Sunday, July 22, 2018

If Teri was treated in 2018?

Fortuitously it occurred the day after the coincidence of Mother’s day and our wedding anniversary, two days laden with memories for both the kids and I.  This year I spent that day with Ron and Kari.  Kari harkens back to Columbus 1986 when she was Rachel and Ben’s Suzuki violin teacher and Teri’s masseuse.  The following day, I had dinner with Dr. H.  Obviously a pearl strand of memories.

I invited Dr. H, mom’s oncologist and bone marrow specialist, to dinner specifically to catch up and for me to ask about Teri, to gain an additional modicum of medical closure.  Even though we work in the same large medical institution, I had not crossed paths with him in more than 6 years since Teri died.  It’s insufficient to say that he was very special to Teri and vice versa.  It was not only his thoughtful care and willingness to go the extra mile to seek unique, cutting edge, individualized solutions but also the relationship they developed.  Dr. H says he still ponders about her twice a month, about what lessons he learned and about what he could have done differently.

His professional career has been ascendant and a reflection of his clinical and administrative expertise.  As Director of Bone Marrow Transplant (BMT), he subsequently grew the BMT physician staff from 3 at Teri’s time to 15 currently.  He stated that their 1 year BMT survival rates have been #1 in the country for the last four years running and exceed the famed MD Anderson in Houston by 20% points!  He has since been promoted to Chief of entire Hematology and Oncology Division encompassing 160 staff.

I talked about my retirement and the impact of Teri’s premature death and the battles over insurance coverage with my institution that hastened my transition.

Then we revisited Teri’s illness. 

What went awry?  Simply stated, in the absence of a high quality live donor match, the partly but best matched umbilical cord sample simply did not provide enough stem cells to allow her to manufacture sufficient numbers of white cells to fend off the multiple viral infections that plagued her to the very end.  Of course, there are now new ways to expand them in the test tube.  And as you may remember, immature umbilical cord stems cells are not armed and targeted towards infections without a sergeant thymus gland that recedes after age 60.  Lastly, the constant viral infections (CMV, herpes and BK) further suppressed her fledgling umbilical marrow from producing new neutrophils (white cells).   

What more could have done?  Dr. H was thinking that the next step, if she had consented, was to inject another dose of her own autologous marrow so she would have a chimeric combination of Ben, umbilical cord and her own.  He projected that she might have lived another year perhaps up to three.  But as we all know, with catheters surfacing from her back, arm and neck weary worn of all the interventions.  She absolutely couldn’t tolerate the physical distress of dialysis.  Most of all, as a vibrant, active and proactive independent soul, she couldn’t accept her complete loss of autonomy and dependence upon others.  She had always been the fulcrum of our family, the emotional center, the earth mother.  And, on her terms, she made the fateful decision to stop all therapy, and faced death with equanimity.  

How would Teri be treated today – 7 years later?  The initial chemotherapy would be the same.  But after the expected relapse, she would now just receive Ben’s partially matched stem cells from leukopheresis without any secondary umbilical cord donor.  In fact, one now needs only a 5/10 match instead of an 8/10 HLA match.  Rejection results from this half match but it is deftly handled by a repurposed drug Cytoxan (cyclophosphamide).  With this new protocol she wouldn’t have developed those infections that afflict the immunocompromised and would have likely survived to see the anticipated births of Naomi and imminent Flora (Ben and Theresa).

So how does this new information feel … closure?  Poignantly, yes it does.  Certainly there is the wistful what if she became ill 3 years later, that there could have been markedly different outcome …  Perhaps lessons learned from her unique, terrifying, complicated illness are helping.  Medicine evolves, especially quickly in oncology and immunology.  And we see the remarkable progress has been made in her mismatched bone marrow transplant in just a few years … for others.  It gives me hope for the future.  We still miss her.

Note:  New pictures uploaded below.

Wednesday, June 20, 2018

Still alive

Still journeying

In February, I was a Road Scholar in Vietnam, Mekong Delta and Cambodia along with close friends Steve, Mary, Liz and Mitch as well as several Vancouverites.  It is difficult to compress the many lingering impressions of Vietnam but they spanned a diametric range from the majestic Guilin-like tower karst arising from the sea in Halong Bay and lush beauty
Halong Bay
and fecundity (3+ rice crops/year) of the Mekong Delta … to evidence of failed devastating U.S. policies with lingering French and U.S. influence (in the south) and our guide’s sobbing recount of his father’s torture by the French and later imprisonment/confiscation of property (made homeless) by a corrupt Viet Cong official.  Cambodia remains fragile but equally disparate from the resplendent Angkor Wat at dawn
Angkor Wat at dawn

Angkor Ta Prohm
Angkor Thom

Angkor Thom
Ato the Killing Fields of encased skulls and our guide’s loss of 20 relatives to the Khmer Rouge.  During a quiet interlude, I asked “Can you forgive them?”  After a lengthy pause he responded “No but where can I place my anger, only 3 of 10,000s have been charged.”  

