This past weekend we drove out to Amherst on the invitation of my college friend Bill, who was performing in a Gilbert & Sullivan production called Yeomen of the Guard.  Bill invited us to stay in a suite which he had finished in the basement of their house.  In addition, he cooked us dinner, and breakfast the next morning!  Overall quite a treat…

I found it humbling to be staying with my old friend.  He showed us all of his proud achievements, including the house which he had helped design and build, a large deck which he built himself, a large hot tub which he frequented every night, and two grand pianos on which he played his own compositions.  In addition, we met most of his family, his wife Marilyn and his younger daughter Zazi (Elizabeth), as well as a dog (Eby, short for Ebony) and two cats (George  & I forget).  Bill works as a lawyer in a one-man firm which deals with issues of children and families, and his office is in the basement as well.  He walks his dog on the public trail behind his house (named after Robert Frost) and is active playing in informal volleyball and tennis leagues.  He is thin and in excellent condition.  He sings in a chorus and an a capella group, and, as a member of his theater group, rehearses three nights a week for three hours at a time over two months in preparation for their two weeks of performances, as well as helping build sets and sew costumes.

I found myself feeling inadequate upon hearing all of this, and began making excuses for my relative lack of productivity.  I have had long commutes for the last twenty-seven years which have sapped my strength and eaten up my time away from work. (I am sad to see what commuting has done to David and Amanda, in their early twenties and too young to be victimized like this.)  I am a big fan of TV, and of various spectator sports including NFL football and NBA basketball.  As a parent I spent many weekday hours and weekend days traveling to and from my kids’ sporting events, including soccer, squash, and ultimate frisbee.

I was ashamed of myself.  I had no good excuse for my lack of productivity other than laziness.  I asked Bill, “Were you like this when I knew you?”

Bill’s answer: “We were both like this when you knew me!  You were a dynamo.  You had that big handmade leather pouch and in it you’d put your flute, your tennis racket, and your books and then you’d be off like a flash, set for the day.  I could barely keep up with you!”  I reflected on this.  He was right, I was a dynamo back then.  I was not self-aware, and I was desperate to become famous.  After seeing classmates who were world-class violinists and cellists, I decided that, by practicing non-stop for one or two years, I could become a flute virtuoso.  In fact, Bill and I played Bach flute and piano sonatas as one of our activities together.   But of course I had completely underestimated the time and  years which had led to the virtuosity of my classmates, time which could not be squeezed like the foam balls in a magician’s sleight of hand trick.

Bill asked me about the fence that he’d seen on Facebook I had built.  I corrected him: I hadn’t built it, but torn it down.  An awkward pause.  “I did start writing a blog”, I said.  “Oh, give me the link and I’ll read your stuff!”

Well it’s Monday night and I’m home from another day at work.  I had a patient with a family history of malignant hyperthermia.  I prepared a “clean machine” and made an anesthetic plan.  Usually in such situations one turns out to be overprepared and nothing happens.  In this case everything happened, and two of the events (hiccups and severe laryngospasm) called for a drug (succinylcholine) which I was prohibited from using because of her possible MH.  The third and scariest event was unexpected regurgitation, one small step away from a true emergency, aspiration.  I got her through okay, but it was exhausting.

I got tired driving home and made some phone calls to help me stay awake.  When I got home I ate Chinese leftovers, then lay on the couch and fell asleep watching “Homeland”.  Carol came home and she had dinner while I ate some more leftovers.  We watched Jeopardy! Tournament of Champions, which resulted in all three contestants qualifying for the semifinals.  Curiously, I had an emotional reaction to this.  (My eyes teared up.)  Meanwhile I defragmented the hard drives on our two computers.

I have decided that Bill has an enviable lifestyle (i.e. life), but he is Bill and I am Ed.  My life may not necessarily be enviable, but it is mine and no one else’s.  I have a happy marriage and two happy healthy sons, and I make enough money to live a comfortable life.  My workplace is not perfect, but I am not a person who could have started his own company.  Too much responsibility and too much stress.  I am a doctor, but I am happy to be in a field which manages to avoid much of the grandiosity that is present (or rampant) in many specialties of medicine.

