Word and Image

Archive for February, 2014

Fall Reflection

2658 27 Fall reflectionThe photo was taken in Ashburnham, Massachusetts on a lake in the fall. It was an early morning with a still wind. The reflection is self-explanatory except that it’s turned on its side. No, no Photoshop. It actually was the real deal. You don’t get this too often. But the story is of four couples, friends for many years (too many to say here) who would gather periodically to hangout and do whatever. In this case it was getting on a pontoon boat for a little early morning cruise. Sorry, if you don’t look your best early in the morning before coffee and tea. The guys were cooking breakfast. 2658 20 Lisa Kathy Susan MA

Ski Bob

2515 31 Julia David ski bobThat’s what Eric called it. He had a boat. We used ski-bob on the Hudson River up by Bear Mountain. We did it twice only. Here’s the memory. It was a nice day on the water. The kids had a ball. Great days come and go so quickly in a twinkle of the eye.


1082 29 Lisa Julia Elsa MaryGreat Grandmas. Lisa was fortunate to have know both her grandmothers. Actually on the left is her step-grandmother. On the other hand, I have no memory or photo of my side of the family. Except for her mother, we have three generations. J, a toddler, has seen the pictures but has no memory of her great grandmas either. I didn’t realize the significance of the moment or I’d have gotten everyone into the picture. I will mention that it was two daughters for Lisa’s sister. So we have only girls on this side of the family. Of course David broke the record and it turns out it’s boys only for both my brothers. Lisa and I got the split. David’s the only boy on Lisa’s side so her relatives call up and ask how’s “the boy?”

Embarrassing Moment

2649 36 Bike see thru pants aWe were on a five borough bike tour of New York City. There were thousands of riders strung out all over. As we rode along a road near La Guardia airport… I snapped this shot from the rear while riding… and was immediately admonished by my spouse (it’s not her!!). Well, if you wear worn out clothes in public, it’s fair game. No names, just places. It’s not a nice thing. It is in the category of street photography. There was no intent to offend. But a word to the wise, watch what you wear and where you wear it.

A Few Years Before…

Hotel Medici sink downShortly after Lisa and I met, we traveled to Barcelona, across the French coast and Riviera, to Italy and then Rome. It was eventful. Before we left Lisa’s grandfather died. I lost my wallet in Barcelona. I left it in a restaurant on a table. American Express “Don’t Leave Home Without It” doesn’t have offices to replace the card. So we had to wait until Rome, the end of the trip, to get a new card. And!! I proposed marriage at the Trevi fountain (Three Coins in the Fountain). It seemed pretty romantic. We almost broke up because, marriage yes, but after I finished residency, that would be in about three years… too long. I just wanted the proposal to happen in the most romantic place I could think of. We’re still married…

We arrived in Rome, down to the last traveler’s check, late at night and booked a room in the Hotel “…” no names please. They still might be looking for us. We took a room “sans bathroom,” cheaper. In the morning Lisa didn’t bother to go down the hall to wash up or shower. I was sitting on the bed. Yes, I remember exactly where I was. She was leaning on the sink.

And… crack!… followed by a torrent of water shooting into the room. The sink was tiled into the wall without any support beneath except for the plumbing. And there were no shutoff valves below the sink. Who thinks of this stuff? The room was rapidly flooding. The carpet was soaked. And I, in my birthday suit, quickly jumped up and did what anyone would do under the circumstances. I stuck a finger into each pipe and stopped the flood. Lisa was screaming in fear (arrest) and pain (sink fell on toe). I was thinking, I’d like to be dressed when the hotel maid arrived. So first, put on my pants. Lisa stopped hopping and screaming; helped with the pants. Remember, hands not free to act. Good! Get a chambermaid. Maid looks in with an inquisitive look. Eyes open wide! Classic! She throws her apron over her head and runs. (You can’t make this stuff up.) Get someone else. The porter comes. He’s clueless. He looks. He doesn’t help. He doesn’t advance into the room. I need him to find and close the shutoff valves. I don’t plan on being the ‘Little Dutch Boy.” No luck naturally, he doesn’t speak English, and I’m don’t speak Italian. We’re in Rome, duh!! The porter finally advances close enough to this half dressed nut (me, remember, only pants) so that I can pull out one finger and squirt him in the face. He runs off… I’m thinking to call the police.

