Archive for the ‘personal’ Category

Another update on the NHS, Bernie’s favorite health plan.

Friday, February 12th, 2016

NHS

I have mentioned problems with the NHS here before.

That was about emergency care.

Last fall there was a concern about junior doctors emigrating to other countries.

Britain is already suffering from a serious, and unprecedented, shortage of GPs, on a scale that doctors’ leaders say is fast becoming a crisis.

According to figures released last week, a staggering 10.2 per cent of full-time GP positions across the UK are currently vacant, a figure that has quadrupled in the past three years.

Two-thirds of practices are now finding it ‘difficult’ or ‘very difficult’ to find locums — freelance medics — to cover the shortfall.
As our population gets steadily older, and sicker, frontline surgeries are becoming increasingly swamped.
‘We are in dire straits if we do not act to address the GP recruitment crisis immediately,’ the Royal College of GPs warned last week.

In standard government medicine fashion, the British Health Minister imposed a new employment contract that ignored doctors complaints.

The result ?

Junior doctors are threatening a mass exodus to Australia after Jeremy Hunt forced through his controversial new contract yesterday.
There has been a huge surge in the numbers seeking certificates to practise abroad and some have already lined up jobs.
Almost 760 doctors were issued with documents by the General Medical Council in the first four weeks of this year – nearly 200 a week and almost double the usual number. Although they include some older GPs and consultants, the vast majority were disillusioned younger doctors.

Becoming a doctor is a classic middle class occupational choice. Few doctors become rich and almost none do so from actual practice. There was a phase in the 1960s when doctors suddenly became much more prosperous as Medicare was introduced, providing payment for care that had been done for no charge mostly. With time, the US government has reduced compensation and imposed rules designed to reduce costs. With the imposition of Obamacare, many older doctors who do not have heavy student loan balances and whose own children are educated, are choosing to drop all insurance, including Medicare, and practice for cash.

Obamacare has resulted in many hospitals consolidating and buying up medical practices to develop a vertically integrated system of health care delivery that resembles old industrial models. The result for physicians is a trend to salary jobs and dissatisfaction with their careers.

I met a woman geriatrician, the only fellowship trained geriatric specialist in central Iowa. She had quit Medicare. That sounds a bit suicidal if all your patients are Medicare age. What had happened was she was being harassed by Medicare because she was seeing patients too often. Many of them were frail elderly living at home. She dropped out and began charging her patients cash for services. She was making a decent living after a year and was happy with her decision. I don’t know how many realize that geriatrics, as a specialty, is a university subsidized field. There is no private geriatric practice because the doctor can’t survive on what Medicare pays. She tried and had to quit. She is doing it on her own now.

That was about Medicare. The same is happening with Obamacare and the medical conglomerates that have been assembled in anticipation of the “Industrial Model” of medical care. How is that working out in Britain ?

(more…)

Will California real estate prices collapse ?

Tuesday, January 26th, 2016

I sold my house in 2010 and moved to Lake Arrowhead where I bought a house on a rare level piece of land that I fenced for my dog.

After, living there for two years, I found that I could not tolerate the altitude, even though it is only 5200 feet. I was short of breath and had trouble sleeping. I had to sell the house and move back to sea level. In doing so, I lost a lot of money and have been renting since 2012, first a small condo and now a three bedroom house in Mission Viejo. I have slowly rebuilt my funds and have started to think about buying another house. I would really like to move to Tucson but my children are in California and I would be alone in Tucson. Jill and I are back together since 2014 and so one reason for staying here is less important. I would not be alone.

The other reason why I am reluctant to buy another house in southern California is the insane level of real estate prices. In moving to Lake Arrowhead, a resort, I found the only real estate market that is NOT increasing in value. Mission Viejo, where I have lived since 1972, is in Orange County and has some very high real estate values. I have been nervous about another collapse in prices and don’t want to buy at the peak of the market.

Recently there have been a few signs that the party may be over.

In the 1980s, there was a surge of buying from Japan as Japanese used the towering real estate prices in Japan to borrow and buy expensive houses in southern California. When Japan entered the present 25 year slump, the prices of southern California homes also dropped and many were sold for a fraction of the previous price. An impressive example, is what happened at the Pebble Beach golf resort. In 1989, a Japanese investor bought the resort for an amazing price. Ten years later, he had to sell for a fraction.

The sale will end nearly a decade of Japanese ownership of Pebble Beach, which became a symbol of the exorbitant prices paid and, subsequently, the massive losses suffered by Japanese investors who flooded into U.S. real estate during the late 1980s and early 1990s.

