Saturday, June 15, 2013

Ruminations on the Question of Legacy

Arguments on a Question of Legacy

 Yet even these bones from insult to protect
 Some frail memorial still erected nigh,
With uncouth rhymes and shapeless sculpture decked,
 Implores the passing tribute of a sigh.

When you get to be as old as I am, as I am aware some are definitely more seasoned than I have been fortunate to consider myself one, you would notice more intangibles that you want to treasure more before you forget them.  At least in my particular case, that had appeared to be a pronounced tendency.
It is not so much because I want to catalogue them before they become totally divorced from me.  Rather because I want to assimilate the essence of their beauty into the substance of my soul.  Hopefully, by so doing, I shall have enriched, tempered, and strengthened the essence of my being to be better able to handle the realm of the unknown in the hereafter.

But if there is no hereafter, you say?  I happen to believe there is.  And should I be wrong, I shall have enjoyed the process of immersing myself in the spirit of the good, the beautiful, and the true.  If you don’t know what they are all about, there is really nothing that I can do about it now that can be of benefit to you.  You should have recognized them early on when you started to notice yourself as a sentient being and began to wonder where your sense and sensibility came from.

In this ever more frequently occurring journey to what I tagged my inner universe, I wish I would discover within me the faculty to create or compose a melody, a musical tune out of whatever it is melodies emerge from, perhaps the nothingness of being.  I know I appreciate the melody I like when I hear one.  But to create one out of nowhere and out of nothing, I cannot help but wonder what the experience is like.  And to be able to communicate it to another sentient being, must constitute the consummation of total nirvana.

It is in this vein of total unknowing and wonderment that I listen to music.  It is in this context that I acknowledge and pay homage to the inventors of YouTube.  It is a wonderful venue to give vent to my passion to listen to melodies which resonate with the most profound dreams and longings of my soul.  Beyond that, it affords me a vehicle to belt out a few tunes myself as a way of letting loose and let go some pent up emotions which cannot otherwise be verbalized.

The concept of a playlist affords me a corridor, a beach, a landscape, or a horizon in the tides of time through which I can wander and get lost in the inner chambers of my reverie, simultaneously as I interface with kindred journeys of kindred souls~ ~they who uploaded the melodies which I strung together into a playlist.  Not to mention the souls whose talents and performance are showcased in the component melodies which constitute each Playlist, I commune with them too.  They are not even aware that my soul is touching theirs in some profound way even if only with the vestige traces of their sojourn in the vast magnificence of both the here and now and the great beyond in God’s Creation and the infinitude thereafter.

The playlist gives me a venue for both prospects and retrospects.  It allows me to look back with gratitude and reverence to the souls who were here before me.  It affords me to look forward with awe and nonchalance at the judgment of posterity from the generations of souls who shall come after me.  Or in the immortal lines of Thomas Gray,
For who to dumb Forgetfulness a prey,
This pleasing anxious being e'er resigned,
Left the warm precincts of the cheerful day,
Nor cast one longing lingering look behind?

On some fond breast the parting soul relies,
Some pious drops the closing eye requires;
Ev'n from the tomb the voice of nature cries,
Ev'n in our ashes live their wonted fires.

It is important to me that I am aware of the various interfaces and interactions.  For as John Donne in Meditation XVII would have it,
No man is an island entire of itself; every man
is a piece of the continent, a part of the main; . . .

It is in this spirit that I nurture my passion to create playlists and endeavor to share them with any and all, who might enjoy what they offer, however different from whatever ecstasy and entertainment I derive from them.

I have so far created twenty-five playlists, ranging in length from two to fifty component videos.  In terms of playback duration it ranges from as short as nine minutes for the two-video list to thirty-two hours for the list of fourteen complete performances of my favorite opera masterpieces.  Below is one of them which I titled “Down Nostalgia Lane.”

I don’t apologize for including number 17.  It may be crude and devoid of any instrumentation.  It however provides a graphic illustration of the emotional outlet function of YouTube that I alluded to earlier above.  Besides, it showcases the lyrics I myself wrote.  I am still hoping to find somebody with better diaphragm and vocal cords than I have at my disposal to take the composition for a much more deserving test drive than I can muster.

You may skip it at playback.  But I beseech you to not eliminate it from the list even if you know how.  That would, ipso facto, violate the intent and charitable spirit of the venue.  Otherwise, enjoy the ride.  Or in the somberly imposing verses of John Milton:
“. . . Live while ye may,
Yet happie pair; enjoy, till I return,
Short pleasures, for long woes are to succeed!”

