Marianas Eye

Guamology Interview for World Peace, a Blind Wife, and Gecko Tails

2011-08-07T08:57:00.005+10:00

I was interviewed about my book back in 2009 by Kel Muna, a film-maker, and host of the Guamology.com website. Since then, Guamaology has gone off-line, as Kel has become busy planning the Guam International Film Festival. I enjoyed the interview, and thought I'd post it here since Guamology is no longer around.

World Peace, A Blind Wife and Gecko Tails. It's such a great title. How did you come up with it? Did you have any alternate titles before settling on your final choice?

As I was having friends review the book, I'd ask them, "What is this book about?" and the typical answer was that because the pieces covered a potpourri of subjects, the title would have to be reflective of that. I also wanted the title to be a bit intriguing and memorable. Someone suggested that many of the pieces were about world peace, so that became the opening of the title. The blind wife and gecko tails are references to specific pieces in the book. I also wanted to give reference to our tropical location, and that's why I chose "Gecko Tails" as part of the title. My first thought for a title was simply, "Thoughts from an Island".

How does it feel to know that Blind Wife is required reading for sociology students at the University of Guam, where before Blind Wife it had been Mitch Albom's "Tuesdays With Morrie"?

Honestly, I'm a bit stunned. I'm always surprised when someone tells me that something I've written is meaningful to them. I receive the reflection papers that the students write after reading the book, and it's both rewarding and humbling to know that something I've written has in some way touched someone's life. "Tuesdays with Morrie" is such a powerful book. I can't really get my head around the fact that Blind Wife has displaced it from the reading list.

I understand that Blind Wife is a compilation of all of your most popular columns from the Saipan Tribune. When and how did you come to write for the paper?

I started writing for the Tribune as a columnist in 2004. I had wanted to be more disciplined in my writing, and I felt like having a weekly deadline would help. I also am a curious person by nature, and like to pull ideas from various places, so the column provided me a place to share the things I was learning or thinking about.

When did you get the idea and interest of turning your columns into a book? How long did the process take to put the book together?

The book came about as a result of panic. About a year before it was published, I decided to take more time off from work and write a book I had been thinking about for some time. I had given a series of talks on the subject of establishing unity in communities. People told me that I should turn that into a book -- "7 Habits of Unity" or something like that. So I took time off to write this book, but really didn't have a clear idea of where I was going with it -- the tone, the audience, the purpose. And because of this uncertainty I began to have all kinds of personal doubts and misgivings while trying to write it. I spent a lot of time just staring into past my computer screen into space. After nine months, I realized that the year was coming to a close, and I had nothing to show for it, and that I'd feel like a total loser if the year ended and I hadn't published a book. So, I realized I could pull together my columns, which were already written and which had been well-received in the community, and publish them. So this book came about because I wimped out at writing the other one.

Your writing style is very easy to relate to as well as reflective. Did you have a formal education in writing?

I got the same training that we all get by virtue of going to school. I didn't take any special writing courses or workshops. But I did have some terrific teachers who taught me the value of re-writing, and the need to read your own writing out load to make sure it makes sense and that it flows. One of my comparative religion professors had a journalism degree, and he emphasized the need to write clearly for a broad audience, even in a term paper. So, I think that's where the conversational tone of my writing comes from. I also believe in being authentic. Even though at times I write about some lofty principles (like being truthful 100% of the time, or not dwelling on the faults of others, or eating well and exercising daily) I know it's difficult, because I fail with the same struggles. I try to make sure I'm conveying that I know I'm on the same human level as my reader.

How did you decide on the number of entries to include in the book? Did an editor choose for you?

I wanted to have about 50 pieces, just because it was a nice round number. I went with 52, because that's the number of weeks in a year, so it's like a year of columns.

Your writing style and reflection of topics are uplifting and the overall tone reminds me of one of my inspirations, Seth Godin, a blogger who totally thinks outside the box. What is your source for inspiration when it comes to writing your entries?

I've never really thought about this before. I think my writing is just a reflection of me, my thoughts, my surroundings and my responses to them. So, in some way, the answer to the question of what inspires my writing is the same as what inspires my life. The biggest sense of inspiration for me is a conviction that the world is moving inexorably toward a fully integrated global society, and that the social structures of old are crumbling, making way for new paradigms, and ultimately for a spiritually rooted civilization. That's what I see when I see the current economic collapse -- the collapse of a system that was not based on sound spiritual principles, and so, it's collapse provides the opportunity for a new, more holistic one, to emerge. The source of this mindset and this perspective -- this overall optimism -- is my exposure the the writings of the Baha'i Faith. Check them out. They are revolutionary both in terms of social organization and human relations, and in terms of the individuals relationship to his or her own existence. www.bahai.org.

Do you get writer's block? If so, what do you do to get over it?

I do have difficulty writing at times, but I don't like to call it "writer's block" because that phrase formalizes the simple fact that at times, everything is difficult. It turns it into a monster. I mean, there are some days I don't want to go to work, but I don't call it "worker's block". That's just an excuse to stay home. "Sorry, can't come in today. I've got worker's block." The best way to get over difficulty writing is to write. It's that simple. As one writer has succinctly phrased the remedy, "ass to chair".

If you had to choose only one favorite entry from your book which one would it be and why?

That's a little like being asked, "of all your children, which is your favorite?" Because the pieces are so diverse, can I pick a favorite from a few categories? Of the serious pieces, my favorite is "Thoughts of a Father" which is what I wrote down while awaiting a diagnosis of cancer in my six-year old son. It was a very personal piece and a very raw reflection of the horrors and doubts of such an experience. Of the humorous pieces, the one that is my, and most people's favorite is "The Relationship Between Moral Health and a Blind Wife," which depicts a Saipan scene of the pitfalls of multicultural communication. Of the medical stories, I like "Sweet Sight" which depicts the drama of a blind man regaining his sight.

Tell us about your writing process. How do you find the time to write with a busy schedule/family life?

Most of the time, I'll write about something that has been on my mind for a while. It takes time for ideas to percolate. I start the writing process inside my head. I have a loose idea of what I want to say, but it really evolves as I'm writing. The act of writing is a sort of unveiling. I'm not sure at the start how it will turn out. The interaction between the writer and the page determines the end result. The page is an active participant, molding the writer's words as they emerge. At least that's how it happens for me. When do I find the time to write? When everyone is asleep. I also write on Thursday mornings. It's my operating room day, and in the 20 or so minutes between surgical cases, I'll pause and write.

You are a very respected ophthalmologist. I'm sure you could have your choice to practice anywhere in the world, so why Saipan?

Are you kidding? Because Saipan is the greatest place in the world! I'm living on a beautiful tropical island, serving people who need and appreciate my services. I live in a community that values human relationships, where my kids are growing up without fear. What more could a person want? One of my professional goals was to work in an under-served area, which is why I left the US after I completed my training. Sometimes I think back on the life I could have had -- working in an academic medical center, teaching, publishing scientific papers -- and all the prestige that comes from that. It can be seductive, but I truly believe that I'm in the setting that gives me happiness, which is much more important, ultimately than prestige.

How big of a role does Saipan play in your writing? Big.

How has your experience growing up as an Iranian boy in Kentucky contributed to your unique views on life? I think more than anything else (and I think this is common among many immigrants), it gave me the perspective of an outsider -- of someone who had to work to fit in, to be accepted. Immigrants were rare in Appalachia when we moved there in the 60's. People didn't know how to categorize us. It was still a time of racial tension, and here was this brown family -- neither black nor white, with strange accents, strange foods, strange religion, strange names, strange strange strange. I carried that sense or having to work to just fit in around with me through my 20's. But once I left the United States, I lost that sense of being an outsider. I think the ethnic diversity of Saipan, where there is no clear majority, is unifying. People are used to people of various colors, with funny names. Here, I'm no more a stranger than anyone else, and ultimately, I imagine many parts of the world will be like Saipan -- a true mix of cultures and peoples. Growing up in rural Kentucky also gave me a sense of appreciation for small towns and tight communities, which is one of the reasons Saipan resonates with me.

What future projects of yours can we look forward to?

I'm not sure. I've been on pause in terms of writing for almost a year. I'm trying to create more space and quite time in my life, and I'm very careful about the things I undertake. I'm contemplating writing some columns again, but not with the same weekly frenzy as before. I'd also like to get back to the "7 Habits of Unity" book, but I'm in no hurry.

Is there anything else you'd like to add?

This is my first interview by a famous film-maker!

Finally,

Our version of James Lipton’s/Bernard Pivo Questions (one word, or short answers please):

What does the Chamorro culture mean to you?

Who’s your favorite local artist?

Greg Elliott

Do you speak Chamorro?

Some

As a person, what turns you on?

Contentment

As a person, what turns you off?

Poverty

What’s your favorite curse word?

Booger (my kids might read this).

What sound or noise do you love?

Laughter

What sound or noise do you hate?

The sound of surgical scissors removing an eye.

What profession other than your own would you like to attempt?

Stand-up comic

What profession would you not like to attempt?

Hitman -- boss is too demanding.

If heaven exists, what would you like to hear God say when you arrive at the pearly gates?

Welcome!

The Retina Blog

2009-11-08T07:53:00.006+10:00

I've got a new blog, over at The Retina Blog. It contains "clinical pearls for retina specialists, fellows, residents and others interested in advances in the field of retina." At least 50% of my practice is dedicated to retinal disease. The field is evolving very rapidly, mostly due to the use of various biological modulators that we inject into the eye. As I read articles and studies that are important to the clinical practice of retinal disease, I summarize them and place them on the blog, mostly as a source of future reference for myself.

Risk of stroke with Lucentis vs. Avastin

2009-10-25T11:10:00.003+10:00

In the February 2009 issue of Ophthalmology, a meta-analysis was reported in a letter to the editor pointing out some risks associated with intravitreal injection of ranibizumab (Lucentis). The letter looked at pooled data from the MARINA, ANCHOR and FOCUS studies which were done to determine effectiveness and adverse effects of Lucentis. The authors of the letter point out that when pooling all the data, the ranibizumab group had a 2.2% incidence of stroke, whereas the control group had a 0.7% incidence of stroke. They conclude that the risk of stroke rises as a result of ranibizumab treatment. When they look at the incidence of myocaridal infarction (MI), the ranibizumab group had a 1.9% incidence whereas the control group had a 3.0% incidence. They did not "conclude" that intravitreal injection was protective for MI, but the incidence is lower in the group receiving the drug vs. the control group.

Since the letter was published, there has been some discussion regarding the implications of this meta-analysis for those of us using Avastin. At the current time the feeling is that this data cannot be extrapolated to Avastin, in part because Avastin is a larger molecule (the entire globulin, vs. the immune arms as with ranibizumab). This molecular characteristic is felt to result in less egress of Avastin into the systemic circulation, and it is to this characteristic that the longer-acting effect of Avastin has been attributed. There is currently an NIH sponsored head-to-head clinical trial comparing Lucentis and Avastin underway. The results are due in 2012. The study is ongoing, and the fact that it has not been stopped is some solace to those of us who prefer Avastin that the study has not to date shown that Avastin is either hugely inferior or has significantly higher side-effects that Lucentis.

What is the Baha'i Faith?

2009-09-14T04:44:00.007+10:00

Here is my Saipan Tribune column from this past week.

***

A close friend of mine recently said to me, "You know David, most people really don't know what the Baha'i Faith is all about." I was a bit surprised to hear this, but I knew it was true. After all, when I mention to people that I am a Baha'i, there is often a puzzled look on their faces. Most people seem to have the impression that the Baha'is are a good bunch of people, working in some way toward peace. But beyond that, most people don't have an understanding of the basic principles of the Baha'i Faith. This realization was a bit surprising to me because the Encyclopedia Britannica lists the Baha'i Faith as the second most widespread religion after Christianity. And The LA Times noted that the Baha'i Faith is among the top two fastest growing religions in the world. So I thought it would be useful to explain the fundamentals of the Baha'i Faith. It is likely something that you will encounter more and more in the coming years.

Baha’u’llah – The Promised One

When someone asks me, "What is the Baha'i Faith?" The brief explanation that I give goes to something like this: The Baha'i Faith is a world religion whose purpose is to unite all peoples and races. Baha'is are the followers of Baha'u'llah, whom they believe is the Promised One of all ages. The traditions of almost every people include the promise of a future time when peace and harmony will be established and humankind will live in prosperity. Baha'is believe that the promised hour has come and that Baha'u'llah is the great personage whose teachings will enable humanity to build a new world.

This brief explanation raises a few key points. First, the Baha'i Faith is an independent world religion. It is not an offshoot, sect or denomination of another Faith. Second, its purpose is to establish unity among the peoples and races of the world. Third, the Baha'i Faith accepts Baha'u'llah as the one whose teachings will establish the long-awaited peace on earth. It's a large claim for sure, and most people are rightfully skeptical at first. But millions of people find it a claim worth looking into.

God is Unknowable

Baha'u'llah teaches that there is a source of creation that we call "God." Yet God is unknowable in his essence. Our finite minds cannot fully grasp God and we should not make images of God in our mind, thinking of him, for example, as a man. God created all things out of love: "O Son of Man! I loved thy creation, hence I created thee. Wherefore, do thou love me, that I may name thy name and fill thy soul with the spirit of life."

The Manifestations of God

Baha’u’llah teaches that throughout the course of history, God has given humanity guidance. This guidance comes to humanity through the Manifestations of God -- those special beings who revealed (or “manifest”) to humanity the word and the will of God. History knows them as the founders of the world's great religions: Krishna, Buddha, Moses, Christ, Muhammad, and Baha'u'llah. This idea that a single God has sent these various Manifestations of himself to humanity is a fundamental teaching of the Baha'i Faith. Baha'is accept the divinity of all of these individuals, that they all speak with the same authority, and that they have progressively revealed the will of God to humanity. Referring to these Manifestations of God, Baha’u’llah has written, “If thou wilt observe with discriminating eyes, thou wilt behold them all abiding in the same tabernacle, soaring in the same heaven, seated upon the same throne, uttering the same speech, and proclaiming the same Faith.”

Teachings for a Global Age

According to Baha’u’llah, the Manifestation of God returns from the same source from age to age, as people stray away from the teachings of the previous Manifestation of God, and as society changes. “This is the changeless faith of God, eternal in the past, eternal in the future.” The Manifestations of God all have the same purpose -- to bring God’s guidance to humanity. Their spiritual teachings remain the same: develop your virtues -- love, kindness, justice, compassion. However, their social teachings – those that guide the complexities of society -- are not the same. The social teachings change in accordance to the circumstances of the times: one says you can divorce, another says you can’t. Eat pork; eat what you want. Have four wives; don’t have four wives. These differences exist not because of intrinsic differences between the Manifestations or of their source. The differences in the social teachings exist only because of the changing circumstances of humanity at a particular time and place in history. Math in one grade is different from math in another grade, not because the teachers are in conflict, but because the students are different. The religions are not really different religions. They are stages of one common faith, like the chapters in the same book.

The spiritual teachings of long ago are still valid today. This is the reason millions of people continue to find sustenance in faiths that are thousands of years old. However, people are increasingly disillusioned by their religions (or any religion) because they do not appear to address the needs of the age, they do not appear to be relevant to life in the 21^st century.

When Baha’u’llah appeared in the mid 1800’s, he claimed to bring God’s message that humanity would soon be moving into a global age, and that new teachings were required to govern a global society. Of course, at the time, these teachings were considered insane. How could anyone speak of “global” society, when the fastest way to travel was by horse? When communication required a message be carried by hand from place to place? But he spoke of the need to recognize the oneness of humanity, the oneness of God, and the oneness of religion. Those who accept his claims do not think of him as an enlightened or prescient man, but regard him as the most recent of the Manifestations of God, who has come to usher in the universal age of peace and unity.

I hope that these basic teachings of the Bahá’í Faith help make it less of a mystery to you. If you want to learn more, information is available at www.bahai.org.

MacSpeech Dicatate: Way Thumbs Up

2009-08-04T22:07:00.004+10:00

I'm dictating this blog entry with new speech recognition software that I've picked up over the last week. One of the worst things that I do for my posture is spend a lot of time at a computer, or rather at a keyboard. I hunched forward, my shoulders droop, my chin moves forward. I developed some serious neck pain over a period of several months which was fairly debilitating. I ended up seeing a neurosurgeon who did an MRI and told me that all my problems had to do with poor posture. So in my quest to stand up straight, I did some research on voice recognition software.

Because I have an Apple computer, I got the only speech recognition software that is compatible with it: MacSpeech Dictate. It is based upon the best voice recognition software out there, Dragon Naturally Speaking, which is designed exclusively for PCs. I've had it a few hours, and it's working great. I've had to make a few corrections as I dictated this entry, but I've made them all with voice navigation and commands. My arms are folded across my chest and I'm sitting up straight.

Of course it's not perfect, but it's pretty accurate. I will read a sentence from an article that is sitting in front of me: "Combining genetic risk markers with clinical risk factors makes for very complex translational challenges with diagnostic, clinical and therapeutic implications for treatment."

Wow! It got it 100% correct, and those are not typical words you'd usually dictate. I'm impressed. MacSpeech Dictate gets five stars from me.

Patients Gone Wild and Healthcare Reform

2009-06-11T08:56:00.002+10:00

(I'm blogging from the operating room. Here's my Saipan Tribune column for this week.)

I recently had the opportunity to read President Barak Obama’s letter on Health Care Reform, dated June 3, 2009. There is one paragraph in particular that jumped out at me, because it seeks to identify the “root cause” of rising health care costs. Here it is:

“At this historic juncture, we share the goal of quality, affordable health care for all Americans. But I want to stress that reform cannot mean focusing on expanded coverage alone. Indeed, without a serious, sustained effort to reduce the growth rate of health care costs, affordable health care coverage will remain out of reach. So we must attack the root causes of the inflation in health care. That means promoting the best practices, not simply the most expensive.… That's how we can achieve reform that preserves and strengthens what's best about our health care system, while fixing what is broken.”

First, let me say, that I agree with the gist of the statement. Rising health care costs are killing our economy (well, that and a few other things), and medical care can definitely be improved so that it is more cost effective.

But here’s the truth. The single best way to reduce the cost of healthcare is to reduce the need for healthcare. We are a sick bunch of people, and for the most part, it’s because of our own behavior – we’re all “patients gone wild.” The majority of us are sick, not because we’re out doing healthy things and suddenly get struck down by some horrific disease. No, we’re sick because we eat too much, sit around too much, eat the wrong foods, smoke, consume alcohol, and generally ignore the things that lead to good health. We’re sick because of the wild and crazy choices we make. The vast majority of healthcare costs in America and the CNMI are tied to chronic “lifestyle” diseases. The top ten causes of death in the US include heart disease, stroke, diabetes, and cancer. And every single one of these has been incontrovertibly linked to how we live our lives – whether it’s what we eat, what we do, what we drink or what we inhale.

To a large extent, we’re digging our graves with our spoons and forks. Last year, we spent over $20 billion dollars on cholesterol lowering drugs. That’s billion, with a “B”. If you had $20 billion dollars, and decided to burn a million dollars a day, every single day, it would take you 55 years to spend $20 billion! Why is our cholesterol high and why does it need to be lowered at a tune of $20 billion a year? High cholesterol is a major risk factor for heart disease and stroke. Our bodies produce some cholesterol, but most of the problem comes from what we eat. Only animals have cholesterol in them. Vegetables have no cholesterol at all. We’ve known for decades that the most effective way (and the cheapest way) to lower cholesterol is to lower our consumption of animal products – animal flesh, animal milk, animal cheese, animal crackers, etc. But you know what? We’d rather not make that kind of change. We’d rather pop a pill and keep eating whatever we want to eat. And that’s $20 billion dollars we spend so we can do what we want to do, which is to eat lots of animals.

The same is true for diabetes, which is devastating our community, and growing at an alarming rate. We know that for most of us, the adult onset variety can be controlled, or at least hugely improved, with diet and exercise. Yet we choose not to make these difficult changes. We choose to eat what we want, and take pills and go on dialysis and lose our vision and our feet and our erections. And we spend untold billions on the cost of care for diabetes and its related problems.

