Seeing this architectural wonder made me reflect on a part of my Urological career. How? Well here it is:

I became involved with the placement of radiation seeds soon after they were introduced in the United States. This procedure intrigued me because it required two specialists, a Radiation Oncologist and a Urologist, with different skill sets to work together on a common goal.                                                                                                 

Over a short time the technique evolved and my Radiation Oncology colleagues started an international training program. I was asked to be one of the Urologists to help teach in lectures and in the operating room.

Teaching was great fun. When the training took place in the operating room, I felt like I was in my home court. For many of the Radiation Oncologists this felt like Siberia, a place far from their home.
Often Dr. Peter Grimm (a Radiation Oncologist and close friend) and I would work together. During a procedure I would say that Radiation oncologists should not be trusted with sharp objects. He would quickly retort, “And Urologists should not be trusted with numbers.”
Teaching Radiation Oncologists manual dexterity with surgical instruments and reading ultrasounds was often difficult. These skills are part of a Urologists training. Radiation Oncologists train primarily in radiation planning and treatment delivery. Many had relatively little experience with the surgical instruments and ultrasound-guided techniques required for prostate seed implantation.  

In the same vein, teaching Urologists about radiation fields had its own set of problems. But that issue was for the Radiation Oncologists to deal with.                                                                         

I had ideas about modifying some surgical instruments and creating some new ones to make them easier for non-surgeons. But I lacked the technical knowledge to design and create them. Through a colleague I was introduced to a company that developed medical equipment and together we worked from ideas through engineering designs. They made working prototypes for use in the operating room under clinical investigation protocols.

Did I make large amounts of money from my work? No, actually I lost my shirt. But I experienced cooperative thinking with different skills to develop equipment from just a concept to a prototype.

I also learned that what seems like a great idea does not always equate to a financial home run.
 
Copenhagen

Upon arrival to Copenhagen, we saw a structure which was a large triangle with a stack on its side billowing out white smoke. It was like nothing we had ever seen before. What type of industrial plant could it be?                                                                                                      

During the day we had the opportunity to view the structure from multiple angles. We first saw that there was a year-round ski run from the top of the structure. And for non-skiers, there was a hiking trail next to the ski run. Finally, we viewed a tall climbing wall on the side of the structure.

But why was there a large smokestack?

This is an example of imagination solving a worldwide problem while creating a place for recreation.     

As our guide explained, the plant burns organic and other non-recyclable municipal waste to generate electricity and district heating. The white plume we had mistaken for smoke was actually water vapor released after the exhaust gases had been cleaned. We were also told us that the facility is so efficient that, at times, Denmark imports waste from Germany to keep it operating at capacity.                                                                                                               

Rather than relegating this to an industrial area outside the city, they transformed it into a piece of useful urban art.

I am not a civil engineer, but it is wonderful to see how the combination of imagination and technical knowledge has resulted in using an urban space for a multi-use project.

And when I see it all I can think is “Get the skis waxed and ready to go!”

  Copenhagen Icon Meets A Multi-Use Structure

We did not come to the British Isles looking to lie on a beach to get a tan. Some of the charm here has to do with the ever-changing weather. The land is harsh at times and at other times soft green and inviting. The people I met were joyous in spite of the difficult conditions. And acceptance of the weather reflects their happy toughness. As a Scottish Guide told us: Don’t worry, if you don’t like the weather, it will change in 15 minutes.
We began with beautiful warm skies and then the 15 minutes of summer ended. We had three days of wind and some rain. But that weather brings out stories and feelings that stay hidden with warm sunny weather. These poems and photos almost feel like pages of a notebook from those three days.   But poetry is not a weather report, I took liberties with the thoughts and feelings. Was it as cold as I write? No, it was not, but the spirit of the days made me imagine what winter would be like.                                                                                                                                            

 My first poem was written months before our trip. But it is included with these poems because it reveals my approach to the day and to new experiences.

 How best
to awaken with
curiosity,
smile at the sun.

When the night
was so dark,
dreams awakened
my essence.
With a sleepless
night,
the mirror is my
guide,
to smiling eyes.

— —

 My bones are cold
like the stones
so well fitted
in a Scottish castle
wind sails over
whipping my ears
my hands shaking
as I pull the lines
to bring my skiff
to dock
humbled by
the stony coastline
fighting currents and waves
seeking to find
warmth behind
an open door
and the fireplace
warming your heart

 — —

Can my teeth chatter
without movement?
motionless hair
so still.
Yet there are
cold winds over the seas.
Scottish heather 
brightens the path
as we walk by the sea
silvery waves in the distance 
waiting to brush upon rocks
uncomfortable air 
forces attention
to the cobblestones
beneath my feet.

Cold soft sputtering rain
follows my ship
as the harbor sits
under grey mist
the bridge from a distance
appeared so low,
so low we can not
clear it
yet now, underneath
the spider web metal supports
become a colorless rainbow
overhead
and our dock
now beckons for our safety.

- —

A castle by the sea
broken by the very
storm it stole
from the generation inside
prevents intruders
but the stones will never
be warm
nor comforting from
the wind and rain
no hearth will bind
those to the land.

Postscript

On the bus in Wales
I lost my cap
the cap from Fairbanks
with the dogsled
the midnight sun
each time I saw it
stirred my thinning memory,
now will the memories be gone?
A doorway erased with the lost cap
thoughts filled now with photos of hiking
scenes of mountains and heather
my hope is grasping the thoughts of before
without needing reminding
without losing my past

The Shard, London

While being guided through London our attention was directed towards the tallest building in the city. With its sharp angular shape, it was called the Shard. Just the name alone got my mind wandering.

More than once in my life I have dropped some glass and while attempting to pick up the broken pieces with my bare hands, I ended up with a shard of glass in my hand. At first it is barely noticeable, but later it is bothersome and irritating. At that point I have taken a needle and scraped the surface of the glass that I really can’t see. With time I have slowly been able to find it and remove it. But the sensation of the glass shard remains for a while until the inflammation dies down.

This is similar to some of the side effects of hormone therapy and chemo therapy. Some effects are irritating, not life threatening, but so bothersome and others can cause real disability. Some resolve with time and others are long lasting. And unlike a shard of glass, they are not easily removed

What Iced Gloves Can Do

In the beginning of our trip, while still in England, we met an engaging couple who were sitting at a table. After a while she got up and he quickly went to her side to help her as she walked. Without much thought she turned and said, I have neuropathy and he helps me in getting around. There was no reason for me to put on my doctor cap and ask why she has neuropathy, but it got me thinking about how lucky I am not to have neuropathy after chemotherapy. Some of this luck was due to my friend and colleague, Emily.

Emily is a Urologist who, unfortunately, developed breast cancer and underwent chemotherapy. She had finished her chemo months before I was diagnosed with advanced prostate cancer. When she heard that I was to undergo chemo she told me about getting ice gloves and socks to decrease the effect of chemo on the nerves in my hands and feet. Since I was already bald, there was no reason to recommend an ice cap to protect my hair.

The ice in the gloves and socks constricts the blood vessels and therefore less chemo affects those areas. Neuropathy in the feet can cause numbness. Think about having your foot fall asleep and attempting to walk. Pretty tough isn’t? You can’t really feel where your foot is and you have to watch your foot placement more than feel it.

In my free time I have enjoyed sports and playing music where I used my feet and hands and my professional work demanded the use of my hands. I wanted to protect my hands and feet to the best of my ability. I went online and ordered the gloves and socks. All I had to do in preparation was to put the in the freezer and bring them to my chemo appointments in a cooler.

Just prior to the chemo, I put them on to prepare the blood vessels to be constricted. That all seemed very easy. But keeping them on during the chemo was brutal. As a child I went sledding for hours without thought about my cold hands. I still remember the feeling of swelling of my hands and pain from frostbite. Having ice on my hands during the infusion brought me back to thoughts of that pain from decades ago. For me the socks were not too bad, but my hands on ice were painful. There were a few times I had to take the gloves off for a short break and then put them back on. I do not know if my results were due to the gloves/socks, but after my 4 infusions of chemotherapy, I have continued to play piano and tennis. If I had had significant neuropathy, neither one of these activities would be possible.

All I can say is: Thank you Emily!

Shirtless On The Beach

As many of you know, I am very much a beach boy and still consider myself a surfer. When I was younger, I would wear a wetsuit if the water was cold, but I far preferred surfing shirtless on warm summer days.
Going on hormone therapy can cause breast tissue to develop in most men. This issue is cosmetic, but for many men the changes significantly affects their body image and self confidence. It can cause embarrassment in going shirtless. Developing breast tissue was something I wanted to avoid.
Did I want Karen to taken me out for the fitting of my 1st bra?
Unfortunately, if preemptive measures are not taken before the development of the breast tissue, the only options would be to live with the changes or undergo surgery, a reduction mammoplasty.
In order to decrease the development of breast tissue, I elected to have radiation to my chest prior to starting hormone therapy. I had this done over 5 days. It was just a matter of showing up at the radiation therapy unit, lying down and over about 5 minutes the radiation is given. When I received the radiation, there was absolutely no sensation at all.
Sometimes discussing development of breast tissue can be awkward. But I look at it this way, bringing up the issue can give a man the option to consider the treatment and weigh the risks. Did the radiation work for me? To some extent - Yes. It was not perfect, my chest looks slightly different, but I did have mild changes that I notice. But I doubt anyone else can see the changes.

Sharing Our Experiences

We can’t prevent every shard that cancer leaves behind, but sometimes someone else’s experience helps us remove one before it becomes part of our lives. Emily helped me with her experience. I have guided men in the management of prostate cancer through my medical training and my personal experiences of treatment. Sharing knowledge can help others during difficult times, and that is a wonderfully human thing to do.

Umpferstedt III by Lionel Feininger 1919

I believe in serendipity. I took this photograph in Norway in 1976. I printed it myself and somehow kept it with me through my many moves for fifty years. Last summer, while downsizing in Seattle, I scanned it because it gave me a fond memory that I did not want to lose. Now, just before returning to Scandinavia, it is in a place where I can always find it.

It looks weathered now. So do I.

50 years ago, I had the opportunity to travel to Scandinavia. I had transferred from medical school in the Philippines to Rutgers Medical School in New Jersey. During the school year, I took a job as a gardener and was able to squirrel away some money. I knew that this would be my final summer break between the 2^nd and 3^rd year of medical school. Afterwards there would be 2 more years of medical school and 6 years of residency. Vacations would not be measured in months.
I decided to use some of the money for a month-long trip to Scandinavia. One of the reasons I chose Scandinavia was to explore my Norwegian heritage. I really did not know very much about my ancestry other than my Norwegian family emigrated from Bergen to the United States. I wanted to get a sense of the people from one of my countries of origin.

Two years later I spent 5 weeks on a medical school rotation in London and Devonshire, working directly with English physicians. That experience gave me a feel for the country and its people and also English socialized medicine.

I am about to take an extended trip with Karen to the British Isles, Scandinavia and countries on the Baltic. I look forward to seeing new places, meeting new people and revisiting places that changed my outlook on life when I first saw them decades ago.