And I have my own relatively new friends on Facebook and in this blogosphere, to whom I can express my feelings without fear of judgement or criticism.  For me, this is therapeutic.

Thank you, my Internet friends, for being there and for reading my humble posts.

Back when Jonny was 14 years old, we sent him to a summer guitar camp.  He had some misgivings about going, but we wanted him to be exposed to the “real world” of guitar excellence, and be inspired to improve his already-accomplished playing.  A week later, when we picked him up in Connecticut, his feelings were still mixed.  He had bought two CDs published by one of the workshop teachers, David Martone, which displayed amazing technical prowess, but overall I feared that the experience had dampened rather than sharpened Jonny’s interest in the guitar.

A few weeks ago Jonny told us about a movie “Whiplash” (director: Damien Chazelle) which follows the experience of a young jazz drummer Andrew (played by Miles Teller) under the manipulative, abusive, even demonic tutelage of bandleader Fletcher (J.K. Simmons) at the fictional Shaffer Conservatory.  We saw the movie last night, and it was an intense and remarkable experience.  (8.6 on IMdB, metascore 87 and worth every point)

What the movie showed was that the unbridled pursuit of virtuosity can distort the psyche of a relatively “normal” young man, and lead him into the maniacal pursuit of both excellence and approval.  He practices until his fingers start to bleed, and keeps on going.  He breaks up with his girlfriend because nothing that she says seems as interesting to him as his music.  He becomes as competitive as all of Fletcher’s other students, one of whom commits suicide, and still he does not realize what these warped priorities are doing to him.

SPOILER ALERT, this paragraph:  The outcome of this struggle is a dramatic scene where Andrew is humiliated by Fletcher at a prestigious jazz competition, and snaps, turning into an unbelievable drumming machine.  The significance of the ending is mysterious and open to individual interpretation.  Does Andrew win or lose?  What do those terms mean relative to his experience with Fletcher?  In any case, the film’s conclusion is intriguing and thought-provoking.

I am proud of my son Jonny, and feel that he was able to keep such a blind pursuit of excellence at bay in favor of a more normal and happy existence.  Even as a  young teenager, he could tell what he did and did not want.  The succeeding years have borne his feelings out.  He still loves his guitar and  his music, but as part of a full and fulfilled life.

Thanks for reading.

We went to see the new play “Ether Dome” at the Huntington Theater Company the night before last, and I found the answer to an important question in my life: Why did I choose to become an anesthesiologist?

The short answer to this question is: Despite its unquestioned importance to humanity, nobody ever won the Nobel Prize in anesthesiology.

“Ether Dome”, besides depicting many of the machinations and events surrounding the development of nitrous oxide and ether as anesthetics, also chronicles the ambitions and ultimate demise of dentists William Morton and Horace Wells, and surgeon Charles Jackson in their quests for anesthesia fame. (The story of surgeon Crawford Long, another legitimate claimant to the discovery, is not touched upon in this treatment.)  All three men died penniless, miserable, and addicted to inhalational agents.  Morton’s only consolation (postmortem) was his gravestone, which was inscribed “Inventor and Revealer of Anaesthetic Inhalation…Since Whom Science Has Control of Pain”.  The play reveals otherwise, that Morton had more in common with a huckstering snake oil salesman than a scientist, and that the others were not much better.

What does this all have to do with me and my quest for the Nobel Prize?  Well in 1970 I was recognized as one of the top 115 high school students in the United States, and honored with a Presidential scholar medal conferred by President Richard Millhouse Nixon and Vice President Spiro “Ted” Agnew.  At the time I clearly remember one of the speakers (probably a politician) telling us “I hope that you don’t think that this is the pinnacle of your career, and that you can take it easy and not accomplish anything else.”  At several points in my life I have feared that his words had come true for me.  (Sad, isn’t it Jennifer?)

