Nov 05


Marike and Marianne visit to Washington State
22-26SEPT2017
Betsy and I had heard that our friend Marike from Germany was coming over to the USA, so wished to introduce her to the Pacific NorthWest. She was accompanied by her friend Marianne, both were environmental studies students in Berlin. Jon and I had encountered Marike in Berlin while we were passing through, and left her my touring bicycle, with agreement that she would pay for it at her earliest convenience. I guess that no time will ever be “convenient” for her. Knowing that she would be in America for a wedding, she and her travel friend decided to see the PNW. We picked her up at the airport, and after settling in, went out to dinner at the Lobster Shop in downtown Tacoma. The next day, it was a planned trip to Mt. Rainier. We did the loop around the mountain going clockwise, starting north through Enumclaw. Our adventure went up to Sunrise, and a 4-5 mile hike ensued. The weather was cloudy, but periods of being able to see the entire mountain would happen, leaving it a spectacular beauty. I didn’t anticipate snow, but Sunrise received a dusting, as you can see from the above photo. We didn’t have enough time to do too much else, but did stop at Reflection Lakes, though it had clouded over by then and no reflections were to be seen.

At Sunrise point


A view of the mountain


That evening, we went out to dinner at Chili Thai, joined by Dr. Peters. The next day ended up to be unexpectedly a bit more clear in weather, but we had other plans, starting with the museum of glass. We decided against doing too much more in downtown Tacoma, and drove home, followed by a long walk on the Foothills trail to the Carbon River crossing from Orting.

On the Carbon River bridge


Monday took us to Seattle proper. We drove to Angle Lake and rode the light rail into the city. Our first adventure was downtown, seeing the sites and hitting Pike Place market. Running a bit short on time, we rode the monorail up to Seattle Center, where we viewed the Space Needle and saw the general sites of the old world fair. At this point, Marike wanted to see the museum of pop culture, but Marianne and I were not so interested, so we split up. Marianne and I went back downtown, and ran down to the waterfront, where we toured various shops. After that, we quickly ran up to the Flagship REI store in Seattle, which Marike and Marianne were both interested in. After purchasing several memorable REI t-shirts, we stopped by the Feathered Friends store (which makes down parka/sleeping bags for fun and expeditions) and then ran back to WestLake Center to reconnoitre with Marike.

In old town Seattle, next to a commemoration of Chief Seattle


Pike Place Market


On the Monorail


The Space Needle


Museum of Pop Culture


The REI headquarters in downtown Seattle


The grounds around the Seattle REI


Tuesday was the day to say goodbyes. I took Marike to the airport, and Marianne went to spend several more days in Seattle, followed by several days in Portland, meeting up with my sister Gloria, who took Marianne around town. It was an enjoyable time with the two girls, though their interest was mostly environmental, and they had arrived right at the dead end of the PNW season for getting outdoors, making it difficult to plan for outings. The two girls were quite enjoyable to be with, but Betsy and I (and Gloria) were left a little bit perplexed about matters, as though we might have offended their sensibilities. Strangely, they have not made any effort to reconnect with us. Perhaps their preconceptions from the German media have left them with an American stereotype offensive to their taste. Perhaps we were just old fogies unable to satisfy the whims of the youthful heart. Whatever it was, I do hope they do well in their studies and that they single-handedly save the world from an environmental catastrophe. So I wish them the best.

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May 17

Why I am Leaving Medicine
Kenneth A. Feucht, M.D., Ph.D.
I formally decided to quasi-retire in October of 2016. This meant for me, getting out of the surgical oncology profession. My intention is to continue working until 31MAR2018 in an outpatient wound care clinic associated with the hospital in Puyallup, WA where I live. Remember that training in my profession consisted of 15 years past the 12 years through high school, so that I have completely identified myself as a surgeon, making my profession not easy to give up. I would have liked to continue practice until I was 65 or more, but frustration with medicine and the changes which have occurred since becoming a physician have led to my desire to leave medicine. This is not an easy decision. I have a deep love for my patients, and found the profession to be quite rewarding. It was particularly satisfying dealing with patients not only for the relief of their physical ailment, but also to help them psychologically and spiritually through a major crisis in their life, which is usually the situation when somebody is given a diagnosis of cancer. With my decision to retire a bit earlier than I had wished, I felt that chronicling the root causes for my decision would be appropriate. The list of my grievances with the health care profession is in no way intended to be comprehensive, but to cover the major areas of frustration for me as a surgeon. This is NOT an in-depth, heavily researched paper with references and documentation, but an off-the-cuff rendering of my feelings regarding the status of health care. Perhaps someday I will take the time to render a more academic version of this treatise.

Health Care Orientation

Hospitals began in the fourth century in central Turkey in a region called Cappadocia. At that time, the poor and destitute who were ill were abandoned by the community and sent away into the woods, where they were often eaten by wolves or other forest beasts. This allowed for containment of communicable diseases, but did not reflect well on the care of the ill patient. It was St. Basil who took these poor people and reincorporated them into a caring community environment. Thus, we get our word “hospice” or “hospital” from the latin word which would be translated as “hospitable”. Hospitals became defined as an agency that attended to and offered the patient an ability to return to the community of the faithful while under care.
Germans have two names for hospitals. The most common is “das Krankenhaus”, though they also use the term “das Hospital”. Translated literally, “Krankenhaus” simply means “sick house”. It is a vastly more fitting word for what we have today, and the term “hospital” should go out of existence. Hospitals are no longer places of caring, and they do not offer the patient a gracious return to the community, or hospitality. They are places where patients are treated with sterile rigor, where children dump aging parents once they have become a nuisance, where occupants are considered to be more work for already overworked nurses, where physicians rapidly fly by patients, knowing that they dare not say either too much or to little, but where everything needs to be documented in a complex electronic database, and where nurses spend most of their time making sure that those databases are replete with boilerplate (and thus useless) data to fulfill various government mandates over what needs to be documented. The entire orientation of healthcare is a narcissistic reflection on themselves looking past and ignoring the raison d’être for their existence, the patient!

Defining “Healthcare”

What is healthcare? What is involved? What is health? What is wellness? How do you define something nebulous? The dictionary defines it as “the maintenance or improvement of health via the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in human beings.” This definition can be strewn out to as broad of meaning as life itself. Is my mental stress over an upcoming test in school a part of healthcare? Is my desire to become and identified as a female when I started out genetically and physically a male a part of healthcare? Is my carelessness in attending to my mental state when I accidentally kill somebody while driving a motor vehicle under the influence of alcohol actually a healthcare problem?
But, why do we even waste the time to precisely define the full nature of healthcare? Is it really important that we have a narrow versus broad definition of healthcare? From a personal point of view, the manner of defining healthcare is unimportant, but from a health care policy perspective, it is vital. The government promises that healthcare will be paid for, but exactly what that means is quite vague. In Germany, going to the spa for a week or two rest is covered. In the USA, the breadth of coverage constantly changes according to what is politically expedient. Oregon attempted to identify and rank cost-effective treatments to determine what might be covered. Since physician assisted suicide is very cost effective, it ranked quite high up. Is this proper? Assisting somebody in suicide seems to be counter to the entire goal of the medical profession, but nobody could doubt that much expense is saved by terminating the patient. If trans-sexual surgery is covered by government policy, why isn’t all cosmetic surgery covered, since it is aiding to personal well-being and how a person defines themselves? Why isn’t food free, since it is really taken to prevent healthcare problems? Why isn’t our housing and the cost of maintaining housing covered, since it all contributes to me maintaining and improving my health?
What about health itself? How do you define health? Is it just the absence of sickness? If so, then obesity would not be a health problem, or smoking, or any other dangerous activity, until it caused a problem. Some people choose to live through disabilities that would be viewed as insurmountable by others and refuse to identify their disabilities as an “illness”.
A frightening result of having an all-encompassing definition of healthcare that is provided for by government, is that they then must adopt the role of supervising our behaviors in order to maximize the government definition of health and well being. Does somebody really want the government telling them that certain activities are forbidden? Does anybody really want government prescribing exactly what you can eat and how much you can eat in order to stay healthy. When Michelle Obama attempted to regulate school lunches in order to decrease obesity, it was found that the children actually became more obese who were on the lunch program. When do we decide that decisions in our life become none of the government’s business? If we allow that government is responsible for health and well-being, we must realize that we are then completely giving away our freedom.
In reality, the public definition of healthcare is impossible and it would be best if we remove any attempt at defining the realm and coverage of what we think as healthcare.

Government interference

We are constantly being bombarded in the news that a new regime of politicians will correct the messes that former regimes have created in federal health care policy. I will speak of ObamaCare specifically a bit later, but here address specifically issues of government policy in health care. Over the course of the last century, we have gone from a situation where there was no government involvement directly in healthcare, to where government pervades virtually every aspect of the healthcare scene. Government first became involved in healthcare in Germany during the tenure of Bismarck. In 1883, he created a national healthcare system which provided insurance to all citizens. Many countries today follow the Bismarck model, though we do not in the USA. (ObamaCare seemed to be a model that attempted to simulate the Bismarck model though not utilizing many of the most important aspects of the Bismarck model.) Through the introduction of Medicare by president Johnson in the 1960’s, there has been a slow invasion of government into the healthcare scene. Government continues to fund increasing amounts of healthcare, and thus has taken an increasing stance toward controlling health care costs. At the same time, the innocent introduction of internal means of quality improvement (such as the JCAHO, which was started by surgeons as a means of voluntarily improving surgical quality across hospitals in the USA) has evolved into a beast that neither improves the care of patient nor the quality of healthcare delivered. More will be spoken on JCAHO later.
In times past, physicians generally took the Hippocratic oath on graduation from medical school. If not the Hippocratic Oath, then a somewhat similar oath (see article on the Hippocratic Oath, referenced below) was offered. In the Hippocratic Oath, three parties are involved, which include the patient, the physician, and the god(s). Glaringly omitted from the ancient oaths were the health care system, insurers, the government, and anybody else outside of the three mentioned. This is only right, and an article I’ve written on the oath covers why such an arrangement is so vital to the doctor-patient interaction (http://feuchtblog.net/die-veroffentlichungen/the-hippocratic-and-other-oaths/ ). Healthcare is now run by a multiplicity of bureaucrats and idiot savants who love to tell physicians and patients what is best for them without any knowledge of either the patient or physician. Government makes a cookie cutter mold that all diseases and persons are supposed to fit into. Diagnoses have a number assigned to them according to the ICD-10 manual, and no diagnosis will fail to have a specific number. Treatments and procedures also have their number, called the CPT code, with a one-size-fits-all mentality.
Government healthcare is run by bureaucrats. These are the self-serving policy wonks and bean counters that control the health care of all occupants of the United States, citizens and non-citizens, consenting and non-consenting, the sick as well as the healthy, the only exception being the politicians themselves. Most often, these healthcare pundits have been in the health care profession as either physicians or nurses, but are now removed from actually providing care, and thus not experiencing the consequences of the policies they implement. Being removed from health care, they may act with heartfelt concern for their colleagues in the trenches, but will never be able to properly address the constantly changing healthcare scene that affects healthcare delivery. In addition, their policies will fail to address all contingencies and variations in the disease process or patient goals and needs.
The government, since they intend on paying for healthcare, are obsessed with the cost of healthcare. Yet, they strangely seem to be the most clueless as to why healthcare costs so much. Perhaps healthcare costs are high because of government interference?
Two organizations from the federal government have been particularly harmful to healthcare, that of the food and drug administration (FDA) and the other the center for disease control (CDC). The FDA started as a well intentioned idea to protect the public from potentially dangerous drugs. The thalidomide incident in the 1960s is instructive. Thalidomide is a medication designed to decrease morning sickness in pregnancy, but was noted well after the fact to occasionally cause phocomelia, very short limbs, in some of the babies exposed to this drug in utero. I’m not sure that thalidomide babies could have been prevented even if the FDA was functioning as they do now, but a good crisis has not gone to waste by the government. It now takes many more years for a drug to go from creation to market in the USA as compared to Europe and other countries in the world. Drug development costs have risen to exceed a billion dollars to get an new drug to market in the USA. Yet, American patients are not safer than European patients, though we are denied rapid access to potentially useful medications.
While the FDA “protects” us against dangerous drugs, the CDC is here to “protect” us from various communicable diseases. I have less of a problem with the CDC than the FDA, though the CDC remains over-reaching in so much of what they do, and persist in trying to justify their own existence. The flu vaccine is a perfect example. It is close to impossible to predict which flu antigens would be dominant in any flu season, and the antigens of choice are made by “educated” guess. I know of no randomized trials that have proven within reasonable doubt that mass forced administration of the flu vaccine decreases morbidity or mortality from the flu. Health care personnel that work for hospitals are mandated to take the flu vaccine, and we have no other options. It matters not that we might have strong personal preferences against the flu vaccine. Another example, Gardasil, the vaccination against HPV, is sold to prevent genital warts, and thus cervical cancer, and is recommended for all males and females between 10-12 years of age. It is of value only for the sexually promiscuous female, but is strongly encouraged that all children receive this vaccine. Long term effects of the vaccine are essentially unknown. The CDC would love to have this vaccine mandated, and there is great pressure on all children to receive the vaccine, even from family physicians. This represents an over-arching hand that doesn’t allow for patients to make personal choices regarding their behaviors and actions, but assumes that all patients (or children) will be irresponsible and not have to take account of their actions. The CDC in effect takes the roll of parent, and displaces the biological parents as having a say in the behavior of your children.