I have been writing about experiences from my life. Travel and change open my world to new ideas and friendships, plus I get stories that either crack me up or embarrass me.
As when we went to Africa, I am hopeful that the adventure to come will stimulate me to write more about topics I cannot even imagine at this time.

Over the past 50 years the world has changed. But so have I. I have gone from medical school to a full career in urology. I have been married, a caregiver at home, a widower, a single parent, and now in a blended marriage. I have dealt with prostate cancer for 23 years with surgery, radiation culminating with chemotherapy and hormone therapy.
The difficult times deepened my sense of gratitude. I am grateful for those days when I feel well enough to enjoy life with my family and friends.

Finally I am adjusting to the desert. In my heart I have always been a surfer dude enjoying warm beach water as a kid, loving the smell and adventure associated with salt water. I then spent half of my life in the Pacific Northwest enjoying the cool rainy mist of the winter and the warm bliss of the emerald green summers. Although I lived hours from the waves of the Pacific Ocean, the cool salt water of Puget Sound was never far away. I imagined that I would eventually return to a warm beach. My sister referred to me as The Slug.
Now I guess I will become The Scorpion. It is such a change to wake up at 5 am in the summer to temperatures already above 85, climbing past 110 later in the day.
On a warm beach, my favorite time has been mid to late afternoon. In the desert in the summer, early morning.

There will be new adventures ahead and I am hopeful for new stories and the chance to see old memories in a new light.

I think it is time to close Volume 3 and begin Volume 4.

For those of you who have started reading my chapters midway through, or are just discovering them now, you can find all the chapters at:
thomasgreen10.substack.com/archive

You can fool some of the people some of the time, but you can’t fool all of the people all of the time.

Bakari: Swahili — He Who Will Succeed
Rascal / Jester

Over the past few years I have reached out to people in my past. These are people whom I have not seen for decades. In the beginning my object was to give them thanks for being important in my life at the time or apologize for my actions years ago. It was quite interesting in that when giving thanks, they appreciated it. When apologizing, most did not remember the incident that caused the guilt I carried deep in my unconscious for years.
As I continued reaching out, I also asked what people thought of me decades ago. I remembered what I thought of myself and how I was presenting myself to the world. I wondered how the rest of the world viewed me.

Those conversations often left me wondering how accurately we ever know another person, or even ourselves.

Aunt Al

I call my mother’s best friend at times. Aunt Al (Alice) as we all knew her. My mother passed away in 1986, yet the bond between them will never change.
Aunt Al is 98, still lives on her own and when talking to her I can see her great smile while she laughs during our conversations. Every time I talk to her, she reminds me of the sailing lessons I gave her. And every time I talk to her she calls me a rascal. I don’t ever remember being referred to in that way when I was a kid, but I guess my personality fit the bill. In fact in my 60’s and 70’s, my mother-in-law, Zoe, and my brother Jim referred to me in the same way.

Our families both lived in the same town in northern NJ during the school year and lived down the street from Aunt Al and her family in the bay side of a beach town, Normandy Beach.
All the kids were brought up swimming, sailing small boats, water skiing and some of us surfing.

When I was about 16, my mother asked me if I would teach Aunt Al how to sail. I had sailed for about 8 years, first as a crew and by the time I was 12 I either took boats out on my own or with friends. In those days no one wore life jackets to go sailing unless we saw a storm approaching. I had never taught anyone to sail before, but I figured I could teach her and so I said, “Yes.” It was also virtually impossible to say no to my mother’s request.

In those days we first learned to sail flat sailboats called a Sailfish. It could be tipped over on its side and then brought upright by just standing on the centerboard which stuck out from the bottom of the boat.

So here we were, Aunt Al in her one-piece bathing suit and bathing cap and skinny me in my cutoff dungarees.
We pushed off in the warm summer water with a very light wind. I first took both the line to the sail and the tiller and slowly instructed her in how to pull the sail in based upon the wind direction and how to steer the boat. After about five minutes doing that, I gave her the line to the sail so she could have a feel for the force of the wind. She managed that quite nicely. We then changed places on the boat and she started steering as I held the line to the sail.

At that point the rascal in me took over. I jumped up from the sitting position, grabbed the mast of the boat and tipped the boat over to Aunt Al’s horror. I thought it was all quite funny, but that is what a 16-year-old rascal would think.
I then guided Aunt Al to the bottom of the boat where the centerboard stuck out and had her pull on it until the boat was brought upright.
At that point a bit exasperated, but laughing, she asked me what I did that for.
It was an easy answer.
“If you want to sail you have to know what to do if the boat tips over.”

Lesson number two started in much the same way. Aunt Al took the tiller and then the line to the sail so she was now single-handing the boat. She seemed a natural for sailing. As a pilot has their first solo, I felt she was ready for that. I jumped overboard and swam next to her while giving some basic instruction.
She was laughing but nervously asking me why I jumped overboard.
Again, it was an easy answer.
“You were ready to handle the boat on your own and I won’t let you sail away from me.”
As far as I remember that was the last lesson from the rascal, but she did learn to sail.

At my 50th college reunion, I hadn’t seen any of those friends in half a century. One of the first things someone said to me, after confirming I was still upright and had a drink in hand, was, “I remember visiting you at the shore and you tipped the boat over.”
Then others chimed in saying the same thing.
I had no memory of doing that to anyone other than Aunt Al. Maybe my nickname back then, Tequila Tom, had something to do with why those memories are a little hazy.

Dizzy (Diz)

I went to a small liberal arts college in Carlisle, Pennsylvania; Dickinson College.
As a freshman I quickly learned that all of the weekend parties were in fraternities. I therefore joined Phi Delta Theta so I could enjoy weekends as I perceived college students should.
I went to the 50-year reunion and still felt a deep connection to many people I had not seen since college. Unfortunately some of my friends had already passed away over the interim. One of those was Diz.
Diz was a year or two behind me. Very few of us even knew his first name. My recollection of Diz is that he was a fun-loving guy who was always up for a party. I have no idea how well he did in school. He gave the impression that academics was a secondary thought far behind enjoying college life.
When my high school sister, Cathlin, and her friend came to campus to visit me, I viewed Diz as a safe, good guy to fix my sister’s friend up with for Saturday night while my sister was fixed up with another friend, Lounge (short for Lounge Lizard).
Diz was on crutches for some leg problem that I don’t even remember. What trouble could he be, a nice fun-loving guy on crutches?
Later in the evening I was told he and the high school girl were in his room and had used the crutch to jam the door closed. Another of my many misreads of people through the years.

At the 50-year reunion I was told of his death and we all toasted him. Later I was sent his obituary and my eyes almost popped out of my head.
This typical Caucasian college student was the son of a legendary OSS operative and CIA counter-intelligence chief. He was born in Karachi, Pakistan and spent much of his youth overseas, most notably in India.

That alone was completely out of character with the Diz I knew.

But then I learned he became a noted nuclear industry expert, served as Director of Public Affairs for the U.S. Department of Energy and Chief of Staff for U.S. Representative Connie Mack. Beyond politics and energy, he co-founded the Kentucky Equine Education Project and was involved with organizations such as the Georgetown Assembly.

And the obituary named many more titles and projects.

It showed me how someone who appears to be unserious may have much more going on than is easily seen.

Bud and Gwynneth
As told to me by my sister, Gwynneth

My grandfather, Bud, was an accomplished songwriter, originally of the Tin Pan Alley era, and he continued to write popular songs until his death in 1982. He was a widower for many years. He lived just outside New York City and we lived in New Jersey so visiting was easy.

In the late 1960’s he was invited to a semi-formal dance. I suspect the dance was put on by the Songwriters Hall of Fame, of which he was a member. Since he was a widower and did not have a girlfriend at the time, he invited my sister, Gwynneth, to be his date.
She was a college student at a nearby school. She had her hair done, wore a beautiful gown and looked smashing when she left the house.

She reported to me that as soon as they arrived, arm in arm, she was receiving ugly stares from many of the women and men.
Eventually one of Bud’s friends came over to say hello. Bud then introduced his granddaughter, Gwynneth, to the gentleman.
Upon hearing that, the man’s wife immediately came over with a smile to meet her. Gwynneth noticed that very quickly the entire hall had smiling faces, many of whom wanted to meet her.

It is not surprising that many thought Bud had a new girlfriend, decades younger than him. And it would be human nature that some people would approve and some would disapprove of the relationship of an elderly man and a much younger girlfriend.

How quickly those assumptions vanished upon hearing she was a family member and not a much younger girlfriend.

Gwynneth had not changed instantaneously, just the perception of who she was.

The Jester

I know my path, however circuitous, ultimately led me to retirement after a successful urology practice in Seattle. I have memories of my mindset during decades of schooling from elementary school through college, medical school, residency and then private practice. I think I know how I tried to carry myself in both work and play. My main question was not how I looked at myself, it was how did the world perceive me.

During my early schooling through high school, I was surrounded by many highly motivated intelligent kids. I learned very quickly that it would take an inordinate amount of work to keep up with them. It was much easier to stay under the radar as a jokester and not try to keep up with their level of schooling. I was a happy-go-lucky kid anyway.

I was constantly reminded by my mother that I was not working up to her perception of my intelligence. I felt that I could graduate with honors and stay under the “smart” radar. I was not interested in high honors, as that was too much work, and I did not want to take advanced placement courses.
When I graduated from high school with honors, my English teacher found me and said she was surprised that I had done so well. She made the comment that she thought she was the only one in the school who had given me an A. It felt as if she had given me a sympathy A, although I knew that I had done the work to receive it.

During college I continued to display the same under-the-radar, unserious student while trying to get the grades needed to be accepted into medical school. I thought I was showing the world I was a musical surfer dude, rather unserious.

I did become more serious from medical school on. But still, during the last fifteen years of private practice as a urologist, I wore Aloha shirts to work in Seattle daily, even in the winter.
A few months ago I was with my sister, Cathlin. We talked about our childhood and I asked her how she perceived me when we were kids.

I was shocked to hear that she said I was a jester at times and tightly focused at others. There was no middle ground.
The jester part did not surprise me. The focus part did.

When I went to my 50th college reunion, one of the very studious fraternity brothers said to me, “When we were in college, I thought you were just another ne’er-do-well.”

I have been lucky. A few weeks ago I was able to connect with and sit down for lunch with the Chairman of Urology from my residency days. We are now more than forty years removed from the time I trained under him.
During those years he was quiet and continuously evaluating the residents. It would have been highly unusual for a resident to receive praise. A good day simply meant that nothing bad was said about you.

I looked up to him even though our personalities were polar opposites. He held his emotions in check with subtle humor. I tried to cover my serious nature with jokes.
When I asked him what I was like under his tutelage, I expected a quiet zinger about being loud and brash.
Instead, he complimented my abilities in ways I did not expect.

When I told Karen this story, she asked why I had not been told those things forty years ago.
Maybe it was better this way. I don’t know.

But hearing this now, I have had to reevaluate how I perceived myself during those years and for decades afterwards.

For many years I kicked myself for not taking fuller advantage of my schooling. I did not work as hard academically as many of my classmates until I reached medical school. Looking back now, I wonder if that assessment is too simple.

