaning of life and of being human.  Some of us are lucky enough to learn this at eighteen, but many of us are still learning these lessons at sixty.  Last night, as I prepared for bed a row of necklaces I have hanging from pegs in the bathroom caught my eye—fossil mammoth ivory turned blue from arctic hoarfrost, and set with a fire opal, lapis prayer beads from Bhutan, ancient carnelian beads from the mountains of Nepal, and an old Chinese quartz crystal set in silver with enameled symbols of yin and yang.  I wondered, for myself, for my nephew and for my old friend, what talismans are these which can keep us safe, which can protect us from our own demons?  And what great musician holds us in his hands?  We can only continue to do the very best we can.

Do Dogs Know They are Dying?

Labor Day, 2006, is a day I will never forget.  It was a gorgeous day here in San Diego—bright, sunny and nearly 90 degrees.  I decided it was a perfect day to give the dogs an outdoor bath.  At the time, we had Valentine, the matriarch at nearly twelve years old, Izzy who was four, and the two young  ones Magic and Angelina who were two years old.  We started with Valentine—at her age she’d had a little problem with urinary incontinence, and she needed her bath the most.  We knew that the coiled up hose sitting in the sun on that hot afternoon had enough warm water to bathe her in, so my daughter and I mixed shampoo in a bucket of hot water from the kitchen sink, and just outside the garage, we soaped her up.  She seemed to be enjoying herself, a nice soapy massage on a beautiful day, and then a quick rinse.  As I turned to get the towel to dry her, I heard my daughter say loudly and in a panic, “VAL, DON’T FALL DOWN!”  I turned back around and she was gone, down on the wet pavement, eyes blank.  She never felt a thing.   I spent the rest of the afternoon sitting on the driveway with my dead dog, brushing her hair until it dried and the crematorium people came to take her away.  Needless to say, no one else got a bath that day.

I once read an essay by an oncologist who said that she hoped that she would die of cancer.   I was baffled by this, because my personal preference would be to go suddenly, of a heart attack or a massive stroke, preferably while doing something I enjoy.  But her reasoning was quite clear:  she said that with cancer, when you know that your days on earth are numbered, you still have time—time to do the things you always wanted to do, time to say good bye, time to make amends.  This has actually been true for most of my patients—when they know that they are diagnosed with a life threatening illness, their priorities change.  If they have the means, they live the lives they always wanted to live, for as long as they are able.  They remember, they forgive and they forget.  The trivialities of daily life become unimportant, except insofar as they struggle to get through them.   Many become the person they always wanted to be, and I hope that if this is my fate, I have the grace to do the same.

Today we took old Magic to the veterinary cardiologist.  Magic is my eldest deerhound—a big male at 120 pounds, and nearly ten years old.  The last two weeks have been hard for him—we’ve had thunderstorms and he has always been afraid of thunder.  In desperation over his anxiety last week I called his vet for a prescription for a tranquilizer.  It worked temporarily, but on Tuesday we had strangers in the house and he was panting, salivating, and his heart was beating far too rapidly.  I laid a hand on his chest and I knew instantly that his big old heart was failing.  Today the diagnostic echocardiogram confirmed what I already knew—that my big guy has dilated cardiomyopathy, and that he is in congestive heart failure.  We started medication immediately, and I am hoping for a few more weeks, or a few more months with this grand old man who is, as my husband says, “the dog who never did anything wrong.”

Do dogs, like humans, know when they are dying?  I don’t think so.  And in fact, for their sake, I hope not.  Unlike us, they have nothing to apologize for, and perhaps their next meal, or a walk in the park, or in a dream a wild chase after a highland stag, followed by a soft bed and the touch of a human hand is all that they hope for and dream about.  As Magic slowly made his way out of the van today onto solid ground, he was greeted warmly by Queen, Quicksilver and little Yoda.  I can no longer promise him a life beyond his years, but I promised him today that every day from now on will be the best day I can give him—lots of treats, a comfortable place to rest, and with all certainty, no more baths.

