04—SEP-B-3

A GOOD DAY THAT BEGINS AT THE HARKENS’ IN THEIR WALNUT CREEK HOME,

CONTINUES IN KAISER AND HIGHLAND HOSPITALS

OF EAST BAY/UCSF IN CONFERENCES,

CONTINUES DOWN THE PENINSULA FOR CHECK IN

TO STANFORD PARK HOTEL AND THE HALSTED SOCIETY ATTEND THE STANFORD UNIVERSITY PROGRAM

ENDING THE EVENING IN THE TOM FOGARTY WINERY OVERLOOKING THE SILICON VALLEY FROM THE RIDGE OF THE COASTAL RANGE

September 9, 2004

Last night as I arrived in the baggage claim area from my nearly empty arriving flight, I walked out and immediately encountered Laurie in the Jeep along with Buffy, the fourth of that name in an almost identical blonde appearance to the antecedents. This dog's only trick is bringing in the newspaper in the morning, but only one of the two. But he is a lovable dog, and that makes up for him shedding all that fur all over the inside of the Jeep. We went into San Francisco downtown and drove along the Embarcadero to the Waterfront Restaurant where I saw Alden and Pat Twomey who preceded us. We had a chance to catch up, swap pictures and then got sated in the window seat with the lights of the Oakland Bay Bridge and the Treasure Island glimmering back across the Bay. We swapped stories and made new ones up as we went. I rode back to the Harkens’ home which I saw for the first time on arrival that night with over 6,000 feet of space on a steeply inclined lot in Walnut Creek CA on an acre lot. It is very large and open and airy, with a separate apartment area in the first floor where Laurie’s Mom lived during the last year of her life until her death of breast cancer in the Highland Medical Center where Alden is now the chief of surgery win the job that Claude Organ had before he became president of the ACS, and is now out on the circuit in what is almost like a political campaign. I toured the house, which is tucked in behind the foothills mountains a barrier for the smog and air pollution as well as cold fog and wind of the SFO area, which makes this part of the East Bay area so much more pleasant for the three times as many people who live here over the population of the much smaller San Francisco.

From the deck over looking what will be the pool, they can see Mount Baldy which is part of a State Park system which we will probably see much more closely on Saturday after noon when we return to go out for a bike ride up the mountain. It is a very pleasant spot with a yard in back against a steep hill which has a lot of mule deer that scare Buffy. I have not yet seen in by light of day, but will when we return since the next two nights will be in the Stanford Park (not the Stanford Court, which is the hotel in Downtown San Francisco which I have stayed in before.) We will be in Palo Alto for two of the four nights that the Stanford-sponsored Halsted Society will be meting, starting and ending here in Walnut Creek East Bay with the Harkens, who are doing very well indeed.

THE ACADEMIC DAY AT EAST BAY:

KAISER HOPITAL, AND HIGHLNAD HOSPITAL,

WITH FORMER STUDENT ADVISEES, AND CURRENT GWU SENIOR STUDNTS ON ELECTIVES IN ATTENDANCE

We were early in arrival at the Kaiser Hospital one of about five in this area, which is a major teaching hospital, but is asking for more residents than they can get from Alden’s UCSF program. The Kaiser is a good junior resident rotation but a bad chief resident rotation, and the tug of war is interesting in this as well as all other institutions, since the junior residents love the idea of an 80-hour work week limit and the chief resident s hate it. It is likely to contract down to something less than 60-hours by law.

As Alden and I waited before the conference, I met Monte Paxton, a former GWU student advisee of mine who says he nearly went into endocrine surgery because of what I had taught him, but he finished and went into vascular surgery instead. He is happy in a very busy practice in the Kaiser system, with three kids that he judiciously avoids having anything interfere with his strictly confined vacation time. The residents are a numb re of oriental folk former Vietnamese refugees who have excelled in the California school system, and one senior GWU student who is asking me for a rotation abroad when she returns. One of the residents presented a good Power Point review of cephalosporin, as I am the last hold out to use slides. Another then gave the readings, this one from Adam Smith, so I got a good introduction to the antibiotics and economics lecture. It was apparently quite pleasing to most judging from the Q & A, most of which, of course, came from a very enthusiastic Alden Harken, the best audience one could hope for, even though he has requested often this same kind of talk, and learns more from it each time. I then listened to my former fellow Patrick Twomey give a lecture on the statistical Power—a story I had just had to review because of my ELDP course and his girl friend Sylvia a psychologist, also attending both talks for the first time to listen to what a typical surgery grand rounds might sound like.

I accompanied Pat Twomey over to the Highland Hospital after phoning in at the last possible moment the scheduled conference call I had with my ELDP group, and I phoned in to eagerly give them the Hertzberg quote I had carried along, and only after reciting to the group for a while, in which everyone had welcomed me, did I fined out that it was a trunk line into another conference call and the group I was to talk with had already logged off!