Those years were spent sailing, surfing, teaching, traveling, working in a lumberyard, a delicatessen and behind the bar of a redneck tavern, making mistakes and meeting people whose lives were very different from my own. The broader life I lived outside the classroom may have helped me understand my patients and their lives in ways that could never have been learned from a textbook.

In the end, it was those connections, not just the medicine, that made me a better physician.

Over my lifetime I have met some clean-cut men who were hell raisers and some long-haired, heavily tattooed people who were gentle and charming. Diz was a nuclear industry expert hiding comfortably inside a fraternity boy. Gwynneth had not changed, only the perception of who she was.
Perhaps the lesson is not that we are poor judges of character. The lesson may be that most of us are far more complicated than the labels we place upon ourselves and others.

Can I be both serious and looney? Can I be both Bakari and Jester?

I think Cathlin had it right. Both versions are in the same person, sometimes visible at the same moment and sometimes one more apparent than the other.

And if that is true for me, it is probably true for most people I meet.

I look over the desert in the spring. The days are hotter than I had imagined. It will be 105 degrees today. Yes, they say, but it is dry heat. My response is always the same, with a laugh, so is putting your head in the oven.
All of this makes me think of the places I have lived in and how, in time, my body acclimates to the challenges of the new environment.

I spent my youth, through college, in the Northeast. Brought up in NJ, college in Pennsylvania. I was used to the seasons: cold and snow of the winter, early rains in the spring, hot and humid summers and the dry, cooling fall when the trees became brillant colors. Each season forced me to dress differently. And I was young, able to tolerate the changes so much easier than I can in my 70’s.
Summer was a great time to be a kid. We had a beachhouse. But the summers could be excruciatingly hot and humid. One sleepless night in my teens I was so hot in our small cottage that I got up, walked 8 blocks to the beach and slept on the sand feeling the coolness of the nearby ocean. Unfortunately as a typical teenager, I did not bring a towel to sleep on and awoke covered with sand.

The Philippines

After college I wound up going to school in The Philippines for 2 ½ years. I was totally unprepared for the change in what is normal heat and humidity of the day. I remember walking down the steps from the plane to the tarmac. There was an immediate, overwhelming blast of hot humid air. I looked to my right expecting that I was standing immediately behind the jet engine. But I was not. It was the afternoon heat and humidity of Manila.
Our school did not have airconditioning. I remember looking up at the fans hanging from the ceiling. It was typical that they had 2 of the 3 blades and moved erratically, while wobbling side to side. They barely moved the air and always looked like they would fall from the ceiling.
We were required to wear uniforms. That alone was so different from the dress of the 70’s in an American liberal arts college. I learned that it was so important to have a uniform made of cotton, rather than polyester. The cotton would breath.
I remember, early on, sitting in my chair with a bead of sweat running down the middle of my chest. It would itch slightly and the normal response was to touch that slow rolling sweat. But touching it was a grave error. Immediately the entire shirt would stick to my slightly sweated chest and then there was no air movement at all. Immediately it seemed to increase my body temperature by 10 degrees. I learned to tolerate the sweat bead and ignore it. And actually this was excellent working knowledge for years ahead when I was a surgeon. I had learned to ignore a natural responses and just proceed with working.
Over time my body response to heat and humidity changed. This was slow and I really did not notice it. I returned to the US. I remember my friend, Steve, asking me to play some indoor tennis. We really were not tennis players and did more running than hitting. After 2 hours we were done. We then decided to take a sauna at the courts. We were in the sauna for about 20 minutes and then I noticed I was still not sweating. I guess my body had adapted.

The Northwest

After Rutgers Medical School in NJ, I was accepted to my internship and residency at OHSU in Portland, Oregon and afterwards I practiced in Seattle. I loved the PNW. I was surrounded by beautiful mountains, the sea. But the environment to contend with was daylight/night darkness.
During the summers I was energized by the light. In Seattle it began to get morning light at 4 am and the end of light seemed to be at 11 pm. I was born with natural energy and this did not tire me out. Winter was just the opposite. I would leave for work in dark and often rainy conditions and darkness in the rain began at about 4. As a surgeon I never got home in the winter with light. I was acclimated to it, but really did not like it. I used to joke in February that the weather in the winter PNW was the reason that Hawaii and Mexico were invented. But I loved my work. I knew that many people could not tolerate the winters, cold dark and rainy. In fact, seasonal affective disorder was first described in Portland, Oregon. As a surgeon, I had an advantage, we would spend hours in surgery with bright lights. I think that allowed many of us to be able to tolerate the weather outdoors.
In essence, many of us were like bears. During the winter we would hibernate. It was very typical that people while working would go home, make a winter meal and enjoy the inside of their homes. Yes, on the weekend, people would run to the ski slopes and enjoy winter activities. In the summer, the people, like bears, would be outside, enjoying the great outdoors. But my mindset was out in the summer, hibernate in the winter. In the winter, when possible you enter your car in a dry garage and drive to another dry garage to shop or to work.
And Karen and I, like many retirees, decided to find a place in the sun for the winters. For us it has been Arizona.

Arizona

After a few years in retirement we found ourselves in the pandemic. The winters seemed even more confining and we decided to buy a small place, sight unseen in Arizona for the winter so that we would have more time to enjoy the sun. At that time the housing market was so hot that most houses in the area were sold within 24 hours or in our case, before they even got on the market. I remember after buying our place in Arizona, flying down in June to set it up. Karen stayed in Seattle. I was my usual energetic self at the time. I would wake up at about 4 and start getting use to the house, where things were in town, getting wifi and all the things that need to be done.
By 5, the temperature outside was 90 degrees. And every day, for the 5 days I was there it reached 117 degrees. Yes, this was unusual, but it certainly got my attention.
I remember on my 3rd morning in our new house, I saw our next door neighbor, Sue, out tending her plants in the front yard. I figured I should introduce myself. She is a hard working, delightful woman. In our first conversation, when I mentioned the heat of the day, I remember her saying, “In Arizona you have 3 months of Hell for 9 months of Heaven.”

We have now moved our residence from Seattle to Arizona. Even in the spring I can see how the heat of the days changes day to day life. At this age I can no longer tolerate the changes in heat as I did as a kid. I am also on hormone therapy which changes my ability to manage heat changes.
But I see that people tend to hibernate in the heat of the summer. Yes, we get out and play sports, but already in June we play tennis outdoors at 6:30 am. We are reaching close to 110 during the day. I leave our air-conditioned garage to drive, hopefully, to another air-conditioned garage. If not, I immediately place a sunshade over the front windshield to keep the car a bit cooler. Outdoor sports, hiking up mountains in 110 degrees does not seem like a good idea.
Outdoor dining and socializing outdoors in the spring is only possible with outdoor misters. God knows what summer will be like.
And if possible, people travel to cooler temps in the summer as people in the PNW travel to warmer temps in the winter.
And typically our joints do not ache so much in the dry heat.

I look at southern Arizona as a place where we hibernate in the summer and the PNW we hibernate in the winter. In the PNW if the sun was out, I was obligated to go outside because it was so frequent that the next day would be cloudy or rainy. Even after four winters in Arizona, I still feel the need to be outside if it is sunny, even though it is sunny most of the time. It is hard to break old patterns.
Once when I was in a grocery store last year, I felt it was quite funny that the check out woman was not only happy, but celebrating because it was raining outside. Coming from Seattle, it almost made me laugh. She was celebrating something that was endured during the long fall and winter in the PNW.

As we all go through the experience called life, we face changes from both the outside world and internally. At times we have a choice of adaption or moving. What we can tolerate as teenagers is entirely different from what we tolerate decades later. When we have no choice we have the option to learn to live in the new world and even find joy in it. I am not sure whether I adapted to the places I lived or whether those places slowly and quietly changed me without my recognizing the change.

I have had a complicated relationship with the American military and war in general. My thoughts about military service have changed over my seven decades.

My formative teenage years were in the 60’s and 70’s. I grew up trying to reconcile the feelings of national purpose from my parent’s WWII generation with the divisive national feelings of my generation during the Vietnam War years.
I spent my professional life trying to heal people, yet many people I loved served in the military and some went to war.

As a boy, I played with plastic army men and watched television shows where Americans always won. The wounded disappeared quickly. The dead were rarely shown. War looked clean, brave, and distant.

The first time war truly entered my life was through the death of a young serviceman from our town who I had never met. I was in a school folk singing group at the time, and we were asked to miss classes to sing at his memorial service at St. Rose of Lima Catholic Church.
I remember feeling disoriented. I had never attended a funeral before. Until then, war had largely been television, toy soldiers, and stories. I was unprepared for a grieving mother, silence broken by muffled crying, uniforms, and a coffin at the front of a church. But I still had to perform with my group and quiet the emotions in my head.

A Different War

The return of Vietnam soldiers to everyday life was confusing to me. Over the kitchen table and in movies I grew up believing that soldiers returning from war were heroes. Many had experienced combat and loss of friends, yet they still went on to fight. Previously, in other wars, they were celebrated and thanked for their service. Yet Vietnam was a different war. It was widely unpopular, especially for the young. A returning soldier had to hide the fact that he had been there. Many college students regarded returning soldiers as if they were the enemy in an unjust war. The press and my parents’ friends frequently portrayed returning soldiers as unstable, dangerous, drug-addicted men rather than young people who had been sent to war. At that time the psychological wounds of war (now called PTSD) were rarely understood or openly discussed.

John

And then there was John.

John was a happy-go-lucky kid in high school, one of my brother’s best friends. They were five years older than me which, at that age, felt almost like a different generation. John and my brother taught swimming and lifesaving lessons together for the community. It was run seriously, but with the constant humor of two young men enjoying themselves. And I, like the others, had fun learning from them.
Then, while I was in high school, John was drafted into the Army and sent to Vietnam. At the time it all felt distant to me. Vietnam was something happening somewhere else, far beyond my daily life.

I did not really think deeply about it until he came home. John left as a joking boy and returned as a serious man. I remember him coming to our house to say hello. There was a melancholy about him that I had never seen before. He spoke briefly about Vietnam, although I do not remember what he said. What I do remember is that he was changed and I no longer really knew him.

One Thing They Agreed On

I was brought up with parents on very different sides politically. Over the dinner table my father would hold court and give us his right of center political views using his strong official voice. My mother would give him the space to talk for a while and then, the strong woman that she was, would push back her left of center views. I do remember one night after he had gone on and on with his thoughts, she loudly with exasperation said, “Bob I’m going to cancel out all of your votes!”
But when it came to their son serving in Vietnam, they were united. They did not want him to serve.

My brother, Jim, received his induction notice to come for a physical exam. There were family discussions of whether he should consider moving to Canada or Sweden where he could avoid the draft. In doing so he would never be able to return to the United States.
He was born with flat feet and had a bad back throughout his adolescence. This did not keep him from playing sports, but his back pain was severe enough for him to see an orthopedist. He got a letter from the orthopedist saying he could not march for miles. However my parents were still concerned that he still might pass the physical. Taking the physical was a risk.
My mother, ever the wise woman, felt that having him show up with a back brace would seal the deal for failure. But a new back brace would easily be noted. She bought a brace for him and it was included in each load of laundry so that it would look clean but used. The day arrived, he showed up and failed the physical!