AAA Pertinent Issues

3A Pertinent Issues

Under ObamaCare the waiting time to get medical attention appeared to have gotten worrisomely longer.  I just got word from my Vascular Surgeon’s (VS) secretary that she received today the written cardiology clearance for the impending Endovascular Repair (Evar) of my Abdwoominal Aortic Aneurysm (AAA/3A).  The VS himself has not seen it yet.  Most likely he won’t see it until “early next week.”

However, the earliest available schedule for the procedure as far as she can tell from the hospital docket is 22-Jul-2013.  That is not even date certain, only a perhaps and probable one.  Meanwhile, the stent needs to be ordered from the manufacturer based on CT-Scan measurements of 8-May-2013.  It is a time horizon of seventy-five days or 2.5 months.  Based on the growth rate historically observed at an average of 0.5 cm every 6 months, we may expect the aneurysm to grow by about 0.25 cm in the interim.

This is what I am about to embark on~~ I’ll write up my concerns that by waiting as long as the time table they envisaged could allow the aneurysm to grow significantly enough to the effect that the discrepancy between the CT-Scan measurements of 8-May-2013 on which the stent manufacture is based and the actual size of the aneurysm when the Evar is attempted seventy-five days later could exponentially increase the risk factors to jeopardize the entire procedure’s outcome.

Am I being overly paranoid and needlessly apprehensive or are my concerns warranted by the numbers?  Is the 0.25 cm discrepancy within the factor of safety normally acceptable in surgical practice?

I am already an extremely high risk patient as it is because of the Plavix and my GI condition.  I should FAX said write-up to my Primary Care Physician (PCP), the VS, my GI Attending Physician (GIAP), and the Cardiologist, enjoining them to seek an alternate venue which can accommodate the Evar procedure at a much earlier date.
Based on what you know of protocols governing medical procedure, do you think this has the slightest chance of being able to move the thinking of those who have to make the decision?
I’m eagerly and gratefully awaiting your feedback, either by leaving comments below or by some other venues you deem expedient.

Thursday, June 13, 2013

A Foggy Worm’s Eyeview

A Foggy Worm’s Eyeview

This is not any fruit market in Divisoria or Quiapo.  It’s the present I got from GI.  Caption should read, left to right, top to bottom, 1) Ulcer at previous band site (healing); 2) Varices; 3) Watermelon stomach; 4) duodenal bulb; 5) 2nd portion duodenum; and 6) Fundus.

I got to the other side of General Anesthesia on the foggy side of lucid.  So I did not have the chance to ask my GI Attending Physician (GIAP) to give me a more detailed explanation of what they are.  I did not even know the images existed before she was gone beyond my access.

Voluntary explanation from anybody is welcome and enjoined.

Saturday, June 8, 2013

Howe~A Name Replete with Historcal Irony

What’s in a name? that which we call a rose
By any other name would smell as sweet;
~William Shakespeare, Romeo & Juliet

The GPS coordinates of my current residence is 7 Howe Court, off of Howe

Figure 1 Viewed from the pool diving board, the backyard landscape with Nikki and Marek frolicking in the pool on the foreground.  The leaves of grass left of the diving board is Krystyna’s potted lemon grass.

Road.  In and of itself it might not be much to write home about.  But it’s home and it has its own story to tell in a curiously unique peculiar way.
Admiral Lord Richard Howe was the commander of the British Fleet during the American War of Independence.  His main mission was to thwart, with extreme prejudice, George Washington’s primary mission of leading the American Revolutionary Forces onto victory. The rest, they say, is history.

Before moving into this neck of the woods, I used to live in the town of Port Washington, last address on Port Washington Blvd.  Don’t blame me if I

Figure 2 Viewed from the driveway with my favorite lilac bush in the foreground.
don’t recall the house number.  I only lived there.  I did not handle much of the meager snail mail logistics.

Before Port Washington I took up residence in the Washington Heights section of Manhattan.  My abode was only a decent Sunday morning jog to George Washington Bridge, the only open sky connection between the North American continent and Manhattan Island, a.k.a. New York City.  This was an exercise route I occasionally indulged in when the weather and my appetite for punishment warranted it.

The point was, I was captivated by the legend of George Washington as the father of the country, the most distinguished of her first citizens.  This came about more than by direct accounts about George Washington’s exploits themselves but rather by what I learned of his relationship with Alexander Hamilton, the Founding Father I studied most, compared to the rest of them.
Like me, Alexander Hamilton took judicious advantage of the generous availability of “other people’s money” to advance his personal education.  