Last week, I returned from a pediatric GI conference in Shanghai plus six invigorating days exploring Shanghai, Wuzhen, Hangzhou and Nanjing (former capital).  The polluted haze perseveres yet their ultramodern air and railway hubs, bullet trains (188 mph) and cashless phone pay far surpasses our antiquated infrastructure.  Bicycle ownership is uncommon and color-branded on-demand bicycles unlock at the click of one’s phone – we rode helmetless through the gridlocked cities next to silent electric motorcycles.  My favorite was unknown (to Western tourists) Wuzhen water (canal) town reminiscent of a Wu Guanzhong painting

Wuzhen water village at night
juxtaposed to an uber contemporary theater and museum dedicated to the artist Muxin who  was imprisoned/prevented from painting during the cultural revolution but emerged to develop in NYC.  Lit up, the town glowed at night.  I was invited to the Prof. Wang Tiande’s (who knew my father) studio/gallery to view and discuss his unique burnt paper and ink landscape paintings.  I spent time walking around Xuanhe Lake in Nanjing reimagining Mom

Xuanhe Lake where Chu-tsing Li and Yao-wen Kwang courted circa 1946
 and Dad courting in 1946 (have pictures) – they attended Nanjing U and Jinling College which harbored women to protect them from the Japanese soldiers.  We enjoyed a number of local delicacies sour fish, sweet lotus root, vinegared chicken, Yang’s fried (juicy) dumplings and of course xiaolongbao (soup dumplings).  All in all, we visited 8 museums, 3 galleries, 14 historical sites, 2 temples, 1 garden and 2 night markets and amassed calf-aching 141,699 steps over 6 days. 

Invariably when I bask invisibly amongst 1.4 billion Han, I reflect on the serendipity of my parents not returning to China as planned, as during the disruptive cultural revolution, my father would certainly have been imprisoned, tortured or worse, and I would have been exiled to the countryside with curtailed prospects for the future (the actual fate of a childhood playmate).  A flip of the coin inexorably altered my fate forever …  

The jarring juxtaposition of looking alike but feeling different in China compels me to wonder what if ... I had grown up in China like any of those besides me ...  where would my abilities have taken me, what would my passions be, and what would my life be like?  And the mirror reflects so clearly that despite my efforts without my parents' trajectory, life choices and consequent opportunities here ...  I am humbled, and so fortunate.  

Still teaching

Besides in Shanghai, I was asked to speak to four APAMSA conferences this spring including Michigan State where Ben graduated and is well remembered.  Two were entitled Lessons from an Academic Life and gave me a wonderful opportunity to introspect and gain hindsight (the GI perspective, of course). I populated powerpoint with self-deprecating images demonstrating my evolution from infant to overweight 5thgrader to sculpted swimmer to guitarist (rock and James Taylor to woo Teri) to long-haired flower-patterned protester to full-bearded pediatric trainee and fledgling faculty.  In this fun process I rediscovered a number of things.  First, I observed how my success was largely built upon foundational skills gained from extracurriculars and jobs – swimming, music, student government, student organizations, rock band, student newspaper, summer jobs – i.e. ‘everything I needed to know came from outside the classroom’.  And I had an omnipotent uber Tiger Mom.  Second, I faced significant adversity that impelled me to change medical schools/uproot family twice and loss of Teri but managed with pretty remarkable resilience to land upright and trudge onward.  Third, my desire to give back to Asian American medical students was derived, I believe, from working through my identity crisis and becoming empowered by protesting our Vietnam policy.  And lastly, I acknowledged that Teri was not only completely supportive but inspired me with her strong inner compass in support of diverse individuals, those with gender differences, and those socioeconomically downtrodden.  It was fascinating to unfold my life visually (changing hair styles), temporally (developmental stage and adultood from WI – OH  – IL – WI), humorously (yes I was fat) and thematically (extracurricular, identity, giving back, resilience). 

Still reading

This was a binge reading week and I read four books, three worth mentioning.  A new definitive biography of Tiger Woods documents his preternatural pressure parenting in a highly dysfunctional family that contributed to his major missteps.  

The Longevity Plan: Seven Life-Transforming Lessons from Ancient China by academic cardiologist Dr. John Day consolidates many of my thoughts on nutrition and lifestyle for optimal aging.  He explores Bapan aka Longevity Village in southwestern China that has the highest rate of centenarians 1/100 (in excellent health without heart disease, cancer, diabetes or disability) 20 times the 1/2000 figure in Okinawa - the gold standard - and 1/5780 in the US.  The first lesson – eat real food – discusses use of plant protein (veggies, tubers, legumes and fruits farm-to-table in hours) with frequent fish occasional meat, whole grains (unpolished rice and millet), longevity soup (hemp seeds and pumpkin greens), no dairy or sugar, and 12 hour ‘fasts’.  The other lessons include change your attitude, connect with others, stay in motion, stick to a schedule, purify your environment and have a passion most of which can be found on other lists for healthy aging.

