Friday, March 30, 2012


Rhonda had a relative named Tucson, pronounced Tuck' Son, with a nickname of Tuck, but this is about the city not the man.  We recently spent several days in the Tucson area, Oro Valley to be specific. 

A View from the Oro Valley

We headquartered at the home of a couple of friends from our Goshen College days, and the view above could easily be their back yard!  We had never visited any place in Arizona, so everything was new-to-us, from the restaurants to the local sights and sounds.  Of course food is always high on our agenda, and thus we usually had a light breakfast so that we could expend all of our 'points' later in the day.  All of the eateries were very good, and included the El Charro Cafe, Noble Hops, Sauce with a bit of gelato at Frost, Choice Greens and Caffe Torino. You can get a feel for each place by clicking on the links, but the Italian fare, bottle of Malbec and a bit of sorbet at the Caffe Torino was particularly special.

Other highlights included a visit to the Tohono Chul Park (outstanding desert botanical garden), a tram ride and walk in Sabino Canyon, a walk-about in the town of Tubac, and browsing at the Mark Sublette Medicine Man Gallery.  A special part of the gallery is the Maynard Dixon Museum, so any of you who are afficiandos of Native American and Southwest art, this is a must-see place.  Dudley and I did a 5.5 mile RT hike to the Catalina Mountains Romero Pools - very nice!

And we learned the proper pronunciation of Saguaro!


Top Money Makers - Hedge Fund Managers
All figures from AR’s 11th annual Rich List ranking of the 25 top-earning hedge fund managers for 2011.
1Ray DalioBridgewater Associates$3.9 billion
2Carl IcahnIcahn Capital Management$2.5 billion
3James H. SimonsRenaissance Technologies Corp.$2.1 billion
4Kenneth C. GriffinCitadel$700 million
5Steven A. CohenSAC Capital Partners$585 million

I guess that most of us are in the wrong business, eh?

Monday, March 26, 2012


It’s Not Like the Rest of Us, But It Should Be - by Ken Murray

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.
It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.
Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).
Almost all medical professionals have seen what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, “Promise me if you find me like this that you’ll kill me.” They mean it. Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo.
To administer medical care that makes people suffer is anguishing. Physicians are trained to gather information without revealing any of their own feelings, but in private, among fellow doctors, they’ll vent. “How can anyone do that to their family members?” they’ll ask. I suspect it’s one reason physicians have higher rates of alcohol abuse and depression than professionals in most other fields. I know it’s one reason I stopped participating in hospital care for the last 10 years of my practice.
How has it come to this—that doctors administer so much care that they wouldn’t want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.
To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices. They’re overwhelmed. When doctors ask if they want “everything” done, they answer yes. Then the nightmare begins. Sometimes, a family really means “do everything,” but often they just mean “do everything that’s reasonable.” The problem is that they may not know what’s reasonable, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them. For their part, doctors told to do “everything” will do it, whether it is reasonable or not.
The above scenario is a common one. Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a “tension pneumothorax”), walked out of the hospital. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. Poor knowledge and misguided expectations lead to a lot of bad decisions.
But of course it’s not just patients making these things happen. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the emergency room with those grieving, possibly hysterical, family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment.
Some doctors are stronger communicators than others, and some doctors are more adamant, but the pressures they all face are similar. When I faced circumstances involving end-of-life choices, I adopted the approach of laying out only the options that I thought were reasonable (as I would in any situation) as early in the process as possible. When patients or families brought up unreasonable choices, I would discuss the issue in layman’s terms that portrayed the downsides clearly. If patients or families still insisted on treatments I considered pointless or harmful, I would offer to transfer their care to another doctor or hospital.
Should I have been more forceful at times? I know that some of those transfers still haunt me. One of the patients of whom I was most fond was an attorney from a famous political family. She had severe diabetes and terrible circulation, and, at one point, she developed a painful sore on her foot. Knowing the hazards of hospitals, I did everything I could to keep her from resorting to surgery. Still, she sought out outside experts with whom I had no relationship. Not knowing as much about her as I did, they decided to perform bypass surgery on her chronically clogged blood vessels in both legs. This didn’t restore her circulation, and the surgical wounds wouldn’t heal. Her feet became gangrenous, and she endured bilateral leg amputations. Two weeks later, in the famous medical center in which all this had occurred, she died.
It’s easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litigation and do whatever they’re asked, with little feedback, to avoid getting in trouble.
Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack, a 78-year-old who had been ill for years and undergone about 15 major surgical procedures. He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. One Saturday, however, Jack suffered a massive stroke and got admitted to the emergency room unconscious, without his wife. Doctors did everything possible to resuscitate him and put him on life support in the ICU. This was Jack’s worst nightmare. When I arrived at the hospital and took over Jack’s care, I spoke to his wife and to hospital staff, bringing in my office notes with his care preferences. Then I turned off the life support machines and sat with him. He died two hours later.
Even with all his wishes documented, Jack hadn’t died as he’d hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it. But the prospect of a police investigation is terrifying for any physician. I could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks. I would even have made a little more money, and Medicare would have ended up with an additional $500,000 bill. It’s no wonder many doctors err on the side of overtreatment.
But doctors still don’t over-treat themselves. They see the consequences of this constantly. Almost anyone can find a way to die in peace at home, and pain can be managed better than ever. Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures. I was struck to hear on the radio recently that the famous reporter Tom Wicker had “died peacefully at home, surrounded by his family.” Such stories are, thankfully, increasingly common.
Several years ago, my older cousin Torch (born at home by the light of a flashlight—or torch) had a seizure that turned out to be the result of lung cancer that had gone to his brain. I arranged for him to see various specialists, and we learned that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with me.
We spent the next eight months doing a bunch of things that he enjoyed, having fun together like we hadn’t had in decades. We went to Disneyland, his first time. We’d hang out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He even gained a bit of weight, eating his favorite foods rather than hospital foods. He had no serious pain, and he remained high-spirited. One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.
Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don’t most of us? If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like my fellow doctors.
Ken Murray, MD, is Clinical Assistant Professor of Family Medicine at USC.

