Vancouver, tooth picks and Teri’s award – please donate

 Vancouver 11/5-11/14

                                 

Dad and I ate many simple Chinese comfort foods – won ton noodles – even those are discernably better than the best in the States.  We ate at two of the three top Dim Sum restaurants in Vancouver, Fisherman’s Terrace and Kirin.  We hosted one Shanghai-style banquet with shrimp, whole fish and crab – Teri’s favorites – for Dad’s friends including Chinese artists, art critic, art historian, and two former graduate students. 

Despite the seasonal rain and drizzle (7 out of 10 days), I ran twice outside and otherwise ellipticized and practiced Tai Chi.  I read Haruki Murakami’s Wind Up Bird Chronicle (intriguing, difficult to describe) and Ha Jin’s Nanjing Requiem historical fiction about the 1937 WWII massacre.  I learned that Dad was there until 5 months before and had he stayed another 10 days, would have been trapped there …  The book used actual names including Minnie Vautrin who protected nearly 10,000 women and children refugees housed at Jinling College.  The book mentioned Eva Spicer, one my Mom’s professors, who she saw again in 1963 in London.  I gave a talk at BC Children’s.

I learned more about my mother from her Jinling College roommate (90+) but was saddened to learn that her husband had died since we last visited.  In the vernacular of 70-90 year olds, chronic illness, hospitalization, disability, end-of-life, and passing were topics du jour.  I can relate.

More closure and reengagement

With Cindy’s help, we organized a celebration of Teri’s life for her Chinese woman’s group Gan Bei (‘bottoms up’) on the 18^th.  I left up the photomontage from the Open House.  Caroline and Eduardo, Kun, Lorraine, Ada and Cecelia, and Tina came for pot stickers, egg roles, fried noodles and dessert.  There was high energy and some tears.  It was something left to do on my ‘closure list’. 

The Gan Bei group brought an abundance of desserts that segued into an impromptu dessert night for neighbors the following day.

Kari, Ben and Rachel’s violin teacher in Columbus for 10+ years, and Ron, invited us over the next night for dinner. 

Seems like we are reengaging, we minus one.

Thanksgiving

Ben returned home for Thanksgiving.  He studied intensely every free moment, following lectures off-line, listening to pod casts, making note cards on his new HTC Rezound smart phone.  It is quite something to experience vicariously his challenges that are both similar and dissimilar (multimedia, much more genetics) to those from my ancient past.  He really enjoys the intellectual challenge, the social experience (group study). and the humanistic (ethical) dilemmas encountered.

Ben and I played ping pong, one of our core family activities in Columbus, at Spin, a nationwide chain combination ping pong palace, restaurant, and bar.  Imagine that you get a bucket of balls, can slam them at will, and someone else retrieves them and refills your bucket.  It was fun. 

We had our usual Thanksgiving turkey with the Koslov/Fulton clan (20+) in Madison preceded by THE best comfort chicken and matzo ball soup.  Steve had his 7^th annual trivia contest “Where was the French horn invented?”  “Where did banana hats originate?”  I spent time with one of my mentors Ray (and Memee) who recently developed AML and is undergoing chemotherapy, and son Michael, spouse Tina, and grandchildren Steven and Maddie from Seattle.  Our experience with neutropenic precautions has been useful for them.  We hope for the best. 

[Germany, Ecuador]

Charlotte and Bob invited us over for a post-Thanksgiving dinner of chicken with a sweet soy basting much like my mother’s.

Toothpicks

Teri typically cleaned between her teeth with Japanese toothpicks (carved at the non-pointed end) after dinner, and to my chagrin, would leave them by her place setting in order to reuse them.  When I was in Vancouver, I discovered one barely visible perched atop a thin ledge next to the bathroom sink.  Was it there before?  It has been 16 months since our last visit.  I chuckled when I saw it.  Typical Teri.  Was she there with us in Vancouver?