We drove to the classic old building of the Highland Hospital no longer used as a hospital but the site of large offices of Alden and others, adjacent to the large new Alameda County Hospital. We had the pre-op teaching conference to discuss each case, including the standard bread and butter general surgery outpatient cases—breast biopsy, hemorrhoidectomy, hernia repair, and then the M & M conference of the kinds of discussion I am very familiar with. They presented one case of what seemed to be a large ecchinoccus cyst, but there was no proof at the end of the case that this I swath it was. I had a chance to comment on a few of the case s and listen to the discussion in the kind of set-up in which Alden does so very well.

I then went with Alden as Laurie came to pick us up, and we drove down the East side of the Bay, until we crossed it at the San Mateo Bridge, into East Palo Alto and over to Palo Alto to the Stanford park Hotel where we each checked in to get over to the Stanford campus to hear the local Stanford University program. I had registered at the last possible moment, so I am paying the late registration fee for the Halsted Society meeting, but the immediate recognition of the good group of my peers, a number of them now retiring from their positions as the chairs and leaders, still with a wide variety of interests, is always a great time to hear from this select group and to find out what is new. The necrology of the Society, in which a number of the members like Andie Munster who was my senior resident at the Brigham and the one who had invited me to be the first visiting professorship at the Medical University of South Carolina to lecture on shock, just about thirty years ago, and to see a number of my colleagues and even a couple of my students reviewed in the “historic overviews” of this distinguished learned society is a bit of a shock. The MUSC under the rather new and young members of the society will be the site of the meeting after next year’s meeting in Cincinnati, which I remember attending there ten years ago when Josef Fisher was there as chief.

The Stanford program was filled with a series of gurus associated with the Silicon Valley money and ideas which make for an exciting future yield of “nanotechnology” and biomaterials. A series of the people involved in my earlier career are now out here in California like Jeff Norton who was just stolen away from UCSF, with a brief association of UCSF and Stanford, a marriage that ended in divorce. I learned a few things from the papers and picked up my packet. I learned a few more things about colleagues a number of whom look no worse for wear in their present positions.

THE EVENING SOIREE IN TOM FOGARTY’S VINEYARD

We got into small airport shuttle buses and drive up a very winding road to the top of the ridge of the Santa Cruz Mountains which had us looking down at the fog-filled Pacific in one direction and the Silicon Valley and south of the San Francisco Bay in the other. Tom Fogarty affects the air of a gruff and profane farmer, but I knew him at the time he was in the NIH as a fellow under Glenn Morrow, when he already had a series of patents and inventions to his credit (he has over a hundred) wand with his wealth he had bought this vineyard and facility which was the site of our dinner. We got a chance to sample each of his best wines, and also sit through a several course dinner, which had the fillet course come about two hours after we started. During that long interval I met a number of folk. Kim Mall came up to me and asked to introduce his new wife, Vicky, a younger blonde with two teenage boys and a Birmingham native. Kim’s wife Molly whom I remembered from the times of prior meetings had committed suicide, so I knew that his long dark period must be over. I sat with Jay Grodin and his wife, who reminded me that we had been together on Heron Island and at scores of other places as well as the Indianapolis of his own twenty year chairmanship, just relinquished this year to Keith Lillimoe from Hopkins also here at the meeting. We talked of many things in family and other parts of our lucky lives, and then he pointed out to me that he is 70 years old—and I realized that almost all the peers from my era are nearing or after than age. It is best to learn that in a mountains top winery than in other settings. We each got a bottle of Tom Fogarty’s special wine to carry home, and then we got into the small buses for an even windier and more nauseating ride down the mountain which Max Langham and his dentist wife Sue sat near me. It was at the High Hampton meeting that he had invited me to give the Grand Rounds at Gainesville, which I did eighteen months ago at which I had hoped to see Donald when I stayed in the Victorian house that had been the site of Donald’s wedding reception. Alas, it is also the last time I have seen them. Sue could not take the winding roods and was nauseated to the point of throwing up before we got back to the hotel, just about the point each of us would have got sick.

So, I am in the Stanford Park Hotel with a plan to attend many but not all of the activities of the Halsted Society meting, such as the football game between the Stanford team and the Brigham Young University’s team on Saturday afternoon by which time Alden Laurie and I will probably be back in the Walnut Creek are riding bikes up Mount Baldy. I have my tuxedo in the bag with the possibility for that banquet on Friday night, on the eve of the somber celebration of September 11’s third anniversary—the date I was headed to Boston for that meting of the Halsted Society, which had been canceled for obvious reasons, and which substitute program was held in High Hampton the following year, when I went there for a special rendezvous with many, but not all, of these special people.

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