Things that Make White People Uncomfortable by Michael Bennett (NFL Probowler and Superbowl champ) is an unexpurgated description of the plight of the black man and athlete who is deemed hero on the field and easily subjected gun to head – as happened to him – while off it.  He waxes on the NFL realities (treated like a piece of meat/CTE/blackballed Colin Kapernick who took an anthem knee), NCAA taking advantage of student-athletes, fresh food deserts in the inner city/food justice, unarmed people shot by police/Black Lives Matter/prison as the new Jim Crow, empowering daughters and women/Me Too, using athletes voice for change (A4I), and forgiveness as a first step to growth.  An indeed a disquieting but illuminating wide-ranging discourse on the pervasive pain in our citizens of color.   

It has been an invigorating and enlivened spring.

Wednesday, April 18, 2018

Last week’s learning: China and Japan, and our current polar ice

It has been a very stimulating, thought provoking week.

Why do you find Song and Yuan Dynasty art and architecture in Japan rather than China, especially that of the Chan masters?

Seeded during my father’s sabbatical (9th grade) was a lurking identity crisis that burgeoned during a summer sojourn (sophomore) in Kyoto JP.  Nurtured by traipsing around the many Zen temples with my parents, my friend Marie and by myself, I began to feel unexpectedly comfortable not only with my aesthetic environment … and my minority myself.  I didn’t understand why.  In unadorned terms it was the gentle sweep of thickly thatched temple roofs, the browned and greyed worn wooden walls, and the ‘naturally’ arranged rocks, combed gravel, verdant moss, gnarled trees and calming ponds.  This aesthetically and viscerally appealed to and calmed me in contradistinction to the gaudy yellow tiled roofs, blue, green, and gold details and red walls of the Manchu taste.  Upon my return to the U.S. I weathered a full blown existential mid-college crisis … for another discussion.

My father told me that visiting Kyoto was in effect being transplanted to Song (960-1279) Dynasty China.  I did not fully grasp this notion until yesterday.  Watching to James Cahill’s (an art historical colleague of my father’s) video and listening to Professor Wang yesterday, the cultural flow across the Sea of Japan of Japanese monks to Chinese Chan temples and the return of Song Chan (Zen) scrolls to Japan led to an infusion of one genre that inspired Japanese art and architecture to the present.  Specifically, the axe cut angular landscape strokes of Ma Yuan, the soft power of Mu Xi’s Six Persimmons and the sketchily spontaneous Chan Two disciples (one a tiger) are recognizably ‘Japanese’ instead of the complex landscapes of the Chinese literati (intellectuals).  Simply, the paintings that could be taken to Japan were those of ‘untrained’ idiosyncratic freewheeling Chan monks whereas those of the master painters could not be removed from literati or royal collections.  Once Japan closed its ports, this flow stopped and those artifacts became iconic in Japanese culture preserved and refined.

Ying Wang, Chinese Painting Course, UW-Milwaukee and James Cahill Video on Chan and Japanese Painting

Why is China building artificial islands in the South China Seas and trying to grab the Senkaku Islands?

What is China’s endgame, safeguarding its shores, protecting its passageways to the Pacific, gaining access to continental hydrocarbons, or domination of Asia, or beyond …?  French traces the current aggressiveness to three concepts.  First is the dynastic Sinocentric view of tian xia (everything under the heavens) with China at the very center and all empires either conquered states or tribute-paying vassals.  Second is 21st China’s rising reaction to the horrific century of humiliation from 1840-1945 spanning the Opium War, international spheres of influence/concessions, sack of Beijing, and Japanese occupation (Nanjing massacre).  Three is countering militarily and surpassing economically the U.S.’s Asian presence by both hard military and soft economic power.  Militarily, they manufactured an island outpost atop submerged Paracel (Fiery Cross) Reefs, repeatedly invaded the 12 mile limits of Senkaku Islands (and stoking anti-Japanese nationalism), unilaterally explored for oil in Vietnamese waters while developing the largest nuclear submarine fleet.  Economically, they are pouring resources into the Maritime Silk Road (Malacca Straits) and One Belt, One Road (OBOR) infrastructure and trade development from China to Europe over the former Silk Road and Asia Infrastructure Investment Bank.

Will this pattern continue inexorably, and China eradicate U.S. influence in Asia?  Possibly yes, probably no.  As China continues to expose its sharp elbows, resistance by the ASEAN coalition and new bedfellows Vietnam, Philippines and India mounts.  The cost of naval military buildup is likely to exceed their inflation rate, hardware innovation further increases cost and scaled production may not occur in the dearth of China’s alliance partners.  Lastly, the growing elderly population (330 million by 2050 and lowest ratio of working/military eligible to elders) and predicted decline to under 1 billion (US 450 million) will exacerbate the military support.  So, perhaps this is Xi Jinping’s brief window of opportunity to reef and island grab, and to expand the military.  So yes, there will be a rebalancing but not complete dominance.  Interesting!

Everything Under the Heavens:  How the past helps shape China’s push for global power by Howard W. French

Why is the current state of affairs in so many countries, toxic and polarized?