A diet high in animal fat is also linked to a slew of cancers. Pass the processed meat that starts with “S” and ends in “M” and rhymes with “PAM”. Or just pass a burger or wiener or any other chunk of meat. Alcohol consumption is linked to many cancers. Pass a Bud (better make that a Bud Lite). Tobacco is irrefutably linked to cancer. But we can’t seem to manage to pass legislation to ban smoking in public spaces. Pass the votes.

I admire efforts to improve the cost-effectiveness of the healthcare we deliver, but I know that the “root cause” of the mess includes our culture of indiscretion, of consumption, of sitting around. Any serious effort to fix the healthcare mess must include a change in our culture – what we eat, what we do, what we drink and what we inhale. These changes won’t solve all the problems, but they’ll make a huge dent in the demand for and the cost of healthcare. A major portion of the responsibility to “reform” belongs on our shoulders -- those who end up needing healthcare. Reduce the need, and you reduce the cost. It’s simple. But it’s not easy. We humans typically don’t like change. Yet failure to change our behavior will result in more and more people needing healthcare every year, rising costs, and eventually, not enough doctors, hospitals or other resources to take care of so many sick people. We’re experiencing the fallout right now, right here in the CNMI.

Addressing our behavior needs move to the front and center in the public policy discussion on healthcare reform. It’s a nut we must crack.

_______________________________________________________________________

David Khorram, MD is the co-founder and medical director of Marianas Eye Institute. He is the author of the book, World Peace, a Blind Wife, and Gecko Tails, which is available on Amazon.com and at Marianas Eye Institute. Dr. Khorram can be emailed by visiting www.MarianasEye.com, or by phone at 670-235-9090. © David Khorram, 2009.

Risk Factor for Swine Flu

2009-05-02T16:51:00.003+10:00

What they're not telling you about Swine Flu

2009-05-01T17:03:00.002+10:00

Here's a portion of an email I got from one of our public health officials, just to put things in perspective:

I am getting more than 8 Swine Flu "Updates" per hour. Good grief. This is a true epidemic, likely soon to be a global pandemic. My guess is that we'll be in Phase 6 next week. But the relatively minor human toll (low morbidity and low mortality) does not yet justify the resource allocation, nor the media attention that we have all seen.

We need to insure that we have a "measured response" that is commensurate with the real, not the perceived, threat. And responding appropriately, in the face of media hype and patient worry and governmental involvement, is a real art. I am hoping to hear your opinions on this.

In the past six weeks, Swine Flu has killed between 20 and 80 people. More than 2000 have had clinically significant infections. In the same time period, more than 40,000 people have died from routine influenza. Millions were infected. More than 40,000 died from TB just last week. 40,000 more died from malaria last week.

Jerks Die Younger

2009-03-13T10:45:00.006+10:00

The next time some jerk is yelling at you for no good reason, you can smile, knowing that they'll be off the planet sooner than you.

A new study published in the Journal of the American College of Cardiology finds that people who are angry and exhibit hostility have a 19% higher risk of dying from coronary artery disease -- i.e. a heart attack.

The average person hopes that future studies will show an increased risk.

Sexualization of Young Girls

2009-03-12T21:31:00.003+10:00

I was at the Thursday night street market, where every week on Saipan you'll find food vendors and live entertainment. Tonight, a dance schools performed. I'll tell you, it was a sad scene. There were kids, girls, six, seven, eight years old, dressed like teenagers, with short skirts, makeup, and shin-high boots, and dancing suggestively to lyrics like "Let's make love, ooh, baby, let's make love."

When did this happen? When did parents start looking the other way, and give their assent to the sexualization of their young girls? It's like they all went out for a walk, let some stranger called a dance instructor come into their house, and in the name of "developing talent" twist their kids into these vacant performers. It disgusts me. What happened to protecting innocence? What are these parents thinking? Do they think this is okay? To have their young daughters thrusting their pelvises while lip-synching these overtly sexual lyrics? I don't get it.

Nagoya City University Hospital

2009-02-28T12:59:00.006+10:00

A few years ago, I needed some surgery that wasn't available on Saipan, so I was faced with finding a surgeon to undertake my care. Part of the issue for me was that I wanted to get the care close-by, and being self-insured, I needed it to be cost effective.

My main four choices came down to Australia, Hawaii, Manila and Japan. I visited one of the top surgeons in Sydney during a trip there, and I wasn't impressed. I scratched Manila off the list pretty quickly. I've had a fair bit of experience with patients going to Manila for care, and although one of the surgeons I've worked with there is good, I've found that in general, the delivery was not up to the standards I expect when sending a patient to a major medical referral center. Sorry guys, but that's the truth. I wouldn't go to Manila unless it was a last resort. I'm sure many have had good experiences there, but seeing many of my patients return, I haven't been too happy with the quality of care they received.

Hawaii was an obvious choice because, well, it's US quality medical care. The problems with US care is that it's expensive. If I'd had the procedure in Hawaii, it would have cost me $10K. If I had had insurance, my 20% co-payment would have been $2K, for an outpatient procedure. So, I just held this option in reserve.

I started to look seriously at Japan. In the world of medicine, Japan is one of the areas, along with the US and parts of Europe, that lead medical research and publish in medical journals. I know the quality of care there is top-notch, and that the cost is reasonable. I ended up finding one of the best surgeons in the world for my condition, and headed there for my surgery. I was very happy with the quality of the care I received, and the cost was only $2K. That included the surgery, and five days in the hospital, getting fed and watered. The system of care in Japan is a little antiquated, and many expatriates in Japan complain about it for this reason, but as someone in the medical field and as someone who has experienced the care first-hand, I think that the care is on par with anyplace in the US, and even better than the US, it's cost effective.

After I returned, I tried to convince the powers that be to start looking at Japan as a place to send our medical referral patients from the CNMI. It close, it's cheap, and the quality of care is outstanding. It's taken a while, but finally the CNMI has a relationship with the Nagoya City University Hospital (NCUH), and we have liaison people on the ground to help patients navigate a foreign country.

Nagoya City University Hospital is an 800 bed medical center (CHC has 72 beds). The first patient from the CNMI that went there was an infant, a few days old, who was on the way to Hawaii for cardiac surgery, decompensated while on the tarmac in Nagoya, and was taken to the NCUH where the pediatric cardiac surgeons did an outstanding job on a very complex surgical procedure. Since that time, the relationship has deepened, and in the next few weeks, I hope to send the first ophthalmology patients there. This should provide closer and less expensive care than is available in Hawaii, and as high a quality of care. I'm looking forward to using NCUH as a referral center.

Truth, Death, Unity and Classroom Cataract Surgery

2009-02-22T10:12:00.004+10:00

Because of my book, I was invited to give the keynote address to the University of Guam during their faculty development day on Friday. I just shared some thoughts that were on my mind. I think in some way, the points I raised had to do with some of the anchoring principles of my life. It was also an opportunity for me to try out some of the stand-up comedy material I had been working on, and most of the jokes got laughs. Here were my key points.

1. "Truthfulness is the foundation of all human virtues. Without truthfulness, progress and success in all the worlds of God are impossible for any soul." Before I really started to think about this principle in my own life, I used to "fib" so much to avoid embarrassment or to stay out of trouble. Being committed to total truthfulness required me to change the way I did a lot of things, but it was a liberating process. It's a pain, and I feel I sell out pretty easily at times. But it's still one of the key principles that I think everyone can benefit from.

2. We're all gonna die. Really. Remaining conscious of this truth on a daily basis helps lend clarity to life. This can be done by bringing oneself to account each day. "Bring thyself to account each day, ere though art summoned to a reckoning, for death unheralded shall come upon thee and thou shalt be called to give account for thy deeds."

3. The motto of UOG is "Unity in Diversity." Unity requires that as individuals we refrain from faultfinding. The process of higher education gears us toward "critical analysis" which makes faultfinding a natural way of life. Faultfinding is an intellectual activity that is quarantined to one's mind. But the real problems arise when we mention the faults of others -- when faultfinding moves to backbiting. It's endemic in our culture, and there is a need to establish "no backbiting zones" around our mouths, and even our ears, so we don't participate in this corrosive force.

4. Cataract surgery brings vision. Teaching brings vision.

The faculty were appreciative of having a speaker who wasn't there with charts and numbers, and as someone said, "we're all human, and it's nice to remember that at times."

Gory Eye Picture - Dermoid from Hell

2009-01-31T07:00:00.004+10:00

This is a weird growth that some people are born with. It's called a dermoid. It can enlarge over time, as this one has. (This guy walked in this week is in his 20's. Time to remove it, don't ya think?) You can see it has hair growing on it. Sometimes there's bone and teeth and cartilage and other Frankensteinian components in them. Growths like this that consist of tissue not normally found at the site are called "choristomas". One choristoma made it to the big screen in the movie, "My Big Fat Greek Wedding," where the Aunt is telling the fiance of the lump that was removed from her back that had teeth and hair in it, and that it was the remnants of her twin that was never born. It was a great scene, and a proud day for choristomas everywhere.

Often, ocular dermoids go deep into the substance of the eye wall, so despite it's "stuck-on" appearance, you can't just slice it off, (or lacking instruments, pluck it off), because you could end up with a hole in the eye. So you have to have donor tissue available to patch up the hole at the time of surgery. They occur in about one per 10,000 people.

2008-10-23T14:56:00.000+10:00

Happiness

2008-09-10T19:15:00.002+10:00

"The fact is that without inner peace and wisdom, we have nothing we need to be happy. Living on a pendulum between hope and doubt, excitement and boredom, desire and weariness, it's easier to fritter away our lives, bit by bit, without even noticing, running all over the place and getting nowhere. Happiness is a state of inner fulfillment, not the gratification of inexhaustible desire for outward things."

~Matthieu Ricard

Gory Eye Picture

2008-08-25T21:33:00.004+10:00

I'm amazed by how many people complain to me that I don't warn them that these pictures might give them nightmares and why don't I warn them of the graphic nature. What do you think it means when the title of the post is "gory eye picture," kittens?

Without further warning, here it is:

(photo credit)

I'm Back

2008-08-17T05:31:00.004+10:00

Sort of... maybe... in a different way.

I've been in blogging rehab. Everything is okay. It's just that blogging was becoming a toxic force in my life. It was taking up way too much of my mental space. I was checking my hit counter every few hours, planning posts days in advance, writing things when I had nothing to write. And all for no clear purpose other than some narcissistic drive to climb higher in the blog rankings. It was pitiful.

I woke up and realized this, and one day, just quit. With the help of my family, I have been able to successfully withstand the pains of withdrawal, and I thank them for their loving support during this difficult time. I know that even writing this post is dangerous for me, since just a little sip has the power to strangle me in its clutches.

So, I'm not sure what the future holds. For now, I'm chilling out. I may post occasionally, when I'm compelled to share something I think is meaningful or profound, or to stay connected with family and friends in far-off lands. If you're from Saipan and you miss what you've been reading here, heck, call me up and let's go to lunch. You know how to get in touch with me.

The Bottom of the Economic Development Ladder

2008-06-30T11:48:00.002+10:00

Here is my Saipan Tribune column from Friday.

***

How do we, who are having such bad economic times here, stack up compared to the rest of the world? Where are we on the world's economic development ladder? I don’t know much about economics, but these questions were recently asked of me, so I thought I’d find out. Economic development, as it turns out has a fascinating history. Economist, Jeffrey Sachs, describes a four step ladder, as a way of viewing the world in terms of economic development. The first step, which I’ll describe today, is not really a “step” because it’s not even on the ladder. It is “extreme poverty.”

Today one billion people – one sixth of the earth’s population – live in extreme poverty. This "bottom billion" is so economically destitute, that their very survival is at risk on a daily basis. Their lives are fragile. They live with drought, famine, starvation. Any small change can make the difference between life and death – a storm that wipes out meager crops, being struck with a simple disease, but having no access to medicine to treat it, late delivery of food – all of theses sorts of threats are very real, and can mean death to entire populations living in extreme poverty. If there is any income that comes into the hands of those in extreme poverty, it is counted in pennies per day.

For much of human history, the vast majority of the world’s population has lived in extreme poverty. Our ancestors struggled for their very survival, in a harsh world, with a fragile existence. Wealth, above extreme poverty, did not become accessible to common people until the mid 1700’s. It is only since about 1750 that humanity has climbed onto the first rungs of the economic development ladder.

Extreme poverty does not exist in developed countries. It is a condition that afflicts swaths of the developing world. Seventy percent of the extreme poor live in Africa. Ten to fifteen thousand of them die of preventable causes, like hunger, malaria, and dysentery every single day, day after day, year after year.

The tragedy of our times is that such dire circumstances affect one billion of our fellow men, women and children, in a world with such vast resources.

One of the goals of the United Nations is to wipe out extreme poverty by the year 2025, and to cut it in half by 2015. It requires commitment from wealthy nations, but I think it also requires awareness by the rest of humanity that such conditions exist and that solutions are available. The bottom billion require assistance to get on the economic ladder, to move from extreme poverty to just regular poverty. It is a small step, but the most important one in terms of the survival.

Marine Sting Photos Wanted

2008-06-23T06:02:00.002+10:00

I got an email from Dr. Paul Auerbach from Stanford University Medical Center. He hosts the blog, Medicine for the Outdoors. He's looking for photos of stings from marine animals.

Thanks for your kind comments about Medicine for the Outdoors at Grand Rounds this week. You have a great blog. If you ever encounter a marine animal sting for which you need assistance, please let me know - I serve as a consultant to the Divers Alert Network for that sort of thing.

Also, if you get any good photos of stings, eye or otherwise, it would be wonderful to see them, as I am always on the lookout for images for the textbook Wilderness Medicine and other teaching purposes. If you allow a photo to be used in a book, it would be credited as you indicate.

Divers, if you get any good photos, let me know and I'll put you in touch with Dr. Paul.

Victoria's Secret to Include Free Safety Goggles with Thong Purchases

2008-06-22T07:33:00.003+10:00

This is all over the news in the past few days. A 52 year-old woman in Los Angeles (where else?) is suing Victoria's Secret because while she was putting on her newly purchased thong, a piece of decorative metal flew from it and struck her eye. Her attorney states that it caused "excruciating pain" and that the injury was so severe it required "steroid drops" and that she'll be living with the effects of it her whole life.

Gimme a break. I treat corneal abrasions all day long, and I'll use steroids in about 25% of them, just to get rid of any residual inflammation after the abrasion has healed. It's no big deal.

Every abrasion has a theoretical risk of becoming a "recurrent erosion." The attachments of the corneal epithelium can sort of get weak after the abrasion heals, and there is a chance that during rapid eye movement of sleep (REM sleep), the epithelium will split open again, causing a few hours of pain. Of all the thousands of abrasions I've treated I've had one patient with recurrent erosions. It's most common with abrasions caused by paper and by fingernails.

I know what it's like. I developed corneal erosions after my son poked me in the eye when he was a year old. The abrasion healed over a few days (and yes, it was very painful), but then a few months later, I'd wake up most nights with pain from recurrent erosions. But guess what? You can get the recurrent erosions fixed. I had some laser treatment done on my eye, and I never had a problem again.

So, boo-hoo is what I say. I just can't understand the mentality that sues over a thong induced corneal abrasion. The woman and her attorney are giving interviews on the morning talk shows, including the Today Show. I'm sure she'll get a book deal, which will spill over into a screenplay, a night at the Oscars, and an action hero figure whose secret weapon is a lethal metal-firing thong that gets activated when placed on a wrinkled butt.

My Blog Knows Me So Well

2008-06-21T14:10:00.001+10:00

Blogging really is a weird kind of sickness -- sort of like love. Bloggers will recognize themselves in this post by The Blog that Ate Manhattan, titled, I Love My Blog.

Gory Finger Picture

2008-06-20T12:32:00.004+10:00

It's been a long time since I've posted a gory eye picture. Having had nothing gory to present, I'm resorting to gory finger pictures.

Remember that story about the guy who was wearing his class ring, and went up to dunk the basketball, but got his ring stuck on the rim? Not urban legend. Photos courtesy of this site. Dr. Ramona Bates, over at Suture for a Living, tipped me off to this story (pun intended).

Hiccups during surgery

2008-06-20T10:45:00.002+10:00

Yesterday was my surgical day. My last case of the day, a cataract patient, got the hiccups during the surgery. Under the operating microscope, it was like a series of earthquakes. It made for an interesting few minutes until the anesthesiologist could give him enough sedation to put the hiccups to sleep. The patient looked great this morning, except that the hiccups woke up after the surgery and are still there.

Recovering from the Heat of Grand Rounds

2008-06-20T10:37:00.003+10:00

I'm still recovering from all the work of putting Grand Rounds together. It was fun, but I needed to be away from the keyboard for a few days. On Tuesday, the day Grand Rounds was posted, I got over 1,000 visits to my blog, which is a testament to how well organized this carnival is. I'm still catching up with all the comments and email I received as a result.

The days are getting hotter here on Saipan. Although we have the most stable temperature in the world, staying right around 85F year round, the sun is HOT this close to the equator, and because of typhoons, houses are built of concrete, which are ovens. The utility is limping along, with power outages rotating around the island all day long to conserve the fuel supply. At the office, we have a generator, so we can keep functioning, but at the house we're in right now, no such luck. Last night, the power went out around 8 PM. I don't think it was scheduled because it was preceded by lots of browning out of the lights. It came on briefly around 10:30 PM, but went out again for the rest of the night. We slept in the sweltering heat, with damp paper towels on us to keep us cool.

Grand Rounds from the South Pacific

2008-06-17T06:00:00.012+10:00

Welcome to this island edition of Grand Rounds. Yes, I really live and practice on a tropical island in the South Pacific. And yes, you can too. I’ll let you know how, in next week's edition of Grand Rounds, which will be hosted by My Three Shrinks. But now, on to this week’s edition.

I’ve always wanted to be a newspaper editor, not because I want to edit, but because I want to write headlines. And not for a respectable paper like the New York Times. Maybe for a newspaper, like the Enquirer -- you know, where an editor can have some creative freedom with the facts. So, finally, I get my chance with this week's Grand Rounds. Sometimes the headlines I’ve written relate to the post, sometimes, they are just a whacked out free associations. Like all headlines, their purpose is to get you to read the posts. I hope I can entice you. There are some really great writers out there. Great job everyone.

Let me know if there are any problems with the links, and let me know if you want to exchange links. Grab your beach towel and snorkel, because here we go... Leave only footprints and comments.

Life is Not Just About Breasts

“What do you think about my breasts?”Random women never asked me that question until I started offering Botox. Now I get it all the time. Let me give you some advice. Don’t even begin to try to answer it. It’s a trick question destined to land you in hot water. Just have your press secretary issue a statement that “The doctor can neither confirm nor deny that your breasts a) are as pert as a pair of saluting Marines; or b) like the jowls of a hound-dog.

If you’ve ever wondered what a set of rejuvenated boobs looks like, drive on down to Arkansas and head to the grocery store with plastic surgeon, Ramona Bates. Her patients may lift their shirts, right there next to the kumquats, just to share with Dr. Bates their joy of a job well done. Read about it, and other awkward plastic surgery moments, at Suture for a Living, on the post, aptly named, Hi!

Indiana Jones and the Kingdom of Malaria

I love Dr. Paul Auerbach’s specialty:“Wilderness Medicine.” Is that cool, or what! Sometimes I refer to myself as a Tropical Ophthalmologist (okay, actually, this is the first time), but I think I’m going to switch to Wilderness Ophthalmologist.

Paul has a great post that gives a fantastic overview of malaria, and links to an article that describes an important drug regimen for the disease. Read about it at Artesunate for Falciparum Malaria

Humanity is Good

Once in a while, I read something on a blog that brings tears to my eyes. Dr. David Loeb, a pediatric oncologist at Doctor David’s Blog, is sure to touch your heart with this post on A Different Kind of Memorial Day. He tells of the annual Memorial Day service held at Johns Hopkins Children’s Center for the families that have lost children to cancer, and the lessons learned.

Humanity is Really Good

I like Susan Palawick. She is an improbably optimistic ED chaplain, who shares a beautifully written portrait of two patients whose encounters renewed her faith in God and in humanity.Renewed Faith

Just When You Thought Humanity Was Good

Can somebody get Bongi an agent? He is a great writer, but he’s too busy opening and closing bellies to put a book together. Someone just needs to go through his blog and put it all together. His post this week, South African Crime, is not pretty in terms of the picture it paints, but like the above two posts, it gives us a peek into the human soul.