To skip through a troubled and brief college career, I stumbled into the elite and new (I was in its third class) Harvard-MIT Program in health sciences and technology, and from there into the laboratory of Dr. Walle Nauta, one of the three greatest living neuroanatomists. (Norwegian Alf Brodal and Czech Janosz Szentagothai were the other two)  and I shared with other members of the lab the secret desire to become famous by solving the puzzle of the brain.  We all followed in the footsteps of neuroanatomy’s single Nobel laureate. Spaniard Santiago Ramon y Cajal, whose exhaustive atlases of the mammalian brain won him the Prize in 1902.

The failure of any succeeding neuroanatomist to win the Prize may be explained by one of Nauta’s “nauta-isms” as we called them, “An anatomist is not likely to find the gold, but he can sure tell you where to look for it.”  The Prize was much more likely go to David Hubel and Torsten Wiesel, neurophysiologists who recorded electrical activity in the thalamus and cortex after stimulation of the retina in cats, than to the anatomists who described these pathways.  The Prize was awarded to James Watson and Francis Crick for the chemical structure of DNA, when the heavy lifting (generating the data leading to the structure) was done by Rosalind Franklin.  As recounted in his book The Double Helix, Watson & Crick stole a glimpse of the data and used logic and inspired reasoning to infer the structure. (Rosalind’s boss Maurice Wilkins was made a co-awardee.)  Several of us were amused to hear Crick present at a meeting of the Society for Neuroscience, as if such an intuitive approach could crack the much harder problem of the workings of our baby, the brain.

Perhaps the paucity of Prizes in neuroanatomy was part of the reason that I was drawn to the field.  We nauta-ites often spoke in whispers, wondering if in the twilight of his career he would be awarded the Prize.  And if he were not chosen, then how could we hope to be chosen ourselves?  One of my colleagues, post-doctoral fellow Miles Herkenham accused me of “wanting to be famous” and then went on to the National Institutes of Health with another Prize-seeker, Candace Pert, who pointed out that, like Rosalind, she had been spurned in the awarding of the pre-Nobel Lasker award to her boss, Sol Snyder, for the discovery of the opiate receptor.

Was it possible that, subconsciously, working in a nearly Nobel-free zone took off some of the pressure that I felt from my dad’s asking me if I could win the Prize?  And then a few years later, when I had the choice between continuing in neuroscience research and becoming a clinical anesthesiologist, my choosing the latter?  At some level I must have gleaned that the highly structured environment of the operating room, like the structure of my childhood home, might be a better way to curb my penchant for grandiosity than the free-form world of science.

Who was it who said “You don’t own your kids, you just borrow them.”  I feel like a “successful” parent, having helped to bring up two responsible young men and set them out into the world, to work, play (music), and start their own family and family-like friendships.  So now what do I do?  Go to work, watch basketball and write this blog?

Since my last post, on time disorientation, it has taken my nervous system several days to adjust to this time change, with a serious dip in my energy level.  I agree with my friend PeggiO, Daylight Savings Time is a counterproductive anachronism which should be done without.

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NBA update:  Meanwhile, in Los Angeles, the Lakers are now 0-5 and proving friend Paul Greenberg right.  They came the closest to a win last night against a young energetic Phoenix Suns team (I shut it off after one quarter but watched the rest just now), but Kobe reverted to his “me” strategy, making a few notable plays but missing even more makeable baskets throughout the game.  And he missed four free throws, which would have made a difference.  He went 14 for 37 from the field, 23 big misses.

Jeremy had a good game, 18 points, 9 for 10 from the foul line, but with Kobe hogging the ball again it was hard to get the offense into any rhythm, especially at the end of the game, when the team got to within three points of the lead.

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I sound kind of downbeat, don’t I?  Oh well, things usually look up after they’ve been down.  We’re going with Jonny and Katie to see Stevie Wonder next week.  That should be fun.

Thanks for reading, friends.