By the time I was old enough to be inducted a lottery based upon birthdate was instituted. There was great anxiety before the lottery. A group of us at college sat in front of the TV, drinking beer and wondering if our student life would suddenly be changed. In my case there was a cause for celebration when my number of 137 was drawn. This was far too high to be called.

Veterans I Know

I have great respect and admiration for men and women who have served their country and put their lives on the line. I never served in an official capacity. A large part of my 6 years of post-medical school training took place at the V.A. Hospital in Portland, Oregon. My service was taking care of veterans outside of war.
I have close friends in Arizona, Big John and Marine Bob. They have told me about their experiences on the front lines of Vietnam. I am not sure I would have come out of their experiences as grounded as they are. I admire them for enduring their experiences in Vietnam and building their lives afterwards.

And all of this has led me back to the Memorial bricks. In our community in Arizona, we have a memorial area to place bricks for veterans. There is a short but meaningful service for the placement of the bricks. I have three ancestors who I knew quite well who served our country: my grandfather Hank (known by us as Hank the Crank) Horn, my Uncle Wally Green and my father, Bob.

Hank

Hank served in World War I as a private in the Army. He was a tough guy from upper Wisconsin of Norwegian extraction. He was used to the cold of winter. But he was not ready for the cold of Siberia. He was shipped out to Vladisvostok as part of the American Expeditionary Force to fight the Bolsheviks, to keep the train lines open for supplies and to help rescue 40,000 men of the Czechoslovak Legion. Grandpa Horn would tell us as kids about the bitter cold, eating rats at times because there were no supplies and his bitter disdain for Russians. But he told these stories always with a grandfatherly laugh.

Uncle Wally

Uncle Wally was First Lieutenant in the Marines during WWII. He never told stories about his time during the war. My only memory about his actual military service was seeing a photo of him in his uniform standing next to my very proud grandfather. In his discharge forms, when asked what he was going to do in civilian life his response was, “Look for a job.” He became an illustrator, but in his free time, for decades, he visited patients in VA hospitals in the greater New York area and was instrumental in putting together a Veterans radio program. His service lasted far beyond his time in the military.

Dad

My Dad, Bob, was a Captain in the Army. Immediately after his internship he was inducted into the Army as a ship’s doctor in Operation Magic Carpet. His mission was to help bring the troops home from Italy while transporting troops over to help maintain stability in postwar Europe.
His viewpoint of Magic Carpet was revealing. Initially he examined the troops going both ways over the Atlantic.
When examining the troops in New York going to Italy, many complained about how ill they were and that they should not be allowed to go. Once the ship set sail, everyone was healthy for the trip. Upon bringing the troops home from Italy, everyone told him they were in great health and were ready for the crossing. Within a day of setting sail, many were quite ill and just wanted to get back home into the States.

My Dad had a difficult first trip across the North Sea. He was a large man who loved to eat. He enjoyed the spirit of the Army’s motto: Take what you want to eat, but eat what you take. During the crossing they were hit by a powerful storm. He was seasick for days. Servicemen would come to his medical office complaining of seasickness and he could only reply that he was sicker than they were. When he came to the officers’ mess after not eating for 3 days, he was met with a standing ovation from the other officers. “The Doc” could now eat again.

The Bricks

I appreciate the service that these 3 men gave. At times we do not acknowledge the service of the women at home. They had the worry of thinking about the soldiers overseas and kept the home ready for their return, not knowing if they would return.
I feel the same way about all who have served this country, men and women and their support at home.
Laying the bricks in their honor in a place of remembrance became a powerful reminder of what others have done and continue to do.

There is a well-known fact that most men do not appreciate: weight gain in the abdomen during menopause is very common.

And it sucks.

Most men do not really understand this until they are suddenly in menopause from hormone therapy.

Then they get it.

I was one of those men.

Hormonal changes shift fat to the midsection. At the same time, muscle quietly disappears. Less muscle means a slower metabolism, and suddenly weight that once came off easily… doesn’t.

In my teens through my 40’s, I had what I thought was a normal body. I enjoyed athletics, and weight was generally not a problem. If I gained a few pounds, usually from enjoying wine a little too much, I could lose ten pounds in a few weeks just by stopping alcohol and continuing to exercise.

I assumed it was normal. It wasn’t.

I had my prostatectomy in my early 50’s and two courses of radiation over the next decade. Aerobic exercise was an outlet for me and kept me in shape.

And then I was diagnosed with widely metastatic disease four years ago.

I was immediately placed on total hormone ablation. At first I was mainly bothered by the hot flashes. I did not notice the weight gain as it came on slowly, quietly.

In my mind, I still believed I could lose it whenever I wanted.

Six months after beginning hormone therapy, I was started on chemotherapy. Prior to chemotherapy I felt in great shape and was playing tennis a few times a week with guys up to 30 years younger than me. I hadn’t really noticed the weight gain. I was more focused on the cancer.

My oncologist told me I would tolerate chemotherapy easily and encouraged me to eat well, as many people lose weight. Chemo hit me harder than anyone expected. Rather than losing my appetite, I continued to eat well. I felt eating was part of my therapy and I wanted to do my part. The only times I didn’t eat were when I was completely exhausted. It wasn’t a loss of appetite. I was just too tired to eat.

By the end of chemotherapy, I had gained 25 pounds, almost all of it in my midsection.

I had lost my energy reserves. Exercise was out of the question. It was a big deal just to walk a block.

It took over two years to rebuild enough stamina to play a single game of pickleball without becoming breathless. Over the next two years, I worked my way back to playing doubles tennis for one to two hours. I also began lifting light weights to try to prevent further muscle loss and osteoporosis.

But the weight in my midsection persisted. I was able to lose ten pounds over time, and then I hit a plateau.
This is where it got dicey.

I wanted to lose weight but couldn’t.

It was clear I needed to focus on my diet as well as continued exercise. Unfortunately, the hormone therapy also made me crave food even when I was full. I had seen a dietitian soon after chemotherapy who recommended a plant-based diet. It was a very foreign idea for me. I was raised on red meats but did transition to fish and chicken as I entered mid-life. I tried incorporating plant-based, eating that way a couple of nights a week, while continuing my usual fish and chicken the rest of the time.

Still the added weight persisted.

Now here is where I made a mistake. I became more focused on the weight and the size of my belly. I cut back significantly on food and continued to drink large amounts of water. Living in Arizona, it is easy to become dehydrated, and I was not replacing electrolytes. My energy level went into the toilet, even as I was slowly losing weight. I continued to play tennis, but I lost energy quickly. I was a bit lighter, but not lighter on my feet. I thought I needed to lift weights to regain strength, but found I was lifting less and less.

What did I learn from this?

How flat your stomach is matters far less than your energy reserves. For me, I can burn through those reserves quickly, and when I do, it can take days to recover. I am better off with larger pants and the energy to get through the day than trying to get back to my old size and being exhausted by noon.

Can I fat shame myself? Absolutely.

No one has mentioned my stomach to me. People are happy I am alive and enjoying life.

I compare myself to what I looked like before

The judgment does not come from others. It comes from within.

Over time, I have come to recognize two patterns when my stress is high. One is external, as when my late wife was at the end of her life. The other is internal when I feel I have fallen well outside of my own values. Under moderate stress, I tend to eat more and drink more, sometimes to excess. Under great stress, I go the opposite direction. I lose my appetite entirely. Food, and even alcohol, hold no interest.
It is as if I try to gain control of my surroundings by controlling myself.
At times, I do not feel entitled to eat.

But I also know this is where I have to be deliberate. Whether I feel hungry or not, whether I feel deserving or not, I have to eat. I have to maintain the energy reserves that allow me to function.

It is a difficult balance to keep energy reserves up while trying to keep weight down. I was told to eat five small meals a day, but I found that once I started eating, I often could not feel satiated. I hated leaving the table still hungry. This is something I still wrestle with.

Do I have a great answer for this? No.

But when I find myself getting hungry soon after a meal, I make popcorn without anything on it. It helps fill the stomach without adding many calories and has good fiber. Butter and salt would defeat the purpose. Cayenne pepper on its own works.
I make high-protein overnight oats with chia seeds in the evening for the next morning. That helps stave off hunger as well. But most mornings, I still just have coffee. A terrible habit after my years as a surgeon. I try, not always successfully, to eat a cupful of oats in the morning.

Is this easy? Hell no. And as I age, it becomes more difficult. But I keep working at it, doing the best I can.

Sometimes it is hard for me to grasp that I am 73 with a life-threatening illness.

Emotionally, I still feel 35, with long blonde hair, a somewhat chiseled body, and a future in my hands. Realistically, I have to remember that I have aged, with all that entails, and that chemotherapy and hormone therapy have kept me alive. I must make peace with these drugs and enjoy my future.
And I need to accept my body as it is naturally aging.

Being overweight and bald is not as bad as the alternative.

Last week I decided to go on a hike which started as moderate and halfway up became very difficult. Within 15 minutes, I felt my energy begin to wane. With multiple stops I made it to the spot where the trail changed from moderate to difficult. My adolescent brain told me to continue, which I did for another five minutes.

Then reality set in.

I had hiked 3/8 mile and climbed 240 feet in rough terrain. What remained was 3/4 mile and 1,024 feet in treacherous terrain.

Could I really consider making it up a difficult climb if I began that section already tired? Would my coordination and ability to quickly regain balance be up to the task? It did not take high level thinking to decide to turn back. But it did take shutting off the adolescent brain to do so.

Better that I make the decision to go back rather than the mountain make the decision for me.

It made me think about how I approach challenges, the choice between meeting them head on, doing only part of what is needed with resentment, or simply complaining, and in the end accepting what I can, with some measure of gratitude for having that choice. As a younger man I would have been disappointed in myself that I did not push on to exhaustion. I would have seen it as a test of my tenacity and drive. Now I am grateful that I can still hike and accept some of my limitations. Hiking up a mountain is a painful reminder of what I have lost from cancer, from chemotherapy, and from aging. It is difficult to fully grasp that I no longer have the energy reserves I once did. I now understand that hiking to the point of exhaustion means that for the next few days I will feel tired, think less clearly, and not exercise with the enthusiasm I expect of myself.

Yet I also feel gratitude.

I can walk. I can hike up a mountain to the point that I am tired. But it is a fine line as to what I want to sacrifice. Do I take the hike and feel the fresh air in my lungs, see the beauty only afforded to me if I push my body, knowing that the next three or four days will leave me physically tired and mentally off my game? Not having the extra mental capacity needed to play music? Or do I limit how far I push so that I will feel good tomorrow? These are not questions I would have even conceived of when I was younger. In my twenties and thirties, I was a long-distance runner. I knew that pushing myself to extreme exhaustion would mean a day of being tired, but in the long run I would get in better physical shape. I now have the gratitude that I can still do these things, but also the quiet grief of the loss of my youth. And here I am, still trying to find the balance between physically pushing myself and the need to rest afterward. For most of my life I pushed myself physically—taking a profession where I would sometimes wake up at 2 am to perform emergency surgery and still put in a full day of work afterward.