“We think it’s the best golfing place on the globe,” said Ueberroth, who began negotiations to purchase the property in March. “I’ve been lucky enough to have played there over the last 40 years.”

The purchase of Pebble Beach Co. includes the Pebble Beach Golf Links and three other nearby courses; two luxury hotels, the Lodge at Pebble Beach and the Inn at Spanish Bay; and 17-Mile Drive, a popular tourist destination.

Pebble Beach Co. is owned by a partnership between Taiheiyo Club Inc., a Japanese golf resort company, and Sumitomo Credit Services Co., one of Japan’s largest issuers of Visa cards. The partnership purchased Pebble Beach in 1992 from golf tycoon Minoru Isutani, who bought the company only two years earlier from a group headed by oilman Marvin Davis. However, the debt-ridden Isutani was forced to sell the property at an estimated $350-million loss.

That’s a big loss and an example of what happened. Now, China is is seeing a stock market crash similar to the Japan real estate crash in 1990.

china

China is still going through a difficult transition from socialism to capitalism, meaning its government that once tightly controlled the economy is slowly letting the global market take the wheel. That’s a tough process, particularly for a government that is used to being able to turn the economic knobs as it pleases. It still likes to do so from time to time, as it did on Thursday — a currency move that will get to in a bit.

But to show how precarious things are, a relatively small tweak sent investors into a pretty steep nose dive. And when China dives, so does everybody else, as evidenced by the market declines around the world.

So, how much effect will that have on Los Angles real estate ? This much.

Prices for the top 5 percent of U.S. real estate transactions remained flat in 2015 while all other houses gained 4.9 percent, according to data from Redfin Corp., a real estate brokerage and data provider.

In the Los Angeles suburb of Arcadia, where Zhang is struggling to sell the six-bedroom home, dozens of aging ranch houses were demolished to make way for 38 mansions built with Chinese buyers in mind. They have manicured lawns and wok kitchens and are priced as high as $12 million. Many of them sit empty because the prices are out of the range of most domestic buyers, said Re/Max broker Rudy Kusuma, who blames a crackdown by the Chinese on large sums leaving the country.

And now, the Chinese market is crashing. Hmmm. Can southern California real estate be far behind ? I’m waiting. Meanwhile, I still like Tucson where prices are much lower.

For example. We are still thinking about it.

2015 is gone, thank God.

Friday, January 1st, 2016

2015-a-maes-Marty_thumb

I am content to see the year 2015 gone. I can remember as a college student thinking that 1960 would never come. That was a good year. I didn’t graduate from USC as planned but I did get married and I did get accepted to medical school.

Some of the story is here in my short biography. More of it is here in my “stream of consciousness.” The next installment is here as I describe Basic Training.

When I got back from Basic Training in December 1959, I had my first date with Irene Lynch. A year later to the day, we were married and a week later, I got a letter from SC Medical School telling I had been accepted to the class beginning in September 1961. So, 1960 was a pretty good year.

In 2015 I spent what I think will be my last year teaching medical students at what is now named “Keck School of Medicine of USC” and is where I attended from 1962 to 1966. I went back to teaching there in 1998 in a program called Introduction to Clinical Medicine, which seems to be disappearing into the “Family Medicine” Department which is a shame.

I now have a book of memoirs called “War Stories: 50 years in Medicine” and which is a Kindle book only so far. Much of my medical school experience is included along with stories from my years as a surgeon. It started to be “40 years a surgeon” but I decided to include the rest and changed to 50. In June 2016, it will 50 years since I graduated from Medical School and that seemed a appropriate.

I enjoyed my time with students and I am quitting only because of frustrations with the Electronic Medical Record, about which I used to be enthusiastic, and with changes in the County Hospital which used to be a wonderful teaching institution. The Electronic Medical Record, now more often called The Electronic Health Record, probably because much of it is not about medicine, is a big problem.

The EHR, as it is called, has acquired a bad reputation.

(more…)

Celestial Navigation

Tuesday, October 13th, 2015

CatalinaLaborDayRace

In 1981, I sailed my 40 foot sailboat to Hawaii in the Transpacific Yacht Race. That year some large yachts had what were called “Sat Nav ” receivers aboard to track a system of satellites that required continuous tracking and took quite a bit of electrical power. It is now called “Transit” or “navSat”

Thousands of warships, freighters and private watercraft used Transit from 1967 until 1991. In the 1970s, the Soviet Union started launching their own satellite navigation system Parus (military) / Tsikada (civilian), that is still in use today besides the next generation GLONASS.[10] Some Soviet warships were equipped with Motorola NavSat receivers.