Rightly or wrongly, I identified the Hamilton-Washington nexus as deliciously parallel, albeit in a far more exalted way, to the Asumen-Miravite connection [c.f., pp.13 ff]. Consequently, among the plethora of personal faults, I had unabashedly and proudly considered myself as a diehard Washingtonian in ego identity.

Then came the Jihadist events of 9/11/2001 which shuttered all heretofore extant equilibrium on American political vulnerability, viewed from my very circumscribed personal prism at least.  A week earlier, I secured a three-month contract engagement with a re-insurance giant at the 104th floor of the South Tower of the World Trade Center (WTC).  I successfully negotiated to delay the start date by a week, to 9/17/2001.  Having just completed a successful engagement with Mercedes Benz USA, I needed at least a week’s reprieve of “nothing but golf” to recharge my batteries.

The Jihadist Arabs took the towers down along with my prospects for gainful employment.  There was no way I could muster the nerves or the wits to venture find out whatever happened to my contract.  Compared to the magnitude of the tragedy my own personal concerns seemed so shamefully trivial and banal.  I just considered myself extremely fortunate that I was in the Christopher Morley golf course that Tuesday morning instead of the 104th floor, 1 WTC South in Manhattan.  Truth be told, I often wondered if I was robbed of the chance to be a hero in such an historic event.  I confess to have remained grateful to Divine Providence for having been spared the painful ordeal of finding out whether I would have turned out a villain, just another by-standing victim, or a hero, i.e., whether, under baptism of fire, the better angels of my nature would prevail over the baser devils of my decadence.

As the cliché goes, “he, who fights and runs away, lives to fight another day.”  My personal version of the cliché would be: “he who pines on what might have been shuns in vain the wage of sin.”

I was radically and definitively taught by my farm-boy upbringing that how you come out of adversity defines the character of your soul.  So I invested flesh and soul to come out of the debacle by subsisting off my credit card liabilities while trying in vain to obtain my next engagement for a gainful, rewarding employment.  My wife, a professional bookkeeper, was also promptly laid off from her job with an industrial cleaning company whose main clients happened to be facilities at the John F. Kennedy and LaGuardia International Airports and the World Trade Center Industrial complex.

Having been schooled in physics and engineering, I have always been proud to claim mastery of systematic and methodological thinking.  In an effort to reverse my ever dwindling fortunes, I employed an imminently patentable logical flippant methodology to get out of my financial bind.  If nothing else but to savor the delicious irony and dwell on its after taste, this approach warrants delving into in much greater depth and detail.

My abode in Port Washington was accessible from the rest of the universe mainly expeditiously through Exit 36 of the Long Island Expressway (LIE), the main traffic artery which dissects the length of Long Island from the East River to the Eastern Forks.  The Northern Fork ends in Orient Point.  The Southern Fork ends in Montauk Point. 

From the East River which separates Long Island from Manhattan, to Montauk Point stretches approximately one hundred forty miles of navigable public road.  The distance to Orient Point is much shorter but the road layout is much more challenging in the best of weather conditions.  Mileage may not necessarily be a good predictor of trip duration.

Between the north and south shores, on average, the distance is between thirty to forty miles.  Hence, from this rather pronouncedly elongated geography, the Island got its Identity-label for being “Long.”

Getting off the LIE at Exit 36, you’d make a left turn at the first traffic light to head north on Searingtown Road which eventually transformed itself into Port Washington Blvd. on entering the town proper.  You should count seven traffic lights on Port Washington Blvd.  The seventh house from the seventh traffic light was the house I lived in for almost a decade.  This seven and seven part of the route made it more fun to give driving directions to occasional visitors.  It made it much easier to remember, to boot.

Pursuing flippancy untempered with an iota of common sense can easily usher in the realm of the ridiculous.  I contend this was not the case in this project.  But you should be the judge.  To paraphrase Fox News: I narrate, you decide; and do whatever you please with your verdict.  So here goes.

One rule of thumb governing economic reality in Long Island is that the closer you are to New York City, the higher is the cost of living.  It stood to reason that I needed to move further away from Manhattan to cope with my new economic normal.  Moving too far out east would intrude into the domain of the rich and famous in the high and mighty Hamptons.  Flipping the digits for LIE Exit 36 yielded Exit 63, ten exits short of the eastern end of the expressway.
So I drove up to Exit 63, turned north at the first light and counted seven traffic lights after getting off the LIE.  I was on County Route 83 (CR83) which connected the town of Patchogue to Mt. Sinai, hence the name Patchogue-Mt Sinai Road, a.k.a, North Ocean Avenue. I found myself in the middle of central Suffolk County.  Hereabouts, there simply is not any one town large enough to need or have seven traffic lights in it.