I am still walking that line…between the joy of pushing myself and the reality of what it costs.

Bharat and me, reconnecting after many years

Playing On Instinct

Through high school and college in the 60’s and 70’s, I played tennis with wooden rackets in pick-up games. I had favorite partners, Jeanette in high school, whom I had a crush on, and later Joe Ferris, a sixty-something who would say “Yours” after most shots. I had no technique or training, but I was fast on the court. All I really remember was hitting the ball hard and smiling and laughing while we played.

Med school, residency, marriage, kids and widowerhood followed. I went decades before picking up a tennis racket again. Then I met Karen, an experienced player, who got me interested in playing again while I was interested in a long term relationship. After she moved to Seattle, I began to take lessons to undo the natural, but incorrect technique I had developed. Learning anything incorrectly requires extra time to unlearn and relearn proper technique.

Eventually I felt competent enough to join a local team. It was great fun to be in competition again and to meet new people from all walks of life.

It was through the team I met Bharat.

Bharat

Bharat was twenty-five years my junior and had played a good portion of his life. He played with the ease and joy that I wanted to have. At least, even in my fifties I could run down most balls. This partially made up for my unsteady play.

I appreciated it when both Bharat and his friend Avniel went to the coach to tell him I should be put in the upcoming match. They felt I deserved it, not for my abilities, but for the fact that I had worked so hard at learning the sport.

I played some doubles matches against people from twenty years old and up. Won some and lost some. But what I brought to the match was my speed and intensity, not a relaxed optimistic play.

My first match playing with Bharat was eye-opening. The match was at 7 pm. We met at a restaurant before the match. I had learned years before not to eat before surgery or sports, the food made me sleepy. So here was the youthful Bharat ordering a full heavy meal complemented by beer. And when we got to the match he played with lightness and joy. My play was tight, agitated and erratic. I really do not remember if we won or lost.

Outside of tennis all I really knew about Bharat was that he was in marketing, and was a relaxed happy guy. Off the court all he knew about me was that I was a surgeon and when not playing, a jokester and a guy who enjoyed life.

When our few seasons ended and we both moved on in our lives we lost touch for almost 2 decades.

The Reconnection

Then out of the blue I got a message from him that he was enjoying my writing. I had no idea that he even knew I was writing about my experiences. We decided to meet and really get to know each other. At first, we talked about our past lives and our present lives, he at work and my retirement.

A couple of weeks later we met over coffee and I had the chance to meet his 11-year-old son, Makaio, who struck me as both thoughtful and remarkably mature. During that meeting, unexpectedly, we both revealed that we had written poetry for years. Not for anyone else, just for ourselves. At that point I asked if he would be willing to share some of his private poems along with mine on Substack.

Bharat’s son Makaio and me the day we discovered we had both been writing poetry.

Sharing those poems, even just between ourselves, would be a big step for both of us. Revealing a side that we had each hidden from our world in our own way.

Poetry for me is personal. Whether the poems are good literature is immaterial, they just display my feelings at the moment I am writing.

Here are some of the poems we shared with each other.

Tom

Outside the kitchen
Listening,
Metal scrape of a hand held peeler
shaving a carrot skin
memory of my mother
her warm kitchen
the smell of love,
swirled in soup.

Bharat - Lausanne, Switzerland 1998

She sings on the hillside
Waiting for the wind
To come and sweep the flowers
Into her sweet and frozen nostrils.

Tom

Some days
I am an unfocused bird in flight
Carried by the mood of the wind
I can only
set my eyes to my distant goal
Unknowing where I will land.

My luck has been good
meeting other wandering hearts
without plans
Eyes meet over coffee and wine
a taste of bread and cheese.
Sometimes to travel in pairs
Only to separate as
the wind fills our sails.

Bharat - Seattle, 2018

Footsteps in the rain

Quiet walks with your father

Wishing that he knew who Emerson was

But I’m ok with just

Walking with my father.

After all these years, it’s not like he’s going to tell me anything new.

Tom - Mexico, 2025

The desert is my ocean
Distant saguaro are ships
on the horizon.
Calm beach
Spiny sea urchins
become cholla.
Silent unexpected burning
from a brief encounter.
The clomp clomp of burros
are gentle undulating waves.

Bleached coral
horn and skull
the same, the same.
The death is gone
the bones remain.

But the new dry heat over cacti
Brings an intoxicating
smell
so foreign from my memory
Of the breeze over sand.

Bharat - NYC, 2004

I said I loved you
Before you knew
What it would mean to you

I watched your hair in the morning sun
While you leafed through your newspaper on the run

I read the note you left behind
On the table
With my coffee.

Over time new colors are revealed with different light.

How and why did I decide to write about my life and impressions a year ago? The last time I took an English class was in high school over 50 years ago. Over the past 40 years I have written e-mails, a few medical papers, medical lectures and in private, poems and musical lyrics. But a Substack about my life as a doctor and a patient? How did that happen?

In short it was an interview. An interview? What interview?

I will go back to the beginning.

I met my friend Raphael soon after starting my Urologic practice in Seattle. We started our practices at about the same time, got married and had kids and had many mutual friends. Both of us were deep into our work life and really spend little time together in those early years, but always seemed to have a deeper connection than small talk at parties. And over the years we drifted apart, not as ex friends, just two people whose worlds demanded too much time.

Decades later at the end of our medical careers we restarted our friendship. How it happened, I really cannot remember, but we started by taking bike rides together and slowly but surely, we began with occasional lunches together and walks with deep and various conversations. The conversations ranged from business, the arts, personal and psychological connections, books. We had a very different view of life, but were very accepting of each other’s opinions.

And then on Feb 27, 2025, I read an article in the New York Times about Dr. Bryant Lin, a professor of medicine at Stanford. In short from the article: Just 50 years old and a nonsmoker, he had been diagnosed with Stage 4 lung cancer four months earlier. The illness is terminal, and Dr. Lin estimated that he had roughly two years left before the drug he was taking stopped working. Instead of pulling back from work, he chose to spend the fall quarter teaching a course about his own illness.

It got me to thinking. I am retired, I had a long and interesting career in Urology where I treated many men for prostate cancer and I have been treated for the same disease, at that time, for 20 years. I enjoy lecturing. What about getting in touch with the University of Washington to see if I could give a lecture or a group of lectures about my life as a doctor and a patient. I certainly had the connections to meet with people in the Med school to discuss this idea. But really what would I say? How would they really know what I was considering?

So, I go back to the conversations with Raphael. Over the years he understood my feelings about my passion of being a physician and my feelings about people. He brought up the thought about writing. That had never occurred to me. He felt I had some important things to say which also didn’t occur to me. At that point he told me about Substack, an online forum where I could give my thoughts.

It took a while, but then I pieced something together. My Substack would be my interview. If ever someone wanted me to talk about my passion for medicine, my fears as a patient and how I look at life, they would have a general idea by just reading chapters. And so, in my own small way, I can use the inspiration I got from the article about Dr. Lin to help people in a way I never imagined.

After a year, I look back at what I have done with writing. At first it was so energizing. I felt I had so much to say that had been bottled up. It was as if I had a new mission, that of uplifting people during their time of fear. I also wanted to show the joy of living and exploring new territory, even during times of difficulty. Hearing a new piece of music or hiking through the woods brings me joy which I want to share. There are also lessons from my past which have helped me during difficult times. And slowly I found a new pace in writing. Rather than needing to write daily, I now let ideas settle into the background of my life and write when the spirit moves me. Sometimes a thought would come and I would write. I enjoy my time with Karen, think about visiting the kids, play and study music, play tennis and experiment in the kitchen. I no longer have the internal pressure to put down my thoughts. And I have rediscovered my love of lyrics and poetry. Writing small snippets about feelings in poetry rather than prose has its own magic.

Has this time writing changed me? No, my balance of retired life is still the same. But I now have a new way to experience life, to give to others. When I was younger, I could give myself thru writing music, cooking and laughter. Then I added taking care of people in their time of need. And now I have just another avenue to explore and to give to people. These are words that my daughters will have when I am long gone.

____________________________________________________________________________

I want to give my appreciation to Dr. Bryant Lin, wherever he is, for the inspiration to start writing.

I also want to acknowledge Dr. Paul Kalanithi who wrote When Breath Becomes Air

Sometimes I find myself scrolling through old documents and e-mails on my computer. Not unusually, I find a scene of my past that shocks me with its immediacy.

This past week, I was cleaning out my e-mail inbox and I found my daughter Katy’s old email address from when she was in her early teens. There were 2 e-mails and the one you will see was written when she was 14. Reading this story gives me a small window about her thoughts in her early teens.

I had dinner with her this past week and reminded her about this piece of writing. She remembered it well and said she won a school writing competition with it. She gave me permission to share it here.

There is so much in this that I remember and parts that I am only now able to see. At the time, I was trying to be a supportive father to the 2 young girls who had lost their mother after a 7-year bout with lymphoma. But there were some things that I was not prepared for in taking care of them. Maybe no one is.

Both of my daughters are now 20 years older, likely carrying scars that they know well and that I will never see. Each year I am prouder of them, but I do wish I had a magic wand to cleanse them of the pain they endured as young children.

Here is Katy’s writing at age 14:

It’s freezing. My bones are deep inside these flaps of skin, yet they still manage to have become icicles, I’m frosty and tired and all I want is normality once again. Usually it doesn’t snow that much near the sea, but things don’t always go as planned. Being snowed in for two days as a blizzard tears up our yard in back was not exactly how I planned spending my weekend. Just my dad, my sister, and I, all alone, in a house, going insane. Let me be the first to tell you, my family has all the luck, because the power has gone out also. This combination is usually diabolical, but since there is no where to run, our efforts are staying towards keeping warm and staying on our best.

The silence froze our cold house but easily a little flicker of voice has shattered it. It creeps in, illuminating us just like the fire on our melted skin. I remember when I was your age- He simply cannot be serious that is the most senile thing he has said yet. When it would snow kids would have to walk to the bus stop, and I always used to feel so bad for the girls, because back in those days, they had to stand waiting in their dresses and skirts. Ah the comforting tales of sexism, this weekend is going to be fabulous.

The fog of boredom breathes into this room. Lauren and I abandoned my dad’s stories long ago; we understand that his family was dysfunctional like any other, and we see no need to exploit it. My family is really afraid to get close, it makes us weak. I guess I brought this on though. I remember when my mom was sick and came home from the hospital for a while. My dad came into my room, sinking me with words of her illness, and that I couldn’t sleep in their room. I couldn’t lie in between them, hugging my mom close. I could hug a pillow. Tears silently slipped down his cheeks tenderly, carrying across the waves of his wrinkles. My selfishness beat him down with the plea, Don’t cry dad, it scares me. There were no words after that, he just left. I guess no one wants to cry, hug, or love, because in my family these things break us. My mom died a couple months later.