To Find, To Have and To Give Away

These days I have begun to separate my life into two separate eras which I call BE and AE, “before eBay” and “after eBay.”  How could there have been so many things in the world which I never knew that I wanted?  I think back to the early days of my marriage, when my husband and I lived in a 1400 sq ft Victorian “doll house” with wide board pine floors and a pitched roof and wonder how I managed to live without so many “accessories?”   It wasn’t until we moved to California, and bought a Spanish style home with very large rooms (“Honey, I shrunk the furniture!”) that the woman who owned the store where I bought my new furniture declared, “Now all you need to do is accessorize!”   And so I did.  Ebay became the source of my many so called “accessories,” previously known to the world of interior design by the Yiddish word “tchotchkes.”  Who knew that thistle themed items could be so attractive, and yet so ubiquitous?

The upside of eBay is that after a while you get to know who the best sellers are.  Everyone makes mistakes at first—I remember the alligator skin antique doctor’s bag which looked SO good in the pictures, but smelled SO bad when it arrived that it went straight into the outdoor dumpster by the barn, usually reserved for horse manure.  Sometimes antiques are charming and full of character.  But sometimes they are just plain old and smelly.  When I got my first deerhound many years ago, I became interested in all things Scottish, and discovered that Queen Victoria of England, was similarly enchanted with Scotland, where the royal family still maintains Balmoral Castle. In the mid to late 19th century, Scottish “pebble” jewelry became immensely popular, formed from polished agate typically surrounding a faceted cairngorm, a type of quartz mined in the Cairngorm mountains.  Brooches of this design, especially the larger ones, were commonly used on kilts, particularly to fasten the shawl or upper portion of the kilt known as the “plaid.”  In addition to beautiful rocks, Victoria also loved dogs and children, in that order– the phrase “children should be seen and not heard” is attributed to her reign. Portraits and etchings of the dog breeds she loved, including the deerhound, abound from that era.  And judging from the walls of my home, I seem to have located most of them!

For the past several years, I have put on an auction to help raise money for our West coast Scottish deerhound club.  The money raised helps us put on our annual regional show and allows us to subsidize our traditional after show dinner.  This year I did it for the National show as well.  I have discovered that my enthusiasm for Scottish and Victorian artifacts is transferable.  I mean, who DOESN’T want to picture themselves as a wild red haired Scottish lassie dancing around the May pole in the rain, or a strong handsome barrel chested kilted lad leaning against the standing stones of remote mountains?  And if you haven’t ever thought of it, tune in to the upcoming new Starz series “Outlander” and you too will be longing for a kilted man, pebble brooches, thistle emblazoned artifacts and an antique etching or two. I have begun to give away some of my collection so that others can share the romance of the Highlands.  Join us and share the fantasy—the best is yet to come.  And by the way, a deerhound puppy is a prerequisite, ye lairds and ladies!

My Days In Dermatology

I’ve always been good at pattern recognition and my visual/spatial orientation is excellent. Photography is my hobby, so it was only natural that as a medical student and internal medicine resident, I loved my dermatology electives.  Each day yielded up a new parade of interesting skin lesions and rashes, and by the end of my rotations I was confident in my diagnoses and recommendations—contact dermatitis?—steroids!  Eczema?—steroids!  Psoriasis—yep, you got it—steroids again!  Pimples?  Well that was a diagnosis that required antibiotics.  But sometimes, when it was really bad—yes, STEROIDS!  These were the days before Botox, and Restylane, and non-invasive mini-lifts, and lasers.  Occasionally there was the excitement of a skin cancer, or a truly serious life threatening dermatologic crisis, but as much as I enjoyed saying the words “pemphigus”, or even “bullous pemphigoid” (try it—they roll right off the tongue)—I didn’t want to spend my career looking at it.  I chose radiation oncology after my internal medicine residency, and never looked back.  I wanted to take care of sick people.