ObamaCare Mess

ObamaCare is presented as the great revolution in healthcare, the solution to all of our problems, the defining policy that will allow all people in America to have adequate health care without obstruction from inability to pay. The health care bill was so voluminous that nobody in congress was able to read it in its entirety, and the proponents demanded that the bill be passed before one could discover what was in it. I won’t belabor the nature of ObamaCare because I have not read the bill, nor have any interest in reading the bill. What I will discuss is how it has affected physicians attempting to care for patients.
Obamacare wished to improve everybody’s access to healthcare, including that of illegal aliens. To do so, health care insurance was mandated to all. If you didn’t purchase healthcare, you were fined. You could either purchase private insurance, or the state would provide options. The rules were tightly defined for enrolling or switching health care plans. The presumption is that all people then had health care. Wrong! The cost of healthcare has continually escalated, and all plans had a copay for any service rendered. Copays were intended to prevent flippant and casual care. In actual fact, it has served to be more restrictive than anything to actual access to care. There are many patients that have turned down a proposed treatment plan for them simply because they could in no way afford the copay. In essence, care became more difficult to get.
ObamaCare also sought to assure that increased value was offered. This had multiple aspects, including patient satisfaction surveys, increased demands on providers to be fully “educated” through CME (more on this later), and increased demands of JCAHO. Patient satisfaction surveys were reported through what are called Press-Ganey scores. For employed physicians, bonuses were heavily dependent of the Press-Ganey scores. While Press-Ganey scores reflected how patients feel about their physician, it had minimal correlation with the competence of the physician. A physician that is the bearer of bad news, no matter how well it is delivered, will often be viewed with less favor than a physician bearing good news. Physicians oftentimes need to reprimand patients or cajole them into healthy behaviors, which is usually not viewed favorably by the patient. Some physicians are quite excellent, but do not have jovial personalities, which patients don’t like. Or, they have a jovial personality but are incompetent, something that a patient might not realize until it is too late. ObamaCare has allowed feelings to supplant honesty and truth, and the end-result will ultimately be disaster. Meanwhile, ObamaCare has flunked in its attempt to define quality in health care, and I’m not sure the ObamaCare act really cares about quality; they simply want the illusion that everybody is getting quality healthcare.
Are people truly having good coverage of their health care problems? The answer is complex, as there are a few people that have coverage that otherwise would have been out. Before government got involved in healthcare, most large cities and all counties had a county hospital that would take care of the indigent. Everybody ultimately received health care. Pharmaceutical firms were good about providing reduced rates on expensive drugs to the poor, and almost all people were able to survive. Now, coverage is actually worse, and many no longer have actual coverage of expensive treatments because they are responsible for a copay, which might be unaffordable. The only group of people who are better covered are those who should not have coverage, such as illegal aliens, or those who are mostly responsible for their own illness, such as burned out drug addicts.
Are the physicians getting rich? Definitely not! Over the last thirty years, physicians had to work harder and longer and more hours to make commensurate pay of the past. As a result, physician burn-out has become a true problem. The solution for physicians has been to become employed. I won’t belabor the problems of employed physicians, save to mention that employment essentially strips them of the definition of a true professional. They are nothing but expensive, sophisticated hired hands, and they will behave as such. People who serve administrative positions in health care are getting rich, and hospital CEOs as well the insurance companies are making out quite well. For the most part, physicians are getting poorer.
ObamaCare has not addressed the reason why healthcare is so expensive, and has diverted the attention from health care costs to health care availability. I am grateful that illegal aliens can receive the best health care in the world for free at my expense. In fact, I am waiting eagerly for anybody to provide an honest analysis of health care costs, and an explanation as to why health care costs in the US are much higher than in Europe or the rest of the world. I can think of many reasons, and simple explanations such as the absence of free markets deflects from serious analysis of costs, which has multifactorial roots.

Physician Regulations

The state has deemed it vital to make sure that physicians are competent. In order to define competence, the state has had to set some sort of prevailing standard, which is an amalgam of current practice and best practice recommendations based on the latest research. This assumes that best practice can be codified and then enforced. It assumes that current prevailing practice is the standard for all physicians and all patients,  and that our knowledge of disease pathology and physiological processes for disease are correct and well understood. Sadly, history is replete with countless times where the medical profession has been wrong and has had to eat their words. It is no wonder that much of what I had learned in training had to be unlearned as simply wrong. Medical practice is in constant change, and not necessarily in the correct direction. One dares not fight the system if the system is going in the wrong direction.
The state needs a way of making sure that physicians are keeping up with the latest and greatest developments in health care. The current standard is to require physician recertification, usually every ten years. The other is the requirement for continuing medical education, or CME. There are serious problems with both of these systems. For recertification, the physician needs to be placed in a box that defines who they are. These boxes are the selected specialties that the physician identifies with, whether that be in family practice, pathology, internal medicine, general surgery, or a host of other specialties. But, these specialties are too vaguely defined, such as in my specialty of general surgery. I am a surgical oncologist, and the American Board of Surgery only recently created a board specific for surgical oncology. Surgical oncology itself is heavily fragmented, between melanoma surgeons, breast surgeons, hepatobiliary surgeons, sarcoma surgeons, and a smattering of other organ specific surgeons. Within the last 20 yars, surgical oncology has essentially lost head and neck surgery, endocrine surgery, thoracic surgery, and colorectal surgery. True, one would like their surgical oncologist proficient in all aspects of cancer surgery, yet reality states otherwise. Regional referral patterns and practices also affect a surgeon’s expertise. Certain diseases are just more prevalent in some areas as compared to other areas of the county. In Chicago, I saw much pancreatic pathology. In Seattle, there is very little pancreatic disease, but a proliferation of other diseases. The truth is that as a professional, one is always reading and educating oneself, and each individual physician will develop a differing broad area of expertise. A simple test imposed by the state is not capable of defining what only the test of real life scenarios can clearly define. Recertification has become a horrid pain to take. I’ve re-certified twice, have done well in my re-certifications, but swore on the last re-certification that I would never do it again, ever, for any reason. Most physicians reach the same conclusions as I have, and the net result is to drive out the aged but experienced physicians. The only exception is in academia, where the surgeon is somewhat protected.
Keeping up with CME is a pain. It is not enough to simply subscribe to various specialty journals and read them on a regular basis. Now, one must answer sets to test questions to assure that you’d acquired the information attempted to be taught by the article. The Journal of the American College of Surgeons would do this for four articles each month, and I dutifully answered their questions for a number of years. About 2 years ago, I realized the stupidity of most of the questions, and how they were usually completely unrelated to my field of practice. The questions were intended to quiz whether you had read the article, but often assumed you had knowledge well beyond that of the article; thus, there was no education of the physician, and failure to judge whether I’ve read and learned from the article. The problem is compounded when articles relate to my own specialty, since I usually read into the question the controversies involved and uncertainty about the information in the article. The multiple guess questions really fail to assess my true knowledge of a subject, yet is mandated in order to assess whether I’m actually staying on top of my specialty. CME updates are demanded by the American Board of Surgery every three years, and I will be letting the next update slide.
Increasing surveillance of physician behavior is happening. This relates to both social behavior, as well as practice outcomes. Hospitals are simply not turning a blind eye to behaviors that would be publicly unacceptable. There has been a change from historical norms, where previously the physician acted mostly without accountability. This is a good thing, and physician antics with the treatment of patients, colleagues or nurses must be now accounted for. The only problem is that it is the hospital that is performing most of the policing, and they have a very strong bias for protecting themselves. Thus, there is predictably unfair judgement against unemployed physicians, and usually it is by someone clueless. I recall, for instance, being reprimanded by the chief medical officer at my hospital for not responding in person to an emergency room call, even though I was in the middle of a case in the operating room. I informed the CMO to no avail that it would be considered unethical and immoral by the American College of Surgeons for me to leave a patient open on the table to attend to another person. Such madness has only gotten worse under ObamaCare. Physicians are still held liable as “captains of the ship” yet are not given the power or authority to maintain that captainship. We are constantly being told to alter our behavior or practice in the most minute ways that have no real bearing on patient outcomes or hospital well-being. The focus has turned from outcomes to process, without any evidence-based data to suggest that behavior changes would be good.
The discussion of “captain of the ship” bears more intensely on issues of hierarchy within the hospital structure. Traditionally, physicians were the main drivers for hospital decisions, dominated the board of directors of a hospital, and were held as primarily responsible for the success or failure of the hospital. Now, responsibility falls to the CEO and his minion of subordinates, most of whom are not physicians, though they might be nurses, pharmacists, physical therapists, or simple business types with no training in medicine. Because of the increasing commercialization of medicine, spread sheets and the color of the bottom line have become the most vital aspect at determining the survivability of a hospital. The physicians have silently gone from being the leaders of the hospital to being nothing but another cost center to be dealt with.

Documentation/HIPPA issues

Until recently, documentation was performed in paper charts, usually a combination of typed text and handwritten notes along with printed reports, lab work, and outside information. Marginal notes would be made in the chart to facilitate jogging the memory of the physician. A typical note would take a few minutes to write, but would be highly effective at documenting an encounter. With the rise of third party indemnification (insurance), the desire to have confirmation of services rendered demanded improved documentation. The saying, “If it isn’t documented, it wasn’t done” became the hallmark message for mass documentation. This led to automation of means of documenting, including boiler plating encounters and procedures. This naturally led to the reverse problem of the past, in that much “documentation” might not have ever been performed. Because boilerplating made possible getting information quicker into electronic format, and with the rise of improved databasing and need for distribution of data, the electronic medical record (EMR) saw its rise. What was once a convenience became a mandated necessity. Many payors no longer accept handwritten charts, and the federal reimbursement systems require EMR for full reimbursement. EMR systems are very expensive, not only to implement, but also to maintain. They solve the problem of a plethora of charts and storage of these charts, as well as issues of lost charts, and the need for multiple simultaneous access to these charts. The down side is harder to see but more destructive. With a combination of requirement for increased documentation, and through the use of boiler plating, excess information now exists, and it is quite challenging to quickly identify the relevant information on a patient. Because of multiple sources for input to the EMR and restricted ability of access users to correct faulty information, the EMR slowly becomes less and less reliable. Errors become quite plentiful, from basic patient information, to diagnoses, medications and treatments.
Meanwhile, privacy of the data has become a greater concern. Physicians were instructed not to talk about patients in the elevator with outside people present, or to share patient data with people outside of the immediate family, unless given permission by the patient. Now, privacy has become a fanatical issue. In the past, I would walk onto a ward, and at the nurses station, a chalkboard list of all the patients and their room number was present. At the door of each room, the patient(s) name(s) were again posted, allowing for re-identification of the patient. This doesn’t happen any more, all in the name of patient privacy. The problem is that it is now easier to confuse or mix up patients, and more errors occur because of that.
Privacy in electronic data is a greater issue. The need for highly secure servers to manage patient data has become the norm, all mandated by HIPPA (federal policy). Yet, the skill of hackers has not been thwarted from obtaining any private patient data that they wish. True privacy is a myth, but the expense that we go through to maintain this illusion of privacy is astronomical. Indeed, true privacy is impossible. Perhaps all patients should present themselves to the physicians office or hospital in full covering like a Burqua or KKK outfit? Yet, the one area where privacy is zilch is with the government. They now know EVERYTHING about you. I fear the government more than I fear some stranger knowing that I happen to be on a β-blocker or some other medication. Yet, the feds have access to every aspect of my health care record.

Big Pharma

I don’t view big pharma as an intrinsic evil, and much of their perceived evil comes from government and legal policy imposed upon them. There is no doubt that the large equipment and pharmaceutical firms have vastly improved the quality of healthcare in our country, as well as throughout the world. It is without a doubt that drugs exist and are available today that never would have been possible without these large companies. But, the large pharmaceutical and equipment firms comes at a terrible cost to all of us.
The large pharmaceutical firms must deal with a host of regulatory agencies, the FDA being the largest of them. One would think that big pharma would be fighting the FDA tooth and nail, yet the opposite is the case. The pharmaceutical firms have seen the FDA as a wonderful means of keeping out smaller competition, which is why you don’t see small pharmaceutical firms in this country. The assistance of the FDA in the assault on the nutritional supplement and vitamin industry is shameful. Big pharma has relished the protection to their industry by the FDA, leading them to become even more powerful at controlling the drug market. Concomitantly, we see larger firms buying up the smaller pharmaceutical firms, and thus becoming ever more powerful.
A secondary problem is created when insurers pay for medication costs, so that the consumer never sees those costs. This becomes problematic if a patient is unable to perform a cost-benefit relationship to determine whether a drug is worth taking. A perfect example are the statin drugs to lower cholesterol. I wait eager to see any statin demonstrate improved survival over the best alternative therapies out there. Statins have a high chance of significant side effects, yet has never been shown to be significantly effective at preventing death from atherosclerotic heart disease. And, they are expensive drugs. Too often, the patient assumes that the physician is using critical judgement in determining the need for a drug, yet the greatest determinant tends to be how good of lunch the drug representative brings to the doctor’s office.

Insurance

A system of third party payment for health care has created the worst possible solution for healthcare. It is a serious misnomer to title health insurance as such, since it does not operate like insurance, but simply as a mode of funding. Insurance supposedly should be most active when there is an acute need, such as with a car accident or a heart attack or a new diagnosis of cancer. Instead, it covers every possible aspect of health care, including runny noses in kids to health maintenance examinations. Under ObamaCare, health insurance is not an optional decision, but mandated by the state. In such a situation, you would expect the health care insurers to making out quite well, and for the most part, they are, with executives of the major insurance companies making exorbitant profits. Yet, there are strains on the system. Insurance is not able to reign in the ever-rising cost of health care, and can only raise premiums and copays to a limit before the system breaks. And, the system is about to break.
Ultimately the big winners in todays system are the insurance companies, but that is a bittersweet win, as they continue to merge with other systems in order to survive. Time will ultimately pass a severe judgement on insurance companies.