My small sailboat could not use such a system. It drew about an amp an hour, far too great a drain on my battery. For that reason I used a sextant and sight tables like these, which are published for the latitudes to be sailed.

sight reduction

That volume is published for latitudes 15 degrees to 30 degrees, which are the ones we most sailed. Hawaii is at about 20 degrees north and Los Angeles is 35 degrees north. The sight tables provide a set of observations that can be compared with an annual book called a “Nautical Almanac.” As it happens, the Nautical Almanac for 1981 is used for training and is still in print.

Nautical al

The third component, besides the sextant, of course, is a star finder, like like this one, to aid with navigational stars.

The whole system is called Celestial Navigation.

The first thing one needs is an accurate clock. This is the reason why sailing ships need a chronometer in the 18th century.

Harrison solved the precision problems with his much smaller H4 chronometer design in 1761. H4 looked much like a large five-inch (12 cm) diameter pocket watch. In 1761, Harrison submitted H4 for the £20,000 longitude prize. His design used a fast-beating balance wheel controlled by a temperature-compensated spiral spring. These features remained in use until stable electronic oscillators allowed very accurate portable timepieces to be made at affordable cost. In 1767, the Board of Longitude published a description of his work in The Principles of Mr. Harrison’s time-keeper.

(more…)

Here We Go !

Monday, August 24th, 2015

ghost

UPDATE: Here is a good description of what I think is coming.

The US stock market is being buoyed upward by technology shares that are pure luxury items, a bit like the China Ghost Cities.

America’s technology darlings aren’t exactly making good on Silicon Valley’s legacy. Microsoft, Cisco, IBM and a few other businesses of the old guard have a reasonable claim to being the companies that run the world, but Twitter and Facebook? Not so much – whatever their crazy valuations.

You see, as much as global financial concerns are going to hit tech companies harder than other sorts of enterprise, so too will their own lack of ambition. The ugly truth is that Silicon Valley has largely given up trying to fix big problems and has retreated into photo-sharing apps and productivity tools. That may sound harsh, but just look at some of the absurd and pointless startups that are getting vast checks written and tell me that founders don’t need a kick up the ass and a reminder that no one has solved batteries yet.

I have been pessimistic for several years. That may be just my own psychological makeup but I am not the only one.

California is getting a bit agitated about what is happening in China.

Gyrations in the stock market have taken California’s fragile finances for a ride before — when the dot-com bubble burst, when the Wall Street crash sank the national economy less than a decade ago.

So when the market continued its dive Monday, state officials began glancing around for their seat belts.

More than most states, California depends heavily on taxes from the wealthy, pulling about half of its income tax revenue from just 1% of residents in recent years.

California is a top down society because it depends on income tax. Texas doesn’t and its state government is funded by sales tax, which everyone pays, even illegals.

The Obama Administration has been playing a Ponzi Scheme for years.

A Ponzi scheme is a fraudulent investment operation where the operator, an individual or organization, pays returns to its investors from new capital paid to the operators by new investors, rather than from profit earned by the operator.

(more…)

The Coming Shortage of Doctors.

Monday, August 3rd, 2015

33 - Lister

This Brietbart article discusses the looming doctor shortage.

Lieb notes, that the U.S. is only seeing 350 new general surgeons a year. That is not even a replacement rate, she observed.

A few years ago, I was talking to a woman general surgeon in San Francisco who told me that she did not know a general surgeon under 50 years old. The “reformers” who designed Obamacare and the other new developments in medicine are, if they are MDs, not in practice and they are almost all in primary care specialties in academic settings. They know nothing about surgical specialties.

They assume that primary care will be delivered by nurse practitioners and physician assistants. They are probably correct as we see with the new Wal Mart primary care clinics.

The company has opened five primary care locations in South Carolina and Texas, and plans to open a sixth clinic in Palestine, Tex., on Friday and another six by the end of the year. The clinics, it says, can offer a broader range of services, like chronic disease management, than the 100 or so acute care clinics leased by hospital operators at Walmarts across the country. Unlike CVS or Walgreens, which also offer some similar services, or Costco, which offers eye care, Walmart is marketing itself as a primary medical provider.

This is all well and good. What happens when a patient comes in with a serious condition ?

(more…)

Metabolic Syndrome and Obesity.