When I announced my retirement in February, the calls started coming in immediately.  Having moved several times since I graduated from medical school, I hold medical licenses in three states which makes me a prime candidate for companies who supply locum tenens or “hired hands”– doctors who cover practices while the regular doctor goes on vacation, takes maternity leave, or just needs a break.   I was vaguely interested, but not enough to commit to spending weeks away from home living in a hotel.  But then a call came in from my old group, a Los Angeles based practice that had just set up a skin cancer treatment unit in a San Diego dermatologist’s office.  The hours were reasonable, and the job was only two days a week, covering while the regular radiation oncologists took their summer vacations.  This type of radiation machine, called the Xoft, is fairly new and uses a miniaturized high dose rate X-ray source to apply radiation directly to the skin cancer, while minimizing the dose to surrounding tissues.  For basal cell and squamous cell skin cancers, the results are extremely good, with excellent cosmetic results providing a great alternative to the Moh’s procedure which can leave patients with a significant “divot” in their faces, sometimes requiring skin grafts.  Dermatologists can buy these machines, however they are not legally allowed to operate them, having no training or background in radiation therapy.  That’s where I come in.

For the last two weeks, I’ve spent Mondays and Wednesdays in the dermatologist’s office.  It is a remarkably busy office with seven exam rooms going at all times, an operating suite and numerous medical assistants scurrying around with headsets on to communicate with Central Command.  The atmosphere is similar to what I would imagine the air traffic control room is like at JFK.  No one ever goes to the bathroom or takes a lunch break. There are flat screen TV sets in every exam room, to entertain the patients while they wait (try explaining skin cancer treatment with radiation to an 86 year old with bilateral hearing aids watching an episode of “24”—challenging to say the least!) As the physician in charge of radiation, I must set up each patient to make sure the applicator is placed correctly.  This involves a brisk walk down a long hallway from my makeshift office to the radiation room many times a day.

In the middle of that hallway, mounted on the ceiling, there is a television which runs a continuous infomercial about the joys of cosmetic dermatology.  It took me a few passes to notice it, but once I did, I was mesmerized.  The pulsatile blue light of the laser erasing wrinkles, the miniscule needles injecting the varicose veins, the tightening of the dewlap under the chin and the apparent dissolution of fatty deposits in the wrong places and their magical reappearance to plump the cheeks and add youth to the lips were hypnotic.  A head-setted medical assistant colliding with my ample in-need-of-liposuction derriere brought me back to reality and the skin cancer patient waiting.

I am beginning to see some advantages in my current part time job.  I smile brightly at the dermatologist in his scrubs.  He is an MD-PhD and very smart to have hired radiation oncologists to treat his skin cancer patients.  I have a new admiration for the tools of his trade.  I think that if I am really diligent, I might just get a free consultation and who knows—with a little buffing and polishing and injecting—a whole new face!

Stuart Scott’s Acceptance Speech

Sometimes I feel like what I have to say isn’t very important and after watching a video clip of Stuart Scott accepting the Jimmy V Award for Perseverance tonight on ESPN, I think you might prefer to hear from him.  Background:  Stuart Scott was diagnosed with cancer of the appendix in 2007 and has been battling the disease for seven years.  Jimmy V, or Jimmy Valvano was the head basketball coach at North Carolina State, who died in 1993 of cancer but was known both in sports and his personal life for his slogan “Don’t give up, don’t ever give up.”  According to Wikipedia, Jimmy V’s tombstone reads, “Take time every day to laugh, to think, to cry.”

If you have time, continue to watch this video to see the clip about Scott’s enrollment in a clinical trial at Johns Hopkins, and then just as amazing, Michael Sam’s emotional speech about tolerance, acceptance and growing up “different” as he accepts the Arthur Ashe Courage Award.  These two guys say it all, so please watch:  http://espn.go.com/video/clip?id=11225895

More about my experiences in Dermatology tomorrow.