Stethoscope Doubles as MP3 Player

Dr. Joshua Schwimmer’s old stethoscope broke, and he reluctantly purchased a new electronic one. He’s a convert and explains Your Next Stethoscope Should Be Electronic. Here's Why.

Bottomless Pits + No Wits = Champion Eaters

A world-class competitive speed eater can put away 60 hot dogs in 12 minutes or 100 hamburgers in 8 minutes. Where do they put it all? (And why?) A recent peer-reviewed radiologic study sheds some light on what it takes to be a champion chomper. The Samuri Radiologist from Not Totally Rad, explains it all on the post Radiology of Competitive Speed Eating

Waiting for India on My Lap

Ian Furst over at Wait Time helps health care providers to decrease wait times and delays. He submits India's Health Care System which looks at the private/public divide in India's Healthcare system and the lessons we might learn in North America.

While you’re on his site, scroll down to Things to do while waiting at the doctors office. Shocking! There is probably some business opportunity in there somewhere.

Is Your Name on This List?

InsureBlog's Bob Vineyard is naming names. He confirms the explosion in diagnoses of ADHD and Bipolar Disorders among children, and names some of the doctors that are fueling the fire, and their payments from drug companies. Drug Money.

Wave of Bad Information Kills Web Surfer

I was impressed with the fact that Dr. Val and the Voice of Reason really is a voice of reason. This week, she writes on How Is Healthcare Like A Garden Fungus?, and points out, “Medicine is incredibly complex, and that a knowledgeable healthcare provider is critical in helping patients successfully navigate the maze. With all the health information on the Internet, it's tempting to self-diagnose. But that's a dangerous proposition - one that might lead you to presume that (to use my analogy) a poisonous mushroom is edible, or that a life threatening symptom is innocuous.”

“Art, this is Death. Say Hello.”

Talk about creative, Christian Sinclair and team have launched a new blog, Pallimed: Arts & Humanities, where palliative care meets the humanities. The underlying concept is that both death and art have been around forever, closely linked to one another. Christian submits a post about a song that discusses dying in the ICU. Included is a video representation of various instruments representing a death in the ICU. (Cool!) Check out, "What Sarah Said" by Death Cab for Cutie: "This presence at the bedside of a dying person can be a demonstration of your love, but it can also tax and exhaust family. A variation on this line ("Love is watching someone die") is occasionally heard from palliative care professionals to allow family credit for the 'work' involved in being present at the deathbed.”

Cool Kid Reject ADHD in Favor of Bipolar Disorder

Did you know that 500,000 children and teenagers were given at least one prescription for an antipsychotic in 2007, including over 20,000 children under age six? What I want to know is, why didn’t anyone tell me? A half-million prescriptions, and not a single one of my four kids was offered the stuff! I feel gypped. Dr. Zhang who is the author of the book, Coackroach Catcher, writes about Bipolar Disorder in Children at Cockroach Catcher Blog. "ADHD was the old black. Bipolar became the new black."

Renegade Diabetics Take Charge of Own Disease

Amy Tenderich hosts the blog, Diabetes Mine, which is “a gold mine of straight talk and encouragement for people with diabetes.” She submits the post, Diabetes... RELOADED, which includes video footage of some of the activities of this group. I deal with diabetic eye disease all day long, and I was encouraged by the innovative vision captured in the post: “Our theme was "Diabetes Reloaded", which stands for redefining not only the role of technology in managing chronic diseases, but also for the newfound self-confidence and ambitions of 21^st century people living with health conditions. What’s special about this new web-enabled world of healthcare? It’s proactive, technology-based, empowered, revolutionary, against all odds, and – if needed – outside the establishment.” The blog is a 2006 Winner of LillyforLife Achievement Award for Diabetes Journalism. Congratulations, and keep up the good work.

Patient Prescribes Own Drug. Doctor Does Own Taxes.

And if the internet weren’t bad enough, people are now taking the next step:
picking up the phone, and telling doctors what to prescribe for them.
Read about this wacky patient’s expectations over at EverythingHealth

Got Munchausen’s? AMA Has Jobs Available

Did you realize that the next patient that walks into your office could be a fake, commissioned by the AMA to check the quality of care you provide? David Williams at Health Business Blog delves into the controversy, Do we really need mystery shoppers in health care?

Pharmacist Sleeps with Drug Researcher; Takes pill to blunt remorse

This doctor has one of the best named blogs ever: The Blog that Ate Manhattan. She takes on Big Pharma yet again, this time noting that Care/CVS seems to be in bed with Bayer. She parodies the "Dear Doctor" letter used to get new drugs to the medical community. A very interesting discussion in the comments section, in particular the input of a Pharma commenter who tells it like it really is in the business of making and selling drugs.CVS/Caremark – Detailing for Bayer?

Blame Informed Patient on Doc Gurley

When your next patient comes in and has a normal fasting blood sugar, then insists that you order a HbA1C, will you wonder why? It’s because they read Doc Gurley’s post, Blind Men and the Diabetes Elephant. She takes a look at this week's mammoth-sized news in diabetes research. Like the fable of six blindfolded men who tried to describe an elephant ("it's a snake!" "it's a tree!"), lots of news reports only got hold of one isolated piece of the action. Her post shows how three different news items, when viewed together, take on pachyderm-sized importance for all of us - diabetics or not.

Poor Ethicist Gets Spanked by Doctor Rich

The Right Way to Think About Medical Ethics, appears on The Covert Rationing Blog. In this post I take medical ethicists to task for promulgating a new utilitarian system of medical ethics that is a) absurd, and b) destructive; and, not wishing to leave the poor souls completely adrift (which would be unethical), Dr. Rich kindly offers for them a system of ethics that both honors the needs of society, and restores the classic doctor-patient relationship.

End Years of Debt-Free Living: Go to Medical School

Why do so many doctors struggle financially? Theresa Chan posts MEconomics, Part Two: The Long Reach of Med School on her blog Rural Doctoring. "Part Two of this series on physician compensation and my personal bottom-line addresses where all the difficulties begin: with medical school debt. Let's walk through the process of accumulating educational debt and estimate whether the published averages tell the whole story."

Cheech and Chong Appointed to Judiciary

Have I been away from America so long that I missed the legalization of medical marijuana? When do you prescribe marijuana? When not?. Theresa Chan at Rural Doctoring shares her opinion in 15 Minutes of Fame: Medical Marijuana in Rural, CA. "For the record, I support medical marijuana use for those patient populations for whom it was originally intended: for cancer and AIDS patients, in order to suppress nausea and promote appetite, and modulate pain symptoms. I have worked with these patients as a physician and a hospice volunteer, and I do believe marijuana is helpful for the nagging symptoms of people facing the end of life. However, I do not believe that marijuana should be recommended generally for chronic diseases such as…” Read the post to find out more.

Man’s Jokester Friends Name Womb Disease After Him

Dr. T posts on "Asherman's Syndrome" which is a condition related to scarring of the intrauterine cavity, usually as the result of a failed pregnancy and a D&C in the presence of infection; or another intrauterine surgical procedure, that causes hypomenorrhea or amenorrhea, infertility, and recurrent pregnancy loss as well as other pregnancy complications. It is more common than most women realize.

Ferret Diagnosed with ADHD; Parents overjoyed

This is actually a very important post. David Rabiner outlines Promising Cognitive Training Studies for ADHD. "Results from these two cognitive training studies highlight that cognitive training interventions may provide an important complement to traditional medication treatment and behavior therapy. Both studies included appropriate control groups, employed random assignment, and had outcome measures provided by individuals who were "blind" to which condition children were assigned to. They are thus well-designed studies from which scientifically sound conclusions can be drawn. They add to the growing research base that intensive practice and training focused of key cognitive skills can have positive effects that extend beyond the training situation itself."

One Should Always Have a Penguin When Needed

I didn’t even make that headline up! It’s the description of the blog, Prn Penguin. I will now start contemplating when a penguin might come in handy. In this outstanding and comprehensive post, the author gives a detailed overview of How to survive your practicum placement as a nursing student. It is also useful information for medical students, job applicants, and humans of all varieties.

That Dang Medical Records Department

Home of the Brave submits Where Are The Ellis Island Hospital Medical Records? Did you know that Ellis Island had a premier large scale hospital and contributed to major public health advances? Help solve one of its tantalizing mysteries by searching for its missing patient records and registration logs. Ten thousand patients, 3500 deaths and over 300 births, plus countless successful treatments and discharges to a new world and new lives are a testament to the hospital and its USPHS physicians and nurses.

Four out of Five Doctors Smoke Camels. (The other one smokes goats.)

I learned something by visiting Peter Zavislak’s blog, Medical PasticheI learned that a Pastiche is a pie made of many different ingredients. I did not know that. The purpose of his blog is to present medical economic analysis, personal experiences within the field of medicine, somewhat-interesting medical factoids, and slightly-humorous tongue-in-cheek medically-themed comic relief. You can find all of this in his post, "'What Cigarette Do You Smoke, Doctor?'", which looks at advertising in the 1950’s.

ER Nurse Strikes Patient

“She was telling me a story about one of her grandchildren when she stopped mid-sentence and said "oh" followed by seizure like activity. I was stunned into immobility for what seemed like an eon but really was only a second. The monitor showed v-fib, a lethal heart rhythm where the heart quivers like jello without pumping any blood. Basically the patient in v-fib is dead and will stay there unless something is immediately done.” Read more about what comes next at ERnursey, under the title, When the Precordial Thump Works

Controlling Your Urge to Control

Laura Edwards is “a 28-year-old writer and college writing instructor trying to balance multiple chronic illnesses (PCD, bronchiectasis, celiac disease, etc) with, you know, the rest of my life.” She submits In Control which explores the relationship between control and chronic illness.

Coke Shares Plummet; Rival bottles water

Nancy L. Brown, PhD writes about Sugar and Soda Free Summer. "The SF Bay Area is gearing up to have a "Soda Free Summer!" Six counties are being encouraged by the public health department and many community-based organizations to learn about the health risks associated with soda consumption and help families avoid soda."

Uninsured Mob Threatens National Security

“So now in addition to 47 million people without any health insurance at all, there are 25 million more who have health insurance but don't really have access to health care because they cannot afford to pay the high copays and deductibles on their policies. So all told that's 72 million Americans who are likely to skip routine health care and recommended non-emergency treatment because they don't know how they'll pay for it.” Read more about this outrage at Colorado Health Insurance Insider’s post, Number of Underinsureds Rising Rapidly

Canada and Australia are Different Countries?

I once made the mistake of telling an Aussie that I thought he was from Canada. He never called me "Mate” again.v(What a relief.) No such luck for Vitum Medicinus, a Canadian medical student, who tells readers of his experience shadowing a doctor in Australia, and how medicine down under differs from what he's seen in Canada. Read about it at Vitum experiences medicine down under!

From Pulp to Electrons

Are you thinking of converting to Electronic Medical Records?DrPenna discuss about advantages and disadvantages of Electronic Medical Records and his experience using them in his hospital.

Serious Feelings

“Few things in medicine are harder than trying to explain to a patient that you don’t understand what is going on.” Thus begins The Mormon MD's post, My Entire Life, where he writes, ” The art of medicine is learning solutions that don’t always involve causes. Beyond that, patient’s are not as passionless and rational as textbooks. This can be a hard thing for a scientist. After all rationality is the only virtue that matters in science. Emotions will only get in the way. On the other hand, The doctor patient relationship is deeply complex, much more that say, mechanic and automobile, or scientist and experiment.”

More Serious Feelings

In Sickness & In Health is a place for couples going though an illness experience - to find resources and advice, hear stories, and discover support. Whether the illness is chronic or acute, the result of disease or accident, couples can learn strategies for coping with the changes illness brings into our relationships and our worlds. The information provided in this blog is for educational and support purposes only. It should not be used as a substitute for seeking professional care. This weeks submission, How to Have the Hard Conversations discussed how to stay connected to your sweetie when he/she wants to go to the movies and all you want to do is lay down in a dark room with a heating pain?"

Vermox Stockpile Available

Frankly, I’m relieved to learn that Global Warming is occurring. All this time, I thought it was Global “Worming,” and was preparing for that. Fortunately, medical student Thomas Robey has a better handle on things. At Hope for Pandora, he has been considering how the lowest rung on the medical hierarchy can reduce medical procedures' carbon footprint. His latest target is the operating room. He gives tips for Reducing and Reusing, if not Recycling in the OR. For example, "If you salvage the batteries from each suction irrigator used for ectopic pregnancy or cholecystectomy cases you assist with, you'll amass 10 hours of digital camera usage per irrigator, or put another way, a lifetime powering of remote controls per surgery clerkship."

Radical Canadian Editors Blog

The editors of The National Review of Medicine have their own blog. That sort of thing is apparently allowed up there in Canada. This week they discuss, Should we screen women over 70 for breast cancer? (Just don't mention "rationing")

Neurofibromatosis Headlines Are Tough to Write

alter Jessen at Highlight HEALTH briefly reports on the 2008 Children's Tumor Foundation Neurofibromatosis (NF) Conference, the preeminent annual meeting of NF researchers worldwide, and describes the three distinct types of neurofibromatosis. Neurofibromatosis: From Genes to Complications to Treatments

Neighborhood Masochist Buys New Suit

Apparently, someone has developed a suit that mimics the pain of osteoarthritis.Read about it at Simulation Suit To Feel the Pain of Osteoarthritis . Visit the blog, The Fitness Fixer “to see how to move in healthful positioning so that your exercise is healthy rather than injurious. You don't need to get treatments, or adjustments, or surgery, or shots, or medicines. It is a win-win situation where you do not have to give up favorite activities, and can become healthier than before. Just use healthy movement as part of normal daily life and get free exercise, better physical abilities, and stop the processes that cause injury, all at the same time.”

D is for Depression

Vitamine D for Depression in the Elderly? Dr. Shock points out that a large population-based study found an association of depression status and severity with decreased Vitamin D (serum 25(OH)D) levels and increased serum parathyroid hormone (PTH) levels in older individuals. Causes of vitamin D deficiency in the elderly are: less sun exposure as a result of decreased outdoor activity, different housing or clothing habits, and decreased vitamin intake. The question remains whether the vitamin D deficiency is secondary to depression, or is depression the consequence of poor vitamin D status.

Cut from the Same Clot

The folks at Clinical Cases and Images - Blog submit Video Interview with Tim Russert's Doctor -- Cause of Death Was a Fresh Clot in LAD. The site also has useful information on studying for cardiology boards, the Mediterranean diet, and how to use Google Blogger’s schedule feature.

How to Get a Hot Body Without Resorting to Kidnapping

Crank up your metabolism, baby! Tara Gidus, who is the team dietitian for the Orlando Magic, gives 10 tips on increasing your metabolism (which is going to help you lose weight) at Turn Up The Heat

Stiff

Dean Moyer of The Back Pain Blog shares a response to one reader's question about Mysterious Morning Neck Pain. In this post he attempts to reassure his readers that most neck pain is not serious and gives them some guidelines for what they should do about it. For example, "… the most common cause of neck pain is muscle or ligament strain ... In most cases the pain will subside within two to ten days without medical attention. However, if it lasts longer than that, you should see your doctor."

***

Thanks again, everyone for your outstanding submissions. Join the gang next week for Grand Rounds, hosted by My Three Shrinks. The theme will be the upcoming iPhone 3G.

Bali Bound

2008-06-14T22:29:00.009+10:00

My friend, sociology professor Kirk Johnson, PhD, has invited me to go along with his Globalization and Social Change class to Bali next spring and to be a guest lecturer during the trip. They'll be using my book as part of the reading for the class. Here's why. (You can skip to the last paragraph in the link.)

I'll be going along to enrich their experience. What a job description.

Last week, we unearthed these Balinese masks in the back of his car while trying to uncover a stroller.

Thumbs up for Zohan

2008-06-13T13:56:00.003+10:00

Mara and I went to see Zohan, the new Adam Sandler movie, last night. I'm usually not a Sandler fan -- most of his characters are too weird for me to be able to relate too -- but Zohan was magnificent. He captured the whole middle eastern cultural quirks in a hilarious way. Just keep your eye on the hummus. I couldn't stop laughing, but at times, I was the only one laughing, probably because my genes are from that part of the world, and so I understood some jokes that went over the island crowd. Well worth it, if you can tolerate the juvenile humor that runs through it.

Injured Reserve

2008-06-11T19:40:00.005+10:00

I can't believe this. I've been waiting nine months for the co-ed soccer season to start, and now that it's here, I'm watching from the sideline because of my back. It's better -- much better -- but Pam, my trusted physical therapist, tells me there is no way I'm ready to play soccer. I actually know that, but wish it weren't so. She's given me a half-dozen exercises which I do every day, and which are bringing gradual relief, but I still have Motrin on board 24/7.

I watched my team play last night, which was immensely frustrating. I want to be out there!

I also keep lobbying for a year-round co-ed league. The men's league, women's league and national teams absorb the better players during the rest of the year, but there are plenty of us in the co-ed league that aren't competitive enough for those leagues. We want to be able to play soccer year round too. Come on, NMIFA, let this be the year-round league for the rest of us.

I'm Hosting Grand Rounds

2008-06-10T10:11:00.004+10:00

From the South Pacific island of Saipan, I'm hosting the June 17 edition of Grand Rounds, the world-wide blog carnival of medically related stuff.

Here are the guidelines:

1. Start submitting your posts to me via email: david (at) MarianasEye (dot) com. Please put GRAND ROUNDS in the subject line. The deadline is Monday June 16 at 12 noon, EDT.

2. Instead of sending me the URL of your blog and the post, please send me the hotlinks. So, instead of http://marianaseye.blogspot.com, you would send Marianas Eye. And for the post, instead of http://marianaseye.blogspot.com/2008/06/medical-whores.html, you would send Medical Whores. It will make hosting a quantum leap easier.

3. Send me a blurb about your post, or a key quote from the post that you think summarizes the content.

4. If you want to increase your Google juice, let me know that you're adding me to your blogroll, and I'll reciprocate.

I'm looking forward to reading your posts, and putting them all together. Let the submissions begin!

Saipan Sunday

2008-06-09T09:19:00.009+10:00

We gathered at the beach yesterday evening to welcome Angelo's mother, Donna, back to Saipan for a visit, accompanied by Jim and Katie and Kevin. It was a typical Saipan event, in that two dozen people represented half-a-dozen nationalities and ethnicities. I love this place.

Arman spent the afternoon with his new buddy, Norman, learning the intricacies of Chamorro grilling. There's the half-eaten hotdog to prove it.

Walking on the sandbar with Kian.

A slightly below average Saipan sunset.

Friends watching the sunset.

Angelo and his mom. (This is actually Brad and Kat, who are more interested in my camera than the sunset. I didn't take a single picture of Angelo or his mom, so this one will have to do.)

The bonfire to end the day.

Back home, bikeless

2008-06-07T22:25:00.003+10:00

I'm back from a few days in Guam. Most of my friends in America don't have to get on a plane to see an orthodontist, but that's the way it is on Saipan. I took Arman over for some orthodontic work, and Nava tagged along. We had a nice time staying with our friends, the Johnson's, and had a chance to get together with many old friends, as well as eat some fantastic Persian food.

We bought bikes for the two older kids, and I found out that if you want to put a bike on a plane, you have to have a box for it (or buy one from the airlines for $30); you have to be able to put the bike in the box which requires having the tools to take off the pedals and the front wheel; and you have to pay another $30 to get it on the plane. Given this combination of impediments (we rode the bikes up to the checkout counter), the bikes are still in Guam.

Saipan's Flirts with Third World Status

2008-06-05T17:01:00.006+10:00

In his book, and The End of Poverty: Economic Possibilities for Our Time, economist Jeffrey Sachs points out,

When the preconditions of basic infrastructure (roads, power, and ports) and human capital (health and education) are in place, markets are powerful engines of development. Without those preconditions, markets can cruelly bypass large parts of the world, leaving them impoverished and suffering without respite.

Let’s take a closer look at this dense statement, that gives a very simple formula for economic success of a people. Development requires the combination of human capital (which consists of two parts – health and education) and basic infrastructure (which consists of three parts – roads, ports and power). Here on Saipan we lack reliable power, and therefore, we simply lack one of the key elements required for development. The lack of power is not just an inconvenience. It changes our status as a developed jurisdiction

Yesterday, at our home we had over five hours of unannounced power outages spread throughout the day. One came during mealtime, another just as we were getting children to bed. We were unable to cook, and our children cried as they tried to fall asleep in the sweltering heat. This is not a scene that you expect in a developed place, especially when it happens daily, as it is now. Power is part of basic infrastructure, and without it, there is limited opportunity for our markets to develop. I hate to say it, but our protracted power problems now bring us into the company of most third world countries. Our power situation puts us in a particular category of underdeveloped nations, and market opportunities cruelly bypass us.