Then, when we were setting up for Teri’s Gan Bei celebration, I noticed one placed under her usual place setting.  I sit there now.  I don’t remember using one.  If I do, I don’t save them.  Was she here with us?  Mysterious …

Award in Teri’s name

I had a flash.  Teri’s passions, were children, education and service.  Amongst our NASPGHAN (North American Society for Pediatric Gastroenterology, Hepatology & Nutrition - I'm the immediate past president) members, the bulk of our young academics are choosing to become clinician-educators.  We have awards for research, life time achievement and service, but none for budding educators.  Why not have an annual award to honor educational contributions by a young pediatric gastroenterologist – Teri Li Award in Education?  I vetted this with our educational gurus and executive council.  They like the idea.  We would like to start it up next year.

We propose a $500 annual award and an initial goal to raise a $5,000 - 10,000.  If successful, we would like to aim for funding to support pilot educational grants. 

Please donate to this award in Teri’s name.

NASPGHAN Foundation – Teri Li Education Fund

NASPGHAN

1501 Bethlehem Pike

PO Box 6

Flourtown, PA  19031

Teri would be embarrassed for herself, but pleased as an educator.

Reminders and Vancouver

For those new to the blog or just returning, here are some highlights:

Oct 25th:  Award dedicated to Teri

Sept 29th:  A photomontage of Teri's life

Aug 31st (BMT +197):  Awake wake - more photos

Aug 27th:  Awake wake 'A celebration of Teri's life'

Reminders happen.

Last Tuesday evening, I spoke to Asian American and other minority medical students about how to choose a specialty.  At my table, an Iranian-American student had heard me speak previously on the differing expectations during the 3^rd year on the wards.  As part of that talk months ago, I had spoken about Teri’s BMT and why it was so important to join the bone marrow registry.  He cited points I made in detail.  Then he pulled up his sleeve and - wow - showed me the green plastic ‘kick butt’ bracelet that was handed out to donors way back in the spring.  I couldn’t believe it.  I showed him mine!  Teri’s supporters are still kicking butt. 

I promised Teri to take my father to Vancouver. 

On the plane we watched photos of Teri and my trip to Venice, Florence and Rome just four months before her diagnosis.  He was enthralled despite having been there a number of times.  “Too bad, you can’t go back to Italy with Teri.”  No, it won’t be the same.  Yes, I can go back.

Getting there.  Things work out.

The key to the condo was stolen and the lock had to be rekeyed.  But, trying to get cleaners in, the concierge was unable to open our door.  Anticipating that we would be up a Canadian creek without a paddle on a Saturday night, I had the locksmith come last week to straighten it out.  The cleaners cleaned and our key keyed.

Anticipating the need of another set of arms, I had Emily, Dad’s former PhD student, to pick us up at the airport.  Wheel chair assistance allowed us to bypass a huge queue of arrivals on China Air.  We went from touch down, through customs, baggage claim, final clearance to exit in < 30 min.  I couldn’t believe our luck.  It probably won’t ever happen again.

In fact, we exited so quickly we forgot to pick up Dad’s walker.  When we realized it and returned later, all the counters were closed.  No one answered the Delta line.  Whoops. The information people were unsuccessful and asked us to return the next day. I wasn’t sure we could transport Dad down the long condo hallway without it.  Discouraged.  We found another information staff – woman with that resourceful twinkle – who after getting no responses, somehow managed to find our original wheelchair driver who had been trying unsuccessfully to reach us by phone.  Lo and behold.

Vancouver is full of memories. 

Teri loved Vancouver.  She set up the household and stamped it with her attention to detail and stylish flair.  She felt at her best of anytime during the 19 month ordeal during July 2010 after her first rounds of chemotherapy, in remission.  Rachel (incubating Jack), John and Ben were here as well.  She ate like a lioness.  Her sticky rice, rolls made to order, the spinach/egg/bean thread bingzi pastry, the xiao long bao (Shanghai steamed dumplings) with vinegar/ginger garnish ... fresh lobster and especially crab with ginger and scallions.