Get me some wine. What! That would be Lisa still screaming… and she knows I don’t drink. I’m frankly amazed that I can think through this emergency that I have never encountered. Two corks from the trays lying in the hallway, thank goodness for room service last night. Corks into the pipes and the water is stopped. The floor is flooded and the carpet is soggy. What now!? We do not have the money for this disaster. Quickly packing… I mean just throw your stuff into the bags… and we’re out of the room and down the elevator. News of our mishap has just made it to the lobby. Lisa stops at the desk, screams out in English (Italian speaking hotel, remember?), “What kind of hotel do you have here?!! My toe is injured! I’ve been damaged by your hotel!” And it appears the desk manager misinterprets Lisa and thinks she is going to blame the hotel, so he yells back in Italian (translation unknown, I don’t speak Italian, I told you already).

With that Lisa picks up the two suitcases (heavy for me, but fear will do amazing things) and stomps out the door saying that we’ll never stay here again. Really? I follow with all the early morning guest staring at the two noisy Americans. All I can say to this is that I took one photo before we evacuated the room. Yeah, priceless. Someday, I’ll find the photo of when we stayed two nights in a working brothel. Oh, to be young, on a budget, and so innocent.


A Couple Years Later….

1178 09 Julia David arrivalPoke it, see if it laughs. J was not too gentle with her brother. Newly arrived, Lisa was more worried how J would feel. It would be a while before David would care. So here’s the first meeting at home. J was at the hospital but mainly to visit mom. Ah! A squeaky toy! Somewhere else there’s a picture of J in a fullblown chokehold of her brother. They were a little older. I got the picture first before I broke up that little scene.

At The Beginning

0940 07 Lisa LaborI have mixed feelings about photos in the labor and delivery room. It didn’t stop me from having a camera on hand. And/but I do have mixed feelings about it. As for Lisa she definitely has some opinions. In fact her friends know her opinions “in no uncertain terms.” J’s labor was 40 hours. That was two nights! After the first sleepless night, here’s what we had. It’s not romantic like the movies. It’s a mess and I will probably regret posting this picture…nothing staged… reality. Hmmm… she even took a picture of me.0940 06 Victor labor room Later on I made the mistake of asking how she felt. Labor hurts! I remember wearing a skinny (very skinny) pink tie (I was sort of at work). In a flash she reached out and grabbed me by that tie, pulled my face in close, choking me, and said, “If you ask me that again, I’ll kill you. Get me some drugs.” So much for Lamaze classes, I got the drugs, and never got close enough for Lisa to strangle me again.0940 15 Lisa Julia holdA day later it was all worth it. The Kodak moment, mom all neat and pretty again.

For the record we had argued about names. But when J popped out at 2AM it was obvious instantly what her name should be. At the other end of things, Lisa naturally asked immediately what sex? I replied, “Girl. Normal, ten fingers, ten toes… eight on one foot, two on the other.” It took a moment to sink in before Lisa said, “What!?”

I had been a physician just long enough to have only really been taking care of birth deformities. You don’t see too many well babies in my specialty. I’m not a pediatrician. My specialty was in caring for the problem children. I had to keep reminding myself that the majority of babies are all born normal. Yup, it’s a curse of the profession that afflicted both Lisa and myself. My buddies and I were all having kids at about the same time. This was something we would confide about and sheepishly admit as we held each others newborn kid and quickly ran a hand up and down the spine and felt the newborn fontanelle for hydrocephalus.