It’s the tribal instinct says the author of the Tiger Mother.  She analyzes the U.S. military failures of the Vietnam, Afghanistan and Iraq wars through the prism of long standing internecine tribal conflicts.  These were not appreciated by US policy or military leaders.  In Vietnam it was between the 1% elite Chinese-Vietnamese who controlled 80% of the economy (market-dominant minorities) and the Vietnamese.  In Afghanistan, it was between the Pashtun elite vs. the Tajiks, Uzbeks and Hazaras.  In Iraq, it was between the Sunni minority elite vs. the Shia and Kurd majority, respectively.  In other words, democracy was a predictable failed exercise and the ‘democractic’ sharing of Afghan power alienated the Pashtuns and directly furthered the rise of the Taliban from amongst their ranks.  All missed opportunities that should have begun with a deep understanding of the tribal milieu.  Hindsight is 20/20. 

She turns to the U.S. and the same tribal model can be applied to the current divide.  The alt right tribe takes Trump seriously but not literally as he represents the symbolic values.  The left takes Trump literally but not seriously in their world view.  And the two sides are not interacting, and the we-they divide expands.  She cites research than indicates how intra-tribal loyalties influence perception of facts and and out-groups, and how these allegiances can be manipulated!  Of concern, poor whites appear to have limited upward social mobility, and perhaps due to lack of attention, are even more underrepresented than minorities in the elite colleges.  At the end, she is sees some crossing of the demilitarized zone and glimmers of hope.  

Political Tribes:  Group instinct and the fate of nations. Amy Chua (author of Tiger Mother)

Friday, April 6, 2018

An award, Mom’s writings, my wanderlust and a surprise

An award

Good things sometimes occur post-career and as I joked ‘posthumously’, that is when you’re done and least expect it.  Two weeks ago, the Medical College awarded me a Diversity and Inclusion Award for my long-standing, ongoing work with Asian American medical students.  You may recall that I founded the national APAMSA (now 90 med school chapters) in 1995, served as faculty advisor for four different local chapters, and continue to speak at many medical schools and conferences most often about countering faculty profiling as passive.  I did this under the radar as being proactive in diversity (as a ‘soft’ area vs. hard science) was not in my time an avenue to academic recognition.  Yet, despite that, it has been my most rewarding give-forward passion, to share my avuncular advice.  An opportunity to reflect on the many wonderful Asian American medical students I have met, advised, mentored, employed, counseled and attended weddings (and even officiated one!).  Whew. 
Again, B is misspelled  (no period!)
My comments at the ceremony:
• My appreciation to MCW Office of Diversity and Inclusion and President Raymond for this wonderful award.  Let me thank two parties.
• First, my student leaders from APAMSA sitting there – please stand up.  When I suggested we find a way to recognize their many contributions to Hmong health in Milwaukee, they turned around and instead nominated me.  And so here I am.  The respect is deep and mutual.  I want to note that for their Hmong Health Project (health education, health screening, student mentoring, radio shows and health fairs), the MCW chapter has been selected the National APAMSA Chapter of the Year for an unprecedented 4 years running!
Our MCW APAMSA Chapter leaders - the best
• Second, my wife Teri Li who passed away prematurely due to leukemia.  Besides being a grandmother and a Montessori teacher, she volunteered regularly in food pantries.  She was my shining example of someone who treated everyone she encountered with respect regardless of race, ethnicity, gender orientation or socioeconomic status.  I accept this award in her honor. 

Teri's favorite Jasmine explodes and exudes fragrance at  this time ...
I received a nice compliment and note from Dr. Raymond about my continued involvement with APAMSA and Teri.

In combing through my mother’s papers last week, I discovered a letter my mother wrote in Chinese about my great grandfather and grandfather (who passed away when I was 3 in Hong Kong).  After translation, I gained another deep root in my tree.  She published Sweet and Sour a book of Chinese folk tales for middle school readers and several short stories about her experiences during war torn China and its aftermath.  And guess what, I found a trove of her unpublished stories.  As I have with my father through his writings, I have another unique and unexpected and welcome opportunity to appreciate my mother.  

Wandering about …

As I have been trying to discern why I travel so much, escape, discovery, walkabout, sabbatical … I just realized that it was foretold in the 22 places (and 46 transitions) I’ve lived/stayed.  Thanks to my father’s sabbaticals, my early experience akin to an army brat planted that restless seed.

Thru high school
Iowa City, IA                      
Oberlin, OH
Bloomington, IN
Cambridge, MA
Princeton, NJ
Hong Kong, CH
Taichung, TW
Kyoto, JP
Lawrence, KS

College, med school, residency
Princeton, NJ
Kyoto, JP
Kansas City, KS
Cuba, NM
Ukiah, CA
Topeka, KS
Halstead, KS
Madison, WI
LaCrosse, WI
China (17 cities during 52 days)

Professional life
Memphis, TN
Columbus, OH
Chicago, IL
Milwaukee, WI
Vancouver, BC (back and forth)

Cumulative stays
-          Japan 9 trips totaling 10 months (my favorite country)
-          China/HK 17 trips totaling 8 months
-          Canada 27 trips totaling 12½ months

A surprise

Ben and Theresa are going to have a girl! 

Wednesday, January 24, 2018

2017 – by the numbers!