Legal Aspects

If you read the popular press, they would suggest that legal issues are a small portion of what’s “broken” in medicine. Whenever malpractice tort reform becomes a subject of referendum up for vote for the public, the advertisements and press attest to litigation being a small part of costs for doing medicine. Yet, those most entrenched in the health care system and actually paying attention what is going on realize that legal aspects of medicine are probably our worst enemy, and that politicians and lawyers who know little of the actual functioning of healthcare are essentially orchestrating how things should be done in the health care world. If a physician suggests changes in the legal world, lawyers tend to attack the physician as ignorant, befuddled, or clueless as to how law actually works. Perhaps outsiders see the legal world a little more clearly than lawyers? Yet, it is most true that lawyers and political meddling in the world of medicine have only left medicine far worse off.
When a physician attends conferences, there are numerous sessions offered on how to avoid or deal with lawsuits. It is made very clear that the physician should understand that everybody gets sued, and that a lawsuit often is the “luck of the draw”, and that a physician should never take a lawsuit personally. Yet, in court, it is presented as just the opposite, and the claim is that there is something wrong with the physician that caused the medical “error”. I place the word error in quotes because it is too often that an error is not an error at all but simply the course of the disease. The lawyer presents a disease process as an entirely controllable phenomenon, and that good outcomes will happen when the standard of care is closely followed. Of course, they will deny this mentality until they are in court, where acts of “nature” serve to reward the lawyer quite generously. In public referenda regarding tort reform, there are usually two most serious claims. The first is that bad physicians need to be punished in order to improve the system. This goes contrary to all evidence yet seen. The second claim is that the tort system preserves patient rights. In actual practice, it does just the opposite, and patients end up with less options and choices in their care because of the malpractice climate which physicians and hospitals have to work in.
Whenever a referendum for tort reform hits the public, the claim defending current practice is that malpractice claims are actually decreasing and that malpractice premiums continue to be less expensive on the physician. Especially after a referendum, this is briefly the case, until the public forgets about matters, after which lawyers come back in force, hungry for more litigation. The malpractice situation has not improved, but remains a crapshoot, where a physician remains highly likely, no matter how excellent they are as a physician, to get sued and lose. The tragedy is that physicians can oftentimes see colleagues that truly are dangerous and yet manage to avoid suits. Cases that hit the public scene are often the most revealing. A few years ago, the leading transplant center in the USA made an error in typing an organ, leading to a hefty lawsuit. But, to what avail? This transplant center defined excellence in care for their service. Does human error necessitate lottery type outcomes for the lawyers and unfortunate patient? That is what happened in the transplant error to a distinguished center of excellence. There are many more similar stories.
What about if the legal profession is eventually proven to be wrong? Do they refund their ill-gotten gains then? I recall the colossal sums won against Dow Corning for the silicone breast implant lawsuit. Not very long later, it was proven beyond doubt that the manufacture of the implant or the nature of silicone did not lead to the alleged autoimmune diseases that the lawsuit purported to have happened. In this situation, the funds should have been returned, at least in part. This only shows that truth and justice are not served in courts of law, and the legal system has no interest in pursuing what is right.
My claim that litigation raises cost of everything is quite easily supported. Think about matters for a brief second. When you stay overnight in the hospital, with minimal attention rendered to you, you could expect a bill for upwards from $20K. I cannot think of any but the most exclusive hotels in the world that would even approach a fraction of that cost, even with servants and the most lavish attention. Why does it cost so much? Medications that are sold for veterinary use typical cost under 10% of what they charge for exactly the same medication with adults. Why? Medical equipment tends to be quite unreasonable in cost compared to similar products in the non-medical market. Oftentimes it is absurd, from a simple little staple gun costing several hundred dollars which if sold as a non-medical item would be several dollars. Why? Incorporated in those costs are both the higher cost of development for the human market, and the potential for litigation. Cows don’t sue, but people do. Yet, there are other subtle cost drivers. Physicians assuredly often act against their best judgement by over-ordering tests and x-rays, and over-treating, all in an effort to protect themselves against litigation. The patient is not given a choice in the matter, or allowed to assume risk. This is because with informed consent, it is still assumed in court that physicians should know better and not have offered choices to the patient if one choice was not assumed to be “standard-of-care”. The physician can’t win, and so plays the game by following the rules, even when the rules are wrong or don’t make sense.

JCAHO

This actually belongs in the “government interference” paragraphs, since the JCAHO is a government organization. Yet, it is so pervasive to all aspects of healthcare, with such overreaching influence on the way medicine is practiced, that it deserves a category of its own. As I write this, my hospital is currently undergoing a JCAHO inspection, and the anxiety of the administration is sky high. They have come by, and declared how various improvements must be made, how there are defects to the system which has so capably served patients. In essence, they are fixing “issues” that are not problems, never were a problem, and never will be a problem. Typically, the fixes are expensive, time consuming, but also require extensive documentation to prove that the fix is actually implemented by the hospital.
One of the most troubling changes in recent years has already be discussed, which are regulations imposed by HIPAA in order to preserve patient privacy. Sadly, HIPAA has failed to recognize that if somebody wishes to bust into the system, it can be done regardless of how intense the security measures are applied to the electronics of the system. The result is the physicians can no longer speak easily with each other about a patient’s care, and the detriment is ultimately to the patient.
JCAHO has long filled any possible useful purpose for itself. Yet, it has become a burgeoning business that must be sustained at all cost. Thus, they have sought desperately to find ways of justifying their own existence. They have accomplished that by creating new and novel regulations each year which they impose on hospitals. They will review hospitals every third year, and if sufficient inadequacies are found, will return a year after their visit to review the hospital for correcting their “mistakes”. During the triennial visit, they will disclose the new regulations, holding the hospital immediately responsible to correct their behaviors and adapt to the regulations. This causes a fleury of anxiety, panic, and hasty development of new hospital policies to match the new regulations. One year, they decided that if a patient was placed in restraints (usually in the ICU), then the order for that had to be renewed weekly. This had never before been a problem, and when there were restraint problems, they were of a nature that a policy would not fix. Another year, it was decided that used instruments or laundry could not be transported to their appropriate destiny in an open environment but had to be completely enclosed. One could hypothesize that bacteria could be spread with these instruments and laundry in open air, yet there has never been an instance where this had ever been a problem. The fix is indeed costly, and must be done in order for a hospital to continue operations. But, the hallway transportation rule defies notion that the hallway itself or the patient room could be transmitting disease between patients. Perhaps the entire hospital needs to be systematically sterilized between patients?
But, JCAHO will continue to work their evil deeds. Health care will become more complex, impersonal, and expensive, and ultimately, less safe. JCAHO is an organization that holds others responsible, but submits to nobody else’s authority. It is a true creature from the black lagoon.

Commercialization of Healthcare

It used to considered immoral for physicians or hospitals to advertise. Pharmaceutical firms were forbidden to advertise prescription products to the public. The American Medical Association held policies forbidding their members from advertising, as found in their code of ethics. The goal for these rules was to keep medicine out of the realm of commercial enterprise. All of that changed in the year 1975, when the federal trade commission considered the AMA policy as an illegal restraint of trade. The AMA rolled over dead. What was immoral one day was considered right and proper the next day. Advertising among health care emerged slowly. Early in my private practice, there was a rule that physicians in our community would not advertise, or even to have their name in bold print in the yellow pages. That disappeared slowly. Soon, one could see a plethora of drug advertising, with elderly patients in perfect health dancing vigorously across the tv screen, proclaiming the miraculous benefits and health giving effects of a medication with multiple side effects and toxicities. A few little lies won’t hurt, would they?
The end result of healthcare commercialization is that it has caused anybody and everybody to seek for a portion of the health care dollar. The highest paid person in a medical community is often the CEO of the hospital. While hospitals still designate themselves as “not for profit”, the non-profit hospital has gone the way of the dodo bird. Quite often, the most vigorously trained physician taking the greatest risks and responsibilities get the least cut of the health care dollar. The pharmaceutical and medical equipment suppliers are making massive profits unheard of in yesteryear.
One could argue that commercialization has led to improved competition and desire for innovation. Yet, competition has always occurred in health care, and innovation has also taken a great toll on our profession, not commensurate with the benefits offered. The most heavily advertised physicians are oftentimes the most marginal physicians. It would be hard to argue that patients are truly better off with advertising. For the reader interested in a erudite discussion of this issue, please read this article… https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563279/ .

The Flexner Report and its Evil children

The Flexner report was funded by the Carnegie foundation, supporting Abraham Flexner in a review of the existing medical schools in the early 20th century. The report was published in 1910, and intended on promoting standardization of medical education and the removal of marginal medical schools. We now see the evil children of the Flexner report, with regulation of the health care professions at an unprecedented level. The net effect we have had on physicians is increased regulation and requirement for continuing education, which was previously discussed. It has restricted the number of physicians in the health care community, and medical schools have not been able to keep up with the demand, especially in an age where increasing numbers of physicians retire early. It is difficult to just build more medical schools, since the cost of medical education is prohibitively expensive, and the state has had to bear part of the burden of these costs in order to keep the supply of physicians at adequate numbers.
There have been several ways in which the health care community has met the demand. First is through the influx of ever greater numbers of foreign medical graduates (FMG’s) from countries where health care education is not so aggressively monitored. The second is the rise of alternative providers, which include physician assistants and nurse practitioners. Both of these groups of providers have much shorter training periods, which would fail the current minimal standards for medical school training as defined by the results of the Flexner report. In essence, the Flexner report has forced its own extinction, and bred an alternative to the physician.

Conclusion

I am not unhappy that I ever became a physician, and feel that it has been a rewarding career. I am very unhappy with what has happened to medicine. It is like a public good has been stolen and no hope for recovery.
I am particularly sad that most people do not identify root causes for problems, but continually ask for immediate, self-serving, quick fixes to the health care problem. It is a truism that until congress and all of government has to live under the same health care plan that they impose on others, there will be no hope for improvement. I wouldn’t count on it ever happening in my lifetime.
Ultimately, health care will kill itself. It is unsustainable. It has lost its soul. Its original driving force was a Judeo-Christian Weltanschauungen, specifically, the belief that all people, young and old, born and unborn, of all races and creeds, were created in God’s image and of intrinsic value. Humans were not viewed as the accidental product of the primordial slime. Human relations were viewed as important as health itself. Suffering had meaning, which oftentimes led patients to delay in seeking a remedy. Pleasure and euphoria (feeling good) were not considered goals of worthy pursuit. Among health care professionals, the pursuit of “health” and prolongation of life seem to be more in line with personal challenges and a game to be played, the chance of honor for a great discovery, rather than the sympathetic concern for the whole person, body and soul. Purpose and meaning in life are oriented around maximizing pleasure and minimizing pain and suffering. Healthcare is the agent responsible for restoring maximal pleasure, either to the individual or to the community, when things go mentally or physically wrong. The greatest creed of healthcare, the Hippocratic Oath, provided the framework for practicing our profession. Without either a framework or a direction, we flounder. Healthcare, rather than being a true profession, becomes the utility of the state to maintain function and order, rather than the pursuit of a higher good. We have lost our soul in medicine. I am leaving medicine because my profession no longer is a profession of Hippocratic orientation. I have no interest in being a duped servant of an evil state.