Downstairs I stare blankly at the sheets of snow beating down on our once green grass. My dad comes back down with some cold hot chocolate for me and Lauren, and the stories start up once again. One after another, about his car, the shark, and about when his mom threw out his stuff. It makes me smile how he tries. He feeds of this energy because Lauren hardly stirs. The stories are started up again of how his family was out for ice cream and Gwyn, his sister, was licking her ice cream cone when Jim, his brother, pushed it in her face getting it stuck to her nose. She cried. It feels almost tainted, laughing at this now, and in the midst of this cold moment, my dad starts with the mom thing. Shut up my mind says absently. Shut up, shut up, shut up. I don’t care how you met her. I don’t care how much she loved me. Most of all I don’t care that your eyes are turning aquamarine and glittering. I can see the tears about to bleed out of this open sore of a family. I see the tears about to beat me. I already know she was wonderful. I lived with her too! All I remember was her being wonderful.

Even though it’s tough, I offer up a piece of me. its tiny but sacred, one that I cannot deny, and being criticized by it might cause me to never trust my family again. I tell about when I found a beetle in the swimming pool while Lauren was at Emily Hildebrand’s house. My mom and I were in the pool and my dad smelling the lavenders. The sky was so dark and grey; it was hard to believe the summer would be biting our backs the next day. A creature glistened, and I took it out of the water. It was so beautiful, it’s mossy back encrusted with gold. Wet hairs slicked to its body. I put it in a box because it was dead, but the next day it started wiggling. I had saved a life. I like to believe that my past is dead, so I box up these memories. Suddenly I can feel the intensity of my mother start pulsating in the room. Everyone in my family can remember swimming with her, sleeping in her bed when they were scared, and loving her.

I watch the innocent snow drift onto the lawn. More hot chocolate anyone? I ask. I realize that no family fits or succeeds. Maybe that is the success, the fact that there will be silence and embarrassment, and weakness. To live as imperfect as the stories we tell is not being snowed in or being stuck, it is freedom. It is happiness.

Within fifteen minutes of posting my recent piece, Saying Goodbye, I got a call from my close friend Jon, my boating and crabbing buddy. “Are you OK?” he asked. “You didn’t tell me you were sick.”

I have since heard similar concerns from others, and I want to be clear.

No, I am not acutely ill.

I am very much alive and living a good life, thanks to my wife, family and friends, my doctors, the many caregivers who have helped me along the way, and the advances made by pharmaceutical companies. Over the past year I have swum with whale sharks twice, surfed in the Seychelles, and played two hours of tennis just this past week.

My recent chapter was difficult to write. It reflected on saying goodbye in medicine, family, and life. It was meant to offer some solace to those who have lived through similar experiences. It was not my own farewell. As I wrote in the very first chapter of this series, my intention has been to write about prostate cancer as both a patient and a doctor, and about travel, music, my interests, relationships, reflection, and life itself. Along the way, I have also been using my time enjoying life and quietly reconciling parts of my own past in private. I have been fortunate to make wonderful friends, both in person and online, through this writing. I expect to keep writing, and I will let you know directly if things ever do go sideways for me.

Thank you for reading my writing. I also appreciate your comments. They encourage me to keep writing.

For those who have started reading recently, the chapters can be read in any order. I hope they offer some comfort. If you think a chapter might help a friend, please feel free to let them know about it.

Thank you, my friends, for your concern about me and my health.

Over the years, I have said goodbye too many times. It has never been easy. At times I wondered whether saying goodbye meant I would never be happy again. Experience has taught me otherwise. Sometimes I have given a final goodbye without even knowing it. At other times it has been long and protracted. And one time, if you can believe it, I experienced a goodbye that was quiet and gentle, one that brought with it an unexpected sweetness.

In my life, I have experienced all of these. And I know that in time, I will say goodbye again. Time can ease the sadness of a final goodbye. Over time, what returns for me is the memory of the joy the person who left brought into my life.

And part of saying goodbye is recognizing what true love really is.

Medical Training

As a medical student, and even more so as a surgical resident, we learned medical skills, but we also learned to distance our emotions. During those ten years of training, I felt a natural bond to patients. I would see them daily while they were in the hospital, and even if I had only a small role in their care, I felt personal joy when they left the hospital. But sometimes I was involved in the care of patients who suffered and ultimately passed away. Sometimes I learned about their deaths after I had finished a rotation or after they were transferred to another medical team. At other times, they were on my service, and my team and I were either present at the time of death or learned of it early in the morning when we returned from our homes. There was sadness, but over time it was set aside so that we could continue to work. As physicians, we are trained to say goodbye professionally. We tell ourselves that this is different.

When I went into urology practice, my relationship with patients changed. Yes, in surgery there are many patients we see only for a single hospital stay. But urologists often care for patients over many years, men with prostate cancer, bladder cancer, kidney stones. Over time, I came to feel that these people were part of my extended family. That alone was reason enough to get up and go to work each day, and to return to the emergency room or the operating room late at night.

But over decades of working with people, there is inevitably death. It was uncommon for me to have a patient die while I was actively caring for them. More often, I learned of their deaths later, from other physicians, from family members, or occasionally from reading an obituary. Whether I had been closely involved in their care or simply heard the news, there was always a sense of loss. From my training, I learned to keep that loss muted in order to continue working. I was trained to remember my patients quietly, and to say goodbye on my own.

In the final eight months of my practice, I chose to do something different. I said goodbye in person to each patient I saw in the office. It was emotionally difficult for me, and likely for my patients, many of whom I had come to think of as family. At times, it felt as if I were saying goodbye in anticipation of my own death. Still, it felt far more important than a letter.

I might have expected that my ability to go on working effectively after a patient’s death would help me in my private life. But as I learned, death and saying goodbye within a family, or among very close friends who are not patients, is a different beast.

Cookie

I remember my mother, Cookie, during her last days. For most of my life, she was a dynamic, smart woman who did not take grief from anyone. I never met a person she could not stand up to. When I was in public elementary school, she demanded that my entire class be transferred to another teacher because she did not respect the one we were assigned for the upcoming year. A single discussion with the principal took care of that. You can imagine the butting of heads between my mother and her son. By the age of fourteen, I was quite sure I understood how the world worked, despite having very little experience. And yet, we both knew we loved each other.

Unfortunately, she developed breast cancer. She underwent a mastectomy and multiple rounds of chemotherapy over thirteen years. Eventually, the cancer metastasized to her bones. My father took care of her at home while still working, giving her pain medication injections until the pain became unmanageable. She was then brought to the hospital for her final days.

All four of us came to see her then. I was living and working in Seattle and had only a short time to visit her in New Jersey. It was difficult to see my mother, the strong and vibrant woman she had always been, lying in bed and at times incoherent. She who once could out talk anyone now spoke in a dreamlike way, often to herself, conversations that were difficult, if not impossible, tofollow. What I have recognized is that I was saying goodbye even while she was still breathing. That was difficult. I had no role in her medical care. I was simply her son.

On the day I was called about my mother’s death, I was scheduled to perform an urgent kidney transplant. I was asked if I wanted another surgeon to do the operation, but I felt I needed to do what I had committed to do. It gave me something clear to do at a moment when I had already said goodbye. After my mother died, I did what I knew how to do. I worked more. Looking back, I think it was my way of keeping my sadness at a manageable distance.

And when she passed away, I was on the other coast, but I knew there was nothing more I could have said to her in a goodbye. The only thing left was to say a final goodbye to myself.

Life goes on, and for me, if I want it to stop, it simply passes by. And not long after my mother died, I met Penny.

Penny

I met my late wife, Penny, a year after my mother had passed away. I was thirty six years old, early in my urologic practice, and trying to make a name for myself. She was an internist giving an early morning lecture on death and dying, and the role of the physician. I was immediately drawn to her because we shared similar feelings about this difficult and emotional topic. I introduced myself, asked her to coffee, and over time we saw each other often, became close, and married. As with my mother, she was a very smart and dynamic woman.

Eighteen months after our second child was born, she suddenly developed a severe headache and was admitted to the ICU with acute meningitis. She recovered, but over time it became clear that something was wrong. She had recurrent infections and repeated hospitalizations, without a clear explanation. Five years later, she developed a lump over her collarbone. A biopsy showed Non-Hodgkin’s lymphoma. In retrospect, it helped explain the years of illness.

She was treated with multiple courses of chemotherapy and experimental radiation given intravenously, but nothing stopped the disease. Because I was a physician, I was able to give her medications at home, much as my father had done for my mother. Eventually, though, her illness progressed to the point that she had to be hospitalized with a large abdominal mass. She remained in the hospital for three months. At times, I was able to take her outside in a wheelchair to briefly feel the sun. It was heartbreaking to see her cry when I told her that we needed to go back inside.

By then, we had accepted that this disease would end her life. We still hoped she might be able to leave the hospital for some time. Her oncologist felt that when all else failed, the mass might be temporarily controlled with standard radiation. As he said, “The mass will melt away with radiation.”

Unfortunately, science and disease do not always go hand in hand, and the tumor slowly worsened.

There was one occasion when I was able to take her home for a few hours. The house was in the middle of a remodel she had wanted and helped plan, work that had begun after she was admitted to the hospital. I wanted her to see what had been done. From the bedroom deck, she could now see Puget Sound. We stayed only a short time. And once again, the hardest part was returning to the hospital.

Penny’s mother came out to help with our two girls. Once, with sadness in her eyes, she said to me, “A child is not supposed to die before the parent.”

I was with her for most of her last three months. During the final five days of her life, I stayed in her room twenty four hours a day. I slept on an inflatable mattress that kept deflating about every three hours, which gave me the opportunity to check on her. The radiation had taken most of her energy, and for days she was unable to talk. On the third day, I asked her if it was time. She nodded yes, and we stopped all of the medications keeping her alive. Just being able to ask the question was difficult, but it had to be done. It was the same wish she had spoken about when she gave that first lecture when we met. And it was with that question that I truly said the final goodbye.

She slept, and there was no need to arouse her. After two days, I felt the need to leave the room for fifteen minutes. I went downstairs to the doctors’ lounge and got a cup of coffee. When I returned, I found that she had passed away.

Even though she had been sleeping, or in a coma, for two days, I felt an emptiness knowing she was alone for her final breath. And then I had to drive to my children’s elementary school to take them to the beach and let them know of their mother’s passing.

Afterwards I was crushed emotionally and exhausted. I had to comfort and raise our two young girls, each with their own terrible loss, and I put my own grief off. With time, I slowly reentered the world I had stepped away from. I knew that I had done what I could, and that her disease could not have been stopped. The sadness remained, but it eased with time. I came to think of it as a fog, with a little more sunlight showing through each day.

“There is a silence where no words reach. There is a presence beyond silence.” Annie Dillard

Jerry

And there was still one final goodbye, at least for this story.

When I finished my residency, I joined my first partner in urologic practice, Jerry. He was fifteen years my senior and had a small but thriving practice. More importantly, we quickly realized that we shared a similar outlook on life. He was a mountain man and skier who had learned how to sail. I was a beach boy and sailor who was learning about mountains. We enjoyed each other’s easy, positive joking manner. It was a pleasure to operate with him. We became a team. We rarely had to talk in the operating room. We knew what the other was thinking and about to do.

I was there for him when he went through his divorce and later celebrated his new marriage to Vicki. And although he was retired by then, he was there for me as Penny became ill, encouraging me through humor when I eventually began to date again.

