Surgical notes #4—2010: Anatomy students meet their first patient

De humani corporis fabrica (Of the Structure of the Human Body) by Andreas Vesalius
   (Metropolitan Museum of Art)

   
     You don't always come into a story at the beginning. When I first visited gross pathology lab at Loyola University's Stritch School of Medicine, it was December, 2009—the end of term. I was pleased with the column, posted here last year, but wanted to see students at the beginning of the semester, when they first met their cadavers. So I returned the following October and produced today's and tomorrow's columns. 
     I give myself credit for going back, because seeing the flayed apart heads—think onion blooms—mentioned in that first column, lingered with me, and not in a good way. I remember, one night shortly after doing the research, in bed, staring up into the darkness thinking, "It's bad enough to have trouble sleeping, but do I also have to be awake and see the FACES OF THE DEAD?!?"
     Not to complain. These columns were my idea. Part of being a professional is, you gird your loins and do the task in front of you. Which has been helpful, post-surgery, such as every morning when I have to inject myself in the stomach with a hypodermic of anti-coagulant, to ward off blood clots and strokes. Do I like it? No. But I do it, before breakfast, to make sure I get it out of the way. 
    Anyway, I hope you enjoy these columns from a decade ago, and appreciate your patience while I convalesce. 

      It isn't as if Emily Zepeda, Hannah Johnson and Lisa Moore have never seen a dead body before. They have.
     "When I interviewed here, they took me around," says Moore, 23, as the others nod.
      Still, the women are nervous. "First-day jitters all over again," Moore says.
     "You do hear stories," says Johnson, 22, "about people who have to step out of the room to avoid fainting."
     "The room" is gross anatomy lab at Loyola University's Stritch School of Medicine. Every October, each first-year medical student goes from being someone who wants to become a doctor, who may have volunteered at a hospital or gone overseas on a medical mission, to someone who can take a scalpel and peel back the skin on a corpse.
     "This is unlike anything we've ever done before," said Johnson. "Some of us have taken some form of anatomy class in undergrad. But this is completely different."
     "This is anatomy," said Zepeda. "This is what every medical student has been doing since the beginning."
    But first, a steeply sloped lecture hall, lights dimmed, a setting straight out of a Dutch engraving, where students sit in 11 tiers. On the screen: "Human Gross Anatomy, Structures of the Human Body."
     "Good morning and welcome," says Dr. Frederick Wezeman, professor of orthopedic surgery and the classic grey-haired, white-coated image of what a doctor should look like. "We have a very full day for you."
     He crosses his arms, gazing at the room.
     "So what are we going to do?" says Dr. Wezeman. "We're going to be doing a lot of identification, of locations and relationships. You have to know your anatomy. What you learn might seem tedious and detailed to the point of 'Why do I have to know that?' Yes, you do have to know that."
     Almost every student has a laptop, some are already studying charts of skeletal and nerve systems. One is on Facebook.
     "We're going to teach you to speak a new language here," Dr. Wezeman says. "You're going to be talking anatomy. Obviously, dissection is very, very important. Lectures are important, you are paying $42,000 in tuition and you want to be able to learn in different modalities."
     He leads the students through the practical considerations of cutting up a body: wear gloves, no cameras, no souvenirs.
     "You can't take anything out to scare someone at Halloween," he says.
     Students must keep their cadavers moist.
     "If it dries out, you'll have to tag dried-out structures," he says.
     The cadavers are not idealized human bodies, but unique, real individuals.
     "Not all cadavers are normal," he says. "We will encounter a lot of surgical intervention, you will encounter pathologies, you'll encounter situations that you're going to scratch your head about. But they're wonderful learning tools. . . . All the things that normally occur in populations. They're going to be downstairs.
     "Some of them are obese. That's going to create an additional challenge. Be aware. Turning a cadaver over is a team effort. We don't want cadavers falling on the ground."
     Dr. Wezeman reviews the muscle system in the back where the students will first cut.
     There is a brief ceremony—three students come to the front of the lecture hall and speak eloquently to the former owners of the bodies waiting for them downstairs, describing the hands that caressed new babies, the lips that smiled and kissed.
     "These are not merely bodies, they have become our teachers," one student says.
     Then the students head downstairs, to change into scrubs, and enter a very bright white room where 22 body-sized white plastic bags are waiting on tables. There is another ceremony—the students bow their heads, fold their purple-gloved hands in front of themselves, praying.
     If Loyola seems to go overboard thanking the cadavers and stressing respect, remember there is a long, ghoulish history to gross anatomy that includes both grave-robbing and comic photographs of cadavers taken by medical students in the first half of the 20th century. That mind-set is long gone, and Loyola intends to keep it that way.
     The prayers done, the room shifts into commotion as students collect forceps and hemostats from large white buckets that once held Schwartz's premium pickles and take their positions around their cadavers.
     Emily Zepeda happens to be by the zipper, open to reveal a curled foot of indescribable color—a deathly greenish white with yellow toenails, arched at an unnatural angle. She reaches for the zipper and pulls.