Talk about being disoriented! Multiple factors here:

1) The onset of daylight savings time.  Spring ahead, FALL BACK!  So now instead of being 4:25PM  it is now 3:25PM.  So the Patriots game hasn’t started yet, which is why we can’t find it on the usual radio stations…

2) Late-night basketball games.  Being new fans of the Los Angeles Lakers (and continuing to be fans of Jeremy Lin) we can look forward to the majority of our games starting at 10 or 10:30 PM.  Brutal!  I have resolved to turn the game off at halftime and watch the remainder the next day on DVR.

3) Beginning of winter weather. It snowed today! (no accumulation but just the idea is revolting)  Tomorrow I’m going to take my car to Tom Lyons and get the tires switched over to snows.  And as soon as I can the same for Carol’s car.

4) Late last night I drank a Swiss Miss hot cocoa, supposed only about 10 mg of caffeine, not much more than a cup of decaf coffee.  Still, had trouble getting to sleep and ended up watching the end of the game.

My body is so confused.  As a neuroscience graduate student I learned about some of the brain structures regulating circadian (approximately-a day) rhythms. Retinohypothalamic pathways to the suprachiasmatic nucleus of the hypothalamus, small nerve cells using vasopressin as their transmitter, projecting through the stria medullaris to the pineal gland, which secretes melatonin.  But how much and in what amounts?  I have some melatonin in the upstairs medicine cabinet, but it’s sold in milligram quantities while the pineal secretes in microgram quantities, one thousandth as much.

Oh well, I took a long nap today.  Two strong cups of coffee, Peet Major Dickason’s blend and Barismo, with no effect.  Might as well as drank two glasses of water.  My body is confused.

Oh well, I’ve finally caught up with the Patriots’ game.  One more nap?  Another cup of coffee?

I feel like I’m channeling my friend Ann Koplow…

Have a nice day all…

It’s been a rich day. This morning I went to an anesthesia course (use of ultrasound in nerve blocks) which the Mass. Society of Anesthesiologists was courteous enough to hold in my home town of Waltham, so I practically had to go. (I am not a frequent flyer at these things.) In the lunch line I was standing next to a fellow who looked a lot like my friend Suraj, but when I saw his face I realized he was not, although he still looked familiar. When I sat across from the same fellow at the table, I saw his nametag and realized that he was an old friend named Navil whom I had not seen in over thirty years. We jumped up and exchanged a big hug, and caught up with old times. Also seated at the table was another thirty-year friend Louise and her collegiate daughter. We all looked at each other, and Navil just said “Where has the time gone, Ed?” After a long pause, “I guess the same place as my hair went.”

As I write this I am listening to a live stream of the concert of the Harvard-Radcliffe Collegium Musicum (“the Collegium” we called it back then) in which my brother Harold and I sang (yes, over thirty years ago). Beautiful Renaissance choral music sung in a very special amphitheater (Harvard’s Sanders Theatre) by bright-eyed young college students, just like we were back then.

I remember one Collegium rehearsal where our incomparable director F. John Adams distributed scores of a new piece for us, Josquin des Prez’ Missa pange lingua, scattered us into mixed lineup, and had us sightread the entire piece cover to cover without a break. This was an intimidating, or at least challenging, task for most of the choir, but for some reason I was feeling very much in tune with Josquin that evening, and so I moved into the middle of the aisle and sang my heart out as if I had sung the piece my entire life. I had one similar experience five years ago at a rehearsal for the Brahms German Requiem at my 35th (there’s that number again) college reunion. Since I have sung the piece twice, once with my brother Howie one summer in New Haven, the other under F. John with Collegium, and listened to it again and again in the wake of my father’s death, I had committed the bass part to memory, and I handed my score to another singer and again sung my heart out.

How lucky to have such special friends and special memories to share, over more than half a lifetime.

Thanks for reading, friends.