Monday, July 20th, 2015

I spent an interesting day last Saturday at a USC post-graduate course on “premalignant lesions of the GI react.”

Part of the session discussed the question of obesity and diet. “Fatty liver” is a condition related to obesity and metabolic syndrome.

The Wikipedia definition includes.
1. abdominal (central) obesity,
2. elevated blood pressure,
3. elevated fasting plasma glucose,
4. high serum triglycerides, and
5. low high-density lipoprotein (HDL) levels

Central obesity is not the same as subcutaneous obesity, which is what we all think of. Titters out there is a racial factor with blacks more likely to have subcutaneous obesity without the central obesity involving the liver and internal organs.

Metabolic syndrome and prediabetes appear to be the same disorder, with insulin resistance as a major factor.

Other signs of metabolic syndrome include high blood pressure, decreased fasting serum HDL cholesterol, elevated fasting serum triglyceride level (VLDL triglyceride), impaired fasting glucose, insulin resistance, or prediabetes.

Associated conditions include:
1. hyperuricemia,
2. fatty liver (especially in concurrent obesity) progressing to
3. nonalcoholic fatty liver disease,a.so called NAFL
4. polycystic ovarian syndrome (in women),
5. erectile dysfunction (in men), and
6. acanthosis nigricans.

It is generally accepted that the current food environment contributes to the development of metabolic syndrome: our diet is mismatched with our biochemistry. Weight gain is associated with metabolic syndrome. Rather than total adiposity, the core clinical component of the syndrome is visceral and/or ectopic fat (i.e., fat in organs not designed for fat storage) whereas the principal metabolic abnormality is insulin resistance.

(more…)

Growing up in South Shore.

Thursday, July 16th, 2015

I grew up in a section of Chicago called “South Shore.” It was a beautiful part of the city now ravaged by crime and economic collapse. I have previously posted an article on my childhood. Here is more.

I was born in 1938 when my parents lived in this building at 77th and Marquette Avenue, near mother’s sister Marguerite and her husband Art.

Apartment 77th and Marqurette

That street was a quiet street and my aunt and uncle had lived there for many years. I think it was the only house they ever owned. Sadly, it is gone having been torn down after being damaged by vandals after they left. My mother had lived with them since she was a girl and her mother had lived there until she died in 1926. By the time I was three and my sister was born, we had moved to a rented house on Clyde Avenue.

Peg and Art and me

Here they are holding me in their yard on Marquette. My uncle Art’s parents had lived right behind them on the next street.

St Brides

That is St Brides, the church in which I was Christened in 1938. Many years later (1967), my daughter Kate was Christened in that same church. In the days when I lived in Chicago, that church was so busy that it held two simultaneous masses on Sunday every hour. One was in the main church and the other in a smaller chapel in the basement. That door to the chapel is seen to the left of the steps.

(more…)

Greece is going glimmering.

Sunday, July 5th, 2015

Greeks

I’ve been planning trip to Greece for months. Back in January, I decided to wait until the Greek monetary crisis was closer to resolution. Finally in May, I made reservations for September. I even posted my plans here.

Well, today it may be all going glimmering. The Greeks have apparently voted NO to the EU deal.

Greece has overwhelmingly rejected Europe’s latest bailout package, plunging the country’s future in the Eurozone into jeopardy.

With most of the votes counted in a referendum that will shape the future of the continent, the ‘No’ campaign has a staggering 61 per cent of the vote – 22 points ahead.
German Chancellor Angela Merkel and French President Francois Hollande called for an EU crisis summit to find a ‘solution’ for Greece, with leaders set to meet in Brussels on Tuesday.
Thousands of anti-austerity voters took to the streets in celebration as the leader of the pro-EU ‘Yes’ campaign resigned, with an official announcement of the final result imminent.
But German politicians warned of ‘disaster’ as they accused Greek Prime Minister Alexis Tsipras of ‘tearing down bridges’ between Greece and Europe.

Now what ?

(more…)

Expensive babies.

Sunday, July 5th, 2015

Mila

There is a post on Instapundit today about expensive babies.

It references a new book about a premature baby and is named “Girl in Glass.”

That baby was referred to by the CEO of AOL in a speech to employees explaining why he was cutting benefits for all employees. Her care cost 1 million dollars. The Guardian article goes on to complain about US healthcare (of course) and the cost of premature baby care.

I have a somewhat similar story in my own new book, War Stories. My story is not about a premature baby, although I have one of those too, but a little boy who was born with a heart defect that caused an 18 month hospital stay at Childrens’ Hospital in Los Angeles.