      Postscript: Dr. Emily Zepeda is a pediatric ophthalmologist in Oklahoma City. Dr. Lisa Moore is in family practice in Glenview. I couldn't find any information on Hannah Johnson. 

     

    Part one of two parts.  To read Part 2, click here.

              —Originally published in the Sun-Times Oct. 20, 2010

Surgical notes #3: 2001—Chicago surgeon tries to do his part

     This is the sidebar to the piece on orthopedic surgery in Lithuania posted yesterday: what happened after Dr. Lubicky finished operating. For some odd reason, I didn't mention the goal of our late-night outing: a bust of Frank Zappa, incongruously situated in Vilnius, that Dr. Lubicky wanted to see.  Dr. Lubicky still practices, as a pediatric orthopedic surgeon in West Virginia. 

Dr. John Lubicky

     VILNIUS, Lithuania After three hours of difficult surgery, Dr. John Lubicky strips off his latex gloves and leaves the operating room as if it were on fire.
      "What a job!" someone says. 

     But the Chicago surgeon is already gone. In a moment, he has washed up, changed into coat and tie and is striding down the dim halls of Children's Hospital here in that rapid gait particular to Olympic speed-walkers and great surgeons. Doctors scramble after Lubicky. Those who hesitate are left behind as he sweeps into an examination area. 

     Children already are waiting for him—they have been for hours, in wheelchairs, in braces, wearing their church clothes, their parents hovering grimly behind them. Ten minutes after surgery, Lubicky is shuttling between two small examining rooms. He sees a frightened, cross-eyed girl in pigtails and a boy in a wheelchair, his eyes rimmed in red. As soon as he finishes in one room, he heads to the other. 

     He flexes a leg, tilts an ankle, then gives the news, which is often grim. He urges an interpreting doctor not to sugar-coat his translation to a worried mother of a 14-year-old who broke his neck. "She has to know it's unlikely anything will improve," he says. The mother of a 9-year-old with acute meningitis wants to know if he might ever walk. Lubicky shakes his head. "No."

     The exchanges seem brusque. But Lubicky has found truth is often in short supply in the Lithuanian medical system. "Their doctors don't always tell them," he says. "They need to know the situation so they can come to terms with it." He finishes with the last child of the day. "Is that it?" Lubicky asks, and he's off again. Lubicky is handed some pictures done in amber, gifts from a grateful patient, one of many. "Do you know how many books on Lithuania I have?" he asks, in an aside, stashing them. 

Frank Zappa bust, Vilnius

      Lubicky doesn't do what he does here for the gratitude. He's not doing it out of cultural pride, either—he isn't Lithuanian. Foreign travel holds no appeal—he rarely goes to see the local sights, other than a ritual late-evening quick-step through the dark streets of Vilnius, his colleagues traipsing after him. So why does he do it? 