From whence I was a wee laddie, t’was a counter … marbles (steelies, favs – clearies), number of cars/makes) passed, scores and averages in my elaborate mini games pencil/marble baseball, pencil/paperclip/eraser hockey and ping pong/can top basketball games. I counted each interminable lap during my first waterlogged mile at age 10. So … here I go again. Surely obsessive but my attempt to account for how I spent my inaugural retirement year. And nothing is as reassuring as data in a counterfactual world.

First, the kids and grand ones
Jack is a 1st grader, math hound who moved from Legos to cards, now a Pokemon fiend and Uno shark where he beats the Depends off his grandpa. Naomi (same school) is a K4’er and despite being the youngest raised her hand to be a guinea pig in front of the entire school assembly – where did this forward behavior come from? Rachel began group coaching on health, diet, and fitness for BeachBody and continues triathlons where she is often a top three female finisher. John is integrating Capsugel into its new Lonza family which necessitates back and forths to Basel CH.

Ben is a 3rd (of 4) grader in his Emergency Medicine residency in Denver and, based upon extra shifts, an extra year and higher through put, encounters 3X’s as many patients as the average. He was selected to serve as one of next year’s chief residents and, stumbling close to the family tree, is deferring a real job to complete a 2-year research fellowship with a master’s in epidemiology focusing on gun violence. Theresa continues to work for two high tech firms in Shanghai (Glow fertility app) and SF and is the chief barnyard manager of 3 rescue dogs and 6 eggy chickens.

Now the numbers …

My year – in travels

Air miles 75,000+ frequent flyer miles (higher than actual)
Car miles 5692
Days out of town 205 = 29.6 weeks
Modes – plane, train, shinkansen (high speed), subway, elevated train, bus, car, ferry, motorcycle side car, auto, bicycle, 2 feet …

In order of places I visited/stayed overnight with single trips listed on one line (* work)
Mendham NJ
Baltimore* / Mendham
Richmond, Vancouver CANADA
Peoria* IL
Mendham / NYC / Lovango Cay / St. Johns USVI
Lawrence KS / Columbia MO / Iowa City (a road trip!)
Boston* / Delphi NY ® Mendham
Beijing* CHINA / Osaka JAPAN / Okayama / Kurashiki* / Naoshima Is / Teshima Is / Yokoyama / Soja City / Osaka / Beijing
Richmond / Vancouver / Surrey / Victoria CANADA
Manhasset / NYC / Brooklyn* / Flushing
LA/Westwood* / Palo Alto* / San Francisco / Walnut Creek CA
Las Vegas* / Richmond / Surrey / Vancouver CANADA / Mendham
Houston / Galveston

Comment: Interestingly, the total is no different (by airline miles) from the two prior years. The biggest difference was the nearly 60% time spent elsewhere. Each trip was lengthened and combined with seeing old friends, parents’ friends, former colleagues and interesting places. This year’s highlight was Naoshima, a bucolic Japanese island suffused with contemporary art installations. The sojourns outside the country in this polarized time provided perspective and refreshed me. My 3 months in Vancouver means Tai Chi boot camp, all biking/no driving, speaking Mandarin, eating all Chinese/Japanese. And a rolling stone gathers no poop.

-in people
Social events 147
Dinner partners 446 includes family and a few large parties
Blog posts 3
Grandkids 6X
Ben/Theresa 2X one family reunion

Comment: Although I lead a mostly solitary life, I was quite surprised to learn how many friend and family dinners kept me company. Sometimes it feels a bit awkward to be the 3rd wheel amongst duos but … so be it. A few dates were sprinkled in ... it has been 45 years out of practice!

-in academic work
Talks given 16 I gave more than one in several places
Conferences attended 5
Articles published 2
Articles submitted 1
UptoDate chapters reviewed 31
Papers reviewed 11
Letters of promotion written 3 for Harvard, Penn faculty
Letters of recommendation 3
Grants reviewed 1
Committees attended 2 for mentoring

Comment: I did a surprising amount of academic work for a retiree but at least it was the more fun part of academic medicine – giving invited talks (Johns Hopkins, Harvard/Boston Children’s, and Beijing Children’s), reviewing and editing. All of it was completed without an assistant (other than me, myself and I), which was a pain. With strong urging from the kids, I also survived the transition from a PC to MacBook.

-in culture
Books read 49
Pages read 17,036
Movies seen 45 mostly on airplanes
Shows seen 89 mostly museums
TV series watched Fresh off the Boat, Dr. Ken
TV serials watched Mozart in Jungle 3, Bosch 3, Westwood, Girls, Ken Burns Vietnam series
Sports watched all OSU football and basketball games my handle ‘bukleye’

Most interesting books:
Little fires everywhere Celeste Ng top 50 2017 book set in Shaker Heights
Do not say we have nothing Madeleine Thein multigenerational saga from China to Canada
The China Study T. Colin Campbell role of animal protein in chronic diseases
Tea girl of Hummingbird Lane Lisa See Chinese adoptee from China to US and back
The Gene Siddartha Mukerjee history of genetic advances
A tale for the time being Ruth Ozeki Vancouver to Japan tale
The sympathizer Viet Thanh Nguyen Pulitzer fiction on human costs of Viet War
Fire in the lake Frances Fitzgerald Pulitzer account of missteps in Vietnam War
Hamilton Ron Chernow The genius who jump started the union & gov’t
The girl - an eye for an eye David Langerkrantz Continuation of Lisbeth Salander’s story

Most interesting movies:
Loving Vincent (van Gogh) Florida Project

Comment: My deeper and enjoyable immersion into culture continues, but actually read only 1/3 more books than last year’s 36. However, I did tackle several monster books including Hamilton, The Gene, and Beatles All These Years v1. I read three authors I know including Dad,
a residency mentor Cathy DeAngelis who became Editor of JAMA, and college roommate Rob Slocum. That was cool. And, I now get antsy if I have to wait somewhere and I don’t have a book in hand.