The Things We Save, The Things We Give Away

Since I just spent the last several months sorting through my own lifetime accumulation of “stuff” in order to get my house ready for sale, it was only fitting that I volunteered to chair the auction and raffle at the Scottish Deerhound Club of America’s annual National Specialty show, held in Richland, Washington last week. After my fall, winter, spring and summer cleaning, I had plenty that I myself could donate, so why not go on vacation just to have the opportunity to sort through someone else’s stuff?  After all, I’ve gotten good at it.  My intrepid road trip companion and auction co-chair Rachel and I rented an SUV a week ago Monday in order to haul the deerhound related treasures 1300 miles, set them beautifully arranged on a table, label and describe them enticingly just so they could, in short order, become part of another deerhounder’s collection of stuff.  George Carlin famously said, “A house is just a place to keep your stuff while you go out and get more stuff.” This time I vowed that I was NOT getting more stuff.

But while we were there…well, the stuff just kept on coming.  Prior to the event, I had fretted because my email entreaties to bring donations for the auction and raffle went largely unanswered, but apparently not unheeded.  The knocks on our hotel room door started as we were unpacking our own suitcases, and the donors came indeed, bearing gifts of cardboard boxes filled to the brim.  By Wednesday evening we could have built a cardboard city, although a bonfire might have been more appropriate.  There were treasures there which were hard to resist—an 1883 edition of William Scrope’s Deerstalking in the Scottish Highlands—clearly a necessary reference book for my life in Southern California, and a handmade deerhound topped casserole dish, oven safe and dishwasher proof, for my imaginary culinary creations.  Some of the items were brand new—a brocade collar fit for the Royal Dog of Scotland, and some were a little more than gently used, with a fluffy patina of dog hair and dust.   We slowly worked our way to the bottom of each box, sorting as we went, until we got to the last one, where I found two old picture frames, face down, and picked them up.

The dog in the picture looks at me, head slightly cocked, ears askew.  His eyes are brown, and questioning. His coat is clean, and not matted, and his head is covered in the soft hair called for by our standard.  He is in a cheap frame, as is his companion, in a matching frame.  Why are they here, buried in the bottom of a cardboard box? I imagine they are dead, and that the photographs are now too painful to look at because they remind the owner of times past, happier times, and I burst into tears.  I hope that I am wrong, that the person who brought these to my room in a cardboard box was just tidying up—that he or she had scanned the photos into his computer as “wallpaper” and had no need for the actual photographs anymore.  But that is not what those pictures said to me.  I put them back in the box.

Bring me your old leashes, your dirty collars, your worn T shirts and sweatshirts.  We will recycle them for the next generation to carry on the “long grey line.” Bring me your antique bronzes lovingly crafted by the Animaliers of France and England in the 19th century, and your tales of stalking the red stag over the heather and the drink of Scotch from the quaich at the end of the hunt.  Bring me your handcrafted jewelry adorned with Celtic knots of silver and gold, and your art work and your crafts.  But please, don’t bring me pictures of your own dogs, buried and perhaps painfully remembered, perhaps forgotten.  Keep them, and the memories you have of them running through the fields, healthy and young again.

We turned in the SUV at the Portland airport, and flew home.  The auction was a huge success, and we came home to our families and dogs—the only things that really truly matter.

Love and Loyalty From the Souls of Dogs

“Such sadness and endearing and abiding love…”  Fran

I am by nature a “right brain” person—despite my training in science and medicine, I prefer paintings and photographs to words and mathematical constructs.  Over the past two years of writing this blog, I have resisted on many occasions the urge to add pictures to this website, despite the fact that I possess wonderful photographs of the things that I write about—my family, my dogs, my horses and my patients.  I am constantly taking pictures—I have chronicled my entire life in photographs from my first Kodak Brownie and I will continue to do so.  But I started writing again, thirty eight years after graduating from college with an English degree, to see if I could “describe” rather than “illustrate” the events in my life which have had an impact.  I want to write stories that leave a little bit to the imagination, to my readers’ right brains—stories that can be read out loud.