Hot Air Balloon

2511 18 Hot air balloonsThis was my first experience with photographing hot air balloons up close. The memory it invokes has nothing to do with the picture. The backstory is that it was Long Island. Lisa had seen a notice for the show at Bookhaven Airport. She also happened to have the worst case of poison ivy, ever! She’d gotten it a few days before. The blisters and the itch were fierce. If you’ve ever had poison ivy, you’re probably cringing right now. We went to the show and the kids and I had our experience. I got my photos. We stayed till the evening to see the balloons launch. They don’t launch during daylight because of the winds. The picture that got away (missed) was the one at the end where Lisa frantically was dipping her blistered arms into the ice barrels (soda) to ease the discomfort. Yeah, I was not high on the  empathy scale. Some things you learn much later in life. Sorry, honey.



2316 25 Julia David Victor skiWhile it’s still winter where I came from, I’d like to post some ski pictures. Old ones… The kids liked it. At least they went along without any grumbling. After a while Lisa kind of dropped out. She was too timid to really enjoy the hair-raising wind in your face skiing that the kids and I did. Ok, she was a lot happier and it was a break for her if we went off for a while.1859 28 Julia ski

1870 11 David ski

Jumping is something that is a challenge. You catch air and it’s a different skill. Just don’t panic and it’s easy. I realize this isn’t much of a jump and not much air. The kids didn’t know it and they didn’t care. Fun is fun.2316 28 Dave ski

2316 29 Julia jump

Organize and Backup

IMG_3495It’s been a year. I dropped my beloved laptop one year ago. Ordinarily it has survived. I have dented the case (aluminum) and it survived. I’ve done it more than once! (Not too bright!) I don’t backup… at least not regularly. And I have priceless hundreds of thousands of images. Dumb!? My images are at least backed up redundantly to a series of external hard drives. So very few images have been lost. Some were gone because if you copy bad files to bad files…. So I only copy the original files to each back up drive. That part is compulsive and paranoid.

I got a call last year, “Come out. We’re going now.” So I leapt up from my seat and my laptop dropped. Unfortunately it was on, as in actually working, spinning the hard drive. That is not good! When it’s asleep or off, the hard drive heads and reader are parked and relatively safe. The bad news is that the drive was dead. No backup! And the good news is that the drive was alive enough to resuscitate most (95%) of the files which took me months to complete the recovery process.IMG_3494

When the kids made their December delivery to me here in Jeddah, I got some new 2TB external drives. The older ones (2 left) had the original image files and scanned slide files. I just completed a comprehensive backup and reconstruction of my Lightroom files. Now I have digital files, scanned slides, and a mishmash of older image files in three catalogs. This is estimated at about 200K images somewhat organized. Certainly my digital files are organized. And the scanned slides are pretty well organized. It’s the mishmash that is the challenge. I filed my slides and original digital images by date. (Start now and you’ll never know how much work you saved yourself later.) I keep a separate database in Excel to track the general place, time, subject, and people. Use Excel, most other programs stop getting supported and database file then can’t be read. (another hard lesson learned)

Well, there it is, a little brick (silver on the far right), sitting on my desk, and waiting to be mined for future blog images. So some random files from the archive, that happen to catch my memory will follow for a while. I have been back and forth about the vision of this blog. Is it current events, Middle East adventure, stories….? So to all of you reading (and I thank you), I’m a bit scattered but there’s a plan. And there’s a backup, too. Ha!

Looking Down

IMG_3480Here’s a party view I don’t often get to see. I was descending on the escalator overlooking Starbucks. A birthday party? Yes, I think so. Cellphone’s the recording device. I was to far away to hear any singing. Happy…happy.