Vicki and he moved to Montana, and for years I didn’t see him. Still, I always knew that if we did meet again, it would feel as if we had last seen each other only a week before. Then Vicki wrote to tell me that he had dementia. It was hard for me to grasp that the person I had worked with for decades, the person with whom I shared the same mental space, was losing exactly that. As things progressed, Vicki told me they would be traveling to Seattle. I asked if I might see him, and after some thought, she said yes.

I remember watching them enter the restaurant. Physically, he looked much the same, but there was a vacant look in his eyes. Vicki looked at me, then at him, and said, “Look, it’s T.C. (my nickname at the time)” Suddenly he brightened. With a wide smile, he said hello. For the next hour, we talked about the years we had worked together and the fun we had shared. When it was time to leave, Vicki gently let me know. As they walked away, I watched the vacant look return. I knew he would not remember our conversation. If he had turned around and come back five minutes later, he would have needed to be reintroduced. It was a bittersweet way to say goodbye to my partner and a very close friend.

A month or so later, my cell phone rang with an unknown number. I could see it was from Montana. I answered cautiously, and when his daughter introduced herself, I knew what she was going to say.

On Saying Goodbye

Saying goodbye after a long, slow downhill road is different from a sudden death, such as a heart attack or car accident. With long term illness, there is time to process what is coming and to slowly say goodbye. With sudden death, there is usually no such time. And yet, the similarity between the two remains the connection. Is there really much difference between saying goodbye to someone who has lost their cognition but still has a beating heart, and someone who loses both at the same time?

Death raises spiritual questions, and everyone has their own beliefs. For me, the question has been less about death itself and more about saying goodbye.

After Penny’s death, my friend Marsha, who is now demented, gave me this poem. It helped me think about goodbye, and about the sadness that comes with it:

Passing is nothing. I have only slipped away into the next room. I am I, and you are you. Whatever we were to each other, that we are still.

Call me by my old familiar name. Speak to me in the easy way which you always used. Put no difference into your tone. Wear no forced air of solemnity or sorrow.

Laugh as we always laughed at the little jokes that we enjoyed together. Play, smile, think of me, pray for me. Let my name be ever the household word that it always was. Let it be spoken without effect, without the trace of a shadow on it.

Life means all that it ever meant. It is the same as it ever was. There is absolute and unbroken continuity.

Why should I be out of mind because I am out of sight? I am but waiting for you, for an interval, somewhere very near, Just around the corner.

All is well.

— St. Augustine (354–430 AD)

For Myself

The irony of my being a Urologist who took care of men with prostate cancer and facing prostate cancer as a potential terminal disease is not lost on me.

How do I feel about my own saying goodbye to those I love, and who love me? I feel lucky. I have been given time to look back at my life, to give thanks, to offer apologies where they were needed, and to tell people that I love them. Those who love me have been given time as well.

For me, saying thank you, asking for forgiveness, giving it, and saying I love you has been freeing.

After my first year of medical school, 1975

Why did I, and why does anyone, become a urologist? I’ve been asked that frequently at parties, usually accompanied by a smirk and a wink. After I tell my usual urologic jokes about why I decided to spend my life examining men’s privates, I tell the real story. And that story is quite long. Fortunately for my friends, I do not go into great detail as I will here.

For some of us, where we land in our careers is a straight line. For others, there are unexpected twists and turns, and changes in direction as we move through life. Often our thoughts about how to explore our options begin with personal interests, but they can be shaped by family influence, financial realities, and the people we meet along the way whom we admire. I am no different.

My dad was a neurosurgeon and, as I was told, the first neurosurgeon in New Jersey. He was wildly admired for his work, but to me he was just Dad. Yet even as a young boy, I wanted to follow in some way in his footsteps.

Thus the school assignment I wrote at age ten. Like many young boys, I dreamed of being rich and famous. Life has a way of changing those dreams.

The dreams of a ten-year-old boy.

Time passed, and those boyhood dreams shifted as I moved through college and into the rigors of medical school. I was now more interested in learning about the human body than where I would stand in society in the distant future.

I was very interested in becoming a surgeon because I saw it as a chance to use both my mind and my hands. During medical school, I spent my summer break working as a surgical tech without a salary. This allowed me to learn the routine of surgery without worrying about being graded. By the time I returned to school, I was quite comfortable in the operating room as an assistant. In those days, we had to make lifetime decisions early on about what we wanted to do in medicine.

I naturally first thought about neurosurgery. Because of my father’s position, I was offered opportunities very few medical students had. In my free time, I assisted in multiple neurosurgical cases at private hospitals and found them very exciting. It was quite something to look directly at a human brain and think about what it can do. But it was unnerving to see a portion of the brain being removed for cancer. That was a dark side of neurosurgery I didn’t think I could psychologically accept. My dad and other neurosurgeons had to live with the fact that they could perform a technically perfect operation, and the patient might still wake up unable to speak or paralyzed on one side. I wasn’t sure I had the strength of character to accept that reality.

Years later, after my dad had retired and I was in the early years of my urology practice, I visited him on vacation. We were sitting on the beach, enjoying a glass of wine at lunch. I said to him, “I know Mom would have wanted me to become a neurosurgeon and practice with you. But I would have been a lousy neurosurgeon and we would have murdered each other.” He replied, “Actually, you would have been a great neurosurgeon, but we would have murdered each other.” Our differences in personality were well known.

With neurosurgery out of the running, I thought about other highly technical surgical fields. I immediately considered cardiac surgery. In my fourth year of medical school, I did a month-long rotation at the University of Washington with the cardiac team. They recognized that I had good technical skills and, under supervision, even allowed me, as a medical student, to harvest the veins used in cardiac bypass surgery. It was a big pat on the shoulder.

But again I looked at what my life might be as a cardiac surgeon. At that time, residents in cardiac surgery worked from 6 a.m., stayed in the hospital overnight on call, and then worked until at least 6 p.m. the next day. You went home when the work was done. One night off, then back at 6 a.m. As a medical student, I stayed on their schedule. I loved the field, but I was honest with myself about my ability to sustain that lifestyle over decades. I used to joke that if I went into cardiac surgery, I’d work nonstop because I loved it, have a beautiful wife and a big house, and die of a heart attack at 45. She would then marry some other guy and enjoy the money I’d made. Not my best option.

I also toyed with becoming an interventional radiologist. I enjoyed the technical aspects of the field and the chance to read X-rays to make diagnoses. The collegiality was appealing, because much of the work involved interfacing with other physicians to diagnose and treat patients. I liked the emergent nature of the field and the chance to make a last-minute save. But for me, the field lacked long-term relationships with patients. I saw it as a specialty where patients would be sent to me for an urgent issue, but once that problem was managed, they would return to their primary doctor for ongoing care. And so, in considering this option, it did not check all of the boxes of what I thought I wanted as a lifetime career. It lacked the long-term personal care of patients that mattered to me. I wanted to be the kind of physician who could manage emergent problems, but also build a long-term rapport with patients and their families.

At this point I thought about the urologists I had met along the way. All of them seemed very happy in their lives. They performed major technical operations, and most patients did well. People genuinely appreciated their work. There was nothing like seeing a patient with the intense pain of a passing kidney stone go to surgery and then wake up without pain. Urologists were not only allowed to tell jokes, they were expected to. On top of that, they had to understand endocrinology, nephrology, hypertension, and radiology as well as their colleagues. Much of the work also involved urologic ultrasound, as well as interventional radiology that radiologists did not perform. All of this fit into my psyche: doing good work, being appreciated, and using technical skills I thought I would enjoy.

With time, it became clear that urology was where I belonged.

At the end of medical school, I was elated to be accepted into the internship and residency program in Urology at Oregon Health Sciences University. It was a premier clinical program, one that suited me to a T. It was the beginning of a career that fit not only my hands, but my personality and my view of what good medicine should feel like.

I am starting Volume 3. I have no specific road or map about where I will head in my writing. I am hoping to help people by writing what is on my mind and looking at my past. At times I will write about how I have made decisions in my life and at other times how the twists and turns of life lead me to where I am in life. I hope you will join me. And if you think any of these writings may help someone else navigate their life, please share them.

Just as a reflection in the water is not perfect, a parallel universe carries its own unknown vagaries.

When I was in high school, I loved reading science fiction novels. They took me into worlds of space travel, time travel, and multiple dimensions of reality. Those stories opened my mind to the vastness of the future and to ideas about time, possibility, and consequence. Over the years, I’ve watched our real world change, and it’s striking how many of those once-fantastical concepts have become part of everyday life.

But others felt too abstract to ever be possible. I was especially intrigued by the idea that a single, small decision could alter not only one person’s life but ripple outward to change the whole world.

Years later, during my urologic practice, I began using a phrase with my patients, the Parallel Universe. The Parallel Universe, as I explain it, is what happens when a small or large change is made by a person. It might be something as simple as leaving the house five minutes later, or as significant as choosing a different cancer therapy. What follows from that single decision can affect the person making it, their family, their community, and eventually the world around them.

When caring for patients with treatable prostate cancer, we had many options aimed at achieving a cure: radical surgery, several types of radiation therapy, cryotherapy (freezing), high-intensity focused ultrasound, and laser therapy. And, of course, there was always the option of observation, watching the cancer to see whether it grew fast enough to warrant treatment at all.

I often told my patients that the good thing about prostate cancer is that we have many choices for treatment. The bad thing is that we have many choices for treatment. Too many options can make people second-guess themselves, wondering whether they picked the right one. Part of my job was to explain each option, the likelihood of cure, and the long list of possible side effects that might follow.

After making the difficult decision between watchful waiting or one of the treatment options, success was always a reason to celebrate. But when the outcome wasn’t ideal, when the cancer wasn’t cured or when a known side effect became harder to live with than expected, patients often began to question their original decision.

It was at this point in their care that I introduced the idea of the Parallel Universe.

When patients or families were unhappy with the outcome, they might say, “If only I had chosen another option. Maybe I’d be cured. Maybe I wouldn’t be impotent.” They naturally assumed that the road not taken, the treatment they didn’t choose, would have given them the perfect outcome.

But life doesn’t work that way. The patient who chose surgery might imagine that radiation would have spared him side effects, yet he could have been in a car accident on the way to his first treatment. The patient who chose radiation might imagine that surgery would have cured him, yet he could have had a stroke on the operating table. The list goes on. A single decision can change a life in countless ways, and not all of them are for the better.

And as we’ve seen in science fiction novels, a small change for one person can create a ripple effect that alters the destiny of many others. The person in the car accident might injure someone else, who then can’t work and whose family has to move, affecting the neighborhood. Someone else takes the job that opened up, changing that person’s future and the life of their family. And these changes ripple outward, touching everyone in their world as time marches on.

I eventually had to make the decision about my own care for prostate cancer. One might think it would be easy for me; after all, I had treated patients for years, understood the options as well as anyone, and knew the potential side effects. But it wasn’t easy at all. I had to look deep into my own heart and decide based on both the likelihood of cure (which was similar for all treatments) and the side effects I might have to endure.