The Lakers, that is.  Unbelievably, they seem to have heeded the words of an occasional fan who only knows as much about basketball as a naive but intelligent person can glean by watching four seasons of NBA games, starting in the “Larry Bird era” over thirty years ago, listening to commentary by ex-player ex-coach Tommy Heinsohn and Celtics great Bob Cousy (unfortunately a pedantic commentator (Tommy was too, but more entertaining)),  tuning out with the post-K.C. Jones demise of the dynasty, and tuning back in with Linsanity three seasons ago.  Actually, I missed Linsanity by just a few games, and only became aware of it when our dear friend Steve Elliott gave us a glass jar of homemade maple syrup, and on the handwritten label scribbled “Linsanity February 2012”.  When I saw this, at their house in the aftermath of another in a series of memorable feasts at the hands of Steve’s wife Margie, I innocently (and ignorantly) asked “What’s Linsanity?”  The rest is, as they say, history in the Koh household (at least THIS Koh household).   By subscribing to NBA LeaguePass that season I was able to watch all of the Linsanity games in their entirety, about fifteen of the games which ignited not only the country, but even more so the entire Chinese-speaking world behind a nearly Messianic figure, a young ABC (American-Born Chinese) man named Jeremy Lin.

Anyway, not to dwell on the subject any more than might be welcomed, the Lakers played WELL last night after two miserable season-starting outings, against a very strong LA Clippers team.  After a poor first quarter which put them down by 18 points, they came back to take a 6 point lead and make an exciting game of it, losing by 8 points.  Surprisingly, Kobe Bryant had after the second game asked Jeremy to be more assertive with the ball and NOT defer to him so much, and to lead the team in a more uptempo, quick passing game.  So my criticism of Kobe as a me-me-me player was valid, but he was man enough to realize it himself and to make the corrections!  Besides the team’s improved play, Jeremy racked up impressive individual numbers (yeah, I know, basketball is a team sport): 17 points, 9 assists, and 4 rebounds, and playing time only exceeded (by seconds) by Kobe’s.  The highpoint for me was a last-second three-pointer over team leader Chris Paul.  I feel like a proud papa…

I feel that I have gone over this many times, but it has usually been with Carol in the privacy of our living room.

Basketball is a TEAM SPORT.  For some reason this simple fact is lost on most of the announcers and analysts of the game, who love to dwell on the stats racked up by the star players. (Perhaps the fact that so many of the analysts are former stars explains this.  For example, Clyde Drexler loved to fawn over James Harden’s individual production while ignoring the contributions of the rest of the Rocket team)  Last night the Lakers lost to the Suns by 20 points, but in that loss Kobe Bryant scored 31 points.  Conclusion: the Lakers stink (quoting from ESPN’s Pardon the interruption), except for one good player: Kobe.

Wrong.  Why?  In racking up his 31 points, Kobe went 11 of 25 from the field, 44%. If his misses were cut in half, to 12 say, and replaced by baskets from teammates who were shooting better, this 24 points would have given the Lakers a chance to win the game.  In other words, Kobe’s “heroics” was a big factor costing them the game.

In other words, Kobe is a ball hog.  When his jump shooting is off,  he still insists on getting the ball.  Jeremy brings the ball up, defers to Kobe (he doesn’t have much choice because Kobe is the only one cutting to get free–the other players know Kobe is getting the ball anyway, so why should they try?), and Kobe then tries to score through double coverage, missing more than half the time.  (And the other team gets the rebound because the Lakers haven’t had time to penetrated.)

Not all stars have this negative effect on their team.  Lebron James is a playmaker as well as a shooter, and scores a high percentage of the time.  On the other hand, Carmelo Anthony is a Kobe-type “me-me-me” type of player who racks up impressive individual numbers while his team “stinks.”

Which brings us to Jeremy Lin.  Jeremy would rather make an assist than a basket.  In doing so, he includes his teammates in the offense, and motivates them to run and cut.  When he played with the Knicks he shot and made many three-pointers.  But he also fed Steve Novak, who during the Linsanity days was the most productive three-point shooter in the NBA.  After Jeremy left New York, under the Carmelo regime, Novak became an underused bit player.

Jeremy is a team builder.  Coach Byron Scott should realize this and take the ball away from Kobe Bryant (at least while his shooting continues to be mediocre) and let Jeremy build the Lakers, who have plenty of talent, into a productive team.