So at the seventh light on CR83 I turned left and took the first right onto Howe Road.  Why I turned left instead of right on Old Towne Road was a no brainer.  Old Towne Road intersected with CR83 at an approximately 30-degree or so angle.  Turning right was in the backwards direction of where I was heading, completely contrary to my quest for going forward.
At the first right turn off of Howe Road was Howe Court where a “for sale” sign was prominently displayed on the front yard of 7 Howe Court, the very head of the court, with the phone number of the realtor marketing the property, standing out in bold typeface.

At first blush I was not overly impressed with the property.  It was dominant as the only non-ranch structure in the court.  I however found the rooms too small by design and the windows too short and narrow, reminiscent of a pigeon’s perch.  The off ground pool in the back yard was more of an addition to the junk that needed to be cleared off the property than an augmentation to its valuation.

But both my daughter and son-in-law were excited at the prospect of putting their renovation ideas to flourish.  Apparently, they had earlier bookmarked the property in the internet into their short list of acquisition candidates.  So being at the short end of our ropes financially, my wife and I just went along for the ride and let the younger generation took unbridled latitude of their moment in the sun.

They promptly widened the main structure by a shade more than a yard.  All the windows were redesigned to sport a French Provençal ambience.  The pool structure in the backyard was completely demolished and landfilled.  And a new in-ground pool was dug in the heretofore unused and wooded part of the property.  A gas-fired charcoal barbecue stove and a child’s play shed with slides completed the backyard additions.

Inside the main structure, a fully finished basement with separate access from the backyard independent of those of the main house promises the prospect of separate living quarters with adequate privacy.

Thus it came to pass that by the time the National U.S. Golf Open was first held in Long Island (Bethpage Black) in June of 2002, we were fully relocated into this neck of the woods.  It was only until then that I realized the levels and dimensions of the irony that the Jihadist Attack of 11-Sep-2001 had imposed on my life.  It was not until much later that I mustered the fortitude to count the ways, to wit:
1.   I ended up living in Long Island because I deliberately refused to deal with the Arabs yet the acts of Arab terrorists sent me further into the heart of Long Island to better survive the disarray from 9/11.
2.   The 9/11 adversity had brought my extended family closer together under one roof.  Pre-9/11 Marek, Krystyna and I lived in Long Island while Renata, Robert, and Nikki resided in Jersey City.

3.    Pre-9/11 I used to take pride in having my abode associated with a great American patriarch’s name.  Post-9/11 my abode has become associated with the name of his arch-enemy.  I content myself in seeking solace with the Vito Corleone formula that in order to make your victories more triumphant it pays to elevate the stature of your enemies with some degree of honor and respectability.
 Ironically, enough it’s on the last count that I deem the reversal of my fortunes due to 9/11 to be consummate and irrevocable.  Although admittedly intangible, it was on this score that the ramifications were most far-reaching and imposed a longer-lasting impact on the soul.

Friday, June 7, 2013

A Penchant to be Misunderstood

I'm just a soul whose intentions are good
Oh Lord, please don't let me be misunderstood
Don't let me be misunderstood.

As I intimated in an earlier post, I have entered into the preliminary stages of a project to repair an acute AAA (Abdominal Aortic Aneurysm).  The definitive options assessment with the vascular surgeon did transpire on Tuesday, 21-May-2013 preceded by an ultrasound on my carotid arteries.

The CT Scan that the vascular surgeon ordered to double check the ultrasound measurements did reveal two significant items: gallstones and the AAA being 6.3 cm instead of the ultrasound measured size of 5.3 cm.  Ergo the condition was more acute than I bargained or hoped for.

But there is more.  I seem to have developed the unenviable penchant to escalate in accelerated mode an extant condition into a full blown crisis.  The ultrasound of my carotid arteries required that I had to fast for the occasion from midnight prior.  I therefore came home extremely hungry and promptly broke my fasting with a hard-boiled egg left over from my lovingly devoted wife Krystyna’s breakfast.

Shortly thereafter the onset of black diarrhea which lasted till 5:30 pm the following day had come to have defined the entirety of my existence.  It being a Tuesday, my primary care physician (PCP) was regularly scheduled to conduct her hospital rounds.  While I was with my vascular surgeon she left me a voice mail to call her at 12:30 pm on Wednesday to discuss results of the blood works done on Thursday, 16-May-2013.