Flat Bread

IMG_2991It’s made in fired ovens. David thinks that it’s two layers and the ‘puffy’ bread rises because of the construction of the dough. To me the dough looks like a single pancake. They make a lot of it. It’s the sliced bread of life here. IMG_2992It’s the Middle East equivalent of French bread served in NY. And then there’s the Tandoori oven. They slap pieces of dough against the sides and make another form of bread. When I attended a banquet at a home, there was a portable Tandoori available for on the spot baking. My assessment – it sure beats sliced white ‘Wonder Bread.’IMG_3001It looks like there’s something stuffed inside. Either way the food is good.IMG_2999Since we were in the outdoor kitchen, it afforded us a view to some pretty good cooking. IMG_3002


IMG_2889I had spoken a few days back about jewelry. People talk about gold. And I was told where to buy jewelry. There are all the big stores as well as some very wealthy jewelry families here in Jeddah. My kids were raised by their mother’s influence to not be attracted to shiny things. It amazes me because I am a ‘hoarder.’ The kids laugh at the things I collect and buy. But they have grown up seemingly immune to shopping and the advertising that accompanies buying.IMG_2892

Growing up the ‘rule of the house’ no commercial TV, Sesame Street and PBS TV were ok. And when the kids finally were allowed to watch cartoons, they were trained to mute the sound whenever a commercial started. The kids were pretty disciplined. I found out when I discovered that David could sing the first five notes of most cereal commercials (the time it takes to grab the remote and mute the sound) but no more than five notes. It really works. My kids did not grow up in any way acquisitive. Buy what you need but it was never about brand or status. For shoes my daughter wore flip flops throughout most of her college years.IMG_2891

So we found ourselves puzzling the mysteries of jewelry. Jewelers like to have brilliant white lighting shining down to show off all the jewels and gold. We speculated about whether the workmanship was local and then looking carefully, some of the labels revealed the countries of origin – India, Pakistan, China. IMG_2895I have been struck by the lack of craftsmanship here in Jeddah. I am sure that I have just not stumbled across local crafts people yet. But still…. So I don’t feel anything compelling about the jewelry displays since they are things made elsewhere on their way to somewhere else.IMG_2959


leaI got a comment from Jennifer. We worked together in another of my lives. She’s a PA, Physician’s Assistant. When she arrived to work with Don and I, she was experienced but still a bit unpolished. Previously, she had been thrown to the sharks to sink or swim so to speak. I got her to the point where she was indeed able to be an asset in surgery, make sound judgement in neurosurgical problems, and in general  to think before acting. I’m proud that she was so willing to learn and become better in a difficult field of work. And her thanks is in the unsolicited comment she made regarding the post I made earlier today.

As I have said things don’t go well every day. And sometimes I have to admit that ‘thank you’ means a lot. In the practice of medicine, the expectation of perfection has clouded much of what we do. It is indeed a high compliment to receive a comment from Jennifer, who has seen the best and the worst times we experience in medicine close up. Thanks kid. I’ll stay in touch.

Ethics and Technology

IMG_3440“Hi doc, I’m Lea’s mom. Thank you so much. We’re at the airport…”

Shortly after I arrived in Jeddah I was faced with an extremely difficult medical case. By difficult I do not refer to the technical part of surgery. Right now great technology is a given in neurosurgery. But it is the ethical decision making that is involved in whether or not to recommend surgical care. A young 29 year old ICU nurse suffered a major stroke of the left brain hemisphere which is ordinarily a devastating brain injury. Recovery is poor and usually associated with major neurological impairment (speech and paralysis) and a good possibility to remain in a vegetative (unaware) state permanently. There was no family available for consent and her nursing colleagues became her health care proxies. In the glare of this discerning audience I would have to make some tough decisions and the outcome would affect my very reputation within the hospital medical community.

Many of my colleagues here in Jeddah have counseled me to be very conservative and not to take any medical risks. This has been a mantra for care since I have been here. It puzzles me because there are inherent risks in any neurosurgery decisions and the results are never guaranteed to go exactly as you plan. Balancing failure and success has never been more difficult than in the past two years. One thing that I have noted is that there is a definite tendency toward unrealistic expectation by patients/families that everything done must be successful.

Our young nurse had deteriorated neurologically and brain death seemed imminent. So a split second decision was made based on my gut feeling and medical experience; the plunge was made. We took her to surgery and in a series of operations proceeded to remove her skull bone, evacuate the blood clot, remove dead brain in order to preserve the brain that would survive, reconstruct her skull, and finally insert a ventricular shunt. I summarized about six months of hard care in that previous sentence. There were many times that I questioned myself as to whether it was the right decision that I made to try to save her life. My questions came because for many months she was completely neurologically severely impaired, unable to speak or care for herself. Mom arrived more than two months later. She had been unable to obtain a travel visa from the Saudi government.