THE BEST DIM SUM, HUGE DUMPLINGS, BURSTING WITH FLAVOR.  THE BEST COMFORT WON TON NOODLES WE’VE HAD.  Supposedly #1 or #2 in North America, competing only with Toronto and Hong Kong.

I retrace our steps of July 2010.  I drive to Terra Nova Park, past the Olympic skating oval, where we saw the bald eagles, but they are gone.  I walk to Diaso the Japanese $2 (Canadian equivalent to US) store to buy a few items where she had so much fun shopping.  I amble to the food market where they made her favorite fresh sticky rice rolls.  It makes me nostalgic, and sad that she is not here to enjoy her favorite things.

Jack turns one!

Jack turned one year old on Saturday.

I (and Teri) went to Columbus for 60 hours to celebrate his 1st birthday.  

I rode down John, a neighbor down the hall, whose son is a walk-on player for the Buckeyes having never played football in high school – an amazing feat due to his feet.  John and I were both going to Columbus, in part to watch the OSU-Wisconsin game, a major Big 10 Conference confrontation since Wisconsin knocked OSU out of national contention last year.

A poem for Jack

John and Jack

Frothing frosting

Wearing a winter present

What is this?

I think you are too old for me

Rachel invited her friends, co-workers, neighbors and some of Teri’s and my close friends: it was good to see Susan, Rhonda and Chris, Peg and Rick, Lilly, Jack and little Rachel.  Teri would be busy showing off Jack.  He takes 5-6 steps but he walks about constantly with his baby walker doing a baby marathon equivalent.  ‘Da’ is his favorite and only word, intoned from growl to high pitch.  If you ask him to clap, gong xi, wiggle, he will do it, and smile.  He ate the frosting from his birthday cupcake, became buzzed, and walked even faster.  

I saw colleagues Carlo, Steve, Hayat and many GI nurses (still there after all these 20 years).  The new Nationwide Children’s tower, the gigantic Digestive Disease Center, and the brand new (3rd) research building make it unrecognizeable from my last visit.  Ironically, the new hospital looks remarkably like Children’s of Wisconsin here.  I had lunch with Bob a former colleague who has left Nationwide Children’s.  Jack’s birthday party.

I went to the OSU-WI game with Rick.  It was an instant classic that turned on a turnover, several long plays, and two touchdowns in the last 2 minutes, the first for Wisconsin with 1:20 left to take the lead, and the second for OSU with 20 secs left to secure an upset win.  A great, great game to be remembered.  I’m still a Buckeye.  

Life goes on with a new cycle spearheaded by a little man name Jack.

NASPGHAN meeting, an award dedicated to Teri

[For those new to blog, a photomontage of Teri's life is in September 19th blog.]

An incredible national meeting with 1075 attending in Orlando this past weekend, underscoring how much NASPGHAN (North American Society for Pediatric Gastroenterology, Hepatology & Nutrition) has become an extended family to Teri and I.  Many, many hugs, condolences, thoughts, prayers and support from colleagues around the country and world.  Even though it was hard to get on the horse again and attend in the wake of Teri’s recent death, it was indeed very comforting to be there.

After such an excruciating 19 months, several other things happened at the Annual Meeting that made me think Teri is looking out for me.  First, I received the Murray Davidson Award from the American Academy of Pediatrics (AAP) to “an outstanding clinician, educator and scientist who has made significant contributions to the field of pediatric gastroenterology.”

Second, it gave me a chance to go out to dinner with the GI Section (AAP) that selected me, and, to organize a 10 course Chinese/Japanese/Korean gastronomical celebration for 33 NASPGHAN and MCW colleagues.  Third, I was acknowledged at the business meeting and in private, despite my shortened tenure as President of NASPGHAN, for instigating a number of initiatives:  inaugural Mexican councilor, new patient website gastrokids.com, practitioner’s forum, neurogastroenterology committee, experiments in social networking, clinical research initiative with the FDA, new career development seminar, and the short and sweet 18 minute presentation format for the annual Post-Graduate Course.  And finally, the authors shocked me by dedicating the just published Board (Certification) Review Book to me.  A highlight of my life that I wish Teri could have shared with me in vivo.