-in health
Clinic visits 19
Surgeries 2
Weight 133.6 (stable X2 years) was 148.4 before beginning intermittent fasting
Cholesterol 214 = Decent, good cholesterol 82 (excellent)
HgbA1C 5.7 = Good, holding off type 2 diabetes
Glucose 96 = Good, holding off type 2 diabetes
Fasted 19 days = Below target of 1X/week

Exercise 343X = 6.6X/week
Tai Chi 155X 2-2.5 hours/day in Vancouver
Biking/spinning 97X = 808 road miles up to 18 mph; 31 miles longest, up to 75 miles/week in summer
Running/elliptical 29X = 21 road miles
Swimming 41X = 25,000 yards
Yoga 23X
Steps 2,190,000 extrapolated from estimated average 6000/day, 17,160/d max

Comment: I’m in better health than I was at age 50 due to ramped up Tai Chi and intermittent fasting. I am finally feeling it – the internal machinations the master describes but which I couldn’t appreciate before. Although the biking and running are declining, I took up swimming again, my high school sport, after rehabbing my shoulder – less overall bodily wear and tear. However Tai Chi is not all benign as I tore my right hip adductors during a butterfly stretch and just finished rehab. This lower weight maintained for 2 years on intermittent fasting has produced more energy, less weight borne wear and tear, and improvement in biochemical parameters! I’m an aficionado!!

-in errands
Total 343+ many combined 3-5 together
Days spent on Dads stuff 22 papers to Taiwan Nat’l U, books to ASU ...
Days spent on Teri’s stuff 4
Days spent on Ben’s stuff 2

Comment. This is an underestimate as I didn’t consistently record errands at the beginning of the year. That number raises a conundrum – how did I ever work, travel for work, take care of Teri and/or my father, and manage four properties with their attendant hiccups before? I cannot fathom …

-in new or renewed activities this year
Took Chinese art history course from Prof. Ying Wang
Taught Tai Chi to Al Liu
Took Mandarin tutoring in Vancouver by Mary Ngai
Collected contemporary Chinese ink paintings extending Dad’s collection
Resumed swimming laps

-in new habits
Qigong – Ba Duan Jin 8 exercises every morning
Drink cocoa bean tea antioxidant superdrink
Drink p’u er tea from Yunnan tea with digestive benefits

Goals for 2018
Finish sorting through Mom and Dad’s papers
Finish sorting through Teri and my (personal and work) stuff
Downsize/move from Milwaukee
Begin teleconsultation with patients and consultation with pharma
Begin creative non-fiction writing

Last thoughts – and less about the numbers.
I am in good health and fit.
My 2017 accounting may be an attempt to prove just that and – competing with those of last year’s self – to stave off the notion that I’m fading.
I’m having a stimulating sabbatical, even with substantial unpaid work.
I love to travel.
I miss Teri.
I’m a better person today because of her, more mindful, more relational and more at peace, I believe.
I experience moments of profound happiness, beauty and adventure.
I laugh.
I love the kids and grandkids, and we have great relationships.
I am much more at peace with Dad as I’ve now read hundreds of his letters revealing him to be as prolific and thoughtful a letter writer in Chinese & English/typer/carbon copier as he was taciturn with me. He churned out gazillions of letters of recommendations, articles, books and catalog introductions, and creative ideas into his 90s for the greater good of classical and modern Chinese art history, many graduate students and modern Chinese artists.
I accept him as he was with fond son-father memories of his last declining years.
I will be moving, but I don’t know where yet. My ideal would be to spend 3-4 months in Vancouver (nearly there), 3 months in NYC close to the grandkids, and 5-6 months at a base camp … where to be determined.
I am thankful.
I am still growing, learning, evolving …
I am whole, not just a fraction, not just an isolated prime.

Happy New Year and Chinese New Year (Feb 16 – dog) to you and your family! For those with children bearing after Feb 16, your grandchildren will be persistent, attentive and wealthy (eventually).

Keep in touch


Thursday, October 19, 2017

Laptop passes, picture found, travellin' man, my mother, blog rating discovered

My trusty sidekick 7 year old (210 human years) world beater Asus laptop passed suddenly on Saturday night.  It was quite ill, had recently lost its memory which I replaced and was still syncopal suddenly shutting down, going blank.  Fortunately .... I had enough warning to save everything on a thumb drive.  With Ben and Rachel's advice, I jumped the chasm to a MacBook and am having the usual startup blues.  It connects to the last paragraph below.