The hospital and the nursing staff were wonderful in supporting a nursing colleague. And day by day my patient became more and more responsive to her environment.

I received this thank you text from her mom at the airport just before they departed for home in the Philippines. My patient, her daughter, was now communicating, not yet speaking, feeding herself, and walking with assistance. She needed help to take care of herself. Her mother was happy for her recovery. And knowing what I knew as she left for home I have no regret in pouring out a maximum effort to save her life despite the tremendous odds against even a fraction of the recovery she made so far. Some days it’s worth being able to think back that we did something that no one thought we could do.

No one likes an unhappy ending. Some years ago it was noted that movies with unhappy endings are not popular. Really, think about it. At the time, it was said to me, Robert Redford in “The Natural” hit a home run to win the game to end the movie. But in the book David Mamet wrote, the character strikes out to end the story.

I have experienced my share of unhappy endings. It can’t be helped. But there are those times when a decision and good skill will touch a life in ways that everything was worth all the hours and work you put into your profession.

Heartfelt Thanks

IMG_3493I had a patient come to the office this past January 11. She had had emergency surgery exactly one year before. That day she had been found at home collapsed and unconscious. A large intracranial hemorrhage was discovered and I soon had her in the operating room for emergency lifesaving surgery. As is usually the case we took her to the operating room in a rush as soon as I arrived in the ER. It really does work that way sometimes. The patient had a stormy post op course. She was paralyzed on one side and couldn’t speak or write for many months. Money was no object as she bounced around rehab programs even taking treatment in Paris. But as with most brain injuries, it is time that heals and I had repeatedly told the patient and her family that it would be a year until the outcome and recovery would become more clear to all. And so on what she refers to as her new “birthday” my patient arrived in the office with the deepest thanks. She brought me a letter of thanks, which she signed in front of me. Just writing was a big achievement. Her speech and strength had returned. She still had deficits but overall she was living life and appreciating her family. As I have often said, “It’s the smile of your thanks that makes all the work we do so rewarding.”


What Are The Odds

IMG_3009I’m not famous. I’m not a celebrity. Really! But it always seems that I run into people who know me in the places that I visit. Jeddah has 3 million people give or take. And when the kids were here, we were cooling our heels waiting for a table at the Palm Garden. Just as a table opened up, I had my camera up and taking a picture. As you can see, a fellow diver greeted me with open arms as he recognized me behind the camera. Coincidence, yes, but not isolated because in this same 10 day period David saw me greeted by a patient I had operated upon in another restaurant far away from this site. This woman graciously invited him to her daughter’s engagement party so he could taste a different aspect of Jeddah. It certainly remains interesting who you meet and who knows you while you try to remain anonymous.

PF Chang

IMG_3431David said don’t do it. He said it’s a chain and it’s not too good, too formula…. He’s eaten in a lot of places by now, so he’s more sophisiticated in his taste and evaluation. Unlike Ajii which both of my kids approved, PF Chang was a place to avoid according to both children. With a lack of choices I found myself drawn to try it. All local reviews were positive and everyone raved about the dynamite shrimp. Now I have found out that the entire six restaurants at this site are owned by a single company group. So far it’s been very successful with no parking and lines everywhere. I’m not impressed that cheesecake costs $8 (33SAR). A burger at Shake Shack is only $8. But my eye was on PF Chang. The singles section is like an afterthought. The space is small and cramped. Service is very attentive. They do a little show to mix some dipping sauce tableside. The food – dynamite shrimp is the local NY version of deep fried shrimp covered in a mayonnaise sauce. It’s pretty funky in NY and so what else can you say. It is a recipe that was made on the spot in NY with ingredients at hand in a combination of ingredients put together from a bad dream. Not bad…. Just not worth mentioning again. Dynamite – it’s in the hot cloying sauce. Anywhere else and without the sauce, this is tempura shrimp.IMG_3418