     "He feels it's a privilege to care for people, not a privilege for them to come to you," says Liana Chotikul, a surgical nurse from Baltimore who is working with him. But why so dedicated? Even his closest associates can only guess. "I think he's very religious," says Norene Jamieson. 

     While he speaks of wanting to scale back, to think more of himself and his own family, Lubicky can't ignore the needs here in Lithuania. The trips will continue, he says, as long as there's a need, the sort of need he saw on his first visit, in 1993. "A continuous line of children," he remembers. "They didn't even have a place for people to sit. They just stood there all day, lining up on the sidewalk, waiting to get in."

     —Originally published in the Sun-Times, March 20, 2001

     

Surgical notes #2—2001: Devoted doctors making a difference

Watching orthopedic surgery, Vilnius, Lithuania, 2001 (Photo by Robert A. Davis)

      I'm home and on the mend after my hip replacement Monday. But I'm giving myself a few days to get settled before I have to scrape together a coherent thought. In the meantime, I'm running some surgical stories from the past. I appreciate your indulgence.

     VILNIUS, Lithuania—The walls of the main operating room at the National University Children's Hospital here are covered with pale green bathroom tile—the same tile, it turns out, found in prisoners' showers in the old KGB prison not far away.
     The tile is old and cracked in places. Inside the walls, the heating pipes can't be regulated, so the operating room is warm, uncomfortably so. Sweating doctors flee from time to time to the coolness of the bleak corridors.
     A hot operating room isn't the only telltale sign you're not in an American hospital. Medical waste is tossed out with the trash. There is little disposable equipment. Food for patients is scooped out of chipped enamel pots trundled on a cart down the hall. The air in the operating room isn't filtered. Instead, the exhaust pipe from the anesthesia machine is merely jammed in a nearby air intake, and whatever is in the patient's lungs is pumped directly into the hospital's ventilation system.
     On the operating table is a 13-year-old Lithuanian girl. Her eyes are taped shut, and she has two red clips in her hair.
     She has a vertical talus—a congenital deformity of her left foot that would have been corrected when she was an infant if she had been born in the United States. But, living in Lithuania, the problem was never fixed, leaving her foot drawn back, toes tightly clenched, nearly touching her shin.
     She can't walk and can't wear a shoe on that foot. After the operation, she should be able to do both.
     The surgeon's hands move with balletic grace, manipulating bones this way and that. He inserts long pins to hold the bones in place and fuses useless joints into useful positions.
     Two hours into the operation, the question arises of how to close the incision because, with the patient's toes properly aligned, there isn't enough skin. The doctor attempts a new procedure—cutting skin from the lower leg, freeing it from the tissue beneath and letting it stretch more easily. The technique is so new it was only just described in the January Journal of Pediatric Orthopedic Surgery, in an article by a noted Chicago surgeon, Dr. John P. Lubicky, chief of staff at Shriners Hospitals for Children.
     Trying it might be reckless for the average doctor in Lithuania. But, in this case, the man holding the scalpel is Dr. John Lubicky.
     "He's the best surgeon I've ever worked with," says Dr. Greg Brebach, an orthopedic surgeon at Rush-Presbyterian-St. Luke's Medical Center.
      Brebach is one of a dozen doctors, residents and nurses Lubicky has brought to Lithuania on this, his 10th, visit as part of an extraordinary humanitarian effort that aims to do no less than help a nation's medical system leap 50 years into the future—or, more aptly, leap 50 years into the present.
     Lubicky made the first trip by himself, in 1993.
     "The Russians were still there, and they left their medical system," says Lubicky. "The hospital was dirty and smelly. Everything was broken and in bad shape. Every case was a failure, practically. There were lots of conditions we don't see here—poor neonatal care, lots of bone and joint infections in newborn and young children, and probably some effect from Chernobyl in terms of congenital defects."
     Norene Jamieson, the nurse manager of surgery at Shriners, is on her ninth trip with Lubicky. She remembers the first trip well. Jamieson brought lots of equipment, but not the special brushes and antibacterial soap used in the United States. She figured they would wash in whatever the Lithuanian manner was, not realizing just how backward the system was.
     "You had to scrub with lye soap for four minutes, then dip your arms in formic acid for three minutes," she says. "They sterilized the formic acid each morning by setting it on fire. My arms were all welted and blistered."
     Jamieson never left the antibacterial soap behind again. She organizes the yearly trips, in addition to her own trips to Colombia with a team of plastic surgeons. It is a major logistical challenge.
     "I solicit people all year long for donations for trips we sponsor," she says.
     This year, the team brought 39 cases of medical equipment, worth $300,000, and left it all behind for the Lithuanians to keep. Included was an $80,000 set of state-of-the-art Moss-Miami tools for spinal surgery.
     "A drop for American medicine," marveled Dr. Jurgita Januskyte, a Lithuanian surgeon. "But, for us, it's expensive."
     The American doctors and nurses flew in the previous Saturday, dropped their bags at the hotel, then went to the hospital. Before the week was out, they would examine 176 children and perform 19 surgeries. That might not seem like a lot, until you realize that the procedure to correct a scoliotic spine—one of the operations they performed—can take 12 hours.
      This is the last surgery of the week. The next day will be spent giving seminars on things such as how those new Moss-Miami tools should be used. Fifty doctors come from all parts of Lithuania to hear Lubicky speak.
     "We never thought our role was to come over here and do a lot of cases," says Lubicky. "Our role was to make them self-sufficient, and I believe that has happened, to a certain extent. They know what to do."
     Some of the Lithuanian doctors use their annual vacation to observe the Americans. They give credit to Lubicky—who last year was decorated by Lithuanian President Valdas Adamkus for his work here—for playing a key role.
     "Dr. Lubicky has changed children's orthopedic surgery in Lithuania," says Dr. Kastutus Saneukas, head of children's orthopedics at the hospital. "We get new techniques, new experience, news, the latest books, journals, education. He changes minds every time he comes."
     The medical personnel on Lubicky's team also speak of the experience in glowing, reverent terms, particularly the residents. "This is what we went to medical school for," says Brebach, who is on his first trip.
     "It gives them an idea how orthopedics are practiced in another country," says Jamieson. "It also opens their eyes to the needs of people in other countries. Maybe when they're finished with their residency and out on their own, they will devote time to helping in other countries. There's a tremendous need."
      —Originally published in the Sun-Times, March 20, 2001