Politics and Sex

2008-06-04T04:41:00.003+10:00

I'm not one to comment on either politics or sex (unless I'm personally involved), but I'm making an exception. This is funny.

Medical Whores

2008-06-02T21:04:00.006+10:00

I just got an email news report from a conference, where one of the speakers rebukes pretty much every ophthalmologist for not using a certain type of vision correcting lens. The speaker is a leading name in refractive ophthalmology. But there is one big problem. The speaker is also a consultant for the company that makes the lenses.

The last conference I attended, a panel of such MD-whores got up and spent 45 minutes extolling the virtues of Retasis drops (a formulation of cyclosporin used to treat dry eye). Any question that came to them was answered unequivocally in favor of drug company, their almighty pimp.

"How long do you recommend using Retasis?" "Indefinitely."
"It's indicated for severe dry eye, but do you recommend it for mild dry eye too." "Absolutely."
"Are there any other indications for its use?" "It can help with scraped knees and pimples, too."
"Is there a shower outside this room, because I feel pretty dirty just listening to you guys." "Sure, first door on the left, and make sure you use the Retasis shampoo."

Why we doctors continue to attend industry sponsored CME luncheons just to listen to these medical whores is unknown. Oh, wait, it actually is known. We're such a cheap lot, we'll do anything for a free lunch, as long as the salad has nice crisp croûtons. Next time I go to one of these conferences, I'll hang a sign around my neck that says, "Will buy your drug for food," which is its own variety of medical whoring.

Emergency Appeal for China - Updated

2008-06-02T20:08:00.005+10:00

The International Red Cross has issued an updated appeal for help for the Sichuan Earthquake. The emergency appeal seeks 92.7 million USD to assist around 100,000 families (up to 500,000 people) affected by the earthquake for 36 months.

Just to give an idea of the scale of this disaster, as of 27 May, 68,109 people had been left dead, 364,552 injured, 20,790 missing and 15 million displaced of which five million are homeless. Five million homeless. Wow.

The massive earthquake also spawned the formation of 34 "quake" lakes, formed by rivers blocked by landslides. Water levels are rising, rains are coming, and an additional 1.3 million people in these areas are now threatened by floods.

The IFRC has issued a report, which is about 15 pages long, includes photos, the budget, and various other facets of the recovery plan.

Give while you can. Donations can be channeled through your national Red Cross societies. Click here to donate through the American Red Cross.

Best of this Blog

2008-06-01T16:09:00.002+10:00

Well, I finally added this list to my blog, over there on the right. They're in no particular order. Feel free to suggest other posts.

You can even call me late for lunch...

2008-06-01T14:15:00.006+10:00

But just don't call me "Doctor." It annoys me. My office is the only place I introduce myself as "Doctor Khorram." Pretty much everywhere else, I'm David. It jolts me when someone I know calls me "Doctor" or worse, "Doc." It makes me feel like a piece of meat (and not in a good way) -- like I'm a commodity, just some guy in a white lab coat with no other function or capacity except as a dispenser of medical care. It's fine with me if you call me "Doctor Khorram" if I'm not on a first name basis with you. But be warned that I hate the free-standing label-as-name: "Hello, Doctor," "How's it going, Doctor," "Is Doctor there?" And please save "Doc" for the guy serving whiskey in the saloon. It's a particularly disorienting title here in our multi-accented island, where I'm wondering, "Did she just call me 'Doc' or 'Duck'?"

As the Elephant Man famously cried, "I am not an animal! I am a human being!"

(For those of you who feel "David" is too intimate, or that it doesn't appropriately reflect your esteeem for me, I'll give you a break. You can call me "dk," which my staff does, or alternatively "Dr. K" or "Dr. D." See how flexible and accomodating I am.)

Stupidity is Surgically Treatable

2008-05-31T22:18:00.003+10:00

One of my favorite medical posts this week is by South African surgeon, Bongi. Reading his post reminded me why I didn't go into general surgery as a career. These guys have to deal with the intestinal tract on a regular basis. Check out his post, There is No Pill for Stupidity.

Things Getting Worse in Iran

2008-05-31T05:12:00.003+10:00

There is growing concern by the international community for the fate of the six Baha'i leaders arrested in Iran two weeks ago. Here is why.

Unleashing Potential

2008-05-30T06:55:00.005+10:00

One of the most progressive aid organizations is Ashoka International, founded by Bill Drayton. It’s been around 25 years or so, and it’s certainly a contender for a Nobel Peace Prize. Bill figured that the best and fastest way to change the world was to identify people in countries who are getting started in socially innovative projects, and supporting them so that they can dedicate themselves to their cause. There is a worldwide “search” committee that consists of thousands of people in local communities who keep their eyes out for these sorts of people – the single-minded, almost fanatical idealist, who has a vision of something great. And every year, the foundation selects “Ashoka Fellows” who are given financial support so that they can pursue their dream, until the dream can get funding from other sources or become self-supporting. The financial support usually lasts about three years. As Bill says, “we’re investing in the person, not the project.” Over the years, they’ve supported 2,000 fellows.

I like the premise – find people who are change-makers, who know their communities and their problems, who are creative in coming up with solutions, and support them so they can make it happen. It’s a beautiful concept.

I do have a little bit of a different perspective, though. I think that more attention needs to be given to the average person, who doesn’t see himself or herself as a social entrepreneur. I think that the kind of change that the world needs will happen when every common citizen starts to recognize and unlock their own potential. My visit to Hopwood junior high still haunts me – all that potential, hidden even from the eyes of those who possess it. I wonder what are the keys to unlocking that potential. It has to be some combination of attitudes, insights and skills, both practical and spiritual.

Any ideas on unleashing this potential in the common citizen?

Marine Monument Dies

2008-05-29T16:17:00.005+10:00

I'm going to predict that the proposed Marianas Trench Marine Monument in CNMI has effectively been killed. After reading the story in today's Saipan Tribune, I don't think President Bush will give much attention to the Marianas. A variety of local government officials here have voiced their opposition to the idea, while no one at the same level is voicing support. Meanwhile, other jurisdictions are clamoring to have a monument designated in their area. If I were the President (or one of his advisers), I'd recommend taking the path of least resistance. Why fight with the CNMI?

As far as I can tell, the resistance to the monument ultimately comes down to a certain psychological stance that is explained in Bornstein's How to Change the World (who is quoting from O'Toole's Leading Change).

Resistance occurs when a group perceives that a change in quesiton will challenge its "power, prestige, position, and satisfaction with who they are, what they believe, and what they cherish....The major factor in our resistance to change is the desire not to have the will of others forces on us."

Carl Talk and the Folly of Aid

2008-05-29T14:19:00.001+10:00

I had a chance to sit down with my favorite French-Canadian general surgeon yesterday, and just chat. Carl is finishing up his stint at CHC, and his departure is a loss to the people of the CNMI. Last week Carl gave a presentation on his year in Ethiopia, his last post of service before arriving in Saipan.

Carl was there with an international aid organization. He was part of a three member team that consisted of a surgeon, an anesthesiologist, and an OR nurse. The project aimed to identify local people who would spend a year with them, get trained in how to be a surgeon, an anesthesiologist, and an OR nurse, and then head back into their provinces to provide service. The aid organization sent 21 of these teams throughout the country. Ideally, by the end of the year, there would be 21 local teams prepared to provide services to their people.

Carl had planned on spending his life doing humanitarian surgery. But his experience so disillusioned him, that he’s taken a break from pursuing that as a career.

He told me about how much difficulty he had when he was applying to various international agencies. He was offering his life to them, for free, and only one agency could accommodate him.

He told me that throughout Ethiopia, there were many international aid organizations, all in competition with one another, refusing to cooperate or pool their resources. The agencies were more concerned with making their annual reports look good and getting more funding than making sure their work actually made a difference.

He told me that the organization he worked for failed to take the local situation into account. They sent these fancy autoclaves to sterilize instruments – fancy because they had microprocessors with them to control the sterilization process. But the chips were set for sea-level, not for the elevation of Ethiopia, so they were useless. It would have been better to simply send pots and teach the people how to sterilize their instruments by boiling them, because that technology would always be available and repairable.

He told me that they used sutures at the central training hospital that would never be available in the provinces.

A year after his departure, of the 21 teams that were trained, only three were still functioning. That’s better than nothing, but it doesn’t make for a success story, especially considering the talent and dedication that poured in the way of the volunteer surgeons, anesthetists and nurses, who gave a year of their lives for this project.

It again points out the need for development projects to be decided locally, on the ground. For people to become empowered to identify their own problems and create their own solutions and seek the assistance they need. Development projects imposed from the outside are simply folly.

How to Change the World

2008-05-28T14:09:00.004+10:00

Further to my post about being a selfish son-of-a-bitch, the books I ordered arrived, and I've been getting quite an education. I ordered four books. The first, The White Man's Burden: Why the West's Efforts to Aid the Rest Have Done So Much Ill and So Little Good by William Easterly, helps us understand what kind of aid doesn't work, and presumably, what kind does work.

Easterly's perspective is balanced by The End of Poverty: Economic Possibilities for Our Time by Jeffrey Sachs. This book extols the power of aid, and is written by the architect of the UN's Millenial Plan to end poverty by 2025.

I knew these books were at opposite ends of the ideological spectrum, and thus thought they both deserved my attention. Both are by well-respected experts/economists, experienced in aid and poverty issues.

Not wanting to get bogged down by too may graphs (which both books have), and also not wanting to get overwhelmed by the massive scope of problems that these two books are sure to address, I also ordered a couple of very practical books.

Creating a World Without Poverty: Social Business and the Future of Capitalism is by Muhammad Yunus, who won the Nobel Peace Prize for his work in "micro-finance." He has shown that the world's poorest people are outstanding credit risks, and that loans as small as $10-20 can break the cycle of poverty by allowing poor families to start their own businesses.

The one I'm reading now, How to Change the World: Social Entrepreneurs and the Power of New Ideas, Updated Edition by David Bornstein, is a collection of accounts of social innovators who through their persistence and dedication to an idea, have changed the world. I'm finding it a fascinating read. I love learning about things I know nothing about. So far, that's included rural electrification in Brazil, child protection in India, and the development of the EPA's "bubble" policies in the 1970's upon which concepts like carbon exchanges have been built. The first few chapters explore the qualities of the people who bring about these sort of social changes. I'll write more about that later.

When the Body Lies

2008-05-26T16:56:00.006+10:00

Sometimes the human body can be deceptive. That really scares me.

I saw a woman recently who had blurred vision that was getting worse over a few weeks. Looking inside the eye, it looked perfectly normal, but the vision was profoundly reduced. The vision in the other eye was normal. When the eye looks normal, and the vision is reduced, then there is something behind the eye causing the reduced vision. But where?

Well, the first step in finding the location of the lesion is to perform a visual field exam. The eye chart measures your straight ahead vision, but not your peripheral vision. You might be able to see 20/20, but you might be looking through a tiny tunnel of lost peripheral vision. A visual field test checks the peripheral vision. You look straight ahead while lights of various intensities pop up in different areas of the peripheral vision, and every time you see one of those lights, you press a button connected to a fancy computer. The computer maps out your visual field.

They eyes are wired in an interesting way. All the information from the retinae of each eye gathers into the optic nerve of each eye and takes off to the brain. But then, once just inside the brain, a funny thing happens. Some of the fibers from each eye cross over to join fibers from the other eye. They "decussate" in a place called the "optic chiasm." The result is that if there is a problem behind the optic chiasm -- after the fibers have crossed -- say, on the right side of the brain, both eyes (not just the right eye) will manifest a visual field defect since fibers from the left eye have crossed over to the right and are being affected by the lesion in the brain. The wiring is so specific that you can even tell how far back the lesion is by the type of visual field pattern loss in each eye. If the damage is in front of the chiasm, the fibers haven't yet crossed over, and the field defect will show up in only one eye.

I'm thinking this as I examine this woman, and I know that in order to find the location of the lesion, I need to know the visual fields of the unaffected eye. Because if the visual field is normal, the problem is in front of the chiasm in the optic nerve of the abnormal eye. If the visual field of the good eye has a defect, then the problem is in the brain. Got it?

I get the visual field. The bad eye is totally wiped out. The good eye is completely normal. That pretty much clinches the diagnosis. Her lesion is in the optic nerve, and in a woman her age, the likely cause is optic neuritis -- actually a specific variant called "retrobulbar" optic neuritis in which the inflammation is behind the eye, not in it, therefore when you look in the eye it looks normal. The maxim for retrobulbar neurtiits is "the patient sees nothing, and you see nothing."

So she has this variant of optic neuritis. What causes optic neuritis? The most likely cause for her is multiple sclerosis -- a lousy diagnosis, but one you want to know about. The next step is to get an MRI of the brain, because the brain in MS has characteristic plaques that light up on the MRI. The MRI won't change the outcome of the optic neuritis, but it helps the patient plan for their future if it is MS.

Problem: there is no MRI machine on Saipan. The closest one is on Guam. I could get a CT here, but it might not show anything, which might mean that the MS plaques may still be there, but CT couldn't see them. If the CT is positive, it helps, but if it's negative, you just spent $800 of her money unecessarily. She makes her way to Guam and gets the MRI.

And this is what can scare the snot out of you. The MRI results come in, and it doesn't show the characteristic MS plaques. It shows a tumor the size of a fist in her brain, back behind her optic chiasm where it should have shown an abnormality in the visual fields of both eyes. Everything that I thought was right, is just plain wrong. There is no way the visual field can be normal in her good eye with a tumor this size, but it is. It's likely that the tumor itself isn't actually causing any visual field problems. The MRI shows the tumor cells have infiltrated down one of her optic nerves and is choking it to death. Thus, only the vision and the visual field in one eye is abnormal. Her body isn't following the rules. But I am.

And the most scary part is that when everything pointed to optic neuritis, I was tempted to save her the trouble and expense of going to Guam for the MRI and just admit her to CHC and treat her according to the guidelines of the optic neuritis treatment trial. That's the sort of thing we often do on Saipan where resources are limited, and people can't afford to go off-island for further testing. If she hadn't been able to go to Guam, I would have done exactly that -- treated it as MS -- and thought nothing of it, confident in the information the human body was conveying to me. What a disaster that would have been.

Sometimes, you don't conquer disease. Sometimes you just accidentally trip over it and it dies. In the instant that you realize how close you were to making a deadly mistake, you find yourself totally humbled. The tumor was found, and she's going for neurosurgical treatment, but it was just dumb luck.

I keep replaying the events, the decisions, wondering what to do differently next time, and really, there isn't much, other than to realize that the body, sometimes will smile coolly at you and just lie with the deepest deception. And there's no way to know of its betrayal, other than with luck and the help of angels.

Green Power in Saipan

2008-05-26T14:36:00.005+10:00

It's been a year or two since the "Green Power" law was passed. Basically, it allows for a concept called "net metering." There are two basic ways people use alternative (solar/wind) power. First, you can buy the power generating stuff -- solar panels, windmills -- and buy batteries that store the power generated, and use it when you need it. There are a couple of difficulties with this. First, the batteries are really expensive, so cost goes up. Second, you have to generate enough power to meet your demands. This is the method people use to live "off the grid." You generate and store their own power.

The other method is "net metering." You buy the solar panels or windmills, but your house is still connected to the utility. The power you generate is gets fed into the city power grid. If you don't generate enough to meet your needs, you get the extra you need from the utility. If you produce more than you need, you feed it into the grid for others to use, and the utility pays you for the power. The excess feeds through your meter and runs your meter backwards, thus the term "net metering". With this method, you use the grid as your "storage" so you save the cost of batteries. Of course, without storing the power yourself, when the CUC power goes out, yours does too.

The fact that we have this net metering law opens some huge possibilities for the consumer to bring down the power rates and also to contribute to power generation for other customers. The glitch for us has been that although the law has been passed, the regulations that define the practicalities of implementing the law have yet to be written.

I fired off an email to an undisclosed source close to the issue to find out about the status of the regulations. Here is a summary of the reply I received. It looks like we're getting close.

***

The net metering regs are being drafted right now. They are a blend of regs from a US green power NGO and 3 or 4 states. The adminstration is committed to making net metering happening, so that the private sector can help CUC meet its customers' needs cost-effectively and reliably. Oil will soon become unaffordable to small markets like the CNMI. We will need the sun, the wind, the ocean and geothermal resources to power our lives.

The consumers issues will be, of course, cost/revenue and reliability (both of your system and CUC). The regs should lock you into revenue of 1/2 the price of power at the time you install the solar. Solar is relatively expensive, but, when installed correctly and maintained (so the panels are clean and connections are protected from the salt air) should last for 10-20 years.

1. The kwh. As you may know, solar panels don't start working at 100% capacity the day you install them. The solar capacity increases to manufacturer's specs over a couple years, then slowly, slowly degrades over time. So, if you are figuring revenue, you will multiply an average output percentage times manufacturer's spec times "availability", or the number of hours per year expected of the "insolation".

2. The rate. You will want as much guarantee as possible that the rate you sign up for is the one you get. One argument from the statute is that your rate will vary as the CUC's rates vary. That means that if oil gets outrageously expensive (it's at $127/bbl now and on its way to $200/bbl by year end), our rates will increase past the 26 cents/kwh we now pay just for the oil, and you will like the variance. (Overheads, operations and maintenance and debt service typically cost about another 8-10 cents/kwh.) If we discover geothermal sources on Saipan, however, the bulk of our power will cost less than 10 cents/kwh total. You won't like that, because you will have paid for expensive solar and CUC won't be paying you very much back.

3. Rate stability. One way to make this all stable is through the regs. Another way is through a contract. The law will protect you better from the Legislature's rate orders for rate decreases if you have a contract. Ordinarily regs are a strong way to protect a customer, but a new statute trumps regs. Also, someone might argue that the CUC's interpretation of PL 15-87 to allow long term stability will stretch the statute's terms.

4. Another consideration for you is batteries. With solar, of course, you are unlikely to generate enough power during bad weather to run your house. And CUC may not be reliable during a supertyphoon. But batteries can easily double your investment. Many people use their utiltiy company as the "battery", relying on their own power when the sun shines.

If cost is not a big issue with you, you will want to buy a system that makes you energy independent -- oversize it, so you never peak in excess of your capacity, and use batteries. Of course you will also purchase very efficient mechanicals and appliances and superinsulate your home, and design a home that orients properly to the sun and the wind. These strategies provide you with much more value than buying the solar panels.

ONLY if there is an active group of potential green power producers examining the draft regs and contracts will you wind up with something satisfactory.

Retinal Physican Blurb: Our Man in Saipan

2008-05-25T13:24:00.008+10:00

I'm not sure why I seem to be bursting upon the national scene at the moment. There was the recent interview by Ophthalmology Times, and now this piece that appears in Retinal Physician. There is also an upcoming story in Ophthalmology Management.

I'm trying to raise some money for a scholarship fund at Brilliant Star School, to allow low income children on Saipan to attend the school, so I'm hoping that the stories will lead to some benefactors. In any event, it seems to be my fifteen minutes of pseudo-fame. I can't say "fame," because, after all, these may be international magazines, but really, they're ophthalmology publications. In the Retinal Physician magazine, I'm wedged between stories titled "Antecortave Acetate Has New Target" and "OPKO Gets Key Patent for siRNA Drugs." The subtitle of the second piece is -- and I'm not making this up -- "But Controversy Erupts Over siRNA Concept." That context very nicely sums up the level of my fame.

I recently found out that the title of the story is a play on words from a 1970's sitcom called "Our Man in Rataan" about a journalist assigned to a god-forsaken post at the ends of the earth.

The best part of the story is where they refer to Marianas Eye Institute as "one of the best-equipped eyecare practices in the Asia-Pacific region." That's something Saipan can be proud of.