As I was combing through pictures for Ben, I came across this picture of two Queens' College alums at a John Kerry fundraiser in Madison in 2003.  I blogged previously about seeing 'Beautiful:  The Carole King Story' musical in NYC in 2015 and the musical connection through my singing her 'You've got a friend' at our wedding back in 1972.  And, here is the picture of Teri with the songwriter herself.

I just returned from a work-and-play trip to the West Coast.   Instead of the past go-attend meeting-return routine, I try to add extra days to connect and meander and that is just what I did.  I began in LA to attend the national APAMSA conference at UCLA's brand new Geffen Center.  As usual I gave two talks (Pitfalls for Asian American medical students:  Educational profiling [as passive] and Bone marrow transplant:  An intimate story).  Interestingly, the students still honor an old fart and labeled my name tag with 'Founder'.  As usual, I spoke with and informally advised many, many medical students, still feeling somewhat relevant and useful.  Took a medical student leader to dinner, met her parents.  And as unplanned, learned of on the spot and attended a world class symposium on the hot area of the microbiome (intestinal bacteria) and as planned wandered off to the mega LACMA to view the Chinese, Japanese and contemporary art on display.  Then flew to up to SF to stay in Palo Alto with a former national APAMSA president and spouse, Sean and Joy, whom I first met in 1995.  From the airport they whisked me off to La Traviata at the SF Opera. and over the next three days we spent many evening hours free ranging from their research endeavors, their faculty development, diversity and gender in academic medicine, work-life balance to raising children - an incredibly stimulating reunion.  Giving hope for the future of academic medicine, both are MD-PhD NIH-funded physician-scientists, yet the nicest and grounded of individuals, as well as a couple, and as the parents of two teenage daughters.  My main purpose was to discuss writing a paper with Sean on Asian American medical students.  Always multitasking, I gave my standard APAMSA talk to the local chapter and then made my rounds of Stanford faculty and administrators in pediatric GI, neurosciences, Dean for Faculty Diversity, head of Asian Liver Center (eradication of Hep B/liver cancer) and Asian American history (although I couldn't connect with an author on how to design a career) - and came away brimming with new ideas.  After, I wandered by the SF Asian Art Museum, met with Li, the curator of Chinese Art and my father's former graduate student, and focused on Shang dynasty Chinese bronzes (related to my auditing) and SE Asian art (related to my upcoming trip).  My last was a day and a half stop in Walnut Creek to visit with nonagenerian Ruth, a very close friend of my parents.  Had lunch with nephew Peter.  The fires in Sonoma and Napa sullied the Bay air and affected/destroyed houses for three friends.

I visited Ruth because she remains one of the last known links to my mother as a child.  Ruth was my mother's classmate and best friend in Pui Do girls school in Guangzhou.  From her, I learned not only a great deal about my mother's youthful character but also of Ruth's early life as well.  Both Ruth (father and mother by age 8) and my mother lost parents at a young age and the mutual losses bonded them.  My mother's mother died when she was only six from tuberculosis contracted from a patient.  I know that loss affected her sense of security throughout her life.  My maternal grandmother was apparently one of the first female graduates of Lingnam Medical School.  Both my mother and Ruth boarded and ate together nearly every day.  Both were energetic and rebellious adolescents and created havoc, some having to do with the kitchen staff.  It is just fun to imagine these two tiny strong-willed Chinese women, 5' at the most, stirring up big 'trouble' at school.  My mother was apparently an accomplished pianist and singer which I caught glimpses of occasionally.  Although she apparently aspired to become a physician like her mother, apparently falling in love with my father diverted her from that path.  Ruth invited us to her nephew Nick's upscale, wine-walled, 'modernized' Chinese restaurant with farm-to-table and Kobe ingredients.  Ruth remains remarkably sharp, ambulatory, healthy, indomitable and at peace.  Someone to aspire to be like as I age.  I'm so happy I got to spend time with her (and my mother).

Ruth standing by her daughter's art work

A reconnecting, life-affirming, mind-expanding and art-appreciating trip!

To close what began as a remembrance of my lapdogtop, during the transition from PC to Apple I discovered an email from Google that noted that the blog was one of the top 50 leukemia blogs.  Whoa.  What?  Wow.  I no longer think of this as a Teri's leukemia story but a paean to Teri's mindful life, my gradual restoration and return to life, and miscellaneous observations on healthy living.  And I don't really know any longer who's reading it.  But perhaps what began with disease and demise now has a healthy life of its own ...  

Saturday, September 23, 2017

Sabbatical in … Milwaukee to Vancouver to …

After Teri died in 2011, several close friends suggested that I take a sabbatical to grieve and recover.  What a rejuvenating suggestion at the time!  Alas, one impossible to pursue as I became the conscripted 22/7 caretaker for my 91 year old father, beginning his long march into aging dementia.  Then after he passed, I organized his memorials and stewarded his academic papers, remaining books and art as he wanted.  Another added effort on top of work.   