Monday, March 19, 2012


Even though everybody and their cousin will likely be writing about Peyton Manning's apparent move to Denver, I am putting this up because I know that some of you have definite opinions about all of this - including my Aunt Betty who will probably be one of many who are now Broncos Fans!

My personal opinion is that Denver should keep Tebow, let him learn and develop, and also be ready in case Manning gets injured, which is a considerable possibility.

Comment away!!

Sunday, March 18, 2012


Belated but definitely worth it!!

And note the playing time!!

h/t Anna M who commented "You are the only person I know who might appreciate this" :-)


Despite a forgettable story line, the movie has beautiful cinematography and outstanding music.  I recently caught some of it once again on cable, where it seems to show up regularly.  Here are two clips that are not necessarily the best songs, but to me they demonstrate how a very simple tune with repetitive lyrics can be both pleasing and engaging.  Hope you enjoy!

Saturday, March 17, 2012


Most of you here know that I am not a fan of Ken Ham and his anti-evolution, anti-science, my-way-or-the-highway brand of Christianity.  Hence, I found this pictorial quite amusing:

Friday, March 16, 2012



I previously wrote about a WWF-style smackdown among Mohler, Giberson and Coyne, and the verbal jousting continues.  Uncle Karl recently wrote a piece in the Huffington Post basically saying that atheists need to learn a bit more about church, maybe even by attending one, before they bomb religion with the petard of rationalism.  Coyne quickly responded with a post at WEIT - interestingly penned by the shadowy Sigmund who runs his own commentary at the Sneer Review.  It seems as though Coyne has turned over his BioLogos-and-Company critiques to Sigmund, who apparently keeps a close eye on the BioLogos website, former BL vice president Giberson, and other science-religion accommodationists.  

For me, both camps make some good points, and by reading both pieces, you can decide for yourself what does or does not resonate with you.  I am currently working on a post entitled The Limits of Religion in which I hope to explore the relationships among the church, state and science.

Tuesday, March 13, 2012


Geoff was a Goshen College classmate and friend.  You can read an obituary here that notes some of his personal achievements, and I have copied another below that highlights Geoff's professional achievements.  Although we all knew that Geoff was very smart and destined to become a great physician, many of us knew him as a dry-witted wag and highly talented bass player.  For many years, he played with The Dukes, a local Goshen band and then with the Backdoor Men at Goshen College.  He often jammed with other fellows, including a group that set up in the Union Building at GC, started playing and instigated what was likely the first rock and roll dance at the college.  Fittingly, Mike Hostetler dubbed the group The Corrupters.  I invite those of you who knew Geoff to add a Geoff-story in the comments section.

PTCA pioneer passes away: Dr Geoffrey Hartzler dead at age 65 March 13, 2012

{PCTA = Percutaneous transluminal coronary angioplasty}

By Michael O'Riordan

Kansas City, MO - Dr Geoffrey Hartzler, one of the pioneers of interventional cardiology, passed away on March 10, 2012 following a battle with cancer. He was 65 years old.