Here it is:

Following my general surgical residency training, I spent an additional year training in pediatric heart surgery at Children’s Hospital. During this time I learned more about the amazing resiliency of children and their recovery from terrible illness. I was also reminded of the constant possibility of catastrophic error in medicine. One young patient named Chris was the best example of the tremendous recuperative powers of children. He was coming in for open-heart surgery to repair a large ventricular septal defect. The ventricles are separated by a muscular wall called the septum, which forms during early fetal development of the heart. The heart has four chambers, two atria and two ventricles, which are separated by walls called “septa,” plural of septum. There are a number of major cardiac anomalies associated with the development of the atrial and ventricular septa and also with the rotation of the heart and the connection of the great arteries to the ventricles from which they arise. Chris was born with a very large defect in the septum between the right and left ventricle. In this situation, the newborn goes into congestive heart failure very shortly after birth. The defect causes no trouble before birth because the lungs are not inflated and the blood flow through the lungs is very small. The cardiac circulation in utero consists of oxygenated blood returning from the placenta through the umbilical veins, passing in a shunt through the liver and then entering the right atrium, which also receives the non-oxygenated venous blood from the body. The oxygenated blood returning from the placenta enters the right atrium and passes through a normal atrial septal opening called “the foramen ovale,” which shunts it directly to the left atrium and left ventricle for circulation out to the body. This bypasses the lungs. The venous blood, and the umbilical vein oxygenated blood that does not go through the foramen ovale, enters the right ventricle where it is pumped into the pulmonary artery. There, because of the high pulmonary resistance it goes through another shunt, the ductus arteriosus, a connection between the pulmonary artery and the aorta, to bypass the lungs and circulate to the body. Minimal flow goes beyond the ductus into the pulmonary arteries until birth. During fetal life, the presence of a ventricular septal defect merely eases the task of shunting the oxygenated blood from the right side of the heart to the left and then out to the general circulation.

When the infant is delivered into the world from its mother’s uterus, it inflates its lungs and very rapidly major circulatory changes occur in the heart and lungs. The pulmonary arteries to the lungs, which during intrauterine life carry almost no blood because of a very high resistance to flow in the collapsed lungs, suddenly become a low resistance circuit with the inflation. The foramen ovale, which has a flap valve as a part of its normal structure, begins to close very quickly and the ductus arteriosus, connecting the pulmonary artery and the aorta, also closes within a matter of several hours. These two shunt closures are accomplished by hormonal changes associated with the changing physiology of the newborn. In very low birth weight preemies, that have low blood oxygen concentration due to immature lungs, the ductus often does not close. In the child with a ventricular septal defect, the sudden drop in resistance to flow in the pulmonary circulation together with the closing of the ductus arteriosus causes the shunt, which was directed from the right to the left heart in utero, to switch to a left to right shunt after birth. The pulmonary circulation is now the low resistance circuit and the systemic circulation; that is, the aorta going out to the arms, legs, and organs is now a relatively high resistance circuit. The flow in the pulmonary circuit goes up tremendously, a short circuit in effect, taxing the ability of the right ventricle to handle the load. At the same time circulation to the organs, the brain and the extremities, drops because of the shunt. This combination of circumstances produces acute congestive heart failure in a newborn. Cardiac output is huge but the flow is going around in a circle through the lungs and then back to the lungs.

Chris had a huge ventricular septal defect and as soon as his lungs inflated and the pulmonary circulation began to assume the normal low resistance of the newborn, he developed an enormous left to right shunt and went into heart failure. The venous return from the body entered his right atrium, passed into the right ventricle and on into the pulmonary artery to circulate through the lungs. Once the oxygenated blood returned to the left atrium on its way to the body, it was shunted back to the lungs because the pressure in the aorta and left ventricle was much higher than that in the right ventricle and pulmonary artery. The short circuit in the heart diverted almost all blood flow to the lungs and little went to the body. The right ventricle, which is thin walled and flat like a wallet, cannot handle the load and quickly fails. The treatment of an infant with a large ventricular septal defect and heart failure is to perform a temporary correction by placing a band around the pulmonary artery above the heart. This accomplishes two purposes. One, it artificially creates a high resistance and equalizes the pressure in the right and left ventricles so that the flow across the ventricular septal defect is minimized. The right ventricular pressure is as high as the left ventricular pressure and little or no shunt occurs. This stops the huge shunt and, with the smaller flow, the ventricle can handle the pressure. It also protects the lungs from high blood flow that damages the pulmonary circulation.

