Archive for October, 2011

The answer to a question I had

Friday, October 21st, 2011

Here is the answer to the question of why Steve Jobs procrastinated about his pancreatic cancer.

I have seen this so many times. One instancewas a young GP who I remembered from the time he was an intern at LA County. He was convinced of the merits of Alternative Medicine. It was sort of a hippie thing. Remember, I finished my surgery training in 1971.

A few years later, he was practicing his version of medicine in Mission Viejo, an unlikely place. He turned up in my office one day close to Christmas. He was having symptoms and wanted me to examine him. The findings showed a large mass in his abdomen. It turned out to be an advanced cancer of the small intestine. These are rare and early diagnosis would probably not have helped. What shocked and distressed me was learning that he did not have any insurance, of any kind. I didn’t charge doctors for care in those days so it didn’t affect me but he didn’t even have life insurance ! He was married and, I believe, he had children.

Steve Jobs’ family will be well cared for but he passed up the best chance he had to be there for them another 20 years by his belief in magical thinking. I suspect his politics may have been affected, as well.

Sorry about the gap in blogging

Wednesday, October 19th, 2011

In September, the 12th, I believe, we decided to drive to Tucson where we have a house. Our daughter, Annie, lives there while she attends the U of Arizona. I have complained about the curriculum before but Annie seems to be immune to the attempted indoctrination. Her US History Since 1877 course, for example, was full of misinformation. She was taught that the settlers in the western plains learned agriculture from the Plains Indians. This is ridiculous as the Plains Indians were hunter-gatherers and were the last of the aboriginal peoples to cross the the Bering Strait. The Pilgrims, as every child in school in the 1950s learned, were taught to plant corn with a fish in each clump for fertilizer. The eastern Indians, like the Iroquois, were far advanced compared to the Plains Indians, and some had glass windows in their houses. Dartmouth College was founded in 1759 to educate the children of the Indians and settlers. Unfortunately, the Indians chose the French in the coming war (A European War they should have stayed out of) in hopes that the English settlers would be driven out. This was a gross miscalculation and was a catastrophe for the Indians. After Quebec fell, they were the enemy.

My daughter is studying French, not due to sympathy for the Indians but in hopes of getting an internship in France next year and then a job for the French company that employes her uncle. She loves France and has been there multiple times. When we visited Nice a few years ago, she spent the next several weeks checking housing prices. At least she has a plan that is grounded in reality.

Anyway, we were in Tucson a couple of days when my daughter found me sitting in the family room looking unwell. I was confused and had slurred speech. I don’t remember this episode and awakened in a hospital in Tucson having a coronary angiogram. At first they thought this was all neurological but my cardiac enzymes bounced above the normal level so it became a heart attack (Myocardial infarction). The angiogram finally showed a high grade (90% stenosis) lesion in my anterior descending coronary. My coronary anatomy is abnormal in that both coronary arteries come off my aorta together. I learned this a couple of years ago when the cardiologist could not find my right coronary artery. A subsequent spiral CT scan showed it and there was no disease seen in either of them. After the coronary lesion was found, it became a matter of surgery. I used to do this surgery, so I knew what was involved. As it happened, I had this solitary lesion so needed only one bypass. The surgeon, a nice young man who looked a little older than my medical students, explained his plan. The internal mammary artery, which runs down the back on the sternum, is about the same diameter of the anterior descending coronary. In years gone by, this artery was used in the Vineberg Operation and implanted into the cardiac muscle. I will give my surgeon a copy of my Book on medical history so he knows this story. Anyway, the plan was to connect the internal mammary to my LAD, or left anterior descending. Osler called this “The artery of sudden death,” so it matters that it is fixed.

I was in St Joseph’s Hospital in Tucson, a pleasant place considering. I was then transferred to Tucson Heart Hospital for the surgery. That was performed on 9/26/11, less than three weeks ago. On the third day post-op, Cindy and I drove back to California and my recovery has been uncomplicated. My chest is still a bit sore (I was warned that this approach would hurt more) but I am getting along pretty well. I posted a few comments on other blogs but didn’t feel up to blogging myself.