In the end, those side effect profiles guided me to choose surgery. Unfortunately, surgery wasn’t successful, and over the years I’ve had radiation twice, chemotherapy, and hormone therapy. I could have spent time imagining my Parallel Universe, the “what if” world where I chose differently, but I didn’t. I know too well that every path carries its own risks and potential disasters.

Am I unhappy that things didn’t turn out the way I hoped? No, just disappointed. But I am not angry. Everyone did the best they could, in making decisions and in carrying out the treatments. I refuse to let the fact that I am not cured, and that I live with side effects, keep me from continuing to explore my world.

I believe that imagining a parallel universe in any part of our lives can be an interesting exercise. But for me, picturing another universe doesn’t change the one we live in. What I — and we — have is this world, imperfect yet still full of meaning and light if we take the time to look for it. I choose acceptance, and to make the best of the life I have.

Acceptance isn’t giving up. It’s finding peace in the life we have rather than the one we imagine.

Parallel lines etched in stone are formed in ways we can’t even imagine.

As many of you know, I took a break from writing. A dear friend from college, whom I hadn’t seen until our 50-year reunion two years ago, recently reached out. Brock knew about my illness and was concerned that the lapse in writing might mean my health was failing.

No, my health is not failing. I simply took a break to recharge my thoughts. I was spending a bit more time reliving the past and it was taking away from experiencing the present. Past, present, and future are all important to me, and each deserves its own balance. Although I am retired, helping others is still very important to me. I try to present my life and my difficult times to show my personal approach to overcoming obstacles. My way is not the only way. But by breaking through personal obstacles, I try to show the moments of happiness that can follow. I hope this helps some people get through their own difficult times.

I’ve merely been taking a nap from writing. That pause has allowed me to refocus on the things that matter most: family, friends, travel, music, and sports. My thoughts about life have had time to be refreshed.

Will I always feel healthy? Probably not. It’s part of being human that we all grow older, get sick, and eventually die. So my advice, to myself and anyone reading, is simple: enjoy life to its fullest while you can.

And how wonderful it was to have a friend from long ago reach out of concern. It brightened my day to call her and say, “I’m OK.”

Just a thought: call someone who’s been part of your life and say hello. It might brighten both of your days.

And thank you, Brock.

© 2025 Tom Green. Thanks for reading. If this piece spoke to you, feel free to restack or share it with someone who might enjoy it too.

Over a year ago my good friend Janine looked at me and said, “I don’t understand you. You’re a surfer and a surgeon, you play classical piano and ukulele. No one does that.”

It has made me think, off and on, about how these interests, which look so divergent from the outside, are in fact deeply similar in my world.

Piano and Ukulele

Let’s start with the easy one: classical piano and ukulele. To play classical music well (not that I claim I ever did), you need years of disciplined practice to train your fingers to speak musically. I was drawn to the piano at an early age, and over time I learned the independence of the fingers that forms the foundation of technique. I was fascinated by sound itself and dabbled with other instruments along the way. Playing classical music means following musical scores precisely, honoring what the masters set down on the page.

In my hands, the ukulele has a very different feel. After learning chords up and down the neck of the uke, some now come without thinking. For me it’s more about mood than discipline. I don’t really play Hawaiian music, and I rarely strum. Instead, I use my fingers as I did on the piano, working them independently to pick out notes on the strings. Music is music. In the end, it’s about playing with your heart, not your head.

So for me, the two instruments live in the same world: music. It is like an eagle and a sparrow. Both have feathers, wings of different colors, each with its own way of flying and its own sense of the sky. But in the end, they are both birds.

Surfer and Surgeon

In the same way that different birds find their own way to fly, a surfer and a surgeon both rely on technical skill and discipline, even if they appear worlds apart. On the surface, the image of a surfer dude and a surgeon could not be more different. Yet beneath that surface, they share similarities that are not always easy to see.

As with classical music, the technical art of becoming a surgeon takes years of directed study. Human anatomy, with all its variations, must be studied until it becomes second nature. The changes brought by disease must be recognized and understood. And the technical use of the hands must be developed patiently over time. A surgeon who performs long procedures must also be in good physical condition, able to stand for hours with an upright stance to reduce back pain. Just as in musical performance, you must also learn to move past the anxiety of performing or in the case of surgery, of making that first cut and simply carry out the art and skill of the work.

From the beach, surfing looks like nothing more than fun in the water. But a real surfer spends years honing his craft. He must be in excellent physical shape just to begin. Over time he learns to read the weather, the wind, and the shape of each wave to know how to ride it. Still, there are moments when the ocean presents waves larger than he’s used to. The mix of excitement and fear is real, that sharp edge between challenge and danger. And once a wave is caught, split-second adjustments are required to stay balanced and not wipe out.

That same mix of preparation, focus, and the ability to react on the spot is just as important in surgery. And, as in surfing, a difficult surgical procedure elicits a mixture of excitement and tension. Subtle, and not so subtle, variations in anatomy, or in the way a disease presents itself, demand constant adjustments. The main difference is time: in most cases a surgeon has seconds or even minutes to alter the plan, while a surfer has to change course instantaneously. In surgery, that changes when sudden bleeding occurs. Then the surgeon must make instantaneous decisions.

But there is one essential difference between surfing and surgery. Surfing has relatively few professionals and plenty of room for amateurs; surgery is different, it leaves no room for amateurs. In surfing, the risk is my own body. In surgery, my responsibility is to someone else’s body and their future.

Two Sides of the Same Coin

In all of us there are complexities of abilities and interests. Some people can immerse themselves in reading the written classics and then unwind with a light beach read. Does that really sound so strange? Many of us hold two sides of the same coin within us. I imagine that in every person there are contrasts that may look puzzling from the outside, yet feel perfectly natural from their viewpoint.

What looks mismatched to others often makes perfect sense within. Being a surfer is a state of mind, while being a surgeon is a trained profession. Both have shaped how I see the world, and together they have made me who I am.

Teamwork and clear language — essential on the water and with patients.

This piece is written for medical students and pre-meds, because how we talk with patients is as important as how we diagnose or operate. Communication is a skill that doesn’t come from textbooks alone. It comes from watching, listening, and learning over years. I want to share a few moments from my own training and practice that shaped how I learned to speak with patients. And there is crossover to almost any field where there is communication between a person trained in the field and someone who is not trained.

Speaking in Sailing Code

As a kid, my brother, Jim, and I raced small sailboats. On the water, Jim and I understood each other instantly, we had to. But to an outsider it would have sounded like another language. “Ease the sheet a notch,” he’d bark, which really just meant letting the rope that controls the sail out about an inch. We had our own racing shorthand, built over a summer. Then there were other terms: the lines are fouled, let’s go goosewinged, jibe ho, let’s tack. None of it would mean much to anyone who hadn’t been on a boat.

A Lesson from Dad

Medical terminology is vital when we speak with peers. It is concise, efficient, and carries depth of meaning that we all understand. But with patients and families it is different. There, it is essential to use words that are not confusing or easily misinterpreted.

I watched my Dad give straightforward but empathetic bad news to a patient in the Emergency Room when I was in High School. The patient had had a stroke, and my Dad told him directly that there was little chance he would regain the full use of his arm and leg. At the time I did not have the life experience to understand that the hard, direct truth can itself be an act of compassion, sparing a patient from unreal expectations. In the same moment he also taught me to give some hope in the midst of a harsh reality. Balancing those two concepts in one conversation is a very difficult dance of words.

Every doctor’s way of talking with patients is personal. Some of it depends upon the doctor’s personality. Some of it depends upon the field of medicine they are in. My style as a Urologist was certainly much different than my father’s style as a Neurosurgeon. In Urology we are almost expected to be able to tell jokes and know when we can be light in our conversations with patients, whereas a neurosurgeon is expected to be fairly serious at all times in patient care. I will tell you how I formed my style based upon what I learned in life.

In the first two years of Medical School, our education came from books — anatomy, physiology, diseases, pharmacology. Then came third year, and it was a jolt. There was still book learning, but now we also met patients, took histories, examined them, assisted in surgery, and began to observe how multiple doctors actually spoke with patients and families. Some attending physicians could put patients instantly at ease, while others, though brilliant, seemed more impressed with themselves than with the human being in front of them.

A Confusing Flower

One of my first rotations was in pediatrics. In that setting, it is equally important, sometimes even more important, to connect with the parents as with the child. Early on I witnessed an encounter that stayed with me for decades. A ten-year-old boy had been brought in because one of his testicles had died after twisting and cutting off its own blood supply. The treatment was surgical removal of the testicle, which is called an orchiectomy. I happened to be in the room when the urologist (this was a year before I chose that field myself) examined the boy and then sat down with his parents.

I can still hear the words he used: “I am so sorry, but we will have to remove his orchid.”

The parents looked puzzled but stayed quiet. The ten-year-old boy glanced fearfully toward them for guidance. I had no idea what was going through their minds. To most people, “orchid” means a flower. To the doctor, it was medical shorthand. I couldn’t tell if he avoided the word testicle or ball out of embarrassment or if he simply assumed they understood. To my untrained eye, they were confused by the word orchid.

That moment taught me an important lesson: always speak in words people can understand, and never assume they follow your terminology. Ask if they do. And this matters even more if English is their second language.

When Radical Meant Big

Years later, when I was a resident, a staff surgeon made teaching rounds, the daily walk from patient to patient with the team of doctors in training. He asked a patient what surgery he had had. The patient quickly and confidently replied, “Radical surgery.” I suspect that the word radical was all he remembered from his prior visit, and I’m not even sure he knew which organ had been removed.

That memory helped build my style of talking with patients. It reminded me that while patients may remember the term “radical surgery,” the words themselves carry no real meaning. So in my own practice, I worked to replace vague or intimidating phrases with clear explanations. Instead of saying, “We are going to perform a radical nephrectomy,” I would say, “We are going to remove your kidney along with the fat around it.” More descriptive, less intimidating.

I used the same style for prostate cancer surgery. I got out of the habit of initially saying, “An option is a radical prostatectomy.” To most patients, that phrase only means “a big and dangerous operation.” I preferred to say, “An option is removing the entire prostate and the small structures next to it, the seminal vesicles.” This was more words, but less confusing, and it allowed us to move forward with fewer barriers. And I noted that the known seemed less frightening than the unknown.

Would my style work for every doctor? Of course not. It was simply mine. It helped me speak with patients at a frightening and vulnerable time for them, when misinterpretation was most likely. Some might have preferred a more formal style. I could certainly do that, but it was important to me that everyone in the room understood what I was saying and thinking.

Learning to speak with patients confidently takes years. As surgeons, we’re trained to focus on making the right diagnosis and developing the technical ability to fix the problem. But good surgery is never just about what happens in the operating room. A large part of the work is talking with patients and families so they understand what we’re thinking and what lies ahead.

That means adjusting how we speak. Some patients want every technical detail, while others just need things explained in everyday language. Either way, the responsibility is ours, not theirs, to make sure they understand.

In the end, surgery is not just diagnosis and technical skill, it is also communication. For those in training, remember that learning to talk with patients is as important as learning to operate. Over time you will find the style of conversation that works for you. And for those who are not physicians, remember that you deserve a doctor who can not only care for you, but also speak with you in a way you can truly understand.