An interventional cardiologist who began practice in 1974 and who performed the first coronary angioplasty at the Mayo Clinic in 1979, Hartzler was doing successful percutaneous transluminal coronary angioplasty (PTCA) just two years after Dr Andreas Gruentzig performed the first procedure on a patient in Switzerland. Hartzler joined the Mid America Heart Institute in Kansas City, MO in 1980, where he started the angioplasty program, one of the busiest programs in the country, and worked there until he retired in 1995 at 49 years of age due to chronic back pain.

To heartwire, Dr Gregg Stone (Columbia University, New York), who completed an advanced coronary angioplasty fellowship with Hartzler in Kansas City, MO, a fellowship he established in 1986 to train two interventional cardiologists per year, said that his contributions to medicine cannot be overstated.

"Whereas Andreas Gruentzig was responsible for bringing angioplasty to the world, Geoff Hartzler was the single person most responsible for extending its application to the millions of patients who currently benefit each year from interventional cardiology," Stone commented to heartwire. "Whereas Andreas believed PTCA should be restricted to proximal focal lesions, Geoff was the pioneer who brought interventional cardiology (balloons only, no less) to patients with acute MI, multivessel and left main disease, chronic total occlusions, and much more."

Hartzler was fearless, added Stone, possessing "technical gifts that to this date have not been equaled," but his career was guided by his compassion for the patient. Along with colleagues at Mid America Heart Institute, Hartzler established a database of interventional cases, and this helped bring evidence-based medicine to the field, said Stone. Live case demonstrations led by Hartzler also helped a generation of doctors become interventional cardiologists.

Speaking with heartwire, Dr Barry Rutherford, the director of interventional research at St Luke's Mid America Heart Institute, called Hartzler's passing a tremendous loss for the cardiology community. He agreed with Stone, saying Hartzler's greatest contribution to interventional cardiology might have been in the acute-MI setting.

"Prior to Geoff, we were all just using streptokinase and waiting for the artery to open," said Rutherford. "Geoff came upon the idea that we could just simply deliver the balloon across the occluded vessel and it would open up. That was so dramatic to see. The patient comes in with an evolving infarct, in a lot of pain, with blood pressure down, and then you open the artery up and suddenly the pain went away and hemodynamics stabilized. He took a lot of criticism over many, many years for that procedure, and we had to defend it at the ACC and AHA, and it probably took 10 years for it to be recognized as the standard of treatment. I think now that he's probably responsible for saving millions of lives around the world."

Dr David Holmes (Mayo Clinic, Rochester, MN) and Hartzler both arrived at the Mayo Clinic together as student clerks in their senior year of medical school. They were assigned to the ECG laboratory together and eventually joined the staff together, working in electrophysiology and also in interventional cardiology.

"He was a brilliant electrophysiologist," Holmes told heartwire. "We think in terms of him being that interventional cardiologist of note, but he was incredibly gifted as an electrophysiologist, doing the first, as far as I know, ablation for ventricular tachycardia."

In addition, Holmes said that Hartzler pioneered advanced pacing and mapping of cardiac arrhythmias and performed work and research that was seminal in the growth of the field. He was always interested in new approaches to treatment, and this interest presaged his groundbreaking work in interventional cardiology.

"In all of these things, his work, his approach, and his life could be summarized by passion, by creativity, by sharing, by educating, and by taking care of patients," said Holmes.

In addition to starting the fellowship program, Hartzler began teaching sessions at Mid America, small sessions that initially had 20 to 30 physicians. These sessions were eventually expanded to include 300 to 400 physicians each year, and in these sessions an entire generation of interventional cardiologists learned their craft.

Despite retirement, Hartzler stayed active in business, serving as a consultant or as a director on a number of companies, including serving as the board chair of IntraLuminal Therapeutics, a company he cofounded, from 1997 to 2004.

In a 2005 feature story on some of the occupational hazards of working in the cath lab, Hartzler detailed some of his back problems, including ruptured vertebrae that led to five lumbar laminectomies and a cervical fusion, related to treating so many patients. At the time, he was nearly a decade removed from the cath lab but said he had no regrets about leaving.

"I retired pretty much at the top of my game," Hartzler told heartwire at the time. "I wanted to stop when I was still appreciated for doing good work. People may have a hard time understanding that when I started, interventional cardiology was just coming into being, and I was honored to be part of developing it."

Hartzler is survived by his wife, Dottie, and their four daughters.



I think that Rick locked up the 'green' vote with this bit of brilliance:

"The dangers of carbon dioxide?  Tell that to a plant."