***

Our Man in Saipan
Dr. Khorram Finds His Tropical Island

David Khorram, MD, who received his retina training during residency at Northwestern University under Lee Jampol, MD, is the only ophthalmologist on the Pacific island of Saipan. Dr. Khorram passed up a retina fellowship because he wanted to practice in a part of the world that had a great need for an ophthalmologist. After doing some research, he chose the Pacific islands, and after a year practicing in American Samoa, he made his way to Saipan.

Over the course of the past 15 years, Dr. Khorram has built the Marianas Eye Institute into one of the best-equipped eyecare practices in the Asia-Pacific region, providing a wide range of both retina and general ophthalmology procedures.

He is also active in civic activities on the island, writing a weekly newspaper column and organizing a national soccer team [I think this is a reference to being a founding board member of NMIFA]. He recently published a collection of his columns in a book titled, "World Peace, a Blind Wife, and Gecko Tails" (available through Amazon.com). Dr. Khorram and his wife, Mara, have four children ages 3, 5, 7 and 9.

Dr. Khorram reports that he sees "a ton" of diabetes-related eyecare problems but almost no cases of macular degeneration, which he attributes to the island's relatively young population as well as genetic factors.

Saipan, which is located about 120 miles north of Guam, is the capital of the United States Commonwealth of the Northern Mariana Islands and has a population of approximately 60,000, many of whom are contract workers and not permanent residents.

The island was the site of fierce fighting in World War II as the United States established a base on Saipan for B-29 bombers that could reach the home islands of Japan.

Helping China's Earthquake Victims

2008-05-23T17:38:00.006+10:00

I got an email yesterday with a bank account number, informing me I could "wire transfer" funds to the account to help the China earthquake victims. The email was from someone I know, but I'm always suspicious of an email that gives instructions on wire transfer of funds, even if the email doesn't begin with, "ATTN: Dearest One of God..."

I wrote to one of my buddies who is an executive with the American Red Cross, and here is his response, with guidance on how to donate.

Like you, I’m always a bit suspicious of anyone who tells me to “wire the funds” As you can see from news reports, the RCSC [Red Cross Society of China] has collected over a ½ billion USD’s thus far and fundraising hasn’t really started yet. American Red Cross had such a huge surge of donations for China that they’re not asking for, or establishing a campaign to raise money.
The complexities of these relief operations are staggering. Global interest peaks for about 3 weeks, and then the disaster is relegated to just another terrible tragedy. The readiness capability of each Red Cross Society often reveals itself when a huge event like this occurs. China is in relatively good shape with a strong Red Cross infrastructure and literally millions of volunteers. They consistently operate within Sphere, IFRC [International Federation of Red Cross and Red Crescent Societies] and WHO standards. The Burma Red Cross is less fortunate having to operate under military rule and limited access to outside resources.

Personally I would give to the IFRC directly. They can then push the funds to China in a manner that makes sense. One advantage of giving to the American Red Cross is that the donation would be tax deductible. I don’t think the IRS provides this benefit to a donation made directly to China or through the IFRC.

Human Potential as Development

2008-05-23T13:56:00.003+10:00

As I've been delving into the area of sustainable development and poverty reduction over the past couple of weeks, a few themes have emerged.

1. Development projects work best when individuals at the grassroots set out to identify and solve their own problems, not when outside agencies and individuals come in to identify and solve their problems.

2. The most meaningful forms of development projects are those that unlock the capacity of the individual at the grassroots to do exactly that -- to believe in their own potential to address their own problems, and to develop the moral capacity to do so in a just and honest way.

3. Lack of money is usually not the biggest problem. There is lots of money and international aid available. The challenge is spending it in a meaningful way, and again, it goes back to having individuals within communities identify the meaningful ways to address their social and economic problems.

Purpose in life

2008-05-23T10:52:00.002+10:00

Mara just shared with me this quotation from the Baha'i writings. I found it very thought provoking. I wondered how our island "nation" fares on the issue of knowledge. The individuals have a strong sense of community, and I feel manifest the idea of enhancing social good more than in most places in the world. Yet there is certainly a lot of untapped potential in this regard. It also got me thinking about the idea of "looking within" in a way to find one's own special talents and gifts and using them to the max.

"The happiness and pride of a nation consist in this, that it should shine out like the sun in the high heaven of knowledge... And the honor and distinction of the individual consist in this, that he among all the world's multitudes should become a source of social good. Is any larger bounty conceivable than this, that an individual, looking within himself, should find that by the confirming grace of God he has become the cause of peace and well-being, of happiness and advantage to his fellow men? No, by the one true God, there is no greater bliss, no more complete delight."

(Abdu'l-Baha, The Secret of Divine Civilization, p. 2)

Marine Monument Activities

2008-05-20T17:04:00.002+10:00

Folks are in town to educate the community on the proposed Marine Monument. Here is the list of upcoming activities.

Tuesday, May 20^th, 11:45am – Hyatt Giovanni’s Restaurant

William Aila will speak to the Rotary Club of Saipan

Tuesday, May 20^th, 5pm-6:30pm – Hawaii Bar & Grill, Garapan

Meet & greet for Jay and William to meet project supporters

Tuesday, May 20^th, 7:15pm – American Memorial Park Auditorium

Presentation to Saipan Fisherman’s Association by Jay Nelson with special guest William Aila

Wednesday, May 21^st, 7:00pm – John Gonzales Show, KSPN Channel 2

General introductions and project information the first half-hour followed by a call-in Q&A in the second half hour

Thursday, May 22^nd, 7:00am – KZMI Radio Talk Show with Harry Blalock

General introductions and project information with Jay Nelson and special guest William Aila

Thursday, May 22^nd, 6:00pm - American Memorial Park Auditorium

Presentation to general public by Jay Nelson with special guest William Aila

Jay Nelson

Director - Global Ocean Legacy for Pew Environment Group. Ocean Legacy originated as an outgrowth of work done by Pew in 2005–2006 to support the creation of a fully protected marine reserve in the northwestern Hawaiian Islands. Partners supporting Ocean Legacy include Pew, the Sandler Family Supporting Foundation, the Oak Foundation, and the Robertson Foundation. Inspired by this success, the Pew-managed Ocean Legacy project is dedicated to establishing, globally, over the next decade, at least three to five large, world-class, no-take marine reserves. Ocean Legacy marine reserves will provide ocean-scale ecosystem benefits and help conserve our global marine heritage.

William Aila

William is a long time harbormaster on the Waianae coast of Oahu and commercial fisherman. He is well-known as an advocate for indigenous Hawaiian rights works closely with the group Na Imi Pono. In 2006 he ran for Governor of Hawai'i in the Democratic primary. William was intimately involved in advocating for the protection of the NW Hawaiian Islands for Native Hawaiian cultural and religious reasons from the late 1990's through today. He remains active in decisions about the management of the NW Hawaiian Islands today. William is very familiar with fisheries management in the Pacific through his more than ten year’s service on various Wespac advisory panels.

On the mend

2008-05-17T10:30:00.003+10:00

My back is much better. It's still bad, but yesterday I didn't have any screaming episodes, and I seem to be able to move around a bit better.

We closed the clinic yesterday afternoon and took a staff outing to PIC for our first Marianas Eye Institute Olympics. I was tempted to participate, but Russ, or CEO on former PIC Clubmate, wouldn't even let me carry the clipboard. But I did get to wear one of the cool rhinestone studded caps, brought out especially for the occasion.

Last night, Mara and I went to a wedding. Our friend, Peter Loyola, who is one of the island's tennis coaches/stars, had recently become reacquainted with Dinna, the bride, while on home visit to the Philippines. Peter and Dinna were in school together from the second grade through high-school. Peter asked us to be "sponsors" of the wedding, which is a tradition in either the Filipino culture, or the Catholic church. I'm not sure which. I had to ask a few friends from both cultures about the significance and duties, and no one could really give a satisfying answer, but it seemed to be a combination of best man/maid of honor, groom's men/bride's maids, and godparents all rolled into one. There were about ten sponsors. The wedding and reception was held at Claret at Fiesta Resort. It's one of my favorite rooms on the island. It was an honor to be asked to participate in the ceremony.

Will this country never change?

2008-05-16T01:18:00.003+10:00

Back in the 1980's, after the Islamic Revolution in Iran, several members of my family were imprisoned and executed because of their activities as members of the Baha'i Faith, whom the authorities regard as infidels. Back then the Baha'is were usually charged with things like "spying for Israel" or "promoting prostitution" (the latter because the Islamic government does not recognize Baha'i marriages). Things are starting to look alarming again.

The article below refers to the abduction and execution of the national-level governing council of the Baha'is back then. The Baha'is quickly reconstituted another nine-member governing body, which the Iranian government again abducted and executed. One of our former CHC doctors lost both of his parents to those executions. His father was a member of the first group, and his mother was elected onto the second group. He was a college student in the States at the time.

***

NEW YORK, 15 May 2008 (BWNS) -- Six Baha'i leaders in Iran were arrested and taken to the notorious Evin prison yesterday in a sweep that is ominously similar to episodes in the 1980s when scores of Iranian Baha'i leaders were summarily rounded up and killed.

The six men and women, all members of the national-level group that helped see to the minimum needs of Baha'is in Iran, were in their homes Wednesday morning when government intelligence agents entered and spent up to five hours searching each home, before taking them away.

The seventh member of the national coordinating group was arrested in early March in Mashhad after being summoned by the Ministry of Intelligence office there on an ostensibly trivial matter.

"We protest in the strongest terms the arrests of our fellow Baha'is in Iran," said Bani Dugal, the principal representative of the Baha'i International Community to the United Nations. "Their only crime is their practice of the Baha'i Faith."

"Especially disturbing is how this latest sweep recalls the wholesale arrest or abduction of the members of two national Iranian Baha'i governing councils in the early 1980s -- which led to the disappearance or execution of 17 individuals," she said.

"The early morning raids on the homes of these prominent Baha'is were well coordinated, and it is clear they represent a high-level effort to strike again at the Baha'is and to intimidate the Iranian Baha'i community at large," said Ms. Dugal.

Arrested yesterday were: Mrs. Fariba Kamalabadi, Mr. Jamaloddin Khanjani, Mr. Afif Naeimi, Mr. Saeid Rezaie, Mr.Behrouz Tavakkoli, and Mr. Vahid Tizfahm. All live in Tehran. Mrs. Kamalabadi, Mr. Khanjani, and Mr. Tavakkoi have been previously arrested and then released after periods ranging from five days to four months.

Arrested in Mashhad on 5 March 2008 was Mrs. Mahvash Sabet, who also resides in Tehran. Mrs. Sabet was summoned to Mashhad by the Ministry of Intelligence, ostensibly on the grounds that she was required to answer questions related to the burial of an individual in the Baha'i cemetery in that city.

On 21 August 1980, all nine members of the National Spiritual Assembly of the Baha'is of Iran were abducted and disappeared without a trace. It is certain that they were killed.

The National Spiritual Assembly of the Baha'is of Iran was reconstituted soon after that but was again ravaged by the execution of eight of its members on 27 December 1981.

A number of members of local Baha'i governing councils, known as local Spiritual Assemblies, were also arrested and executed in the early 1980s, before an international outcry forced the government to slow its execution of Baha'is. Since 1979, more than 200 Baha'is have been killed or executed in Iran, although none have been executed since 1998.

In 1983, the government outlawed all formal Baha'i administrative institutions and the Iranian Baha'i community responded by disbanding its National Spiritual Assembly, which is an elected governing council, along with some 400 local level elected governing councils. Baha'is throughout Iran also suspended nearly all of their regular organizational activity.

The informal national-level coordinating group, known as the Friends, was established with the knowledge of the government to help cope with the diverse needs of Iran's 300,000-member Baha'i community, which is the country's largest religious minority.

Wonder drug fails me

2008-05-15T20:44:00.002+10:00

There is a saying in medicine: When a new drug comes out, make sure you use it while it still works.

The first two doses of the Baclofen worked great, eliminating the muscle spasms that feel like someone sticking a hot knife between my ribs. The spasms drop me to my knees, make me gasp and shriek simultaneously, and bring tears to my eyes. But the dose I took at 1 AM only lasted two hours. I didn't get much sleep after that. The next couple of doses only lasted two hours also, and the stuff makes me feel like I'm in a cloud.

So, now I'm just learning to move in such a way that the spasms don't occur. I'm getting better at it, but it's pretty delicate.

The X-ray showed some age appropriate degeneration (translation -- normal for a 45-year-old spine). There is probably some mild disk herniation there, which unless it starts causing neurological symptoms (numbness, weakness, tingling) is just treated conservatively.

Wonder Drugs

2008-05-14T17:36:00.003+10:00

I never cease to be amazed by the power of drugs. This morning, I was screaming (literally screaming) with every time I tried to sit down because the the back pain. I crawled down to the orthopedic surgeon at CHC, Dr. Ruben Arafilis, who told me the pain was coming from a muscle spasm, and put me on Baclofen. Thirty minutes after taking the pill, the pain stopped. The spasm is happening either because of a herniated disk or a compressed disk -- neither of which is good. A compressed disk can be seen with a simple X-ray, so I got one today. If it's normal, then I may have to go to Guam for an MRI to evaluate for a herniated disk.

In the meantime, no soccer for me I've been waiting all year for the co-ed season to start again, and here I am sidelined, as the games get underway.

Netfilx works for Saipan

2008-05-13T14:14:00.004+10:00

After the movie theater closed, and we started having more trouble getting movies at the video rental shops, we joined Netflix and have been getting our DVD rentals mailed to us.

I'm a big proponent supporting our local businesses, but when the service fails me, I go elsewhere. At our "one week rental" place, the videos are always out because someone else has them for the week. I'm not sure I understand the business model. And our mom and pop video store recently went nutty. The last time we returned a DVD, the clerk insisted that we had returned it in a different case. We returned it in the same case we got it in, complete with all the labels and bar codes, but for some reason she insisted we peeled these labels off of the original case and affixed them to the case we were now returning them in. "Why in the world would we do that?" "I don't know, but I know you did." "Listen, why don't I just pay you for a new case. It's like two bucks, right?" "I don't the money, I just want the truth." And the next couple of times we went in, she gave us the "tsk tsk" for having pulled some sort of a case switcheroo. Life is weird enough without gettin silently scolded every time you go to rent a DVD, so we looked to Netflix.

Netflix works great. You pay a monthly fee, they mail DVD's to you, and you mail them back whenever you're done watching them -- no due date. There are no shipping charges, and they include a mailer to send it back to them. You just open an account with them, create a list (or queue) of movies you want to receive, and as soon as they receive one back from you, they mail the next one out. They mail out of Honolulu, so the total turn-around time to Saipan is about 4-5 days.

The monthly fee varies depending on how many DVD's you want out at a particular time. If you get one at a time, it's around $5.99 per month.

I love it. We are watching some classics that the kids are really enjoying and that you just can't find here, like The Princess Bride, and Big. Any time I hear of a good movie, or see a preview that I like, I just add it to my queue. It's because of Netflix that I know I'll be watching Gandhi next week. You can browse by genre -- Drama, Comedy, Foreign, Documentary, etc. They also have nice collection of TV shows on DVD.

It's another option for cheap entertainment here on the rock.

On Poverty

2008-05-12T10:09:00.007+10:00

I'm a selfish son-of-a-bitch.

On Wednesday, I watched the movie, Born into Brothels. If you haven't seen this movie, watch it. For those on Saipan, there is a copy available at the Public Library. A few years ago, it won the Academy Award, and a bunch of other major film festival awards, for best documentary. I usually hate documentaries, and rarely watch them. I can't say I really enjoyed the movie, but it really stayed with me, which is probably more important.

Born into Brothels is the story of the film-maker, who wanted to photograph women's issues in India, and ended up moving into a brothel in Calcutta in order to get to know the women and be trusted by them. In the process, she got to know the children whose mothers populated the red light district of Calcutta, and set out to teach them photography. It's a moving story of the children's experience of creativity, individuality, and for some, freedom from their surroundings and a chance for a better life. Watch the special features, which include the film-maker's visit to the children three years later, and a segment of them watching film and their reactions.

I had tears in my eyes during much of the movie. Man, these are children subjected to such horrible situations, and walking a predetermined path. And here, one woman changes the path for them, shows them that destiny has options.

Lately, I've been thinking about life. Some might characterize it as "mid-life crisis." For me, it's been mid-life evaluation. I've reached the pinnacle of accomplishments in my profession, and though it's satisfying, oddly enough, it's not automatically fulfilling. Sure, it's fulfilling looking back, but that doesn't necessarily carry me forward. There is a nagging feeling that there is more to be done. My friends tell me I'll go insane thinking like this, and that I should relax and just enjoy myself. I should. But movies like this get under my skin, because it's such a self-centered existence to think that once I've got everything I need, the rest is not my concern. We all spend so much of our lives thinking of our narrow self-interests -- our careers, our families, our children, our retirement, and we might even placate our hunger to feel good about our humanitarian souls by contributing to the worthy cause du jour. In the end, it's all pretty hollow.

All of this rumbling around in my head for the past few days has gotten me thinking about poverty, and the misery it brings. But also realizing that poverty doesn't come purely from lack of material goods, but from lack of morality. Aid gets pilfered or misappropriated (fancy words for "stolen") by people who line the trail from donor to recipient. And the aid often subjugates the recipient to a mentality of dependency. Aid is needed, but it has to be linked with education, transformation, a change of mind and heart for all parties. Long-term solutions require systemic changes.

I often think of the tragedy of many of the people who work here on Saipan. Because of the inequality of wealth among nations, our housekeeper left her boys in the Philippines when the children were under four-years old. She came to a place where the wages for a housekeeper were $350 a month, managed to live on this, and send enough home each month to put her boys through college. But she saw them once every five years. A mother removed from her sons, because of that nation's poverty and our wealth.

I'm trying to go beyond these words and figure out how to do something meaningful about all of this. I'm reflecting on something I read a few days ago also, that talks about "right living" and being "undeterred by fear."

We must be like the fountain or spring that is continually emptying itself of all that it has and is continually being refilled from an invisible source. To be continually giving out for the good of our fellows undeterred by the fear of poverty and reliant on the unfailing bounty of the Source of all wealth and all good -- this is the secret of right living.

I also know that without ongoing stimulation, I'll get distracted by the concerns of my own life. It's just so easy, because they are so readily accessible to my brain, like the blood that bathes it. So, I'm trying to give my mind some regular access to great issues, great ideas, just to stay engaged with the needs of my fellow human beings that for some stupid reason didn't have access to the things I did. The problems are big and complex. I don't pretend to have any clue of how to solve any of them, and I doubt I'll figure it out. But it is becoming clearer and more urgent for me to put my energy toward them, rather than toward my own little troubles.

So, the first step? I'm reflecting. I'm going to learn about some of the problems with being a savior. And I'm going to stay inspired -- I ordered the film, Gandhi, from Netflix and it should be here by the weekend. Yeah, it might seem like a pretty lame effort. Edmund Burke said, "All that is necessary for evil to triumph is for good men to do nothing." And although I don't want to be one of those good men doing nothing, I do want to be doing a meaningful something, which requires some thought, understanding and preparation.

It's also going to require me to stop being a selfish son-of-a-bitch, which is probably the biggest global impediment to ending poverty.

Lower Back Pain on Mother's Day

2008-05-12T09:50:00.005+10:00

I've been flat on my back for about five days now. I'm not sure what I did, but my lower back has been killing me. I tried to ignore it for a while, but it's been pretty loud. For the past two days, I've been getting up minimally, like just to eat. The ice is helping, and I'm taking ibuprofen around the clock. I had a similar episode about two years ago, and managed to get long-term relief with some core strengthening exercises (Pilates). But, man, when a body gets to be 40 or so years old, it takes active work to maintain it.

I did get up yesterday and headed to the Hyatt for Mother's Day brunch. It's still the best Sunday brunch on the island, combining great food, beautiful atmosphere, and good company. But over the years, the price has gotten really high, and our family has gotten really big. So, we hadn't been for five years, or so. It was an opulent experience, and I even ate flesh from some formerly-living animals. (I don't want to say "dead" because that would be too graphic.) It was good. Savage, but good.

SurgeXperiences 121

2008-05-11T21:41:00.004+10:00

The Surgery Blog Carnival is up at Sterile Eye, who is in Norway. The theme of the Carnival is "Tools of the Trade." I wrote the post just for the Carnival (and also used it for my weekly Saipan Tribune column). I like it when the carnival host picks a theme. It's like getting an assignment to write a story, and the theme stimulates my thinking. Here is the snippet about my submission.