Chicken lettuce wrap has the standard iceberg lettuce – ice cold – to wrap around diced chicken and deep fried crispy rice noodles. Decent. IMG_3424The shrimp dumplings were covered by steamed wonton skins and were largely tasteless, hence the dipping sauces. IMG_3427There was green apple soda, way too sweet, but with a crunch green apple slice. I’ve not made another foray to try the mains yet. But so far David and his sister were right.IMG_3417

Jet Lag

IMG_2698Yes, it is possible to be asleep on your feet. Actually there was a time when I was an assistant surgeon (residency) and it would happen regularly. Up all night long, then leaning in able to see the operating field with only one eye open (and the other closed) as the surgeon worked. Before you knew it I would be bumping his headlight as I dozed. When I finished my training he said to my wife/significant other then, “Great guy, I just don’t know how he ever managed to learn any surgery.” (I just didn’t sleep when it wasn’t boring.)IMG_2697Well, I told you that J had been through multiple time zones from LA to NY to Jeddah. David and I had no mercy. So it was no surprise to have her sleeping during our self-portrait. Not just eyes blinking, no no no, it was a full blown drowse. She’s a good sport about it and we even went to dinner afterward. We just didn’t keep her up later.


_DSC3666I’ve done this shot whenever there is the opportunity. Usually it’s an early morning shot. In this instance David and I were on a mission to Al Waba. We left early in the morning and began to take a series of shots of the passing countryside. The clouds/mist/fog/smog hung over the mountains (hills) and, voila! You have to do a bit of cropping and you need to pull out the hills layered upon layer. But it works.

Amara, Missing Shots

IMG_2445I bet you wondered when I spoke about Amara (lukewarm) if I had left out the pictures of the restaurant because it wasn’t the greatest. Nope, just a senior moment. IMG_2739David was the one to find it. He pushed me on a quest to find roadside sculpture. And with a family (J, daughter) we could eat upstairs!IMG_2723Yeah, it’s a lot different view. If you are single you eat somewhere else. IMG_2724Same food, just different view. As a single, I read. I’ve got a library on my iTouch. Reading ain’t conversation. But a good page turner  is a distraction. Yay for ebooks.

Do Fish Kiss?

IMG_6501 aI was diving with the kids who were off to the left swimming slowly along the reef. I topped a small coral rise and there in front of me floating above the sand… The scene was there for a few seconds, enough for me to pull up the camera and fire one frame. There was no second shot. They parted and the kids never saw this till I downloaded this to the computer. I’ve haven’t been around that much, but I don’t think anyone else has this.


IMG_2476It’s a multilevel restaurant. Singles (men) sit in the open air sidewalk tables. Families (aha! I had one with me) can use the outdoor terrace overlooking some apartments, police station, hotel, and an unfinished tower. Did I mention a view of the ocean? But you can’t see this at night. Of course you never have a chance if they seat you away from the view. Which they did, even though they promised a nicer table if we had a reservation. It seems my (our face) face didn’t rate. Dinner wasn’t bad. And afterwards we had the pleasure of walking across the street to the mosaic octopus. Yeah!

It was in the same building as Ajii. Actually we found and targeted Amara first. We had to return to Amara twice when we were out of restaurant options because of the late hour (11:30PM) and the failed attempt at Palm Garden. It was so late because of that night dive. See… all my posts have lately tied together in a logically illogical way. Horray!


Mosaic Octopus

IMG_3167Yup! It’s a big giant mosaic octopus off the beaten path in the middle of a traffic circle behind the Corniche (beach road) that you would have to actively seek out. And what do you do after dinner in Ajii…. I guess we were in a pretty good mood after a satisfying meal. The only thing was risking life and limb to cross the circle and get to said octopus. And then J wouldn’t standby for any fooling around in plain view of all the passing cars. David had fewer qualms so he shot his dad embarrassing his kids. IMG_3173