Friday, March 09, 2012


Some day, Blogger will make it easier to post audio clips.  I would really like to post some of the songs written and recorded by brother-in-law Ken Willems, aka The Folksingin' Junkie.  He just recorded another CD with all original tunes, and the blues tune lyrics below made me laugh out loud. 

White Trash Blues

This is a great country, and we’re takin’ it back.
Socialists in Washington, got us off track.
In front of my big screen, watchin’ Fox News,
Here in my trailer, with the white trash blues.

There’s a socialist nearby, can’t be no doubt,
But I ain’t workin’, ‘till unemployment runs out.
Can’t even use my food stamps on cigarettes and booze,
Here in my trailer, with the white trash blues.

Got eight kids, only three by my wives.
Soon as one leaves, a new on arrives.
But I believe in God, and family values,
Here in my trailer, with the white trash blues.

Got a reinforced bunker and 36 guns,
Eight cars in the yard, and none of them runs.
Got me a mullet, and a bunch of tattoos,
Here in my trailer, with the white trash blues.

The American Nazis, they ain’t all that bad.
Never did join ‘em, but I kind of wish I had.
This country is run now by socialist blacks and Jews,
And I’m here in my trailer, with the white trash blues.

The Folksingin' Junkie in the Upper Room of his barn.

Thursday, March 08, 2012


GOSHEN, Ind. -- Goshen College's twelfth annual Conference on Science and Religion will be held March 23-25, and will feature Notre Dame theologian and scientist Celia Deane-Drummond. The theme for this year's conference is "Re-Imaging the Divine Image: Humans and Other Animals." Deane-Drummond will offer a public lecture on Friday, March 23 at 7:30 p.m., titled "Re-Imaging the Divine Image: Freedom," and another on Saturday, March 24 at 10:30 a.m., titled "Re-Imagining the Divine Image: Virtue." Both lectures will take place in Goshen College's Church-Chapel.

Deane-Drummond has been professor of theology at the University of Notre Dame since August 2011. Her unique appointment is concurrent between the Department of Theology in the College of Arts and Letters and the College of Science. She was elected fellow of the Eck Institute for Global Health at the University of Notre Dame in September 2011.

Deane-Drummond graduated with a degree in natural sciences from Cambridge University and obtained a doctorate in plant physiology at Reading University prior to two postdoctoral fellowships at the University of British Columbia and Cambridge University. She subsequently took up a lectureship in plant physiology at Durham University before turning her attention more fully to theological study, obtaining an honors degree in theology and then a doctorate in systematic theology from Manchester University.

During her scientific career Deane-Drummond lectured both nationally and internationally, and published over 30 scientific articles. Since then, she has published numerous articles, books, edited collections and contributions to books, focusing particularly on the engagement of systematic theology and the biological sciences, alongside practical, ethical discussion in bioethics and environmental ethics. She has lectured widely both nationally and internationally on all areas relating theology and theological ethics with different aspects of the biosciences, especially ecology and genetics.

From 2000 to 2011 Deane-Drummond was professor of theology and the biological sciences at the University of Chester, and was director of the Center for Religion and the Biosciences that was launched in 2002.  In May 2011, she was elected chair of the European Forum for the Study of Religion and Environment. She was editor of the international journal "Ecotheology" for six years.

Since 1992 Deane-Drummond has published as a single author or as an editor 22 books, as well as 33 contributions to books and 43 articles in areas relating to theology or ethics. Her more recent books
include: "Ecotheology" (DLT/Novalis/St Mary's Press, 2008); "Christ and Evolution: Wonder and Wisdom" (Minneapolis: Fortress/London: SCM Press, 2009); "Creaturely Theology: On God, Humans and Other Animals," edited with David Clough (London: SCM Press, 2009); "Seeds of Hope:
Facing the Challenge of Climate Justice" (London: CAFOD, 2010) and "Religion and Ecology in the Public Sphere," edited with Heinrich Bedford-Strohm (London, Continuum, 2011).

Goshen College's Religion and Science Conference is designed to provide maximum interaction with one of the principal thinkers in the dialogue between religion and science. A single invited speaker presents three lectures, two of which are open to the public. Small, moderated discussion sessions provide conference participants an opportunity to address topics from the lectures, and others, in conversation with the speaker.

Conference attendants and participants include pastors and interested laypersons, as well as academic scientists, mathematicians, theologians and students. For more information about the conference, visit

Friday, March 02, 2012


A while back, I posted a favorite oldie, He's So Fine, by the Chiffons.  The publisher blocked the video, so I went looking for another [and fixed the link on the original post].  But I also found this - a very interesting comparison.  Enjoy!