So, my sabbatical began this year, known otherwise as retirement.  People asked often how it was going.  I couldn’t respond as it was too early to know and I had no established routines.  Now I do.  I sleep in and awaken environmentally to traffic rhythms outside my window, no longer the alarm!  I begin with 8 Qi Gong exercises gleaned from Margaret an artist friend of my parents, the Ba Duan Jin that addresses specific health issues including hypertension.  I drink cocoa bean tea an superdrink steeped in antioxidants.  (Harvard/NIH invited me to be a 7 year participant to study its anticancer and antiheart disease effects.)  I remain on the Portfolio diet with more plant based proteins (oatmeal, almonds), little dairy, meat and red and white, less refined sugar.  I drink P’u er (fermented in Yunnan Province) tea for its digestive benefits.  I continue to exercise 7 days a week, Chen Tai Chi, biking or spinning, running, restarted swimming this year, yoga.  More on Tai Chi later.

I read the disheartening real news but try to maintain a precarious equanimity as events devolve.  I answer e-mails, the personal ones with delight.  A moving letter arrived from a former patient who survived a liver transplant at age one and invited me to her wedding.  Made my month!  Although I don’t see patients, I still do academic work.  This year, I have given a surprising number of invited talks including ones at Johns Hopkins, Harvard and Beijing Children’s Hospital.  And several to APAMSA groups at Stanford, UCLA, UW-Madison and here.  This will certainly decline so I enjoy it, while it continues.  I review manuscripts, write letters for promotion and edit for UpToDate the most used online clinical reference textbook.  I’m about to launch a part-time 2nd opinion teleconsultation for long distance patients with cyclic vomiting syndrome.  However, without a trusted assistant, I am:  secretary, transcriptionist, travel agent, telephone interface and bottle washer.  I appear to have an unquenchable thirst for words despite 36 books so far including tomes on Alexander Hamilton, the Beatles, and The Gene.  With the assistance of a Chinese art historian and a Chinese reading friend from Taiwan, I just completed reviewing and shipping 13 large boxes of my father's academic papers and slides to Taiwan National University and three boxes of his books to Arizona State University.  With further help, I am getting his art cataloged, organized, stored, insured.  And I see Rachel, John, Jack and Naomi, Ben and Theresa, Steve, Memee … with regularity. 

Ah, Vancouver (Oh, Canada) for two months!
It has become an essential, healing haven for me.  It began with Teri and I visiting my parents during summers, then accompanying my father after my mother passed, then three times my father and I, and finally the last three years by myself.  I switched from Yang-style (soft) Tai Chi studied in Milwaukee to Chen (original form, more martial) Tai Chi there.  The Sifu (master) Paul Tam (a national champion of Southern Fist) is a student of the highest rated Tai Chi expert in China Chen Zhenglai also a direct descendent of the founder of Tai Chi.  What I began as a hobbyist five years ago, has progressed to aficionado and now dedicated pupil.  This summer I trained two hours every day – my boot camp –and just completed learning the core 74 form old frame I (Lao Jia Yi Lu).  This year I really noticed the benefits.  Lost weight, built muscle.  Improved balance, increased energy, enhanced flexibility.  But some costs.  Due to the crouch (horse stance), my quads are continually sore.  Last year an overuse injury of knees and this year torn right hip adductors. 

Life in Vancouver with its temperate dry sunny days, screenless (bugless) windows, scenic sea and mountains in a single view (with a touch of retained snow caps) and endless excellent Asian cuisine – is otherwise simple for me.  I don’t have to cook as Chinese comfort food (dumplings, bing zi) abound.  Sans car, I bike everywhere.  I study Mandarin with a tutor for four hours a week.  I go out to museums, openings and eat with friends.  For the first time, I participated in a Tai Chi performance at the Taiwan festival.  The grand kids came to tear around an indoor water park, an indoor kids city and an outdoor park with zip line and 30 foot tower slide.  Steve my best buddy transformed me into a Vancouver tourist and ferried us to Victoria and Butchart Gardens.  For the first time, I put up paintings on the barren walls, converting it from temporary abode to colorful pied-à-terre.  And, I made a decision to expand my father’s contemporary abstract ink theme and purchased some new paintings this year.  A serendipitous encounter lead me to an editor of a contemporary Chinese art magazine who will advise me.

Now returned to Milwaukee just in time to resume my annual fall meeting journeys.  I am auditing a graduate seminar on Neolithic development and early Chinese bronzes at UW-Milwaukee.  I am teaching/practicing Chen Tai Chi to/with a Chinese American trainer. 

So how am I doing?
Brimming with stimulation, words, exercise, travel and even work … on slow time, no longer frenetic.  I notice that I don’t get upset – as I used to overreact and catastrophize – when traffic builds up, can’t find parking, and things don’t unfold as I meticulously planned …  Still improving this self, body and mind.  I’ve maintained my new weight (11% lower) for 22 months and feel quite empowered at this ripe age that I can remold and rejuvenate my somatic self.  I’m establishing new physical skills and muscle memory.  I’m listening to my body.  I’m learning about Chinese art and many other miscellany while keeping active in my pediatric gastroenterology field.  So bottom line, more energy, more positivity, more peace, more mindfulness and openness to new experiences.  So yes, after six years, I’ve finally come up for air and the sabbatical is rejuvenating.

As James Brown belted out “I feel good”.