Surgical notes #1—1988: A new heart beats the odds

Saint Catherine of Siena Exchanging Her Heart with Christ
by Giovanni di Paolo (Metropolitan Museum of Art)

    

     Happy New Year! 
     One rule of mine is not to dwell too long on any topic. So having written four columns on spine surgery in July, and a big sleep apnea piece earlier this month, the prudent strategy would be to avoid first person accounts of medical procedures for a while. 
      But the spine surgery series did really well—Apple News picked it up—and my boss barked, "Steinberg! Can't you get your hip replaced or something?" 
     Well, okay chief, if you insist...
     Kidding.  He didn't say that. What happened is, my professional discretion might have said one thing, but my body had other ideas. The right hip has been deteriorating for years; some days it felt like somebody has jammed a pine cone in there. I've been using a cane for three months. Lately it has been getting even worse. So I went under the knife at Northwestern Monday. Nothing as complicated as the summertime laminoplasty. Just a quick hip replacement, which I'm told is a very simple, routine procedure nowadays. I should be home Tuesday afternoon.
     I will write about it, eventually. Over 300,000 Americans had hip replacement surgeries last year, so it's not as if this is some esoteric topic.
     Still, I want to give myself a few days to let the drugs wear off, the cobwebs clear and to learn how to sit again. I've written about a good many surgeries over the years, and thought I would share a few while waiting for Mother Nature to sign off on my recovery. How long? We'll see. This story was a favorite of mine. I can still see myself flipping through two notebooks, seeing the scribbled words "baby chick" and wondering: why did I write that?