I asked several colleagues if they were trying to make me feel better, given the year that I had, and they said no.  I felt I as President had developed good synergy with my Committee Chairs and proposed ideas but let them run with them, take ownership and credit – I do know they enjoyed working with me.  Because I am much more comfortable brainstorming in the back rather than ‘leading out front', I didn’t expect these kudos.  I had a chance to thank many of my Chairs and Councilors in person.  Almost too much for one individual … but it nevertheless felt very good to the core. 

First Asian American or minority President of NASPGHAN.  First Asian American or minority career achievement award winner.

Tom Sferra, a former GI fellow and mentee, who is becoming Chief of GI at Rainbow Babies, introduced me at the awards ceremony.  He didn’t roast me too badly, only lightly singed me as he talked about how I used to slice and dice fruit so it could be divided amongst the four colleagues at lunch.  He described how the four of us would share each other’s foods, even soup with one spoon, whenever we ate out in restaurants.  I commented that we were trying to train his intestinal microbiome, the intestinal bacteria that are proving to be so important to many diseases.

Here are my acceptance remarks to thank my mentors and a few of my colleagues.

It’s great honor to be here.  I would first like to thank the American Academy of Pediatrics for this award, especially my colleagues within the AAP Section of GI, Hepatology and Nutrition.  This award came as a very pleasant and unexpected surprise.  That I am in the mold of Murray Davidson – i.e. clinician-observer-educator-hobbyist investigator-activist – is most fitting.

I came to GI through a detour around my original intention to obtain an MPH and work globally.  Few I suspect will know who was the mentor most responsible for my detour into GI.  In this SLIDE, 

you will recognize the twin-like resemblance similar akin to that between Danny DiVito and Arnold the Governor.  For those of you who don’t know him, he is 6’5” Peter Whitington.  The graphic reversal was performed by my son.  Peter as a GI fellow, was the best teacher I had as a resident and inspired me with his prodigious clinical knowledge and investigative acumen.  LESSON:  Be open to opportunities, even in detour and even in arm twisting.

I initially worked under Gerry Odell a self-trained gastroenterologist and bilirubinologist and the 1994 Shwachman Award Winner who thought I should become a BLIrubinologist. 

Not to be.  I switched to Ward Olsen’s lab at the VA Hospital;  he mentored my studies on intestinal transport of carnitine.  

As part of the rigor, he required all GI fellows to do a triathlon with him – ultimately to help fish him out of the drink during the swimming leg.  OBSERVATION:  they don’t challenge fellows like the old days when giants walked the halls.

As a young faculty at Columbus/Nationwide Children’s Hospital, I prospered under chief Juhling McClung’s leadership philosophy (SLIDE) – let the inmates make decisions. 

 So, during our daily brown bag lunches, my fellow junior faculty inmates Bob Murray, Leo Heitlinger SLIDE and I began discussing Buckeye sports, troubleshooting divisional problems, and thinking creatively about change. 

The collaboration, synergistic thinking, and proactive desire to improve things provided horizontal peer-to-peer mentoring that has served me well throughout my career.  GOAL:  may you find simpatico colleagues who stimulate and energize your development.  

To these colleagues, I add Colin Rudolph a close friend and former chief at Medical College of Wisconsin who constantly challenged me to think broadly and ethically about NASPGHAN.  SLIDE  

Here he is performing an exam on a ancient tree in Scotland, true to his nature, plunging in head first.

Two NASPGHAN presidents provided the first windows of opportunity to me.  SLIDE  Dick Colletti took a chance and promoted me to Training Chair based upon no track record but an outline of a vision of how the fellows’ conferences could provide career development in an integrated curriculum.