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Mar 31

The quirks of Presbyterianism
in relation to my Anabaptist roots
My wife and I are religious schizophrenics—we are deeply rooted in both the Presbyterian and Anabaptist traditions. These traditions seem to be polar opposites, though in many ways, the opposite is true. I would like to briefly explore my thoughts on their similarities and differences.
History
My wife and I grew up in the Apostolic Christian Church (ACCA [Apostolic Christian Church in America] and ACCN [Apostolic Christian Church Nazarean]), which are actually two denominations of the Amish-Mennonite Anabaptist tradition that split in the early twentieth century. It is a denomination, in spite of their quirks, that is still dearly loved by me. I consider myself as having a world view shaped by their teaching, notably that of fervor for God’s word, of intense love for the Brethren (which is a non-sexist word and includes females), and anti-militarism. For various pragmatic reasons, our family attended Moody Church while we were living in Chicago, Illinois when I was in surgery residency, a church we also dearly loved, especially with the preaching of pastor Irwin Lutzer. We attended a Baptist church while I was in the Air Force in Biloxi, MS, and really did not like it at all. There was a PCA (Presbyterian Church in America) church in town, but did not attend there because we felt the Presbyterians were heretics and totally off base. It was during my time in Biloxi that I started reading intensely on Dispensationalism versus Reformed theology, and became convinced that Reformed theology (Calvinism, if you wish), had a more consistent approach to Scripture in its entirety than either Dispensational or Anabaptist theology. I also realized that the description of “Calvinism” by Anabaptists and Dispensationalists was entirely in error. On moving to Puyallup, WA, we attended a generic Christian church for a little over a year. I absolutely hated it for its irreverent worship style and weak theology. On recommendation of a close colleague at the hospital, our family broke down and started attending Faith Presbyterian Church in Tacoma, WA, a member of the Presbyterian Church in America denomination. The pastor was the son of the first president of Covenant Seminary in St. Louis, Missouri, and well acquainted with Francis Schaeffer. He was a large drawing point for us. We have been there ever since, with no plans of leaving. We had never formally left the Apostolic Christian Church, and have no idea whether they still consider us to be “members”. Our departure was more by incidence of our life’s journey, rather than a formal choice to leave the ACCN. Thus, my wife and I still consider ourselves to be a part of both worlds.
Comparisons of Anabaptist/Reformed theology
Theology was the driving force for leaving the generic church and going to a church that has Reformed doctrine. Contrary to many thinkers, Calvinism is everything but “once saved, always saved”. This is especially true of the covenantal manifestations of Calvinism. In fact, what is portrayed as Calvinism and what is the true meaning of Reformed doctrine are unrecognizable. I’ll offer several examples. Perseverance of the saints as a doctrine means that the saints will persevere in holiness. It never was intended to mean that a person could never “lose” their salvation, except for that if one is truly saved, they will persist in holiness. The discussable issue on this topic for both Anabaptists and Reformed thinkers relates to assurance of salvation, even though arguments for assurance will follow different lines of thought. Both Anabaptists and Reformed thinkers share the necessity for godly living. A second topic of contention is that of limited atonement, which is a terrible phase that means particular redemption. Most Reformed thinkers advocate a universal calling, and bona fide offer of the gospel for all. The only realm of contention regarding particular redemption is that the Reformed thinkers will say that Christ’s death was EFFICACIOUS only for the saved, something that even Anabaptists would ultimately agree with, unless they hold to the doctrine of ultimate universal salvation for all. The doctrine of total depravity would be an area of contention between Anabaptists and Reformed thinkers that would not be resolvable. Oddly, this is not an issue commonly fought over. Nobody wishes to consider themselves to be Pelagian, so one will usually default to a semi-Pelagian position regarding total depravity, which in my thinking is a most confused approach to depravity. As GK Chesterton has noted, total depravity is the one and only doctrine which is easily verifiable in real life.
The baptism of infants is a point of contention with Anabaptists which is usually terribly misunderstood. Baptism is considered neither a confirmation of salvation nor a witness to the world of salvation. Rather, it, like circumcision, is a representation of a covenant with God.  This covenant has both promises as well as obligations. Much of the obligation is on the parents to raise their children as Christians, and duly expect them to make a profession of faith throughout their life. Many non-Reformed churches have a dedication ceremony which is neither Scriptural or meaningful, save for trying to imitate the ceremony of infant baptism. In terms of when a person actually becomes a Christian, the Reformed doctrine refuses to define a precise method. In fact, virtually every New Testament conversion that is discussed is different. Some children of believers may be converted in utero, others in childhood, others after a period of sinful life, and others never. The point is that the Christian will always need to persist in their profession of faith until death.
Some of the ramifications of the doctrine of predestination may be troubling to the Anabaptist until they give worthy pause to what is actually being said. Predestination most certainly is NOT fatalism, i.e., that the course of history has been set in motion in which nothing will change. I would refer the reader to J.I. Packers’ “Evangelism and the Sovereignty of God” to grasp this issue. It is certain that we are both totally determined yet totally free in our decisions and actions. The explanation for this remains in the divine wisdom of God which cannot be explained. Finally, I wish to note that when one looks at both the Anabaptists and Reformed churches, there are multiple splits numbering in the hundreds to thousands. Most of these splits are related to some subtle doctrinal issue which presents itself as irreconcilable to the church leaders. Even in my lifetime, I’ve seen a number of splits in churches (both Apostolic Christian and PCA) that are inexplainable save for our persisting depravity.
Both the Reformed and Anabaptist traditions are quite intense about their theology and hold it of great importance. The Reformed thinkers have approached theology in a more systematic fashion, and win out in terms of have a more consistent and organized theological base. Unfortunately, the Reformed church knows this, and it tends to breed a very strong sense of arrogance on their part for having “the best” doctrine. The Reformed folk also manifest a sense of divisiveness in their theology, discussed kindly in a recent internet article by John Frame (http://frame-poythress.org/machens-warrior-children/). This article discusses 21 topics that are highly divisive in the PCA church—I think that he is kind, and under-estimates divisive issues, and I mean divisive enough that various groups would hold charges of heresy against contrary thinking. I have seen Presbyterians approach theology with such opinionated aggressive as to wonder if they were not terminally constipated. A recent move in the PCA condemning the theology of federal vision had a vitriol of extreme proportions, yet one had a challenge even defining what one meant by federal vision!
Anabaptists also excel in divisiveness, and there are countless sub-factions of Amish, Mennonites and the like. This Anabaptist divisiveness can either be theological (like a recent ACCA split debating whether or not a Christian could/does sin) or practical (like whether it is permissible to grow beards or have lightning rods on your house). In the Anabaptist circle that I grew up in, theology was a constant discussion. Our discussions as kids were quite crude and seriously misinformed, but we took theology quite seriously and it was a typical subject of discussion when we would get together. I don’t see that fervor in the Reformed church youth—after all, since they hold the “correct” theology, by bother discussing it?
Church polity/discipline
While this may sound strange, both the Reformed and Anabaptist traditions tend toward the Presbyterian model of polity, in contrast to the Congregational or Episcopalian models. Anabaptists do not generally have a paid clergy, though there are exceptions to this rule. Yet, there are central Anabaptist structures, and national meetings of the elders that are akin to the annual presbytery/synod meetings that occur in Reformed circles. The interest of both traditions is to maintain commonalities in theology and worship that define the denomination. To the surprise of Anabaptists, the conservative Reformed denominations (such as the PCA) take church discipline very seriously, and do exercise member expulsion for various sins or absence of repentance. The terms of expulsion or other forms of church discipline differ, but yet there is a very strong sense of the necessity of the church to exercise discipline of its members, and preach the value of a godly lifestyle in all things.
Worship style
The similarities between Anabaptist and Reformed worship is greater than their differences. Both hold a very high estimation of worship and formality in their church meetings. This is true, even though the Anabaptists do everything possible to remove distinctive display elements to their worship, including the display of crosses in church, the wearing of special garments by the ministry, or other outward displays. Oddly, Anabaptist members usually are required to have special garments, such as specially defined head coverings for females, and distinct dress for men. The Anabaptists would never call their service a “high-church” style, yet it has a formality and regulation that is uniform and consistent between churches and enduring through the years. Both Anabaptist and Reformed thinkers have an equal problem with the current contemporary worship service, which consists of worship as entertainment.
Music
The Reformed churches would love to think that they have the great advantage in music. In this regard, they are sorely wrong. As a matter of fact, Presbyterians simply cannot sing. It is true that many Reformed members go on to become professional musicians and that musical instrumentation in the church is of high value. Many Anabaptist churches, including the ACCA denomination which my parents came out of, never even used a keyboard in their services. Yet, I would estimate that most Anabaptist members had home musical training, and greater than 90% were able to sing in 4 part harmony during worship services. They would stay on tune, even singing a cappella. If you examine closely their hymnody, the Anabaptists mostly drew on the German Lutheran/Bach choral tradition, with far more complex harmonies and melodies than could ever be found in a Reformed/Presbyterian congregational hymnal. In addition, the Anabaptists would sing those songs quite well. Playing or singing the ACC hymnal (Zion’s Harp) is far more challenging than playing or singing the PCA Trinity Hymnal. The Presbyterians are slightly more cautious regarding good theology in their songs, but even there, the ACC hymnal has much better tunes for praise, consecration of one’s life, the afterlife, suffering, and general worship than any Reformed Hymnal. The British and Scots just were not as artful in music as the Germans!
Fellowship
In the Anabaptist family, one feels like family. It doesn’t matter where you go in the world. If you encounter another “AC”, you might as well consider yourself a real brother or sister. You are always welcome in their home, as you would welcome them into your home. Much of your free time would be spent at church or with fellow AC’s. The Presbyterians also maintain a sense of community, but no where near the intensity that is found in traditional AC circles. It is common in Anabaptist communities to see them going out of their way to care for each other. An example are the nursing homes that the ACC’s have developed in conjunction with their churches. These serve several uses. First, they care for the debilitated elderly while keeping them out of the ward of the state. Secondly, they allow elderly in the nursing homes to be useful and active, rather than simply shuttering them in. It is a shame that Reformed churches cannot develop such a modality—I presume that they are in fear of “offending” the state or its ordinances.
The fellowship among Anabaptists extends in other ways. Most of the brethren of the AC church could be assumed to be “trustable”. By that, I mean that if there were business contracts or other dealings that transpired among two brothers in the AC denomination, even if the agreement was verbal and not in print, one could assume that the agreement would be faithfully adhered to. It is not the case in the Presbyterian world, and though members all consider themselves as Christian and adhering to the laws of God, your probability of integrity among the “faithful” in the Presbyterian church isn’t much higher than you’d find from somebody randomly picked from the telephone directory or pulled off the street. Indeed it is a sad state of affairs when professing Christians are no different than the world.
Influence in the world/Politics
The Anabaptists tend to stay out of politics. Yet, a number of its sons do go into politics, such as one of the long-standing senators from Illinois who grew up in an ACCA home. The first Presbyterian politician of great acclaim also shamefully happened to be among our worst presidents—Woodrow Wilson. America would have been better off without Presbyterians in government. Presbyterians have served as a positive influence in society, the best example being that of Francis Schaeffer, though often his actions were at odds with those of the Presbyterian church, explaining why he tended to act independent of any Presbyterian mission board. To this date, Presbyterian actions in politics frighten me. While I appreciate their willingness to act as salt and light in the world, and influence the political structure for good, many of the actions of devout Presbyterians have been more detrimental than good on society. I wait pensively for how Donald Trump proves to be as president since he states that he is Presbyterian—his saving grace might be that he is despised by many prominent Presbyterians of both the conservative and liberal stripes. Contrariwise, the action of Anabaptists have also been a touch problematic in that they have not been willing to confront society in the public square and speak truth. Their policy of “letting the world go to hell as we will maintain our private devotion to God” might absolve them from taking a stand for truth and righteousness in the public square, but their failure to speak out will be ruled against them at the last judgement. In my final analysis, I will act like a Presbyterian in the public square, but will shy away from getting political advice from the Presbyterians and vote like a traditional Apostolic Christian.
Summary
My wife and I are caught between two worlds. We love our Anabaptist heritage, and we love our current Presbyterian situation. We see both the best and the worst of both worlds, and see neither as distinctly superior to the other. I could not have had a better time growing up in the ACCN denomination in Portland, Oregon. It nurtured me well in the faith. Yet, we remain most happy in my current situation in the PCA church. We have a beloved and wonderful pastor, our faith has grown steadily under his preaching, and doctrinally we’ve been challenged and grown in ways which never could have happened in nearly other setting. Thus, we feel doubly blessed.
In a previously quoted article, John Frame speaks at length about ceasing quibbling about petty doctrinal and behavior issues in the church. It is a plea for Christian charity and humility among other Christians. I saw this in action when I took a class in systematic theology from JI Packer, experiencing  graciousness of abounding proportions when angrily challenged and confronted on touchy topics in class. I wish that I could manifest the spirit of Dr. Packer! Francis Schaeffer also wrote much about Christians fighting among each other, and his book “The Mark of a Christian” emphasized that as important as doctrine and behavior may be, love for each other needs to shine out strongest.
We will remain Presbyterian for now, but our hearts (and hopefully our behavior) are Anabaptist. Without a doubt, in heaven, these issues will all work out, and we will not have to take sides as Catholic, Anabaptist, Generic Protestant, Lutheran, Presbyterian, Reformed, Anglican, Baptist, or Orthodox. Christ isn’t divided, and I pray that the church would seek more the spirit of unity in Christ than of obscure technical differences.

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Nov 30

trump
Trump: The Art of the Deal, by Donald J. Trump and Tony Schwartz ★★★★
I received this autographed hardback copy before Donald was elected president, and read it in spurts after that. The book’s value is in giving one an insight into how Trump thinks.  The book was written in 1987, and starts with a review of one week in his life, ending with a follow-up of what became of the decisions of that week. The intervening chapters are a limited autobiography of the man, starting from childhood, through his schooling, and then summarizing his early big deals up to 1987. The details of his wheeling-dealing is not terribly interesting save for realizing a few things. 1. Seeing how Trump makes decisions. He always looks for people that he could trust, and who are the best in the business. His biggest admiration is for people of integrity. 2. Seeing how politics affects the most mundane things in life, and how Trump was able to use as well as was hindered by politics. 3. Seeing how bumbling so many other business executives were. There were many examples of very poor decision making, not just in government real estate projects, but also in private interest projects that should never have gone wrong, but did.
This book is of value to read in order to understand the way in which Trump makes decisions. He is neither conservative nor liberal. He is not Republican or Democrat, his religious leaning is toward Christian predominance, and he is not an extreme moralist (or immoralist–he neither smokes nor drinks). Donald is very much a pragmatist, that tends to set goals and hold to those goals. He is not an ideologue, though tends to have guiding principles. He is a great negotiator who is used to holding his cards close to himself, which might irk the ever-snooping main stream media and liberals. He has a strong tendency toward honest success, which we will probably see in the next four years.