As we’re about to move from physical to more metaphysical instruments we turn to eye surgeon David Khorram and his blog Marianas Eye. As a young student he found himself about to be seduced by a stethoscope. Fortunately he was saved from committing the cardinal sin of gadgetry. As the blood rushed back into his brain he realized the patients make appointments with doctors, not instruments.

The end of an era, the beginning of a new one...

2008-05-09T14:47:00.003+10:00

President Bush signed the "Federalization" law. The Commonwealth of the Northern Mariana Islands will no longer control it's own immigration, and we will come fully under the US immigration system.

The repercussions are not yet fully known, but lots will change, for sure.

Various statements from members of Congress regarding the signing of the law can be found here.

Seduced by a Stethoscope

2008-05-08T14:01:00.003+10:00

It was the first week of medical school and Littman, the world-famous medical equipment maker was on campus giving brand new stethoscopes to every entering student. The free “little gray Littman” was unadorned – the disc to place on the chest, the tube to carry the sound, the hollow ear buds. Littman also brought the sparkling models with them, all making the little gray Littman look okay, but not very sexy, like a homely dress in a room full of evening gowns. The sultry knockout of all stethoscopes was the Littman 501. She could be seen draped around the necks of all great cardiologists -- in their clinics, hospitals, and family photos.

Ahh, the Littman 501. Her sound capturing device was like a warm hand that would lie gently on any chest. Her double tube body with dedicated conveyance to separate ear canals ignored all voices but the one she was intent upon. Her soft ergonometric buds were like lips that would whisper sweet lub-dubs into your ears. She was dressed in elegant black with silver accessories. Walk with her through the wards, and hearts throb, beats skip, murmurs rise for you and your 501. Your unbuttoned white coat flutters, leaving those with lesser stethoscopes gazing admiringly, with a twinge of envy, then hurrying to keep pace. Stay with her long enough and she would curl up into a perfect halo, illuminating your way.

I held the little gray Littman in my hand, and saw the 501 gaze seductively at me from across the room, promising love, happiness and the ability to hear a paradoxically-split S2.

“What do you think?” I asked the cardiology attending who was there to browse. His Kentucky drawl thickened the air before his lips, the words slowly making their way through it. His statement stayed with me throughout my career. “It ain’t what’s in your ears that counts; it’s what’s between them.”

I love the high-tech tools of my trade – my slit lamp, the ocular coherence tomographer, my phaco machine, the laser -- but the most valuable tool I possess is me: my brain, followed closely by my eyes and my hands, all held together by my soul which helps me work compassionately.

The doctor-as-tool may seem obvious, but it isn’t. We often give better care to our equipment than to our selves, thus growing dull, sometimes even broken, from lack of maintenance. People come to see us, because of who we are. They’re happy when we have the best equipment, but they know that without the talent to use the technology, and the soul to stay off grumpiness, the doctor isn’t much use.

Last week the new patient looked stunned when I said that the treatment for her lingering red eye would be, well, brain surgery -- that without it, she would die. She had walked in, expecting more drops. But my eyes had seen the tortuosity of her conjunctival blood vessels. My brain had noticed them and drawn a conclusion. My hands opened the drawer, dusted off the stethoscope, and placed it, oddly enough, on her skull. I heard the faint swoosh swoosh swoosh – a leak from a vessel in her brain, squirting blood with every heartbeat. The leak was raising the pressure inside the cavernous sinus, slowing drainage of blood from her left eye. This was causing her chronic “conjunctivitis” which no drops seemed to cure. I put my little gray Littman back into the drawer, and smiled, knowing that technology can be seductive, but it’s not what matters most.

On the Other Side of the Diagnosis

2008-05-04T18:23:00.005+10:00

After reading the post about my lectures at the University of Guam, a few people have asked me, "What did you read from your book that made the students and faculty cry?" Here is the piece. Truth be told I didn't read it. Someone asked me what was the most personal piece I'd written, and if I would read it. I can never read this piece out loud, so the professor asked one of the students to read it. It's hard to believe that this all happened only a year ago.

***

Thoughts of a Father

Have you ever wondered what it would be like to wait for a diagnosis of cancer? I now know. Here are my thoughts from the first day this began last week. I think he’ll be okay.

My son has a 6.5 centimeter lymph node on his neck. Ultrasound shows an 11.4 centimeter spleen – huge, upper limit of normal for an adult, much less for a six-year-old child. Blood work mostly normal, no clear diagnosis, mono test results two weeks away. Thus the recommendation to biopsy. Look for cancer – lymphoma, Hodgkin’s disease, childhood death.

I held him as he screamed yesterday, the needle entering his vein, and I thought, “I hope and pray this is not the beginning.” My sweet six-year-old child, so full of life and joy and determination and creativity and enthusiasm and lost in his plans to move up from kindergarten to the elementary classroom.

We’d take him to MD Anderson or Sloan-Kettering or wherever could give him the chance for cure. Should he be taken from us, such emptiness would be left all my days. For his sister, her life a dance with his, she just two years older, a gaping emptiness. And every day I would talk to his soul beyond, and ask for his intercession on behalf of his father, for strength and patience to make it without him.

I can imagine all this, but in my heart, it has to just be an exuberant immune response to mono, right? Please? How can my child have cancer? Diverse genetic mix, mostly vegetarian diet, clear island air, no carcinogens. It’s just not possible. I try to cut a deal with God: Save my son, let this all be a lump of nothing, make it all smaller, and I promise I will be good. In however many ways that I’m not, I’ll be good.

All my personal concerns, various worries, evaporate under the heat of this lump.

I saw my friend of long ago last year at the Hawaiian Eye Conference. “How many kids do you have,” I asked. “Two,” he responded, “a twelve-year-old and a ten-year-old.” “I thought you had twins.” “We did. One died two years ago. Lymphoma.” He talked of how this trip to the conference was the first he and his wife had been able to take. There was no time to mourn two years ago. “What can you do?” he said. “You’ve got these other kids that are alive and who need you. They need your love, your presence, your joy and enthusiasm for them. So you bury one child and try to keep moving forward.”

The universe and God I do not understand. Suffering and the suffering of the innocent, I do not understand. And at times like this, I don’t try to understand, fearing my explanation

or theory may just be false placation. It’s just the way it is, and there is nothing I can do about it. Will my magical thinking help? Will the universe still respond with “your wish is my command”? Is my son any more important, just because he is mine? Thousands of despondent parents bury their children every day – death by lymphoma, or leukemia, or tuberculosis, or starvation, or war, or murder. And the world just keeps going on. I just keep going on, thinking about me, my concerns, my pursuits, my hopes, oblivious of their pain and the fragments of their broken hearts. Why would I be so special as to receive my request from the universe, from God? I feel reticent even to ask.

Over the last few years when death would come up in conversations (your great-great grandmother died, Duke died, the cat died), Arman has so often said, “I’m scared to die, I don’t want to die alone, can you die with me, Dad?” We realized he thinks that the next world is in the ground, somehow related to the grave. “How will we be able to see each other if we get buried in different holes?”

For most of the day, I’m just doing something else. I look up from my work, and wonder what it was that was causing my anxiety? Briefly forgotten. And the knowledge rushes in, pushes the fragile calm out, my tears well up, and I sob.

(Published in World Peace, a Blind Wife, and Gecko Tails, by David Khorram, MD)

Movies, Power, Federalization and Pew

2008-05-01T14:57:00.002+10:00

(My Saipan Tribune column for this week.)

Well, it’s been a newsworthy couple of weeks. The closing of Hollywood Theaters has definitely put a damper on spirits, even for those who never went to the movies. Its presence made us feel like a part of the “civilized” world. I was in Guam earlier this week, and when people asked me “How are things on Saipan,” the best way to sum it up was to say, “Our only movie theater just closed.” People immediately understood, and shook their heads in disbelief. Yes, things are bad, and “consumer confidence” is dwindling.

People would ask me what I think needed to be done to improve things, and really, I don’t think there is an easy solution. Certainly, we need a reliable utility. But we don’t control the price of oil, and it’s predicted to climb from its current level around $100 a barrel, up to $200 a barrel within the next year or two. Repairing the power plant can give us reliability, but it might not prevent the cost of power doubling. How can we cope with that? Alternative energy sources such as solar and wind power are simply not cost effective, however, they may become so as the price of oil rises.

Certainly another area that still needs improvement is government waste. We’d have more money available for various public services if waste wasn’t present. And honestly, much of that waste is related to power. Anytime I visit a government office, I take a jacket with me, because I know I’m going to be cold. It’s still beyond me why we don’t just adjust the thermostats around here.

A couple of years ago at the energy symposium that was sponsored by the Chamber of Commerce, one of the presenters told the story of a utility in California that was meeting increasing demand for power and was faced with building a new power plant. They analyzed the situation and realized that it would be more cost effective for them to hand out free energy saving light bulbs so that every home and business would convert to the compact fluorescent technology. It cost the utility money to give away the bulbs, but it saved them the expense of building a new plant. Just an idea that might help address a piece of our current problem. But honestly, there is no silver bullet.

Tourism is generally holding steady, but it’s clear that with rising travel costs, we cannot expect to see a significant rise in the coming months. There are no new industries, and we’re scratching our heads wondering how we can stimulate the economy, attract investors, create jobs. But we’re not alone. I take some consolation that at least the entire globe is flirting with recession.

And of course there is federalization. Whether you were for it or against it, it’s now a done deal, and though it’s certain that it’s going to happen, we don’t know what it’s impact will be. There will be things that some of us like about it, and things that we dislike. It will require the passage of time to sort it all out.

A ray of hope that was on the horizon was the proposed “Sanctuary at Sea”. Forget about all the arguments about more jobs, more tourists, and more federal money. Certainly those are beneficial outcomes. But for every good thing, someone else can give evidence of some possible bad outcome. Arguments at that level of “what can we get out of it” can go on forever. I felt that the monument was simply the opportunity, perhaps never to come our way again, for us to have the privilege of giving a gift to the world. The practicalities will work themselves out, if the desire is there. Let’s set our gaze outward, and into the future, and think of this as a gift worth giving to humanity. “Why should I? Maybe there are diamonds there for me! Maybe there are fish there for me!” Maybe. Yet, maybe, we can rise above these “me” centered concerns and think of leaving a legacy. Maybe centuries from now, we will be remembered in human history for our foresight and generosity in preserving a piece of the planet that increasing population pressures will threaten. The “Monument at Sea” is an opportunity for us to leave a positive mark, to create a positive image. And for people that care about being respected, that’s worth more than diamonds. It’s an opportunity for us to live up to our heritage as people of the land, people of the sea, people of the planet for whom we’ll serve as trustees. The monument is a small ray of hope that doesn’t solve all the problems we face, but it is something that lifts the spirit. And I have a feeling that with the myriad challenges sure to mount, it will be our spirits that guide the way.

___________________________________________________________________

David Khorram, MD is a board certified ophthalmologist and director of Marianas Eye Institute and the author of the book, World Peace, a Blind Wife, and Gecko Tails. Comments and questions are welcome. Call 235-9090 or email him through www.MarianasEye.com, or leave comments at www.MarianasEye.blogspot.com. Copyright © 2008 David Khorram

Lectures at University of Guam

2008-04-30T10:26:00.005+10:00

I just returned for two days in Guam. I had been invited to lecture at University of Guam by Professor Kirk Johnson. His Introduction to Sociology classes have been reading my book. I spent Monday afternoon at the UOG library preparing my thoughts, and as I sat there, surrounded by students and books, I thought it could be exciting to work in academia -- people seeking knowledge, exchanging ideas, working to change the world, mentoring one another. That stuff excites me. But on Tuesday morning reality sank it. I enjoyed my first lecture to about 50 students. The students were engaged, asked questions, wrote down their thoughts, laughed at my jokes. At the end of the hour and a half, I signed their copies of the book. Then, after a 10 minute break, another 50 students came in, and I had to give the same lecture all over again. I was exhausted by the end. I didn't anticipate that the "exchange of ideas" would require back to back identical lectures on any given day of the week.

The evening made up for it though. Kirk had read some of my essays from the book to his upper level class on Community Development and Globalization. These fifteen students gathered at the home of Dianne Strong, a retired UOG English professor, and they were joined by members of the faculty in the fields of anthropology, archeology, psychology, and library science. We sat outside, overlooking the Pacific, and since no one had read the book, I talked a bit about what motivated me to write it, and I read some of the essays. I was truly humbled by the response. People laughed at the humorous pieces, and cried (even bawled) at the more personal ones. It still amazes me that anything that I write is of meaning to someone else, and to see this response from the students and especially the faculty was very moving.

Doctor's Who Kill Themselves

2008-04-25T06:00:00.002+10:00

(Here is my hastily written Saipan Tribune column for this week.)

This week’s issue of Newsweek magazine features an essay by this same title by David Noonan, highlighting the problem of suicide among doctors. Believe it or not, doctors have the highest suicide rate of any profession. “Struggling in Silence,” a documentary film which will appear on public television stations, examines this problem.

The underlying cause of suicide is depression. For decades we have recognized that depression is not simply sadness caused by the bad occurrences in life. It’s related to a chemical imbalance in the brain, and is treatable with medication.

According to Noonan’s essay, the rate of depression among doctors is the same as in the general population, but it remains undiagnosed and untreated in more doctors. You’d think that doctors would recognize the signs of depression within themselves and seek treatment, but it seems to be that being a doctor prevents seeking help. You see, there is pressure among physicians to be strong, and although patients can accept a doctor with some physical ailments (like diabetes or high blood pressure), the public is less likely to accept a doctor with depression.

The pressure to avoid medical care for depression is tremendous among doctors. Every year, when I receive my licensing renewal applications, there is a question on there that asks whether or not the doctor has had any mental health issues. Of course, licensing boards have a responsibility to protect the public from a physician whose mental condition may harm the public, but depression is generally not one of those kinds of problems. But just seeing the question on the renewal application can be enough to nudge a doctor away from seeking care.

The suicide rate is higher among doctors in part because they have a higher success rate when they attempt suicide. They know what they’re doing. They know the human body, and what it takes to stop a pulse. They have access to lethal drugs. They know how to use them.

The suicide rate among women doctors is even higher than for men. A female physicians is more than twice as likely to commit suicide as a non-physician.

Depression often strikes young adults, and medical schools are currently developing programs to help these young doctors-in-training to seek help for depression that may be starting to afflict them.

Depression, of course can strike anyone, and anti-depressants are the most subscribed group of medications in the United States. It’s ironic that the ones writing the prescriptions are the least likely to seek their benefit.

Ophthalmology Times Interview

2008-04-19T11:39:00.004+10:00

A few weeks ago I was contacted by a writer from Ophthalmology Times, a biweekly nationwide publication that goes to every ophthalmologist in the United States. They wanted to do a story about me -- you know, guy in the middle of nowhere. The story is up on their website. Click here to read the article. I didn't realize how much of the story would be about blogging.

(Edit: Actually, I'm posting the article here in case it disappears from their website.)

Practicing ophthalmology in Saipan

Apr 15, 2008

By:Noelle Creamer

Ophthalmology Times

David Khorram, MD, meets many ophthalmologists who wish they could work internationally and make a difference in a society that needs their expertise. Some travel for a week or two every year and find opportunities to help around the world. But Dr. Khorram is living the dream.

He is an ophthalmologist in private practice on the island of Saipan in the South Pacific.

Finding his island

Dr. Khorram grew up in Kentucky and attended Northwestern University, Chicago, then the University of Kentucky for medical school, and then returned to Northwestern for his ophthalmology training.

"This was a very exciting time, and although I had the opportunity to pursue a career in academic medicine, my heart was set on serving a community that needed an ophthalmologist," said Dr. Khorram. "I had always wanted to serve internationally, so I sent letters all over the world, and ended up in the Pacific."

He spent a year as the director of ophthalmology at the Lyndon Baines Johnston Tropical Medical Center in Pago Pago, American Samoa, before going to the Commonwealth of Northern Mariana Islands (CNMI). For his first 5 years in Saipan, he worked at the Commonwealth Health Center before co-founding Marianas Eye Institute in 1998.

Different needs

Running an eye institute on this tropical island is different from doing so in the United States for several reasons, explained Dr. Khorram. "There are no subspecialists nearby for me to refer patients to," said Dr. Khorram. "I'm the only ophthalmologist serving the island. So when something needs to be done, I'm the one to do it.

"I handle a much broader range of cases than I would in the States," he added. "Many people here delay eye care, so I see a lot of end-stage disease. A good chunk of the cataract surgery that I perform is on white lenses. Diabetes is rampant, and a lot of people walk in the door for the first time with a vitreous hemorrhage."

The demographics of the island distinguish the practice, too. Dr. Khorram explained, "There is an indigenous population of about 20,000. People die young, often in their 50s. The rest of the population is made up of young, healthy contract workers from Asia who don't access health-care. I'm doing about 80 or 100 cataracts per year. That's just all there is on the island. Minimum wage is $3.55 per hour, and the average annual income on the island is around $11,000. So there isn't any significant disposable income for people to spend on the elective facets of eye care, which, from what I understand, is driving American ophthalmology—refractive surgery, presbyopic correcting IOLs, and cosmetic procedures. We provide a lot of free care and a lot of indigent care.

"Yet, I love my work because the people I serve are extremely appreciative," said Dr. Khorram. "Economics are obviously not the driving force behind working here."

A wired practice

Technology plays a huge role in Dr. Khorram's practice—in part because he values it and in part because his remote location demands it.

"I think our level of technology is probably not typical for even U.S. mainland practices," he said. "When ophthalmologists from Japan, Australia, and the US have passed through and visited our office, they have commented that the combination of technologies in our office far surpasses typical comprehensive ophthalmology practices in their countries.

"For example, because the people here are more visual learners than verbal learners, we have digital cameras attached to our slit lamps, which project images onto computer screens in the exam rooms. The families can watch the exam, and we can freeze the images and explain to our patients what is going on with their eyes. The pictures make sense to them, and the education helps them understand their condition.

"I'm also an early adopter of new technologies. Even though I'm in the middle of nowhere and not very busy, I still want to practice first-world medicine. Because of the technology, we probably look more like the sort of practice you'd see in an academic center, rather than in this tiny practice on a far-away island. We need the best in diagnostic equipment, because if we don't have it, it isn't available down the street.

"I also rely on telemedicine quite a bit. When I have a challenging case, I send the [images]—OCTs, retinal photos, anterior segment photos, visual fields, fluorescein angiograms, you name it—via the Internet to friends around the country. The digital imaging technology makes this possible. And my friends are a great help."

More than an ophthalmologist

But this cutting-edge practice is only part of the story, part of what sets Dr. Khorram apart. The rest of the story centers on the fact that Dr. Khorram has come to realize that who he is as a person is much richer as a result of his interests beyond his profession.

In addition to being an ophthalmologist, Dr. Khorram is a husband, a father of four, writer, blogger, stand-up comedian, coach, and more.

"Because the population of the island is relatively small, I'm not very busy. It leaves me a lot of time to pursue other things," he said.

In his blog Marianas Eye, he writes widely about daily life on Saipan, his practice, his travels, family life, politics, religion, history, geography, even the "wacko of the week." He shares beautiful photos of friends and scenery and—also a popular feature—the "gory eye" pictures.

He writes a weekly column for the local newspaper, and his first published book, "World Peace, a Blind Wife, and Gecko Tails: Intriguing thoughts from an island on making life happier and healthier, and laughing along the way," is now available from Amazon and other retailers.

He is also working on a few other books. "One of them is a collection of stories by a few friends about day-to-day life on Saipan, and I think that will be the first one that's completed," he said.

"I'm a writer, so blogging is a way to capture random thoughts and experiences and let others read about them," Dr. Khorram explained. "With blogging, readers can give feedback. Sometimes the pieces that appear on my blog develop into parts of other writing projects. So, in some way, the blog is like a laboratory for my writing.

"My audience is made up of people on Saipan who just want to check in and see what's going on with me and what's on my mind. I also seem to have a following that's scattered around the globe, but mostly in the United States. There aren't too many physicians who are blogging, and certainly not many in the South Pacific, so it all makes for an entertaining story, I suppose. Quite a few people come to my blog via search engines, looking for some specific piece of information that happens to be on my blog."