For the past few months I have been following the saga of Roo on Facebook.  Roo is an Ibizan hound owned by the artist Nan Kilgore Little. Affectionately known by their owners as “beezers”, this breed’s history dates back 5,000 years to the times of the Egyptian pharaohs.  The erect ears and tall lean bodies of these hounds are depicted in hieroglyphs in the tombs of Ptolemy, Nefermat, Mereku and Tutankhamen.  Think of the god Anubis, Protector of the Dead, and you will have a good visual image of the head of this hound.  Brought to the Balearic Islands off the coast of Spain by the Phoenicians in 800 B.C., these dogs have hunted to put food on the table of their masters for centuries.

Roo turned sixteen years old a few weeks ago, an extraordinary old age for a large sighthound. You can see it in the pictures—the eyes, once keen are now cloudy and the strongly muscled hindquarters have wasted.  The bone structure appears more prominent, and yet more delicate at the same time. The ears are nearly transparent, and beautifully veined.  Nan started to post pictures of him on his daily walks, interacting with the other dogs in the household, and resting on his favorite pillow—pictures which have inspired a legion of Facebook followers who clearly feel privileged to watch the “old man” in his waning days and to take that last journey with him and his loving family.

The last forty-eight hours have been tough. Old Roo, with his brightly colored bandanna and his watchful countenance has stopped eating and has taken to his bed, his head resting on his favorite pillow.  He is not in pain, but he is very tired.  No more walking in the Wild Yard and no more jumping over the Big Tree.  His best friend, an Australian cattle dog named Barkool, has taken up watch and rarely leaves his side.  Barkool is neither elegant, nor particularly beautiful and his squat body is a contrast to the lean and classical Ibizan.  He is Sancho Panza to Roo’s Don Quixote.  He is the friend we wish we all had.

My Facebook friends love dogs as do Nan’s and as a result, we frequently feel compelled to put up photographs of abused, starving and abandoned canines in need of rescue, or dogs beaten and bloodied in the service of man’s cruelest whims.  But rarely, in these hastily posted pictures, we see a glimpse of life as it can and should be.  Yesterday Nan posted a photograph of Roo and Barkool.  Roo is wearing his blue bandana and is wrapped the cocoon of his softest blanket, one covered by multicolored hearts.  Barkool’s head is tucked under Roo’s chin as a pillow and his stocky body is still as can be.  His eyes show apprehension, and resignation at the same time.  He is, above all, present for his buddy.

Sometimes friends and families of my patients are uncomfortable visiting their loved ones after a diagnosis of cancer, or even more so at the end of life.  They ask me, “What should I say?” or “What can I do?” The answer is revealed in Nan’s picture of Roo and Barkool:  without fanfare, without words, without tears, just be there.

Rethinking The Hunger Games

When the movie The Hunger Games was released in the spring of 2012, it broke box office records during its opening weekend.  Not familiar with the books of the same name for young adults by author Suzanne Collins, I did not rush out to see it but I liked its young star Jennifer Lawrence, and was eager to learn more about the new film.  I asked my son, who had taken his girlfriend to see it in IMAX, what it was about.  He said, “You wouldn’t like it Mom.  It’s about children killing children.  It’s “Gladiator” for kids.”  Since “Gladiator” is the only movie I have ever paid, not once, but THREE times to see on the big screen, I beat a hasty path to “The Hunger Games” and I was not disappointed.  Yes, it is a movie about children killing children, but the shining presence of its young star Lawrence, as the fiercely determined and staunchly moral Katniss Everdeen–a name as evocative of lithe cat-like goodness, emerging sexuality, intelligence and of course nine lives as Humbert Humbert was of blunt force, dullness and downright evil… but I digress—diverts the viewer’s attention from the sad specter of death as mass media entertainment.

How strangely ironic it was then, today, to wake up to the news of the shootings at Isla Vista, the residential community that houses a large number of University of California at Santa Barbara students, and to find out that the perpetrator of this heinous crime—a child killing other children—was the son of the assistant director of the Hunger Games movies.  A nightmare come true—to see one’s son in videos detailing exactly what grievances would lead to this explosion of violence, and worse, to have called the police because of concerns over a son’s mental and physical health, and to have those concerns brushed aside when action could have possibly prevented the tragedy. The finger pointing and blame assignments have only just begun.  But the facts remain, whether we are speaking of Columbine, or Virginia Tech, or Sandy Hook or Aurora—alienated mentally ill teenagers and young adults with weapons destroying the hopes and dreams of many families’ futures.