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Mar 12

24FEB2016
The campaign season is now in full force, and opinions flow freely about who will be our next emperor. The news media is quite busy at their subtle but fake “unbiased” spin as to who would be best.
Even Ron Paul, whom I voted for the last four elections, offers his opinion in which no candidate merits his support. This is all fine and dandy, save that some candidates are the “lesser of evils”, a write-in or blank vote will be worthless, and there is a sense in which some candidates would be truly intolerable. Thus, Ron Paul playing ostrich will not work in this election cycle for presidency.
The press has taken another stance. Headlines speak of “angry voters going for Trump”. Does the press really believe that Trump fans are more angry than Col. Sanders fans or Cruz fans? Do they interpret any sort of cool-headed rejection of the Republicrat Party as anger? How many buildings have angry Trump supporters destroyed, how many cars have been destroyed or street riots engendered with much human bodily injury?  If the press would like to see real anger, try revisiting Ferguson or Baltimore.
There is the milquetoast mass who would vote for Hillarious or Rubio, and certainly the press and Republican National committee seem to make Rubio the clear-cut choice for the Republican nominee, and the DNC and press with Hillarious for Democratic nominee. This is the New York Times stance. Why would I take advice from the most liberal rag in America that intends to indoctrinate the American public?
Fear mongering has been the approach of both Republicans and Democrats. Special interests drive select candidates, as the Feminazi influence in advocating for Hillarious. The press would like us to believe that Trump appeals to the less intelligent and under-educated masses, based on a comment by Trump that the less educated masses love him. The logic of concluding that his statement that “ONLY” the uneducated masses love him defies my sane reasoning.
So, I march through the available candidates for president looking at the pros and cons for each of the active candidates. I left out Vermin Supreme, but then, I decided that I really have no use for a free pony (google or u-tube search Vermin Supreme if you have no clue as to what I’m talking about).
Hillarious:
Con:
1. She’s an inveterate liar and never to be trusted.
2. She’s a war monger who will get us worse into war than Obama has done. We will probably see conflict with either China or Russia during the reign of Empress Hillarious.
3. She’s a part of the established Republicrat regime, and would continue business as usual.
4. We don’t need a Clinton dynasty. They’ve done enough trouble while Billy was in office. I don’t forget the lengthy list of scandals and offenses that occurred during his reign, many with Hillarious in collusion.
5. She has poor health and she is old, benefited only by massive use of make-up. Her VP would probably soon be president.
6. She is allied to too many special interests, such as the Feminazi interests, the gay/lesbian/trans-sexual interests, etc., Goldman Sachs and Wall Street, for a short list.
7. I don’t want a lesbian as president.
Pro:
Absolutely none
Col. Sanders
Con:
1. A socialist by any name is still a socialist. The banks are already teetering to unmitigated collapse, though we don’t know when. The Colonel will only accelerate that ultimate collapse.
2. He’s a fake. He could have voted his heart and supported the audit of the fed bill in the senate, but did not. I don’t trust him.
3. He is really old. I suspect that he is also partially senile. We’ll have a situation like the end of the Woodrow Wilson years, where a presidential advisor essentially runs the nation.
4. His solutions never have a basis is serious reality, whether it be economic solutions, public policy solutions, or foreign policy solutions.
5. His past life was miserably anti-American, which he needs to make account for.
6. The guy was a useless parasite on society before he got into politics, not even holding a job until he was 40 years old. He would remain a useless parasite if he became president.
Pro:
1. He sees the problem of America’s monetary system, and wants to do something about it. He clearly sees the corrupt banking system, the problem of the Federal Reserve, and how Wall Street is about as anti-American as ISIS or Obama.
2. He seems to have a shred of integrity.
Ben Carson
Con:
1. He has minimal familiarity with politics. He would be a lamb among wolves.
2. He doesn’t have a “leadership” persona.
3. He would involve America in war in other countries.
4. He hasn’t expressed a comprehensive stand on many matters of concern.
5. He would not make a great president but would  otherwise be fantastic in Washington on whoever’s cabinet.
Pro:
1. He is probably the smartest candidate, Republican or Democrat. Honestly, he is frankly brilliant.
2. He is  Negro and unlike our current “black-white Mulato” president, and so would very certainly start bringing a correction to race issues in the USA.
3. His integrity and morality are completely impeccable, regardless of accusations of his opponents and the press.
4. He stands first among all the candidates in being a gentleman and man of honor.
Marco Rubio
Con:
1. He would perpetuate and exacerbate the current immigration problem. He would do a terrible job with America’s borders.
2. He tends to be a “company man”, and would march to the beat of the Republicrat regime. It would mean politics as usual.
3. His policies are pseudo-conservative. This might garner liberal votes, but then, if one wishes to vote liberal, feel the Bern.
4. His public persona is awful. He looks like a little kid. He is nigh brain dead in his speeches. He will need a teleprompter just like the Bummer.
Pro:
1. This is a tough one, but he does have some conservative leanings regarding economic issues.
2. He has a reasonable morality. I find it odd that so many presidential candidates come to Jesus during the campaign year, making professions of faith that they could have said before hand but strangely did not.
3. He clearly sees that our current president is super-bad. I think he repeated that 4 times in a recent debate.
Ted Cruz
Con:
1. His public persona is horrible.
2. He doesn’t do the best job at selecting the people around him, a good example being his campaign manager
3. His policy stances regarding foreign wars, economics, domestic issues are weak.
4. If running against either of the democratic candidates, he will lose. The press will make mince meat of him.
5. He would make an absolutely superb Supreme court justice.
Pro:
1. He has good, solid policies on many issues, especially regarding immigration/border issues.
2. In spite of what the press and RNC tried to do to smear him, he is a man of integrity.
3. He is willing to stand up for what is right and speak out when there is a wrong or an injustice, even if it may mean political harm. His action of calling many of the lead Republicans liars was both truthful and proper.
Donald Trump
Con:
1. He is a novice in politics
2. He seems to be taking strong stances and expressing opinions which are often contrary to what he was saying just a few years ago. True, even President Reagan was originally a liberal, but Trump has not had the time to prove to the public that he really has mended his ways and thinking.
3. He has every reason to be self-serving as president.
4. He has a terrible grasp on the constitution. He will approach his job (similar to Obama) more as Führer than as a constitutional president.
5.  If elected president, there is a high chance that some liberal nitwit will assassinate him. (some people might put this in the “Pro” column).
Pro:
1. The press and established Republican Regime hate him, which means he is probably all right.
2. You usually don’t need to worry about him speaking his mind.
3. He seems to be the most outspoken about standing up for USA interests
4. He will not get us involved in crazy and expensive foreign wars without assuring ourselves a benefit from those wars.
5. He is the most clear about fixing the immigration issues. Above all, he understands that “illegal” in the phrase “illegal alien” does not mean anything but the plain reading of the words. It certainly does NOT mean undocumented workers.
6. He has some grasp of economics and would probably look out for the “little guy” in business.
7. He is VERY clear on other important issues, such as terminating ObamaCare as soon as he gets into office.
8. He’ll have Hillarious behind bars, where she belongs.
9. From his life in the business world, I suspect that he would be adept at recruiting competent men around him.
10. He generates very strong reactions from many of my friends about how dangerous he would be as president, accusing him of being a chameleon that will be a different color in office. I interpret those strong reactions (from even the friends that I trust) as all the more reason to vote for him. I find it intriguing that such notable characters as Pat Buchanan (whose opinions I always respect) and Ann Coulter (who I tend to agree with even though I detest her persona, and besides, she’s a damn lawyer), and Alex Jones (a very strange character but who usually gets it right) are all in favor of Trump (at least, at this time).
11. He is not a lawyer. We need a government with more people than just lawyers and political science majors. Lawyers and political scientists have the worst grasp on truth of anybody I know, and which I always count as a strike against them.
I’m sure this list will grow and change over the next few months. You might have noticed that I have not opted in favor of any candidate. Your notice is correct. You might have noticed that I also have some political leanings for this election. That is also correct. I remain moderately undecided at this point. If you wish to change my mind, don’t waste your time, as I’ll probably vote for somebody else just because you tried to persuade me otherwise.
Of course, some of my friends will bring up the question as to whether the candidate is a Christian. I would remind them that I have some very dear (but politically brain dead) friends who lauded Obama for being a Christian. I remember liking Jimmy Carter because he was “born-again”, and what a colossal mistake he was of a president. Our last great president that generally stood for Christian values was Reagan, but he came under attack for his lack of Christian faith. Meanwhile, the Bush clan were lauded as Christians, yet I have serious questions about their integrity and self-serving expectations while in office. I am reminded of the Cromwell regime in England, which stacked the parliament with Christians, but who were incompetent at running a country.
So, I now offer a serious question. Does America deserve a good president? Perhaps not. I see no candidate that will make king Hezekiah or king Josiah style reforms to correct public sins and evil, and foster a more righteous nation. Ultimately, is this not the ONLY thing that matters? Making America great is a matter of making America Christianly moral. But, returning to a biblical foundation will not happen because not even most Christians have a clue as to what that is. Why do so many Christians (like the current Pope Francis) view socialism as a form of Christianity by doing good to the poor? Are they so foolish as to imagine that goodness can be forced and delegated by an evil government? Judgement on our nation looms, and Christians need to get off their Pollyannish pie-in-the-sky-in-the-sweet-by-and-by mentality that God still loves America, and that other countries might be bad, but at least we are not as evil as Russia or China. Just see what Habakkuk says… (You who are of purer eyes than to see evil and cannot look at wrong, why do you idly look at traitors and remain silent when the wicked swallows up the man more righteous than he? Hab 1:13)
Perhaps Christians wish for more social justice. God’s law specifically forbids judgements in favor of “the poor” just because they are poor (“You shall not fall in with the many to do evil, nor shall you bear witness in a lawsuit, siding with the many, so as to pervert justice, nor shall you be partial to a poor man in his lawsuit” Exo 23:2,3). A strong sense regarding personal ownership of property and goods must not be viewed as being evil, but the wish to re-distribute the goods of “the rich” as being very evil (You shall not covet-10th commandment, Exo 20:17).
Our current president has accelerated the process of wickedness in our nation. We are far worse now in being racially divided. We no longer grasp that having a penis means that you are male, regardless of your feelings on the subject. The gay/lesbian/trans-sexual/confused-sexuality agenda has flourished under our current Nobel peace prize gay bath-house visiting “Christian” president. Social programs have removed any moral responsibility from people, so that any sexual, economic, or behavioral issue might get you time behind bars or in the Krankenhaus, but will not result in you suffering the full impact of your inappropriate behaviors. We no longer fear the influx of foreign gods, including Buddhism, the Muslim “god”, Satanism in its various forms, and the god of mammon. The Scriptures are not silent on this. (Beware lest you say in your heart, ‘My power and the might of my hand have gotten me this wealth.  You shall remember the Lord your God, for it is he who gives you power to get wealth, that he may confirm his covenant that he swore to your fathers, as it is this day. And if you forget the Lord your God and go after other gods and serve them and worship them, I solemnly warn you today that you shall surely perish. Like the nations that the Lord makes to perish before you, so shall you perish, because you would not obey the voice of the Lord your God Deut 8:17).
So, my action items are as follows.
1. Pray. God is in ultimate control of everything. Remember that Obama was ordained by God (it doesn’t mean that God loves Obama! Contrary, God truly hates Obama!).
2. Stand up for what is right. Work for a crisis pregnancy center that offers alternatives to abortion. Refuse to patronize businesses that cater to the gay/lesbian/trans agenda (including the YMCA). Speak your mind for truth. Don’t be ashamed that you are a Christian. Go to a real church. Not a feel good, “Jesus loves you, come as you are” “Get in touch with the real-you”, self-empowerment church, but a real church.
3. Quit thinking that God loves America. He doesn’t. Quit thinking that America is a Christian country. It might have been at one time, but it sure is not now. Quit thinking that most Americans that say they are Christian are Christian. Do they truly understand God’s laws, and seek to live by them? (As a father shows compassion to his children, so the Lord shows compassion to those who fear him. But the steadfast love of the Lord is from everlasting to everlasting on those who fear him, and his righteousness to children’s children, to those who keep his covenant and remember to do his commandments Ps 103:13, 17,18). Do you erroneously consider the Older Testament as obsolete and replaced by “grace” under Jesus? Are we all Marcionites now? Are there two different gods in the bible, the old testament and new testament gods? Or did God announce through Jesus that he was just kidding, and really will not be imposing a harsh moral law on mankind from Jesus on out? Do you realize that all of America is enemy territory, the worst being many “conservative” American Christian churches?
4. Pay close attention to practicing a personal morality. It really does matter. Don’t complain when God’s judgement hits, if you are not personally walking with God, and remembering to keep His covenant. Do you encourage your neighbor to seek a biblical faith.
5. Let Scripture alone rule as your moral guide. Memorize it. Start with Ps. 1 and Ps. 2. Psalm 1 is a summary for the entire Scripture regarding the need for personal morality. Psalm 2 is a summary for the entire Scripture regarding God’s ideas regarding politics. They are eternal inviolate truths.
6. Refuse to vote for the status quo. If you do vote, trust that God will establish the perfect person for America. It will probably NOT be the person you wanted to be president.
7. Remember that over ½ of Americans voted for Obama twice over. If you think that our country truly wants what is right and good, you are living under a massive delusion.
Thanks for hearing out my rant.
Though the fig tree should not blossom,
nor fruit be on the vines,
the produce of the olive fail
and the fields yield no food,
the flock be cut off from the fold
and there be no herd in the stalls,
yet I will rejoice in the Lord;
I will take joy in the God of my salvation.
God, the Lord, is my strength;
he makes my feet like the deer’s;
he makes me tread on my high places. Hab. 3:17-19
All Bible quotes in this blog were taken from the English Standard Version, complements to some of my friends who participated in this translation.
 
ADDENDUM: 28FEB2016
You might have noticed that I did not review Kasich. The simple reason is that I have nothing to say about him. I won’t move out of the USA if he becomes president, but I view him as a weak liberal.
I am feeling that Trump is shooting himself with his mouth. I am becoming increasingly concerned about him being president. He will be a better alternative that Col. Sanders or Hillarious, but feel that it would be very risky voting for him as president. I’ve also appreciated Ted Cruz more as time goes on. He’s a sharp cookie, even though he is a lawyer. If I had to vote tomorrow, it would probably be for Cruz. Who knows who my next addendum will prefer? I’ll be glad when the Republican and Democratic conventions are over with. Who knows if there will be a third party candidate? We wait in prayer that God will show at least a modicum of his steadfast love on the USA as a country, that his wrath not be too severe.
 