Dr. Khorram said he is trying his hand at stand-up comedy, too, organizing and participating in a comedy workshop. "I'm enjoying it. It's an opportunity to focus on the funny things in life and to make people laugh. You can't ask for much more than that."

Another way to teach

Another interest of his is education. He and his wife, Mara, founded Brilliant Star School on Saipan in 2000.

"When our first daughter turned 1 year old, she seemed a bit bored at home," Dr. Khorram recounted. "We looked around the island for an enrichment program of some sort, but none existed. So, Mara and I started doing some research and came across the work of Maria Montessori. We had a friend who was a teacher at a public school and was ready for a career change, so we banded together to open Brilliant Star School as a not-for-profit toddler enrichment program.

"The program started with 12 kids. The families liked the curriculum and the philosophy behind it, and so each year, we added more grades. Our goal became to give kids on the island the opportunity for a world-class education. Eventually, the government granted us a public land lease and six buildings, which we renovated."

Now, the school is on a beautiful hillside campus with 7,500 square feet of classrooms. About 100 children represent some 15 ethnicities, from toddler age through sixth grade. Dr. Khorram and Mara continue to serve on the board of trustees but are no longer involved with the day-to-day management of the school.

"Our biggest challenge is that education, particularly high-quality education, is very expensive for the sort of incomes we have on the island," said Dr. Khorram. "We need to recruit dynamic teachers from the States and offer them competitive salaries, which is a challenge.

"Right now, I'm in the process of trying to find 100 benefactors from around the world who are willing to donate $1,000 per year, for 10 years or so, to help continue providing outstanding education to the people of this island, who otherwise might not have the opportunity. A thousand dollars a year is the sort of contribution that isn't much for a U.S. ophthalmologist, but in terms of the education it provides, it can change generations to come."

Homesick?

Dr. Khorram said he considers Saipan home now but does miss things from living in the United States.

"This may sound mundane, but I really miss the variety of fresh fruits and vegetables that are abundant in the United States. I miss things like fresh berries, varieties of lettuce, mushrooms, asparagus, things like that. When I walk into the produce section in a grocery store in the States, and see the abundance, I get choked up. We just don't have that here."

He added, "It's also hard being so far from my sister and her family. If we're lucky, we see each other once a year."

And, occasionally, he misses things such as live blues, trendy restaurants, the super store, comedy clubs, and fall weather.

But, he's happy that he doesn't own a suit.

"Seriously," said Dr. Khorram. "Most of what makes me different is that I took 'the road less traveled.' The differences are focused around having left the United States to practice international medicine—living out here in the South Pacific, exploring, and pursuing a variety of interests."

Books are Here!

2008-04-15T21:50:00.003+10:00

After spending three months floating in the Pacific Ocean, 200 copies of my book arrived on Saipan yesterday. They are available for purchase on Saipan here.

If your name is on this list, send me a quick email to check if your copy is ready for pick up.

Anyone know anything about Paris?

2008-04-14T17:14:00.003+10:00

Summer plans are underway and, it turns out it's cheaper for our family to get "around the world" tickets to the States than to go straight east. We're going Saipan-Tokyo-Paris as our first stop, where we'll spend five day. Anyone out there been to Paris? Can you recommend which part of Paris a romantic couple with four children ages 3, 5, 7 and 9 should stay? I've spent the last hour looking at vacation apartments in Paris, which seem to be the way to go for us. But in which part of the city?

SurgeXperiences 19 - Surgery Carnival

2008-04-13T00:25:00.008+10:00

I'd like to thank Jeffrey Leow, the Monash Medical Student down in Australia, who found my blog and invited me to host the 19 edition of SurgeXperiences, the worldwide Surgery Carnival. As anyone reading my blog can see, the practice of medicine is just one of the activities I pursue, and so I have never really wandered the blogosphere looking for medical blogs. But now, through hosting this Carnival, I've found that there are some really fascinating ones out there. It's also inspired me to write a bit more about my own medical and surgical experiences.

I designated the theme of this Carnival,"Funny Operating Room Moments," and there are quite a few of them here, but many are just entertaining posts about various facets of surgery and medicine, and, well, the human condition. I'm posting them in the order they were received. Here we go.

***

One of the most fascinating surgery blogs I came across is from Israel, and belongs to The Sandman, an anesthesiologist in Tel Aviv. (The Sandman -- get it? Puts people to sleep.) I found two of his recent posts quite compelling. The first is a story of having an elderly couple in his office. Because he took the time to get to know them better, they shared with him their story of arriving in Israel after the holocaust on the ship that was at the center of the story of the historical novel, Exodus. His second post that I enjoyed shares his thoughts on the calm face that seems to often be present on people who die violent deaths. It's a graphic post, but gives a peek into the task of pronouncing a person dead. ("I now pronounce you dead.")

You can also browse through his blog and get a different perspective on the violence in that country -- as seen from the inside of an operating room. The Sandman did send a post for this Carnival, "It ain't over til' the fat lady sings" which points out the importance of making sure your patient is asleep when you think they're asleep.

***

Jeffrey Leow forwarded a few links to save me time finding them, including A Lesson (Not Just a Joke) From an Orthopedic Surgeon posted at The Differential: Medscape Med Students Blogs. It’s a story by medical student Ben Bryer that describes the unexpected use of a hand drill (instead of a power drill) to fix a patient’s leg. It’s just like here in Saipan, where improvising is a way of life. In fact, there is a sign hanging on our OR wall (by the former chief of orthopedic surgery) that reads, “If you have to have everything you need to do the case, you probably shouldn’t be here.”

***

All of us have experiences of non-nonchalantly almost killing someone. I almost did it when I was an intern and admitted a patient who was experiencing weakness. I tucked him in for the night, thinking we'd deal with the problem in the morning. The resident stopped by to see him an hour later and diagnoses Guillane-Barre syndrome, a rare disorder that causes paralysis and therefore stops breathing. If the resident hadn't stopped by, the patient would have been dead by midnight. It was a learning experience I never forgot. In How We Learn posted at The Differential: Medscape Med Students Blogs, Anna Burkhead describes witnessing a surgical resident's similar learning experience.

***

Jeffrey also brought my attention to the post, Surgery and the Blowfish, again by Ben Bryner, who gives proof that we surgeons are way smarter than blowfish chefs. Find out why.

***

Pimping. Do other professions use the word the way we do? In medicine, it refers to the endless series of questions that will come the way of a "junior" medical type, by a "senior" medical type. Most commonly, it is a hapless medical student getting pimped into oblivion by the attending physician (the "professor"). It's usually conducted on rounds or in the operating room, and it's rare that there isn't a gaggle of spectators present -- the whole medical team -- silent witnesses with downcast eyes, folder arms and beaded sweat. Pimping ends when either the pimper runs out of questions, or the pimped doesn't know the answer. And the pimper never runs out of questions. So, the session will conclude when you're wrong, which is why pimping never feels like it has a happy ending. If you have a sense of humor, you can get away with a lot, especially if you know the answer. Once during rounds when I was being pimped, the attending, while studying an EKG asked me "What is one of the clearest indications of an elevated blood potassium level?" I answered, "The word 'HIGH' next the the letter 'K' [the symbol for potassium] on the lab sheet." Jeffrey Leow directs us to How to Survive Pimping in the OR posted by Anna Burkhead, where she gives some useful tips.

***

Sid Schwab, who like myself is the author of a book, has written about a tube at an unexpected orifice. For some reason, whatever the conversation may be, orifices seem to be fertile ground for a giggle. Sid's post is Snakes on a Pan, over at SurgeonsBlog.

***

When people move to Saipan (the island on which I live) and work for the government, they typically rant incessantly about the problems with the system, as if problems and inefficiencies are unique to this island. I usually respond, "Dude, you haven't ever worked at a VA, have you?" Dr. Rob Oliver paints some accurate (and funny) pictures of life at a VA at his post VA Voodoo Economics - Krugman wrong on John McCain posted at Plastic Surgery 101.

***

Dr. Oliver also presents Dumb laws and smart laws re. plastic surgery. It regards legislation in California that will require medical clearance for all plastic surgery patients. Believe it or not, I get medical clearance for all my cataract patients, mostly because here on the island, you can rarely get a straight story about someone's medical problems. I send them all to see their internist, and we find some interesting things (like blood sugars in the 400's, just walkin' around). It's best in my opinion to leave medical decisions up to doctors, not legislators. We get medical clearance when we think it's necessary. And we're generally a careful group of folks, particularly in America where a lawyer with a briefcase is only a stopped heart (or an inconvenient rash) away. Thank-you, Dr. Oliver.

***

All stereotypes are based on some element of reality. In medicine, we all know the stereotype of the orthopedic surgeon ("As strong as an ox, and twice as smart.") Dr. Val Jones shares some excerpts from a talk by an orthopedic surgeon, which I honestly found refreshing. I like these guys. They're the surfer dudes of medicine. Check out her post at Revolution Health.

***

"I was filming a nipple reconstruction..." Thus begins a "Tale of Two... " um, no, I'm not going to say it... thus begins a tale by Norwegian surgical videographer, The Sterile Eye, who presents Yo mammae! That sentence is sure to become a classic in medical blogging literature. I give Sterile Eye the "Call me Ishmael" Award (which I just created) for week's best opening sentence of a Carnival post.

***

Dr. R Bates, a plastic surgeon and quilter in Arkansas (who, by the way, is married to a wonderful man) is author of Suture for a Living. She explains the surgeon's "druthers" card, in her post appropriately named, Druthers. Her post, She's a Beautiful Girl! , which comes complete with it's own music video (is that Dr. Bates on the drums?) tells the touching story of a young girl who gains new self-image as a result of Dr. Bates skill. It's a reminder to all of us to pause and recognize how some of the little, "insignificant" things we do can so greatly affect the lives of others. Thank-you, Dr. Bates.

***

South Africa's Bongi has some great posts at his site, Other Things Amanzi. If you're one of my regular readers who gets cheerfully grossed out by my "gory eye pictures," you're gonna love Bongi's writing. Here is a "taste" from his post, Fettuchini:

the patient came in after being involved in a car accident. he had an acute abdomen, but was otherwise stable. x-rays confirmed free air in the abdomen. easy call. the patient went to theater. we opened the abdomen. it was full of intestinal content. not too surprising. and then...lying in this soup, free in the abdomen we found a meter long tape worm! i'm not embarrassed to say i gagged. i threw it in a kidney dish where it entertained us with its peristaltic movements.

Bongi's hilarious post on operating in various states of undress deserves reading: Fashion Statements.

And what's worse than poop? Well, according to Bongi, it's poop that has gone rancid. Yep, rancid poop happens, and if you want to read about how it happens, and how to remain a macho surgeon in the midst of its indescribable fragrance, read this entertaining post, Tough Surgeon.

***

Surgery has lots of "laws" -- dicta (that's apparently the plural of dictum) that give pithy bits of knowledge and wisdom. Many of them are specific to a particular institution. At the University of Kentucky where I went to medical school, there were "Five Laws of Surgery." I remember two of them: A bump in a breast belongs in a bottle; and Surgery, like sex, should be slow and gentle, and requires good exposure. (You're welcome to share your own opinion on whether or not good exposure is really required.) Bongi writes about this law of surgery: Eat when you can, sleep when you can, and don't f@*% with the pancreas. If you ever need advice on getting some sleep when little time is available, you can read this chilling post: Other Things Amanzi: Wakeup Call. Thanks, Bongi, I enjoyed your posts and I'm bestowing upon you a coveted Marianas Eye Funniest Medical Blogger of the Week Award.

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Doc Ness, an anesthesiologist not far from me, writes about the experience of being in the operating room, not as a doctor, but as a patient. Most of us will have to face the other side of the table sooner or later. You can read about Doc Ness' experience at random ness.

***

And that's all folks. Thanks for stopping by. And buy my book, World Peace, a Blind Wife, and Gecko Tails. It's available on Amazon. (Yes, I know it's shameless self-promotions, but hey, I have four kids to put through college and Oprah hasn't called yet.) I hope you enjoy reading this Carnival as much as I enjoyed putting it together. I look forward to your comments and to regularly visiting your blogs.

The next edition of SurgeXperiences will be hosted by Dr. Sidney Schwab and will presented on April 27.

Change Your Life

2008-04-07T16:01:00.004+10:00

Well, I wasn't really planning on doing this. I posted the review about this book, and a couple of people have gone ahead and ordered it and said, "let's get together to discuss it every couple of weeks like the author recommends." So, that's what we're going to do. Take a look at the links and let me know if you want to join us. I've read about 30 pages of it, and have done a couple of the exercises, I must say (and I'm not one to say stuff like this lightly), it's made a huge difference in my approach to life. Some total shifts in my life. Go figure.

Let me know if you want to join us. Once we find out how many people are in, we'll go from there. I'm just accepting that since people want to do it, it was meant to be. Consider that since you're reading this, you're meant to be a part of it.

Exercising for Results

2008-04-06T14:38:00.007+10:00

For about the past nine months, I've been running intermittently, thinking I was getting into better shape. Then I had a chat with Saipan's leading triathlete, Eli Torgeson, and as it turns out, I've been sort of wasting my time -- at least in terms of building my cardiac capacity. See, aerobic activity is all about making your heart stronger. I've been stressing my heart, but not building it's capacity.

Here is the deal. You can find your maximum heart rate by taking 225 and subtracting your age. For me, that's 180. For the past week or two, when I've been on my usual run, I've been stopping to check my pusle, and it's always right there around 170. Not good.

What you need to do is build the heart's capacity to handle the load, and you can't to this by having it carry the full load all the time. Eli tells me I need to start by getting my heartrate up to 140 for about 40 minutes. If it goes higher, I need slow down, or even just walk. I need to play with my pace until I can find this spot. Gradually, as my cardiac capacity builds, I'll be able to run faster and still keep my rate at 140. And then I can work in periodic bursts of faster running, to get the rate up, and then have it come back down -- "interval training"

It's been cumbersome to stop every five minutes and check my pulse rate, so I just ordered a heartrate monitor. There are all kinds out there, including ones which include GPS and can measure your distance also. If I keep with this, one of those might be cool to have eventually. But for now, I'm just going with the $45 model that just measures heartrate. It's the Timex T5G971, favorite of mall-walkers.

I'm looking forward to getting into better shape. Will I really be ready for a triathlon? Who knows. First things first.

Me and the Kids

2008-04-05T21:41:00.003+10:00

Today was a great day. Mara is away in Hawaii for the weekend attending a meeting of a regional Board of Trustees of which she is a member, and I decided to have our housekeeper NOT come, just so I could spend time with my kids. There is a certain peace in being the only adult in their lives for a day, in part because there is no other authority to whom they can appeal my decisions. It's also just nice to see each other.

After breakfast and chores, I took them down to Micro Beach. What a magnificent morning. The lagoon was turquoise, the sun was behind us, still rising, as we sat under the shade of palm trees and ironwoods and dug in the sand, waded on the sandbar. It was one of those days when the sky is bright blue and the clouds are gleaming white, drifting by like silent herds of animals. And off in the distant, Managaha Island. I was full of joy just watching them and spending the day with them.

Irritated eye

2008-04-05T18:59:00.004+10:00

When provoked, an eye will on rare occasion stick its tongue out at the examiner.

Funny Operating Room Moments

2008-04-05T18:11:00.004+10:00

So, it appears there is a "surgery carnival," and I've been asked to pick a theme and host the 19th edition. When I was first asked to host the carnival, I imagined an event where clowns would juggle solid organs, and admissions to some of the tents would include the chance to watch an amputation or two. But no, it's where surgeons and medical types around the world will write on the theme, the host will place a synopsis of all the stories on a blog, with links to the original stories. It sounds like fun.

So, medical people around the world, send me your funny stories. They don't have to be from the operating room per se (or more aptly the "operating theatre" as our British influenced colleagues would say). Write about any funny experience that occurred in the vicinity of a knife. You can see previous editions of the Surgery Carnival by clicking here.

A Life Changing Book

2008-04-02T09:38:00.006+10:00

I don't know how I stumbled upon this book. I bought it a few weeks ago, and only picked it up to read today. I think it's going to be pretty good, despite it's lame "marketing oriented" title.

The author, Srikumar S. Rao, teaches a radical course at Columbia University Business School, upon which this book is based. Here is what has to be one of the most compelling reviews I've ever read on Amazon.

***

It will be fairly difficult for me to give an unbiased review of Are You Ready to Succeed, as the course on which it's based set me upon a path of growth and self-discovery and allowed me for first time to know true fulfillment. For this, I feel immense gratitude, incapable of expression with words. I'll divide this review into two parts: 1. The effect the wisdom and exercises within the book had on my life and 2. My feelings about the book itself.

Prior to taking Creativity and Personal Mastery, the course upon which the book is based, I was an obnoxious, mechanistic, sociopathic prince of capitalism. I viewed wealth as a means to exert dominance over others, as well as a vehicle to procure hedonistic bliss. I found a happy home for this way of thinking in the world of investment banking, venture capital and startups. I drank, drugged, womanized, broke the law; I created a world in which those without a similar plunderer-type mentality were weak and destined to be dominated. At the beginning of the course, I had been fired twice, totally four cars, been arrested in five states and inflicted emotional harm on countless females. I didn't read; I thought introspection was for meek, those incapable of enjoying the finer things in life. In short, I was miserable - a gerbil on wheel of chemical and emotional highs, a slave to the influence of my fellow "pirate" peers. You could say I was ready for a change.

The course had several effects upon me. There are too many to list, so I will detail only four.

The first is the notion that the universe is benevolent, a partner in creating not only fulfilling personal endeavors, but a brighter future. The second is that I have an opportunity to be truly happy, i.e. fulfilled, not through striving and external action, but through removing that which is unreal and not me, thereby allowing my true nature to shine. The third is that HOW is not important, rather only the WHAT and the WHY, meaning I need not obsess over how desirable things such as fulfillment and impact come into my life, only a clear conception of what it is I want to achieve and why I want to achieve it. The last insight I was blessed with was, "If you build it, they will come", meaning that attention to my own personal mastery is the most important thing I can do in terms of creating the life and manifesting the impact I desire.

Since finishing the course, I have gone on to read several of the recommended texts, traveled to India to learn meditation, attended various personal growth related retreats, consulted with non-profits, helped people start companies, become a more effective writer and public speaker, begun creating healthy platonic and authentic romantic relationships, found fulfilling employment with a renewable energy company and am currently helping launch a non-profit. In addition to taking up meditation, I have stopped drinking, eating meat, eating sweets (and in doing so, lost 60 pounds), doing drugs, watching porn and have filled this gap with yoga, reading, writing, love-making, cooking and hiking.

Certainly the wisdom and exercises from the course (and book) did not do all of this, I did, but it was the seed crystal that allowed me to embark on a path of rapid transformation and achieve an infinitely more rewarding life. I owe Prof. Rao, the course, and by extension this book a tremendous debt of gratitude for which I am only beginning to repay.

I really enjoyed the book as well. It was a beautiful encapsulation of the course, touching on the major themes. Given the limited scope of the chosen media (in this case a book, as compared to a semester-long course) it is an excellent effort and if used as stated could produce extraordinary results for those who employ it. I say employ instead of read, because to merely read this book is not sufficient. As Prof. Rao says, the book should viewed more as a workbook, a guide for exercises. Viewing this book as anything else will produce only limited results. I echo the following recommendations: 1. Buy the book, 2. Convince 5 friends to also buy the book, 3. Spend 3 months reading the book, stopping to do each exercise for a week or so, 4. Hold weekly meetings to discuss the exercises with your group, 4. Keep a journal throughout the process.

Obliviously, the wisdom and exercises in this book had a marked affect on my life. I believe that if you are serious about reaching your true potential and enjoying

Fear of Success

2008-04-01T13:44:00.003+10:00

I just received this email from a guy who's a doctor and runs a coaching service for other doctors. Very clever fellow. But, I do have to say, I think he has a point.

I was reminded recently that deep inside we are all afraid of success. I don't mean some of us or even many of us. I mean all of us. We have been conditioned in our society to believe that the price of success is very high. We are always told the story of the struggling artist or the starving actor who finally made a big. And in the very next breath we are also told of the thousands and thousands of others who sacrificed just as much and never made it at all.