I therefore held off going to the Emergency Room (ER) for as long as my strength lasted.  Besides I was not sure which ER I should go to.  I saw the options to be: The Good Samaritan Hospital in West Islip where my vascular surgeon could attend to me if the need arose.  I was acutely aware of the possibility that my internal bleeding had to do with osmotic seepage from the AAA.  The second alternative was Southside Hospital of North Shore LIJ in Bay Shore which was my PCP’s affiliated facility.

The lion’s share of my medical history having transpired at Stony Brook University Hospital (SBUH), their ER had the leverage of being a virtual default option.  It had the advantage of being the closest to my residence. Besides, my cardiologist was affiliated with SBUH and it has been said that in the hierarchy of medical sciences “Cardiology is King.”

When I did not get a call back from my PCP by 14:30 hrs, I wrote up the issues I needed to discuss with her and FAXed her the list as a subtle way of following up on the phone call.  This also had the added effect of elucidating the issues for my own edification and emphasizing the urgency of my cause.

She finally called me at 16:00 hrs.  The most remarkable results about the blood works were that the cholesterol indices were excellent and that the blood cell count had undergone a significant reduction since it was last taken six months earlier.  I had no clue how serious was “significant.”  She threw some numbers my way but they barely meant anything since I had no idea what was supposed to be the normally desirable value.

We mutually agreed that SBUH was the most prudent venue.  Meanwhile, Krystyna en route home from work urged me to wait for her before calling for the ambulance.  On arrival, she informed me that my countenance was on the green side of pale.  Ergo, I was bleeding much more than I had bargained for.  While I felt in full command of my faculties, I was on the wasted side of lethargy and getting further depleted in a big hurry.

The ambulance arrived within ten minutes.  The crew prepped me for the trip to the ER by promptly installing a standard-issue Intravenous needle into the one prominent vein located directly opposite my elbow.  I reckoned he was more concerned with complying with regulation than the longer-term implication of the IV location.  This was noteworthy because unless physically constrained it would be a tall order to expect me to completely avoid bending my elbow during my stay in the ER.

This was exactly what happened three days later.  The needle pierced the other side of the vein and the fluid meant for intravenous transfusion went into the flesh of the arm causing it to swell and harden, reminiscent of the nostalgic magkono, the renowned Philippine ironwood in Cagdayanaw, the southernmost village of my Philippine hometown of Claver, famous for the abundance of iron-rich laterite.

By the time I got to the ER I was more foggy than lucid.  When I went through the triage protocol, the people asking questions sounded to be in the adjacent room instead of being by my bedside.  So when I was asked about my alcohol consumption habits I gave them my boilerplate spiel about how it is the wont of aspiring writers, as I claim to be one, to have the proclivities of either beating up the wife or excessive indulgence in hard liquor.  And that since I could ill-afford to beat my wife up because of my inherent gentle nature, I gravitate more towards alcohol intake.

Alas, my vain attempt at subtle witticism proved unequal to the perfunctory rote of overworked and sleep-deprived medical internists.  For them it opened a Pandora’s Box of perceived alcohol dependence worthy of Jack Lemmon and Lee Remick in the 1962 Blake Edwards classic, Days of Wine and Roses. 

I was simultaneously subjected to a deluge of kids’ glove tenderness calculated not to harm the fragile character of the substance abuser and the assurance of counseling available aplenty to rescue the addicted from the quagmire of substance dependency.  Except that the poor tormented soul was supposed to be mine.

Two CT Scans and an X-ray later, the bleeding had been attributed to an advanced case of Esophageal Varices, presumably resulting from a damaged liver.  It remained to explore how and why.  From my standpoint at least, delving into the wherefores would be extremely important because my liver activity was supposed to have been closely monitored by my PCP.

But from the medical providers’ standpoint who had to go by my triage transcript, that the liver had been pronounced "half gone" meant, among others, goodbye forever to Napoleon Brandy. With a subtle touch of hyperbole, the Gastro-Intestinal (GI) attending physician at the Intensive Care Unit (ICU) ward counseled that even to look at an empty bottle of my coveted brand of alcoholic drink would trigger a bleeding of the liver of guaranteed lethal consequences.

This is so much a shock or maybe I have a case for a malpractice suit if I find a halfway decent enough lawyer. The issue is my Primary Care Physician was supposed to have been monitoring my liver's handling of the high dosage of gout medication I have steadily taken over a prolonged period. That I was never warned of how strained my liver had been surviving over the last few years should call for a speculation worthy of a Perry Mason. 

It had alarmingly become clear that the triage transcript virtually overshadowed the Plavix factor as the main culprit to cause the internal bleeding.  Alarming because the medical elite seemed invested in minimizing the deleterious effect of medication.