ADDENNDUM: 12MAR2016
I’m seeing why it was a good reason not to cast my vote firmly. Events of the past few weeks have changed my mind. Issues that have developed with Cruz.

  1. He selected Neal Bush to be on his financial staff. Why in the Sam Hill did he do this? Is he trying to get in good through the back door with the established politicians that we have learned to so thoroughly despise? Wasn’t it Neal that was involved criminally in the Savings and Loan disruption many years ago?
  2. Cruz is throwing unnecessary mud at other candidates, suggesting that he is desperate; not a good trait for a president. He now accuses Trump of stirring up the crowds. But, the crowds stirred up are the worthless chronic parasitic students, Negros, of Chicago. Get out the Kleenex. Like spoiled children, it’s time somebody told them off. Cruz cannot let go of his establishment mentality.
  3. Cruz has some very strange “magical” concepts of Christianity. The Lord told him that he would be King in America, according to his father. I don’t mind Pentecostalism, but they sometimes have the worst approach to truth.
  4. Cruz would make a good attorney general, but an awful president.

What about Trump?

  1. He has shown that he can behave and be presidential.
  2. He pisses off the liberals. Good. Hopefully, he’ll put some of those sorry asses back to real work. Hopefully, he’ll terminate half the funding to colleges, so that we don’t produce yet another generation of totally useless BS’s and BA’s, trained in gender studies, political science, environmental studies, racial studies, or law.
  3. He pisses off neocon conservatives. Good. They can keep their little playacting at party meetings, but they are just as criminal at bringing collapse to America as the liberals. The neocon arguments are ridiculous, and without substance. His hair. He looks haughty (like Hillary, Rubio, and others don’t???). He’ll get us into war (really now, are you so deaf that you can’t hear what Trump has said a million times—if we go to war (ever), THEY will pay!!!)
  4. He is acquiring more and more people that like him. My favorite candidate (above) in terms or morality and wisdom and personality was Carson, and Carson threw his towel in with Trump. The liberal neocon right simply can’t bear that, and are now coming down hard on Carson for stupidity. They lack a mirror. Phyllis Schafly has supported Trump. There are many others that are coming out.
  5. I actually ventured onto Trump’s website, prompted by the baby-ass crying neocons. I reviewed his policy statements. I agree with nearly every one of them, such as his foreign policy (except for his involvement in the South China Sea – we don’t belong there), economic issues, education (he’s listening to Carson! on that one), healthcare reform (abolish ObamaCare), immigration reform, tax reform, eliminating the death tax, and second amendment rights. I love his idea to make concealed carry permits applicable across state lines, like driver’s licenses. There’s almost nothing that I disagree with. Plus, and most importantly, he promised to put Hillary in prison. I hope that he also tries Obama for treason, makes illegitimate all of his actions as president, puts half the Supreme Court before the firing squad for treason, hangs Loretta Lynch for treason, and fires half of everybody in government.

So, I’m not totally committed but would vote for Trump if the ballot was given to me today. This has not been a good election cycle. The worst thing is not who the candidates are, but how the professional politicians of all stripes are responding to the election that isn’t going their way. They are working too hard to protect their own comfortable turf. Because of that, I dearly hope that whoever gets into office removes any retirement benefits for congress and presidents. They don’t deserve it. They get enough already in other royalties. I dearly hope that a law is passed that makes that forces congress and executive office members to live by the same laws that we have to live by. We are not supposed to have a class of royalty. Let’s get rid of them!
 

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Jan 03

Christmas2014-624
Weihnachten 2014
Many of you readers are wondering why I took so long to post a Christmas report. Why didn’t it come on late Christmas? Or, at least, on 26DEC. Well, if you are asking, go suck on green persimmons. My top priority in life is NOT to provide the world instantaneous reports of what I just happened to do in the last hour, or what one of my children/grandchildren/nephew-niece or other relative just said that was cute. I will enjoy their cuteness in a hedonistic fashion, realizing to the rest of the world, my child/grandchild/whatever will be viewed as a solipsistic spoiled brat. No, I’m also not going to tell you what I just happened to cook, or what I am currently eating (I just happen to be taking my Abendmedikamente geschluckt mit Bier und eine Dose Rosarote Lachs für Eiweis Anhang); and if you can’t read German, you really don’t need to know what I eat/ate/will eat.
So, today, I went for a short bicycle ride (41 miles) with Russ Anderson and had an inspiration to write this post. The ride was at freezing point, and we returned quite cold. It took about 2 hours to thaw out. I don’t mind those sort of experiences. I get more annoyed when it is too hot, and I am borderline on a heat stroke. But, thinking about Christmas, Christmas tends to be melodramatic. We spend a lot for presents which don’t seem to be appreciated commensurate with the money spent or the time taken to select and purchase those items. This year, we avoided the mall altogether (Betsy and I went once just to visit the Apple Store several days after Christmas-we didn’t buy anything). We had the Hastings over, and sang Christmas carols, which we all really enjoyed.
Christmas Evening – Jon and I attended the 11 pm Gottesdienst. Bei Mitternacht gibt es Kerzenanzundung mit dem Raumlicht aus und das Stille Nacht Lied singen. Und dann, zu Hause. Every year, I make up cinnamon rolls from scratch, make about 8-12 platters of them, and then freeze them, giving them to friends, fiends, and family as gifts (aber, nicht giftig!). You simply set them out the evening before, and they unthaw, and then rise by morning, allowing you to stick them in the oven and have fresh cinnamon rolls in the morning. I made up a prime rib on the Trager grill and we had all the kids over (except for our dearest Rachel and Alex and kids). We had just installed an outdoor fireplace, into which we got a fire going, while the older kids played with the bb gun. Then, dinner.
 

Patrick as marksman on the bb rifle.

Patrick as marksman on the bb rifle.


Sammy as competitive marksman.

Sammy as competitive marksman.


Dean smirking at Patrick and Sammy, knowing that some day he will whip their Arsch on the firing range.

Dean smirking at Patrick and Sammy, knowing that some day he will whip their Arsch on the firing range.


Me cutting up the prime rib.

Me cutting up the prime rib.


Die Kinder devouring the Christmas Dinner.

Die Kinder devouring the Christmas Dinner.


Dean wanted prime rib but enjoying what he got.

Dean wanted prime rib but enjoying what he got.


The adult table.

The adult table.


Then, it was time for the kids to open up presents.
Elizabeth showing off her doll.

Elizabeth showing off her doll.


Elizabeth with mutant Frozen character themes.

Elizabeth with mutant Frozen character themes.


Sammy loves rocks.

Sammy loves rocks.


Dean wasn't sure at first what to do with the presents, but soon figured things out.

Dean wasn’t sure at first what to do with the presents, but soon figured things out.


Afterwards, we decided on S’Mores for dessert. The outdoor fireplace was the perfect place for that.
Roasting marshmallows on the campfire.

Roasting marshmallows on the campfire.


Roasting buttocks on the campfire. Left to right, Doug, Diane, Sarah, Andrew

Roasting buttocks on the campfire. Left to right, Doug, Diane, Sarah, Andrew


It was a wonderful Christmas, with a focus on God and family. Hopefully, each Christmas could be all the more so. By the way, I got the shirt in the first photo from my favorite German patient. It seems to sum up matters in few words.
The Feucht family wishes you all a Merry Christmas and a Happy New Year.
 

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May 28


MayCycleRides-576
Riding in Oregon with friends, family, and self, 21-26MAY2014
I had always wished to return to Portland to do some rides that I had tried as a kid, but which didn’t end so well. I wished to ride the Gorge, do Larch Mountain, and run around a number of the places I used to ride bicycles when I was growing up in Portland.  So, this adventure gave me that opportunity. I started by driving down to Portland after work of Wednesday evening. The next morning, Aaron H. came to meet me at the hotel, and we took off north. Riding across the I-205 bridge, we rode eastward along the Columbia River, following the Washugal River once we reached Camas, WA. A short segment brought us back to the Columbia River highway, where we passed Beacon Rock, crossed the Bridge of the Gods (photo above, with Aaron showing off his banana), and then rode back along the old Columbia River highway. The bicycle trail was now complete all the way out to Cascade Locks, though my cycle instructions did not realize that. The ride up to Crown Point and then back to Gresham and Portland was exhilarating. Here is the Garmin data…

The next day, I touched base with brother Gaylon, and rode a ways out the Springwater Trail to Boring, OR. It was boring, and so we turned around and came back. Garmin data…

On Saturday, I had wanted to ride up Larch Mountain with Aaron, but we decided to do something a little less strenuous, and so I came down to Salem, to do a fantastic and beautiful ride with him in the foothills of the Coast Range, and through the farmland of the Willamette Valley. Here is the Garmin for that…

Sunday was a day to relax. I spent about 4 hours with Lewis, which was much needed. I then spent time later again with Gaylon.  The weather was drizzly, and I was worried about Memorial Day, Monday, where it was supposed to rain heavily. On awakening, the weather was cloudy with sun, so I decided to go for it. On Gaylon’s advice, I headed down the I-205 corridor to Sunnyside Road, over to 152nd, down to the Clackamas River, and then back the Clackamas to Oregon City, crossing the old Oregon city bridge into West Linn, riding up to Terwilliger Blvd, headed up Terwilliger past the medical school,  (seeing the Terwilliger trail which I jogged many times while in medical school), crossing back across the Hawthorne bridge, and then (mostly) up Clinton Avenue back to the hotel on 92nd and Stark St.  I had rode the Hawthorne Bridge many times on my bike, but it was much easier now, as the wooden planks had been replaced with a solid platform. Here’s the Garmin, and a photo while crossing the bridge…

MayCycleRides-572

Hawthorne Bridge Crossing


On returning to the hotel, I threw everything in the car and dashed home. My ole BMC was a wonderful bike to do all of this riding, and it proved immense comfort and efficiency. Someday, I’d like to do the Larch Mountain climb. I’ve already worked out with Aaron to return to Oregon for the Crater Lake loop. I need to do much more riding with Gaylon, getting him into a little longer endurance rides. Altogether, it was a delightful and successful trip. Besides bicycle riding, I got to stop in at Powells Book Store, Bob’s Red Mill, and REI, as well as several bicycle shops. I should be back in Portland at the end of the STP in July, and hopefully one more time this summer for some riding.

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Apr 29

China2014-586

I have had a flurry of writing at the beginning of the year, but it has now been two months since I’ve written a review or commentary on my life. So, away we go with a trip to China. Together, Betsy and I took over 1200 photos, so, you are seeing only a small sampling.
Dr. Liao invited us to go on a trip with him to China. He had been suggesting this to me for quite a while now, and we have finally gotten around to going. The trip lasted from 10-26APRIL, and we visited 5 cities, representing central China. The weather was cool, with intermittent rain. The atmosphere was not smoggy, but actually quite hazy, making for less than optimal photographs. Click on the individual photographs for a larger view. Here is the blow by blow of our travels…
Friday Diane tok us to the airport, and we met Mike, before getting on the Hainan express to Beijing. The flight went 1 hour shorter than expected, and eleven hours later, 4:50 the next day, we landed in Beijing. After finding our hotel and checking in, we went out for a quick dinner, and crashed.
Sunday: Mike had arranged a guided tour for today, which included first a visit to the Great wall. It was  great. According to Mao, anybody that visits the Great Wall is a hero, so, Betsy and I are now heros. After that,  we visited the tombs of the Ming dynasty emperors, with a focus on the third, Yongle. We then visited a silk factory and purchased a silk comforter, a jade factory, and a tea specialty house for a tea tasting. That evening, we decided to do some Chinese cuisine, which we enjoyed. This was on what was called “bar row”, where we met a friend, XiaoDong, of Mike, who joined us at dinner. This restaurant was on a lake, which we then walked around before heading home. XiaoDong is a biomedical scientist, possibly in line for the nobel prize, but very delightful in personality.

Dr. Liao at the Great Wall - a real hero!

Dr. Liao at the Great Wall – a real hero! 


The tomb area of Yongle

The tomb area of Yongle


The restaurant menus come as picture books. Here is an example.

The restaurant menus come as picture books. Here is an example.


Out for tea

Out for tea


Monday: first, Tian’nanmen square, which is just a large plaza. We wished to see the Chairman, but his tomb was closed, as well as the Forbidden City. So, we opted for seeing a flower garden next to the Forbidden City, and then going to the Summer Palace. The Summer Palace was build by the Ming dynasty, but burned by the British, and then again by the British and the French, and each time rebuilt. It was massive, with a very large lake in the center. The Buildings were all over the hillside and very ornate. After dinner, Betsy and I were exhausted and crashed.
The gardens next to the Forbidden City

The gardens next to the Forbidden City


Ming dynasty architecture at the Summer Palace in Beijing.

Ming dynasty architecture at the Summer Palace in Beijing.


A stiff climb up to the top of the hill in the summer palace area.

A stiff climb up to the top of the hill in the summer palace area.