What do you think of when you think of success? Do you think about how much harder you will have to work? Do you think about sacrifice and loneliness and time away from those you love? If you do, you will probably never be successful. Anytime we associate pain or sacrifice with something, we tend to avoid that thing. Just ask any fat guy what he thinks about dieting and he will probably tell you about the pain and the sacrifice involved. On the other hand, when you talk to a thin person about dieting, he or she will probably say "what diet?" Most thin people associate pleasure with the good eating habits they have developed.

I could go on and on, but I think you get the point. A successful career or business is no good if you have to trade your soul for it. Instead, it should be built on a foundation of effective strategies and habits that become unconsciously simple with time. I am there, are you?

To get started on your own path to success, call me for more information.

Technical Support

2008-04-01T11:09:00.006+10:00

My laptop battery died after three months. I'm on hold right now with IBM in Atlanta, Georgia. It took me a solid 10 minutes, going through about 15 automated options to get there. You know, "Hello. You've reached IBM technical support. For existing tickets, press one, for new tickets, press two, for concert tickets, press three, for traffic tickets, press four, for Levono products, press five."

Once I finally got to the Atlanta connection, I sat on hold, listening to soft jazz, punctuated by a message every minute saying "Thank you for holding. All our customer representatives are helping other customers. We will be right with you." That was another solid ten minutes. Finally I hear the line ringing and a thickly accented man saying, "This really is Atlanta, Georgia, even though I sound like I'm in a far away Middle Eastern country. What is your fr digi nmba?" "I'm sorry, Mr. Technical Support Man, I didn't catch the last thing you said." "What is your FOUR DIGIT NUMBER." "For what?" "For da par you clmeantarasy." "I'm sorry Mr. Technical Support Man, I'm having difficulty understanding you." "One moment please."

Wow. That's pretty progressive. He realized I can't understand him, so he's going to look for someone with a milder accent who speaks slower. How great is that!

The line rings. How exciting! The automated voice begins. "Hello, you've reached IBM technical support. For an existing ticket, press one. For a new ticket, press two. For razor blades or a gun, press three." That's what you get for not understanding the technical support guy's accent. He's safe. I can never find him. And he's laughing in his cubicle as he hits the transfer button, sending me into another ten minutes of phone tree button pushing to get back to Atlanta.

Nava Khorram: Environmental Champion

2008-03-28T21:04:00.011+10:00

At last nights Beautify CNMI! concert with Jake Shimabukuro, Nava received an "Environmental Champion" award for being the initiating force behind the restoration of the lighthouse. It was very cool for Nava. She was the first to be called up, and was recognized along with some other powerful forces of change on the island. We're proud of her. She's a force, and she's only nine (eight when she set this all in motion).

Here is the background about the award, taken from the Marianas Variety.

The winners of this year’s Beautify CNMI! Steward and Champion awards will be announced at the Saipan World Resort on March 27.

Beautify CNMI! volunteer Angelo Villagomez said the two recipients of the awards will be recognized for their contribution as exceptional environmental leaders during the last 12 months.

“Beautify CNMI! is celebrating its second anniversary and we will be giving out two award categories: the Environmental Steward and the Environmental Champion,” Villagomez said.

The Steward Award is given to an individual or an organization who has demonstrated real concern for the islands of the CNMI.

The Champion Award is given to a person or group who shows the true spirit of Beautify CNMI!

Among the criteria used for picking the winners are volunteerism, innovation, cooperation, creativity and the ability to spread the “beauty virus” all over the island.

Here are a few snippets from the Beautify CNMI! website about the Lighthouse and Nava, along with before and after photos.

Tuesday, November 28, 2006 (From the Beautify CNMI! blog)

Volunteer of the Week

From the Brilliant Star School Newsletter:

Over the summer, Kinney and Nava Khorram learned how to collect water samples using tools from the Stream Team. This year, one of the elementary student’s service projects will be volunteering for that group. They will be monitoring and collecting samples from designated streams in Garapan and turning those water samples in for testing at the DEQ. They will also plant trees and collect trash around our adopted streams. The Stream Team is a new volunteer organization dedicated to monitoring and improving the quality of the water flowing off the land and into the ocean around Saipan.
We have been throwing around the idea to restore the Navy Hill Lighthouse for a few months now, but we always came up with an excuse to ignore it.

Recently Nava asked her Dad to ask us to take the lighthouse on as one of our projects. He relayed her request to me over the weekend. Nava helped me collect water samples over the summer, so how could I say no?

Nava Khorram is the Beautify CNMI! volunteer of the week. Thank you, Nava, for providing the spark to get this worthy project underway. It took a kid...sorry, young adult to get us to finally do something. Now you have to prove your Volunteer of the Week status by bringing all of your classmates to the restoration event this weekend!

For those of you not on the Beautify CNMI! mailing list, this weekend we will be cleaning up garbage, clearing weeds, and possibly painting over graffiti and planting trees in the area in and around the Navy Hill Lighthouse. We will meet at the lighthouse Sunday, December 3 at 10:00 AM. The only thing you need to bring is two friends. Beautify CNMI! will provide all the tools.

Saipan Tribune, Wednesday, November 30, 2006

Beautify CNMI! sets upcoming activities

Beautify CNMI! is set to begin work on its holiday activities:

- San Antonio Beach on Saturday at 8am. Volunteers are asked to use Aguas Street (road between the school and PIC). The cleanup will head north toward Chalan Piao. This event is the monthly DEQ cleanup brigade.

“Want to be famous? We will be filming our first Beautify CNMI! commercial at this event,” said Beautify CNMI!'s Angelo Villagomez.

- Garapan Tourist District on Sunday at 8am. Participants will meet in the parking lot of the American Memorial Park. This is Beautify CNMI's third cleanup of the tourist district. It is being led by volunteer group MOVER.

- Navy Hill Lighthouse on Sunday at 10am. “You asked for it, you got it. David & Mara Khorram’s daughter, Nava, asked us if we could clean this historical area up. How could I say no? We are going to pick up trash, remove some weeds, and if allowed, paint over some graffiti,” said Villagomez.

Sunday, September 09, 2007 (From the Beautify CNMI! blog)

Lighthouse Cleanup

We painted the lighthouse from about 7 AM until 4 PM. A huge thanks goes out to Ken Kramer, Marianas RC&D Coordinator. He helped me all week coordinate today's rather large event. He was also the first volunteer to show up and the last volunteer to go home today.

Thank you, Ken.

We managed to apply a layer of primer on most of the Lighthouse and got a layer of paint on about two rooms worth of walls. We're not finished. We have to go back in a week or two.

Here is the lighthouse before we really got started:

...and here is the lighthouse at the end of the day:

We are about half way done. We're going to have to go back and add a little more primer and then paint over the whole thing with a final coat of paint. Here are a few more pictures:

BEFORE:
AFTER:
BEFORE:
AFTER:

BEFORE:
AFTER:
BEFORE:
AFTER:

The money for the paint was donated by the Marianas Visitors Authority. They donated $10,000 to Beautify CNMI! about a year ago, but it wasn't until this week that I was spurred to action.

There were two things that made me finally get off my butt and paint the lighthouse. The first one happened last Saturday when Dr. David Khorram's daughter, Nava, handed me an envelope full of dollar bills and coins totaling $49.02. She told me that she had collected the money at school to pay for paint for the lighthouse. I felt so guilty.

The second thing that made me decide that it was time to paint the lighthouse was one of the music videos from the Fiesta Pop Music Festival. The video was shot at the lighthouse and the whole structure was just covered in graffiti. It was time to do something about it.

Stuck to the Toilet

2008-03-27T16:58:00.004+10:00

(Here is my Saipan Tribune column for this week.)

***

A few weeks ago, the news story was published about a woman who walked into her bathroom one day, and just decided to stay. She took a seat, and for two years, she sat on the toilet, until eventually, her skin grew around the toilet seat, linking her to it. Her partner commented that he thought that when she went into the bathroom, she would be out soon, but the minutes stretched into hours, days, weeks, months, and that it just became a way of life for them. Everything was normal, except that she was stuck on the toilet. Things become so weird, and you don’t know how to cope with them, so you eventually start to think they’re normal. Then one day, someone walks into your bathroom and you realize the anomaly of your situation. “Hello Mr. Fireman. What brings you into my bathroom today?”

Gradually, over the past few months, the city water supply to our home has diminished. We already only get water for an hour a day, but for years it’s been enough to fill our tank. Now, every few weeks, the tank runs dry. I call the ever-ready trouble desk at the utility. I say something like, “Salutations. Thou art hearkening to the namesake of biblical kings. I summon thee from yonder naval knoll. Liquid hath gone thither. Wherefore art thy words to bring peace to puzzled souls?” As expected, the answerer at the trouble desk says, “huh?” So I repeat myself, word for word.. “Hello. This is David Khorram. I’m calling from Navy Hill. Our water has run out. Can you help us.” Well, if I’m going to say the same thing, then the answerer is going to say the same thing. He responds, “huh?” This will go on for several exchanges, each time with me using fewer words to simplify the description of the situation, until finally, I’m down to “Nothing water Navy Hill.” The response: “Call back tomorrow.” I call back tomorrow. We do it all over again. Day after day, this exchange takes place with high anticipation of a different outcome. But every day, it ends with the same Shakespearean quote rambling in my head -- “Tomorrow, and tomorrow, and tomorrow creeps in this petty pace from day to day to the last syllable of recorded time; and all our yesterdays have lighted fools the way to dusty death.” I find myself getting used to the absence of a solution. So, we’ve been paying an extra $100 or so a month to have water delivered to our home when we run out. “Hello Mr. Fireman. Why are you bringing a crowbar into my bathroom today?”

I’ve been doing some work with a freelance graphic artist who lives in a country where snow is currently falling on the ground. All of his work is for clients that live around the world, all done through the internet. I was going to suggest to him that he move to Saipan. After all, his location matters not, because he is “internet based”. Then I realized I had forgotten that a one man show like his, and like thousands around the world, who would love to relocate to a low-tax tropical island and set up clean environmentally friendly businesses that consume and generate only electrons, needs a reliable source of electrons. Power. Electricity. Sure, bigger businesses can buy a generator. But the little guy can’t. And, wow, the economy that could be built around selling Saipan to these freelance internet entrepreneurs! But, people from most developed countries don’t think about the prospect of not having power for hours at a stretch, certainly not for days out of a month, and absolutely not on a scheduled rotating basis. “Hello Mr. Fireman. Look, my skin has grown into the toilet seat! Please don’t pry me loose.”

Let’s just fix it. Power and water. Those are some pretty basic first steps toward calling yourself a developed “investor friendly” “tourist friendly” “resident friendly” place. C’mon guys. It’s time to pry ourselves off the toilet seat.

_____________________________________________________________

David Khorram, MD is a board certified ophthalmologist and director of Marianas Eye Institute, as well as the author of World Peace, a Blind Wife, and Gecko Tails. Comments and questions are welcome. Call 235-9090 or email him through www.MarianasEye.com, or leave comments at www.MarianasEye.blogspot.com. Copyright © 2008 David Khorram

George Carlin on Comedy and Humanity

2008-03-25T20:56:00.003+10:00

Jeff Turbitt handed me a fascinating book today: Comedy at the Edge - How stand-up in the 1970's changed America. It's a history of modern stand-up starting with Lenny Bruce. In the chapter on George Carlin, Carlin states:

"I think I was looking for familiar frames of reference that lend themselves to distortion. Because distortion is one of the most important things in comedy. You look at an ordinary event, an ordinary tableau, and you say, what element can I distort in this? And suddenly you have at least the potential for a joke."

Later, Carlin more darkly observes,

"I sort of gave up on this whole human adventure a long time ago. Divorced myself from it emotionally. I think the human race has squandered its gift, and I think this country has squandered its promise. I think people in America sold out very cheaply, for sneakers and cheeseburgers. I think they lost their way, and I really have no sympathy for that. And I don't think it's fixable."

Ladder Beach

2008-03-24T07:47:00.006+10:00

It was a weekend of beaches for us. On Friday, we celebrated the Baha'i New Year and the end of the nineteen day fast with a party at Marine Beach. On Saturday, we went to Ladder Beach, and yesterday, we went to Tenke Beach where my nine-year-old environmentalist daughter brought garbage bags and made us all pick up trash. Here are some photos of Ladder Beach.

Years ago the only way to get down to the beach was with a ladder. Now there are stairs. That's Tinian in the distance.

The natural overhangs at Ladder Beach provide shade during most of the day.

Greatness at Hopwood

2008-03-20T16:56:00.001+10:00

(Here is my Saipan Tribune column for this week.)

***

I was invited to participate as a judge at the Hopwood Junior High Science Fair this week. I had never been to Hopwood, but I was impressed.

A junior high is a place of potential and promise. On this day, the cafeteria was teeming with students and their science projects. I was impressed by the care that they had put into their presentations. They reported on the moons of Saturn, global warming, the ebb and flow of the tides. Some used color photos and graphs to illustrate their points. Others cited the scientific literature from which they had gathered their information.

Other students went a step beyond, and conducted scientific experiments. They formulated hypotheses, experiments to test their hypotheses, recorded their methods, collected data and recorded their conclusions. There were experiments to answer questions like, what is required to conduct electricity? Is Outrageous Ooze a solid or a liquid? Can a very small amount of pollution cause a plant to die? Can the heat from the sun cook a hot-dog? How does wind speed affect the waves in the ocean?

One group of students showed amazing computer skills and creativity, forgoing the traditional three-panel cardboard display, to produce a digital film that reported on their subject: volcanoes.

The science fair was a glimpse into the greatness walking the halls at Hopwood. The age is a time of transition between childhood and youth – potent internal changes, self-doubts, questions about meaning and purpose. Those short years are a window of opportunity opening onto the vista of the person to emerge.

There was a light in the eyes of most of the students, but a light which they themselves do not seem to see. Their own vastness, they do not recognize. They are, for the most part, unaware of their own greatness, bound and gagged by an innocent awkwardness. It is at this age, in a search for Nirvana, that kids either recognize their importance to the world, and aspire to all that lies within them, or they slide into a haze of sex and alcohol and reefer and mediocrity.

If I could say anything to all those students I met, I would say, you have greatness within you. You can aspire to anything. See not your limitations, but the vastness of your souls. Dream big, huge, gigantic dreams. Accept no ceilings. Aim for the stars. Whatever obstacles that may stifle your hopes can be overcome. You have God-give talents. Set out to discover them. Dream of solving the world’s problems, because you can. The greatness at the halls of Hopwood is the same as in any school in the world. Believe it. Accept it. Act as if it’s real. It is. The light of the world is within you.

_____________________________________________________________

David Khorram, MD is a board certified ophthalmologist and director of Marianas Eye Institute. Comments and questions are welcome. Call 235-9090 or email him through www.MarianasEye.com, or leave comments at www.MarianasEye.blogspot.com. Copyright © 2008 David Khorram

Found

2008-03-18T11:35:00.004+10:00

Ever since I returned from Hawaii in January, I've been unable to find the charger and USB cable for my digital camera. I knew I packed them and got them back to Saipan, but the day after opening my suitcase, they were no where to be found. I looked everywhere, and finally just decided they must have slipped out of the suitcase when TSA was doing their inspection, or just disappeared into that black hole that seems to exist in every home, maintained by the hands of small children. Today, Mara found the black hole. Some small child had taken the plastic bag full of these gizmos straight out of the suitcase and carried them into the family room, opened the cabinet of videos, and stuffed the bag behind them.

So, here are some pictures that I never got to post.

This is Dr. Salofi, whom I met at the Hawaiian Eye conference and who is now working at my old stomping grounds -- the eye clinic at the LBJ Tropical Medical Center in Pago Pago. (Why do they call it "stomping grounds"?)

Here is our team at the conference. Emilly Taitano, me, Russ Quinn, and Melonie Norita.

Me in Cairns, Australia, from February when Mara and I went. I'm taking my Beautify CNMI t-shirt around the world with me.

With old friends and new friends in Cairns. Dinner at the Zadeh's with the Bolton-Bound family.

This week, I'm a teacher.

2008-03-17T10:10:00.004+10:00

Spring break has started for the kids, and it's always a challenge to plan activities for them. This year, I'm doing something different for the older two, and their friends. I'm teaching a class on religion and spirituality. So far, so good. These Montessori kids are pretty self-motivated. I got them started on a project, and they're off and running.

I have become increasingly convinced that the Montessori method of education is the future of reaching the multiple intelligences in a classroom. The essential focus is that children are given learning tasks and set out to complete them, with guide from a teacher. It avoids nailing children to a desk, and allows them to discover the reality of things for themselves. I spent a few days last week observing in their classrooms and asking questions of their teachers, so I could get a sense of how to design these classes to keep them engaged. It's working!

Here is the invitation I sent to the parents.

***

I’m going to be teaching a class for elementary age children that will explore religion and spirituality. (I was a comparative religion major in college.) I’ll be approaching it from the perspective of the Bahá’í Faith, which emphasizes the oneness and unity of all religions, taking the approach that they all come from the same source at different times in humanity’s history to provide socially and historically appropriate guidance to the world.

The subjects that I plan to touch upon include:

The lives of the Manifestations of God: Krishna, Buddha, Zoroaster, Moses, Christ, Muhammad, and Bahá’u’lláh.

The key teachings of the major world religions: Hinduism, Buddhism, Zoroastrianism, Judaism, Christianity, Islam, and the Bahá’í Faith.

Exploring the concepts of God, the soul, prayer, meditation, and the purpose of life.

Developing virtues in our lives: Truthfulness, trustworthiness, courtesy, kindness, etc.

Social principles related to Peace Studies such as the need for independent search after truth, the oneness of the entire human race, the elimination of all forms of prejudice, the harmony between science and religion, and the equality of men and women.

I hope to convey this information through some lessons to stimulate their interest, and guide the children in their own research of the subjects. We’ll also have art and drama, as well as physical activity.

Jake Shimabukuro Concert

2008-03-15T19:42:00.006+10:00

I saw Jake a few years ago when he was here, and it was a phenomenal evening. (I wrote about it in my book.) This a concert you don't want to miss. He's one of the biggest entertainers in the world. He's in Melbourne next week playing at the music festival there, and he was on Conan O'Brien recently. Marianas Eye Institute is one of the sponsors of this concert... see, right there by Jake's left foot.

Lid Lift

2008-03-13T17:36:00.003+10:00

Two Outstanding Posts

2008-03-12T15:58:00.004+10:00

The Saipan blogs have produced two of my all-time favorite posts this past week.

The first is from Jeff Turbitt. His post on an unexpected death moved me to tears.

The second is by Bev, whose post has inspired me to participate in next year's XTERRA triathalon. It just needs to be scheduled so it's not during the Baha'i Fast in March. Didn't it used to be in April?

If you haven't read them, head over to their blogs and take a look at these two moving pieces.

Book Blog

2008-03-11T14:48:00.004+10:00

I don't know how to make a website, so I set up a blog for the book I've written. I've tried to design it like a website. There you can read the first few pages of the book, which include all the blurbs, the foreword and the introduction.

Amazon is setting up the "Search Inside This Book" feature on their website, but it apparently takes six weeks. In the meantime, a little bit of World Peace, a Blind Wife, and Gecko Tails is available by clicking on the title.

Is your name on this list?

2008-03-09T06:54:00.006+10:00

My book has been published and has been available on Amazon for a couple of months. I just got my first piece of fan mail from Cindy in Virginia. Thanks, Cindy. I figured I'd put a link to Amazon on my blog.

I ordered 200 copies for distribution on Saipan, but they are on the slowest boat ever. It's been over eight weeks, and they are still not here. Hopefully, they'll arrive within the next couple of weeks.

I'm planning on giving a copy to all the people who helped in one way or another. If your name is on this list, you have a gift copy coming from me.

Jayvee Vallajera, Frances Demapan, Carol Danelius, Houdin Dehnad, James Oh, David Yamartino, Sarah Johnson, Anne Erhard, Mark Robertson, Cinta Kaipat, Walt Goodridge, Randy Clark, Jeff Turbitt, Senator Maria Pangelinan, Jeff Schorr, Bob Coldeen, Michael Ernest, Angelo Villagomez, Jaleh Slominski, Ed Propst, Annette Donner, Don Bader, Bud Carroll, Robert T. Torres, Joseph Kevin Villagomez, Kirk Johnson, Velin Saramov, and Daniel Lamar.

If your name is Oprah, and if you contact me, I'll send you a copy too.

I wish I had gotten copies before JP passed away.