Tonight I looked at the Facebook page of Elliot Rodger, the 22 year old assailant who died last night along with his victims in Santa Barbara.  Oddly enough, the page has not been taken down. There are pictures upon pictures—“selfies”—shot with a cell phone of the handsome young man and his black BMW and his Armani sunglasses and his expensive clothing.  It is telling that there are no other human beings in these pictures—just a young man and his fancy things—and yet there is a glimmer of talent there in the few photos taken from vantage points on solitary hikes in the Hollywood Hills—a moonrise, a view of the Los Angeles skyline in the evening.   But the rantings on video and even the captioning on his Facebook self-portraits speaks to a deeply disturbed, alienated and delusional youth, who is more than anything, alone and lonely.

The father of one of the victims has already cited that this tragedy is the fault of the NRA.  I do not believe that.  I believe that the problem lies in our society itself—a culture which creates a pressure cooker for high school students to succeed at any cost, a culture which glorifies violence while ignoring mental illness, a culture where movies about children killing children become major box office hits. It’s time to take pictures of our friends, and look at them and above all LISTEN to them instead of taking pictures of ourselves, our food, our sunglasses and our cars.  It is time, indeed, to rethink The Hunger Games.  My deepest sympathy goes out to all of those affected by this terrible event.

The Irony of It All, Part Two

The dogs are quiet today, sprawled out across their various rugs and beds in the family room.  After the panic and anxiety caused by the fires here in San Diego last week and the heat that generated them, it is pleasant to feel the cool breeze created by opposing windows in my kitchen.  I am waiting for delivery of a piece of furniture—an old Chinese grain storage bin which had been “repurposed” as a decorative cabinet long ago, and which is about to be “repurposed” anew to hold the television controller and cable box for my new flat screen wall mounted tv—the evolutionary equivalent of man’s preoccupation with necessity progressing towards his preoccupation with luxury.  I treasure the symbolism in my treasures, as it were.

The cabinet will put the finishing touches on the home improvement projects we started nearly a year ago.  My friends with giant dogs and horses will feel a pang of recognition when I say that by moving in here over sixteen years ago, we traded a beautiful home graced with a gourmet kitchen (with two dishwashers, no less!) for acreage with a tumble down ranch house that was a few years beyond “fixer upper” into true “tear down” geriatrics.  It all started with the cat, that self-same Bitty Kitty who visited a year ago while my daughter traveled for internship interviews.  He took a dust bath in the living room fireplace and carried the blackened ashes to the already worn couches and carpet stained by a myriad of prior pets.  When we replaced the couches and carpet, the owner of the furniture store oversaw delivery and remarked, “You’re too old to be living with three-day-blinds!  This is not an apartment!  Why don’t you get some real curtains?!” The new curtains gave the old paint job a dingy tint and the new paint job made the bathroom tiles look ever so dated, and well…you know how it goes.  Last week we actually epoxy’d the garage floor.  It is now perfect.

Severe drought in the West over the last few years and overly aggressive tree roots furtively seeking water had taken their toll on our landscaping, and the bulk of our meager water supply was emptying underground from broken pipes, so that too needed attention and correction and above all, money.  Six months after completing the irrigation work, our water bills are lower than they’ve ever been, and the rose bushes are blooming again.  San Diego may be a desert, but how green are my pastures!

So I am enjoying this brief period of “this old house” being “as good as it gets.” I am no Martha Stewart, nor was ever meant to be, and my husband is definitely not “handy”—he would rather hire someone than change a light bulb.  The kids are grown, the horses are ancient, and even the dogs have slowed down a bit.  The house is for sale, and rightly so.  But every so often, I sit in the kitchen and listen to the wind chimes and watch the mother bird nesting and chirping in the ceramic birdhouse outside the open window. And I wonder why it took me sixteen years to realize that my “tear down” is instead, a little piece of paradise.