Boat trip across the lake at the Summer palace

Boat trip across the lake at the Summer palace


 
Tuesday:   A quick breakfast first was followed by a trip back to Mao’s grave, and then the Forbidden City.  Mao’s grave was most interesting. There was an hour long line, as roughly 200,000 plus people visit the grave each day. You pass through security, and are not allowed to have bags or cameras, no photos were obtained. You are sold white flowers to leave at his grave. In the building, you enter a large room where his statue is sitting in a friendly pose,  carved in giant white stone, similar to the Lincoln memorial. In the next room, his body lays in state, reasonably well preserved. Mao has had a comeback in China, remembering him not so much for his colossal mistakes (the great leap forward and the cultural revolution)  but for his absence of corruption and for uniting the Chinese people.  We then went to the Forbidden City. Mein Gott! This made any European palace system, including Versailles, look like kid’s stuff. The palace and grounds were huge. There were over 8,000 rooms. There were huge squares. Sadly, Chaing Kai Shek looted most of the treasures of the Forbidden City. Schwein! They now sit in Taiwan, and don’t belong to them. Every building was exquisitely decorated in the most ornate fashion. It all made you feel quite small. The evening was spent having Peking duck, and then cha he pijiu (tea and beer) on a rotating restaurant on top of our hotel.
At the enclosure leading to the Forbidden City.

At the enclosure leading to the Forbidden City.


Inside the Forbidden City

Inside the Forbidden City


A small section of the Forbidden City showing its immense size

A small section of the Forbidden City showing its immense size


Wednesday:  Today, we say goodby to Beijing and hello to Xi’an. After breakfast, Mike and I first visited the Beijing Hospital, the best hospital in the country of China. It was a zoo. There were wall-to-wall people lined up various activities, such as waiting to pay for an appointment, waiting for the doctor, etc. There is no such thing as an appointment time as it is first come, first served. The hospital was nice, but just miserably crowded. After that we went to the Beijing Cancer Hospital, the best cancer hospital in the country. We met a doctor friend of Mike’s, and toured the place. It also was a zoo. China needs a better system—they have great doctors but no system. From there, we checked out of our hotel, ran down to the other end of Chang’An Jie (Long Peace Street) caught our high speed train to Xi’an, was picked up by a driver, and delivered to our hotel after having dinner. This hotel would have been a $4-500 hotel in the US, but we paid slightly more than $100. Throughout the travel, including the high sped train, and the hotel, it did not seem like we were in China, as things seemed to be nicer than in the USA. Construction was occurring everywhere you looked.  There was an unbelievable dynamism occurring.
A crowded waiting room at Beijing Hospital

A crowded waiting room at Beijing Hospital


Thursday:  this was another hectic day. After a quick breakfast, we headed off to the terra cotta soldiers of Qin She Huangdi. The site was massive and overwhelming. We then went to a site that had the swimming pools of the emperor’s favorite concubine. After a massive lunch, we headed to the museum and burial site of China’s only female emperor, Wu Zetain. Dinner was again held, with a bit of overeating, but meeting some of Dr. Liao’s acquaintances in Xi’an.
Main area of the Terra Cotta warriors. There are over 6000 that have already been excavated.

Main area of the Terra Cotta warriors. There are over 6000 that have already been excavated.


Terra Cotta soldier wanna be's.

Terra Cotta soldier wanna be’s.


A typical lunch scene.

A typical lunch scene.


Today we got to try duck's feet and duck's heads

Today we got to try duck’s feet and duck’s heads


Mike practices his calligraphy at Mr. Yeung's office

Mike practices his calligraphy at Mr. Yeung’s office


Our most gratious host, Mr. Yeung.

Our most gracious host, Mr. Yeung.


Example of instructions everywhere not to walk on the grass, in poetic form.

Example of instructions everywhere not to walk on the grass, in poetic form.


At the swimming pool of the emporer's concubine. She was reportedly the most beautiful woman in China (next to Betsy, of course)

At the swimming pool of the emporer’s concubine. She was reportedly the most beautiful woman in China (next to Betsy, of course)


Friday: another quick breakfast, and then we headed off to a local Xi’an hospital. This was a private hospital, and they were in the process of building an entirely new hospital, which we toured in the construction phase. It is 27 floors,  1000 beds, with both in and outpatient facilities in the same structure. They then held a conference to ask our ideas on forming a more American style service to the hospital. The hospital is private, in that it was owned 80% by the doctors and nurses in the hospital, and 20% by other investors. After lunch, we went to a museum of ancient history, where relics from s far back as the Shang dynasty were on exhibit, going up to the Tang dynasty. I was amazed at the exquisite character of the workmanship in the bronze material. Xi’an has the largest complete still existing city wall in the world. It was huge, 15 km in length, and bounded by a river. We looked at the gate which was essentially the starting point for the silk road. There were amazingly no tourists there, but it was an impressive site. After paying a visit to a local Catholic church, where they were having a Bible study, we headed off to dinner.
Part of the 15 km wall of Xi'an. It was very large on top, room for 4 lanes of traffic.

Part of the 15 km wall of Xi’an. It was very large on top, room for 4 lanes of traffic.


Saturday: We checked out of our hotel, which was probably the nicest hotel that I’ve stayed in ever. There was even a private sauna in our room. We went to breakfast, and then visited the large Buddhist temple in town. Xi’an was one of the main towns that promoted Buddhism early on in its introduction to China, so it was a significant town for Buddhism. The restaurant experience for lunch was most unique, as Betsy and I saw foods that we never dreamt to be possible. Duck feet and duck heads, chicken feet, squid, frog legs, and vegetables that I have never even heard of before. The food was Anhui, which I’d probably avoid in the future.  We later stopped at the largest hospital in Xi’an, and drifted around. It certainly was large enough for over 2000 in-patients. Next stop was the airport. So far, we’ve been in a city of 22 million, and 8 million. We are now heading to Chongqing,a city of 11 million persons. Small towns just are a bit hard to find. Dr. Liao’s two older brothers met us for dinner. Dinner in Chongqing was at a hot pot, where each seat has a hot plate that has a sauce pan with boiling water with spices. You take various items and cook them yourself to eat. The hot pot was first done done in Chongqing.
Our hotel, on the banks of the Yangzi river.

Our hotel, on the banks of the Yangzi river.


The cross-walk just outside of our hotel.

The cross-walk just outside of our hotel.


Sunday- this was a lazy day. We started out by hitting a McDonalds for Betsy’s sake for breakfast. Mike left us alone to tend to family issues, and we were able to spend a relaxing morning in our hotel room. We took a long walk along the Changjiang (Yangtzi River), while Mike went to help resolve family issues. Later, we met Mike’s brother, who is a physics professor at the University and Susan, who took us to a historical museum in Chongqing where the forces of the Kuomintang slaughtered a large number of Mao supporters who were in prison here. The evening was a family get together, where we met Mike’s parents, and had a large, real Sichuan dinner. Nothing was recognizable except for the kung pao chicken, which was super-hot.
Historical museum of the Chongqing prison.

Historical museum of the Chongqing prison.


Old shopping district in Chongqing.

Old shopping district in Chongqing.


Les Trois Mousquetaires - Two of Mike's three brothers

Les Trois Mousquetaires – Two of Mike’s three brothers


The Liao family gathering in Chongqing. Mike had the sweetest parents.

The Liao family gathering in Chongqing. Mike had the sweetest parents.


Monday- breakfast was at Starbucks! We took a walk again along the Changjiang before checking out of the hotel. Mike’s brother, the physics professor, picked us up from the hotel, and we went down to the center of town, which was a large shopping center with super-rich shops such as would be found in Bellevue, or on the Kö. Lunch included the standard Sichuan cuisine, which was quite hot and spicy, but very flavor-able. Much of the food was unrecognizable to us, and contained very strange creatures. We then dashed to the airport, flew to Hangzhou, and was picked up by Mike’s sister-in-law, who taught traditional Chinese medicine at the medical school in town. This includes using acupuncture, herbal medicines and things of the like. Every hospital has traditional medicine doctors, who are used in treating select illnesses. We got to our hotel by 9pm and collapsed. The area of the hotel is called the Xihu Qu, or the Westlake District, the most expense real estate in all of China. I’m told that Hangzhou was an area of the first experiments in capitalism in China, and there was clear success.
Mike's sister-in-law outside one of the pagodas on WestLake

Mike’s sister-in-law outside one of the pagodas on WestLake


Pagoda on WestLake

Pagoda on WestLake


Tuesday—after breakfast at the hotel, we were picked up by Mike’s sister-in-law, and toured a number of museums and places of interest. The museums in Hangzhou were all free, making it nice. We first went to a silk museum, where they had on display historical silks from many mons ago. They also had a nice display of the silk making process. We went to a large experimental farm established by one of the emperors from several hundred years ago. We toured a ceramic museum, which showed the development of porcelain from ceramics many moons ago. We went to one of the large pagodas on the banks of Xihu. There was lunch, and the took a long walk around Westlake, including a boat ride to one of the islands in the lake. The Xihu (Westlake) area is like one massive park on steroids, very popular and thus very crowded even in slow times, though not often visited by foreigners. It is meticulously cared for, massive flower beds, and most beautiful. We had dinner on the lake. Hangzhou is known for its particular cuisine, which is not hot, but distinctly different from other Chinese cuisines. The food tends to have more fish in it, and tends to have a more slimy character. After dinner we were tired, stuffed, and wanted to crash.
WestLake area

WestLake area


View of part of WestLake from the top of the pagoda

View of part of WestLake from the top of the pagoda


Scene on WestLake

Scene on WestLake


Mike searching for directions

Mike searching for directions


Wednesday—This was a slower day for us. We spent much time walking along Xihu, people watching, buying tea and other things, eating at Burger King (not as good as the US), and then drifting on back to the hotel. We then met Dr. liao’s brother-in-law, who is working on a PhD in constitutional law in Beijing. He took Mike and I on an extended tour of our hotel side of the lake (Xihu). We again visited a number of museums, and then tried this famous local dessert made out of the powder of the lotus plant root. It tasted good, but was a bit slimy in texture, but is well liked by Chinese. We had dinner in a very popular restaurant along the shore of Xihu, and the restaurant where Mike was married. Dr. Liao’s nephew Andy was with us, 11 years old, and who will be starting boarding school in Connecticut this August.
Elderly couples dancing in the park in Hangzhou. This was commonly seen by us.

Elderly couples dancing in the park in Hangzhou. This was commonly seen by us.


Mike's brother in law, talking seriously with Mike.

Mike’s brother in law, talking seriously with Mike.


Outside of one of the museums with Mike's brother in law.

Outside of one of the museums with Mike’s brother in law.


Lotus schleim. I actually tasted good.

Lotus schleim. I actually tasted good.


Scene from the WestLake park.

Scene from the WestLake park.


Girls loved to have their photographs with Betsy.

Girls loved to have their photographs with Betsy.


Thursday—today we were picked up by Mike’s sister-in-law and taken to the train station. The ride was one hour from Hangzhou to Shanghai. In Shanghai, we first found our hotel, and then took a cab ride to the international district. We saw the building where Mao and twelve people wrote the constitution for China, and then we went out to eat at a faux-German restaurant. The beer was good, food very so-so. Afterwards, we walked along the riverfront, looking at the buildings of Shanghai, and slowly drifted home. Hangzhou was a small town of only 3 million people and 8 million in the metropolitan area, but Shanghai had 10 million in the city and 20 million in the whole area, a little bit larger city.
Shanghai architecture across the river from Mike and I

Shanghai architecture across the river from Mike and I


Friday—today is a lazy day, with a focus on shopping. We went to two shopping areas, where we focused on buying tea, porcelain, and gifts for the kids. The first shopping district was close to our hotel, anf a very long shopping road, off limits to cars, and with very fancy shops. We then hopped in a taxi, and went to a very large shopping center with a Ming dynasty architecture motive. This place was huge, we spent all of our renminbis, and had an awesome time. We then got ready for dinner, hopped the subway to the other side of the river that runs through Shanghi, and went into a very large shopping center, larger than anything that I’ve ever seen in the US. It was a total of thirteen floors. Before entering, we got an appreciation for the building architecture of the new Shanghi, which is beyond anything found in America. Dinner tonight was with Drs. En and Mrs. Li. He taught biochemistry and did biochemical research at Harvard University, before getting a job working for Novartis, back home in Shanghai. China, because of its burgeoning economic status, is extremely favorable for scientists, and it is very easy for me to see why. Dinner, by the way, was probably the best meal we ever had in China, though entirely Chinese. En has apparently lived long enough in the US to know what the American taste would like.
Ming style architecture in large shopping district in Shanghai.

Ming style architecture in large shopping district in Shanghai.


Typical buildings in Shanghai

Typical buildings in Shanghai


More very creative architecture in Shanghai

More very creative architecture in Shanghai


Family at a small tea shop where we purchased tea and tea cups

Family at a small tea shop where we purchased tea and tea cups. Note that Oma cares for the baby.


Inside the large shopping mall. This only a small view of the whole mall.

Inside the large shopping mall. This only a small view of the whole mall.


Dinner with our gracious host in Shanghai, Li En and wife.

Dinner with our gracious host in Shanghai, Li En and wife.


 
Saturday—we are eager to get home, though we have most thoroughly enjoyed China, and it is sad to say goodbye. A cab ride got us to the train station, and the train from Shanghai to Beijing was 5 hours, with 5 stops. It was mostly through very flat farmland. In Beijing, a friend of Mike’s picked us up and shuttled us to the airport, a little over an hour drive, and giving us our last taste of crazy Chinese driving. The flight home was 9 hours. We left Beijing at 4:30 pm and arrived in Seattle the same day at noon. It was two days packed into one. After saying goodbye to our dear friend Mike, Sarah shuttled us home. We unpacked, and noted piles of tea, as well as no broken porcelain. It was good to be home.