In a related anomaly called “Tetralogy of Fallot” a partial shunt occurs but it is the other way, right to left, since the pulmonary artery is severely narrowed at its origin as part of the anomaly. These children do not go into heart failure, but they are blue because of the mixture of venous blood from the right side and arterial blood from the left. Some patients with ventricular septal defect (VSD) do not go into heart failure because the shunt is not that large but if treatment is delayed and a continued high flow through the lungs persists, in later life they develop irreversible changes in the lungs from the damage to the pulmonary circulation by high flow rates. They become blue later as the increasing pulmonary resistance in the lungs reverses the shunt from left to right to right to left as in Tetrology of Fallot. This condition is called “Eisenmenger’s Complex” and, once it occurs, cannot be corrected. Once this reversal occurs they do not benefit from correction and require heart and lung transplantation. Some VSDs are small and do not produce enough flow to cause trouble, at least in childhood.

Chris had a pulmonary artery banding procedure at about two or three days of life and an extremely stormy course for a very long time postop. He was in the Intensive Care Unit at Children’s Hospital for over a year. He had a tracheostomy for much of that time as he was unable to breathe without a respirator for a year. He had intravenous feeding for well over a year. During this time he had several cardiac arrests and the staff became convinced that he would be brain damaged if he survived. Finally, after 18 months in Children’s Hospital, he went home. This had all occurred before my time. Now, 3 years later, he was being admitted for the definitive repair of his heart defect. The pulmonary band is Teflon tape and does not grow so the pulmonary stenosis, which had saved his life, was now a threat, as it did not permit adequate flow to his growing lungs. He was five years old and was joyously normal. His intellectual development, in spite of everything, was normal and he was a very calm and self-confident little kid. He was not afraid of the hospital or of us, the white coat brigade. Most nurses and staff in children’s hospitals and pediatric clinics avoid white coats preferring colorful smocks to reassure kids that we are all regular folks. The kids are not fooled but it does seem to defuse the tension, especially at first. When we would make rounds on the ward for the few days Chris was in the hospital for pre-op checks, he would go around with us. He wore his little bathrobe and sometimes carried charts for us. He was completely unafraid. I don’t know if it was because he remembered his previous experience; I didn’t think that memory would be very reassuring.

Anyway, the day of surgery came. His mother was a nervous wreck because she had come so close to losing him and here they were risking him again. I did not see much of the family on the day of surgery. His grandfather was a famous movie star, one of the biggest box office leaders of all time, and the hospital had thrown a big luncheon bash for the family as they waited. We heard about it and grumbled that they could have spent the money on a better blood bank (we were having trouble getting blood for elective cases), but no doubt they hoped for a big donation. The surgery, itself, was almost an anticlimax. The data from the original heart cath, when he was a newborn, suggested that he had almost no interventricular septum and we anticipated trouble reconstructing a new septum. As it turned out, his heart, in its growth during the past five years, had developed a good septum with a modest sized defect in the usual place. It was easy to patch and the surgery went well. The other worry with VSDs is the conduction system, the Bundle of His, which carries the electrical stimulation to the ventricles, and runs right along the edge of the defect but this was not a problem. There was no sign of heart block after the sutures were placed and tied. Postop we always took the kids straight to the Heart Room, a combination recovery room and ICU. The nurses there knew more about cardiology than I did and probably more than anyone else at Children’s below the rank of associate professor. His mother came in and stood at his bedside for a while just thankful to have him. I never saw the rest of the family although I did meet his father before he went home. He recovered quickly and completely. I had one more encounter with him about a year later.

After his recovery from the heart surgery he had another operation, this time on his leg. He had been in the hospital for so long as a baby with an IV line in his groin that his hip would not straighten out completely. A few months after the heart surgery he had another operation to release that contracture, the scar that had formed limiting his hip movement. It also went well but had been postponed until his heart was fixed. A couple of months after that procedure he was well enough to climb trees. I know that because he fell out of one of them and cut his forehead requiring several stitches. I removed the stitches in the office a couple of months after I started practice in Burbank. He recovered completely and is now an executive in the entertainment business. I have not seen him since 1972.

I don’t know what Chris’s care cost but I think it was worth it. AOL was foolish to self-insure and not buy reinsurance for catastrophic cases like Chris and Mila’s. There are ways to reform health care and to cut costs but they are not what AOL did or what Obamacare did.