Mitch Cohen gave me the opportunity to design the Teaching and Tomorrow and First Year Fellows’ Conferences and stood by (not too close) while I nearly hung myself with the Uniform Date of Offer for Fellows affectionately known as Black Monday – the precursor of the Match.   Lesson:  mistakes can be the segue into better things.

My family unfortunately couldn’t be here with me today SLIDE. 

Rachel our daughter is an 4X ironwoman who presented us with our first grandson Jack in October. SLIDE  Here he is one week old.

SLIDE  Here Jack is 10 months of age looking like he wants a cigar and a drink.  SLIDE
 

Ben our son has been a part of the NASPGHAN family:  he worked for pediatric gastroenterologist, presented an abstract here last year, and just began medical school.  

I’m very proud of both of them.

As I reflect, I realize that one of my key role models stood by my side for 39 years.  Teri was a Montessori teacher and volunteer who cared deeply about family, children, ethnic diversity and socioeconomic discrepancies.  She was my sounding board and ethical compass.  I’ll describe one teaching moment at a welcome party for incoming Asian American medical students just before she died 1.5 months ago.  To a medical student who was disparaging another medical school, I overheard her say SLIDE: 

“It is not about where your school is ranked [by U.S. News & World Report], it’s about what you do with your career, how you manifest your passion and compassion.” 
 

SLIDE

I was overcome by her inspired teaching lesson.  It is to Teri, my partner, that I dedicate this award.  [Standing ovation.]

Thank you.  Thank you all for your support.  [Somehow, I got through it without breaking down. - thank you Teri.]

A tribute to Teri from the national Asian Pacific American Medical Student Association

I was aware that APAMSA students were going to honor Teri in some format, but imagine my surprise when I discovered the insert (below) in the program late in the day (how unobservant I can be when focused on my talks).  Teri would be and I was very touched.  I immediately sought out the organizers Pinyi and Sophie and thanked them.  Some 350 students came to beautiful Palo Alto (shorts and flip flops student attire) in the brand new Li Ka Shing Meduica Education building and attended the national conference.   I co-.founded national APAMSA with 5 medical students in 1995 and still feel that it is my baby, now maybe grandbaby.  Jhemon Lee is doing an admirable job a president of the advisory board try to herd accomplished and involved Asian American physician advisors.

In one session on bone marrow registration by Asian Americans, I spoke entirely about Teri, reviewing her clinical course, how she lived in the present, uncomplaining, her bucket list, her impact upon others, her living wake, the minority issues around BMT, and her peace of mind at the end, when she decided not to continue her hemodialysis.  There were many tears, including my own,.  It put a beautiful face with a horrendous medical story to highlight the critical need to expand the minority bone marrow registries.

In a second session on profiling and stereotypical Asian American medical students as passive. Asian American students in general tend to be quiet based on a culturally appropriate active listener role in small groups.  However, this 'quiet' is subjected to interpretation of their clinical performance as ... disinterested ... lack of fund of knowledge... and incompetent ... even failing rotations.  This misinterpretation was validated by a senior faculty (non-Asian) who serves as an academic advisor to many of Asian American medical students and a senior internal medicine resident, both there at Stanford in 2011!.

The most important was to interact with friends (Winnie Chu SF, Gordon Chang Palo Alto) at dinner, Steve by phone and  former high school classmate Joan, ( Paul) by phone, family (Teri's siblings Terri Lin and Tony and Terri's son Greg, Cindy, grandkids Christian and Darien - full of vim and vigor) and airline seatmate over the weekend and gain fresh insight on how to proceed with my life.

Winnie & Gordon (separately):  "You have a unique opportunity.  You should take a sabbitical or leave of absence for 3-6 months to recover from the exhausting journey and find yourself, even if it leads to things different than what you now do, even if not a specific goal but just a path."

Several:  "Teri gave you a gift by achieving her peace."


Terri Lin:  "I will have a memorial for her locally."