Thoughts on China…

Just a few minor observations. Cars… Brother Dennis purchased a Chinese vehicle in Belize, which was a total piece of junk. I anticipated that I would see cities full of junky cars and rickshaws, bicycles, and baby taxis, like in India. Instead, there were no rickshaws or baby taxis, almost no bicycles, and the most popular car was the Mercedes Benz, followed closely by the other German cars, BMW and VW. Chinese cars are reportedly next in popularity, followed by American cars,  and Korean/Japanese cars were the least frequent. I did not see a single Chinese made car until Chongqing, but it was a nice looking sports utility vehicle. Supposedly, they have vastly improved the quality of their vehicles. At the end of two weeks, we saw less than five Chinese built vehicles.
Secondly, the big cities do not have slums. They do have poorer parts of the city, but nothing that I would call a slum. The countryside had some very poor areas, but no worse than found in Belize, Jamaica, Cameroon, or Bangladesh, the “third world countries” that we’ve been to. The dress that people wear is identical to the western world. There was no ability to recognize that you were not in the US or Europe except for the Chinese writing, and that everybody was oriental. There is minimal unemployment in China, as there are no unemployment checks, welfare, food stamps, or anything of that sort. In a strong sense, it is more capitalistic than America! Regardless of your status or education, if out of a job, you will take anything in order to survive. The state will not be your nanny. There are no messy employment laws, and you can fire an employee at will. Employers tend to treat their employees well. One morning, we saw at a clothing store and then at a restaurant all of the employees out in front of the store doing Zumba like exercises. Many larger firms will have a cafeteria for free lunch. Our friend also had a large library at his firm for employees to encourage their continued education.
Thirdly, traffic is absolutely horrid in China. Why most the cars do not have bumps and scrapes is a total mystery to me. An American traffic cop would find violations literally every second. People use the shoulders of expressways as a passing lane. People run red lights. Cars do not yield to pedestrians but vice versa. People will aggressively violate every traffic rule on the books to pass a car in front of them. I watched my taxi driver pull into the on-coming lane of a four-lane road in order to beat a traffic light. I could not ride in the front seat of a car. Historically, I feared the taxi drivers of NYC. Now, China has exceeded that 10-fold. Next time I go to China, I bring mass quantities of Valium if I anticipate an automobile ride.
Fourthly, the Chinese put a very high value on family and relationships. This is a little odd, since their value for human life is less than in the US. Everywhere we went, we saw grandparents with grandchildren. I was surprised to see that the state was not raising the child, but the grandparents. In family relationships, the grandparents are usually asked permission for any major decision, such as marriage.  The eldest son held priority in family decisions. Nursing homes did not exist, as the children were expected to care for their aging parents. I did not expect this.
Fifthly, the language and poetry are important. Everywhere you go, you see poetry. Apparently, the Chinese language lends itself easily to poetic expression. We would see signs not to walk on the grass, and it was written in a poetic fashion (so I am told by Dr. Liao).  The Chinese hold those who are masters at poetry in the highest regard. And, the person in recent history who excelled in poetry was none other than Chairman Mao.
Sixthly, Mao Ren Zi (Chairman Mao) is the most poorly represented person in the west. Before my visit to China, I viewed Mao as nothing but a beast who slaughtered millions of people. That is perhaps true, but it lacks the full impact of who this man was. Why is it that Mao now has a near 100% acceptance rating in China? Why is he generally appreciated everywhere in China, and not because it is forced on the Chinese people? As mentioned above, the Chinese knew that Mao was most brilliant, and had a mastery of the language beyond most intellectuals. His poetry is everywhere, because it was very well done. During the years that Mao was chairman, he changed the Chinese language for the good, like having the symbols simplified. The Chinese now read and write right to left, like we do. Why? They used to write up to down and backwards, but Mao had that changed. Mao not only liberated the farmers, but also women, stopping crazy practices like feet binding, and giving them more rights. Secondly, the greatest problem with all Chinese emporers and rulers was serious corruption. If one faulted Mao for anything, it certainly was not corruption. Chaing Kai Shek was very corrupt, and the peasants knew it well, which is why they flocked in support of Mao. Mao had no love for the privileged elite, and exalted the poor peasants to a better living. That is seen well in China nowadays, with there being many multi-millionaires, but the farmers in the countryside have a reasonably good living in comfortable circumstances, and not as it was before 1949. With the current corruption in government, there is a sense of nostalgia for a leader who could act for everybody’s best interest without corruption. People often cite the fact that Mao murdered millions ruthlessly. Actually, most of the deaths under Mao’s watch were from serious mistakes that he made, and most people in China acknowlege that. I am referring to the great leap forward, and to the cultural revolution, which were truly stupid mistakes, which led to millions of Chinese dying, though not intentionally by Mao. One cannot forget history. China is a somewhat diverse group of people, with 56 ethnic groups, multiple religions, and multiple languages. In my reading of Chinese history, I don’t know of a single emporer that did not have to do a major “purge” to acquire unity and control of the country. Now, perhaps unity in China is not a good thing, but that is not something that I would propose—I don’t wish to be like the French, who felt the a united Germany (back in 1870) was not a good thing, since they would lose control of the weak individual German states. In any case, power was used consistently to achieve unity in the country. Finally, many in China view there to be two major revolutions in the country. The first was with the rise of the Qin dynasty, a very short dynasty from 221 to 206BC, and best known for the terra cotta warriors. What most don’t realize, was that the Qin leaders were quite ruthless at leading to the unity of the country. They also unified the language, and standardized many things, such as the width of wagon wheels. Important? Think about India, that has 5 different gauges for the railroads. That wasn’t to happen in China, because of wise but strong leadership. The second revolution was with Mao. Mao is now gone, and we are able to speak freely about him. There is much wrong with Mao, and I don’t think that the ends ever justifies the means. No doubt, Chairman Mao is a complex person, and my attempt to understand why he has such a pull in Chinese society at this time now has a little better insight.
Finally, what about “communist” China? Are they “communist” only in that the leadership is not necessarily elected, and that they do not permit criticism of the government? In China at this time, that is not bad, because the leaders have been capable of brilliant leadership. What about restrictions of speech? Facebook is not allowed in China, as well as many other forms of social networking. But then, homosexuality and pornography are also not allowed. Is that bad? I wish it were so in the USA. Meanwhile, the USA is far more communistic and socialistic than China. Perhaps we need to re-think the corruption and evil than rules strong in Amerika?
In conclusion, this trip to China was fantastic, and Betsy and I thoroughly enjoyed ourself. The food was sometimes slightly wearisome, but was always quite good – just not what we are used to. The mass crowds were also a little challenging. China was nothing like we expected, and the wealth and immensity was overwhelming. I now have a feel for Marco Polo returning to Italy only to find that nobody could believe his fantastic tales of China. China truly is dazzling, and the people everywhere were friendly. Most signs had English translations, suggesting that we Amerikans are still welcome in China. Hopefully, we don’t create an artificial war that treats China like an enemy. They have no interest in war, as their internal problems are great enough. I would hope that politicians could see China as a friend, understanding the differences that separate our two countries.

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Feb 03

Seahawks
Much hype was made over the Superbowl in the Seattle area. Everybody (hyperbole, actually, only about 30%) was wearing Superbowl shirts over the past week, and the mania reached to all branches of life. The super-rich flew to Christie-Land (kind of like Fantasy Land) to personally attend the festivities. There was great apprehension, because the Reds (* see below for explanation of the colors) had the most valuable player. Conversely, the Blue-Greens had the favor of Nero, as well as the Reformed Pope of Seattle (Mark Driscoll).
The game was not watched by me, but I could tell that it was practically over from the start. The only anxiety remaining was whether the Blue-Greens would be able to pull off a total shut-out. Actually, they did accomplish a total shut-down, as the city of Seattle and its accompanying megalopolis rested quietly, all citizens glued to their personal sewer pipes (televisions). The streets were empty, and shops were stilled. Even the houses of worship that still met on Sunday evening were poorly attended—I know, since I went, but heard one of the best sermons ever last night-Zechariah 14. Facebook was littered with photos of home Superbowl parties, photos of nauseating junk food spreads fit for Rosanne Barr or Oprah, and scores were updated on a continuous basis. Since I am friends on Facebook only of Seahawk devotees, I delighted in their spontaneous posts of rapturous praise to the Blue-Green god. The red devotees were not happy, but I never heard from them, and they got what they deserved—dogs and blasphemers never deserve to win.
Now that the Superbowl is over and the Blue-Greens are the victors, all is well in the Land of Oz. The Emerald City has returned to it’s usual helter-skelter. But, there is a noticeable difference. There is now love in the city. No crimes have happened since the clock struck game-time zero the Land of Oz.  There is a prevailing sense of peace. There is joy unspeakable among the residents of Oz. It is a transformation like has never occurred in our great land. Meanwhile, Nero has announced that he was just kidding regarding Nero-Care and is terminating it as of this moment. He is withdrawing troops from Afghanistan, shut down the Federal Reserve, and has confessed to being an inveterate liar, never to lie again. Salvation has come to our dear Pacific Northwest, and we’ve all found jesus. The Seattle Pope has already declared that many of the Blue-Greens have found jesus, and while the rumor exists that while some of the Reds have professed finding the same man, we know most assuredly that that simply cannot be true, as jesus loves sports and would only allow true believers to win.
 
*In Greek and Roman society, the sports teams were named by color, so that instead of the SeaHawks, the Broncos, the Cubs, the Trailblazers, you had the Blues, the Reds, the Greens, the Whites, etc. The White Sox or the Red Sox most closely approximate the ancient standard. The SeaHawks colors are Blue-Green and the Broncos Orange with a touch of Blue (call them Red since an Orange team did not exist in Rome), so they are referred to with color terminology in this post. Ancient Nero, like most of the emperors, was an avid Green fan, so he probably would have been a SeaHawks Blue-Green fan. The reincarnation of Nero in the White House almost certainly is a Blue-Green fan.

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Jan 01

Happy New Year! The year has had some great trials, as well as bringing supreme joys.
Joys? Not only has Rachel given us Lily Mae and Adalyn Grace, but Diane also have given us Dean, leaving us with 8 grandchildren. It’s an odd thing to think how much joy one gets out of the grandchildren.
The trials (and trial, literally) last year has been hard, but has been good for both Betsy and me. We have acquired a rich discovery of each other that has been a blessing. It is typical to have the empty nest turn on parents as a strenuous time for each other, but we have found it just the opposite. It has been fun traveling together, and just living together.
The trial from last Spring has been elaborated in a blog entry from April and can be read about there. The supposition is that one gets over a lawsuit, knowing that they are going to happen, and one gets on with life. That has not happened to me. I have felt the horrible injustice of the court system that does not seek after truth and rightness. When a physician does everything right, he still is legally culpable if a problem arises. In response, I have backed down considerably in what I do in my practice, and plan on retiring sooner than later. I see God’s hand in all of this, as it is otherwise quite difficult to slow down one’s practice and yet be able to remain in practice. It feels as though the entire system has you trapped.
Trips have included a bicycle ride with the ACA in Death Valley, a trip with Dr. Tate in upstate Michigan on bicycles, a trip to Germany with Jonny, and a bicycle ride on the eastern side of the Sierras with the ACA and also with Jonny. All of these trips are chronicled previously on this website. I took a brief trip to San Antonio (not recorded in a blog entry) in early December for the San Antonio Breast Cancer Symposium. There were other small trips.
Last year, I noted that I was working through all of my classical music. I have since acquired about 20 days more music, including a complete Wagner (with 2 sets combined), a nearly complete Haydn set, a complete Verdi, and multiple other works. My classical collection is now 66633 songs, consisting of 418.3 Gbytes, which would take me 204 days, 10:22 hours to listen to. At the end of the year, I am now left with 4189 songs, 29.5 Gbytes, and 14 days, 11:31 hours of music. I have acquired a set of the complete Bach organ works by Marie-Claire Alain that I have yet to load. So, I should be completely through my classical collection some time in late February or early March.
Plans for the coming year include more bicycle rides. More people from church have become interested in cycling, including Rick DeMass, the associate pastor. I am planning a week loop in Washington with Jonny, as well as a ride in the Black Hills with the ACA. Before the Black Hills trip, Betsy I plan on driving to Sioux Center to see Alex and Rachel and Lily and Adelyn, who will then meet me in the Black Hills for several days.  Betsy and I will be traveling to China with Dr. Liao in April. I am trying to put together a church trip to Israel with John Delancey for early 2015.  I also plan on going with Betsy to Phoenix in March to meet Dr. Tate and attend the SSO. I might also go to the American College of Surgeons meeting either this year or next. This year, I’d like to do the STP (Seattle to Portland bicycle ride), as well as a ride in Oregon with an old friend Aaron Hughes. There are no plans yet for Germany this year, though a trip in the fall is appealing. I really appreciate my time with all my German friends, including Dr. Herbert, Dr. Hannes and Katja, and Dr. Carsten and family. For 2015, I’d really like to do a 2-3 week Danau Radweg ride (Danube bicycle route) from Danaueschigen to Wien. I have no current plan to change my practice as it is right now, but will be working on forming a more cohesive atmosphere for cancer at Good Samaritan Hospital.
I still have a large stack of books to get through. Some time this year, I plan on reading Calvin’s Institutes, translated by Battles, as well as reading Hermann Bavinck’s 4 volume set on systematic theology. Neither of those books are available (yet) on Kindle.
Most of the sleepless nights that I and Betsy have had have been related to the troubles that close friends have had. Sometimes, it can be harder to endure watching a friend suffer, than to be going through such suffering yourself. Relationships to friends, family and God have become more important over the past year. Sundays at church remain a defining moment in Betsy and my lives. All else becomes meaningless before an infinite, personal God.

Whom have I in heaven but you? And there is nothing on earth that I desire besides you. My flesh and my heart may fail, but God is the strength of my heart and my portion forever… as for me, it is good to be near God: I have made the Lord God my refuge. From Psalms 73

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