Steve:  "Teri felt you became much stronger over the year and a half.  It was really important that she saw that you could live on your own, before she let go in peace."

B:  "I can begin to see that in a Buddhist sence, that she had all she needed in the end, a peaceful state of mind despite the constant pain, the destruction of her body, the disability and poor quality of life, and the constricted life outside the hospital ..."

Rick (airline seatmate):  "Life is mysterious.  Teri and you are both on new journeys, it is just that you can't send post cards to each other."  [I break out laughing at that unique spin.]

Although it was emotional on my first foray to a meeting in over a year, it was filled with meaningful interactions, needed feedback, invaluable insight, and proactive advice.

It was, a positive weekend away.

Whitherto

I am in uncharted waters, stranger in a strange sea. 

I am overwhelmed by numerous things that Teri formerly did for both me and my father (finances, condo, travel, health, time share … plants, cleaning, maintenance) – I’m gradually getting my arms around them. 

I am surrounded by Teri’s aesthetic sense for things large and immovable and small and portable throughout our condo. 

I am overwhelmed by the emptiness which I try to fill up with the many tasks she used to undertake and with her soothing Hawaiian music and our James Taylor or even the TV.

I am supposed to continue to grieve, for my own mental health.  There are times when I feel absolutely lost and empty, even viscerally queasy.  There are times when I just sit immobilized and paralyzed, with the TV on.  There are times when I become filled with laden emotions and cry.  This is all supposed to be my ‘normal’.

Little things cause me to well up.  I opened the kitchen drawer and caught sight of Glad Press ‘n’ Seal the adhesive cellophane that we used to wrap all her lines in order to keep them dry when helping her shower.  It was part of our intricate ritual of disability that we had become so accustomed to.  That bonded us in unforeseen ways.

Many colleagues, neighbors and friends near and regional have called, brought food over, invited us over, and took us out to eat …  I even went to a movie at the Milwaukee Film Festival, first theater film in at least 9 months, second time in 19 months.

The future is a complete blank screen.  Where will I be, what will I do, …

On the other hand, I find myself experiencing little zen moments, when I[m handling cut flowers or trying to resuscitate her long lost plants … even enjoying the present moment rather than treating it, as I usually did, as a chore.

I miss Teri’s practical, anchored, clear sighted sounding board that always provided me with course corrections.  Our psychologist reassures me that I can still talk to her ... that I should still speak with her, regularly, as I need to.

I’m over in East Lansing, MI with Ben, Rachel and Jack as we celebrate Ben's birthday.  He says he is overwhelmed but is enjoying the learning and keeping his head above water.  His apartment is comfortable, neat and organized, and Spartan (literally, sorry for the pun).  We spend a lot of time watching his back as he is studying constantly and intensively.  We took a brief tour of the campus, sampling the campus ice cream.  We took him to a Chinese-Thai-Vietnamese restaurant.  Rachel and I have restocked his fridge and freezer from the Oriental Mart and Meijers.  We bought household items, bowls, utensils.  I cooked two dishes to be frozen ahead, basil chicken (Thai) and Jyajiang mian (Chinese spaghetti). Rachel makes beef stew in a crock pot.

We reminisce and console – and express continued disbelief.

Baby Jack eats everything:  Indian food, jyajiang mian, pad sie ew.  He moves rapidly, and opens everything.  He crawls and cruises.  He stood up alone without support for the first time on this trip!

I can begin to see some positives.

A photomontage of Teri's life and journey

From her open house

Here are the pictures of the pictures on our walls.  I emphasized the last 19 months to provide a pictorial sense of the grueling struggle, the lows and the few highs.  Teri’s smile comes shining through to the end.  She was such a trooper.  Enjoy and emote.

This is quintessential Teri ... having fun!

The 'baby' of the family

She was of legal age!

4 months before she was diagnosed

2 months before she was diagnosed

Best friends, Steve and Mary

Brother Tony, SIsters Anita and Terri

Teri got to put Ben's white coat on him!