     Dr. Bryan Foy gently scoops up the human heart and holds it, as he would a newborn chick, with one hand cupped underneath, one hand over the top.
     It is 1:24 a.m. at Illinois Masonic Medical Center, 836 W. Wellington. Foy turns, takes a step, and places the heart in a metal bowl of frozen slush. Taking a pair of long tweezers, he peers into the various orifices of the heart. It looks good.
     Meanwhile, at Loyola University Medical Center in Maywood, other surgeons are waiting to remove the Jarvik-7 artificial heart that has kept Peter Reali, a 55-year-old machinery repairman from Brookfield, alive for the past 34 days.
     Loyola receives a phone call from the operating room at Illinois Masonic. The donor heart is out. Foy and the transplant team are heading for the helicopter and the seven-minute trip back to Loyola.
     Heart transplants, once rare and experimental, are becoming more common. When Loyola began transplanting hearts in the spring of 1984, there were 14 transplant centers in the country. Now there are more than 100, including seven in Illinois. Loyola has given hearts to more than 120 people—100 of whom are still alive.
     One of them is Peter Reali, who had never been in a hospital when he had his heart attack last April. Two weeks later, his heart stopped four times, to be restarted by electric shock. Doctors decided his heart was about to give out, and placed him on the Jarvik until a donor heart could be found.
     During tense weeks of waiting, the irony that his life could only be saved by someone else's accidental death was not lost on Reali.
     "It don't seem right, waiting for somebody to die," he said, the Jarvik ticking loudly at the foot of his bed. "But you still want to live. There's no other way to do it. You can't go to a used heart store."
     Hopes were high around Memorial Day. Most heart donors come from trauma victims; motorcycle accidents are so frequently a source of donated hearts that doctors dub them "donorcycles."
     On May 31, an ex-con was shot in the head and taken to Illinois Masonic, where he was pronounced brain dead. His family agreed to donate his organs.
     Two other heart patients in the state besides Reali had blood types and body sizes that made them eligible for the heart. Their doctors conferred, and Dr. Roque Pifarre, the chairman of the department of cardiovascular surgery at Loyola, convinced them the heart should go to Reali.
     An hour before the transplant is to begin, the Loyola surgical team assembles at Loyola: surgeon Foy; Ravi Kamath, his assistant; Kathleen Siebold, procurement coordinator, and Hazem Tillawi, a profusionist (person who floods the donor heart with cold fluids to keep it viable). Together, they wait for a helicopter to take them to Illinois Masonic to pick up the heart.
     To cover their apprehension, the team members joke among them selves. Foy speculates on the possible effect that the heart of a felon might have on Reali.
     "If Mr. Reali wakes up and has an irresistible desire to steal objects and carry a baseball bat, we'll know why," he says.
     At 11:39 p.m., a Long Ranger II helicopter looms from the east, a cluster of multicolored lights against a black sky. The group moves quickly to the chopper and climbs in for the quick ride to a landing zone near the hospital.
     At precisely midnight, they enter a large surgical theater, brimming with shining instruments. In the center, stretched out on a table, is the gunshot victim, both arms straight out. His chest heaves up and down as the respirator breathes for him. Someone covers his face with a towel.
     His chest is scrubbed with a yellow antiseptic and a thin plastic film placed over it. At 12:18 a.m., Foy takes a small electric saw and cuts into the chest. The air is filled with the smell of burning flesh.
     While another team digs into the glistening intestines, isolating the kidneys, Foy carefully cuts the connective tissue around the heart, until it is isolated, a beige and purplish muscle the size of a fist, beating furiously.
     The pace picks up as both teams prepare to remove the heart and kidneys. At one point, eight pairs of hands are frantically working inside the chest.
     At 1:20, the heart is stopped, the aorta clamps off and Foy makes the final cuts to remove the heart. The kidneys are close behind.
     After checking the heart, Foy places it in the freezing saline solution and seals it in a round Tupperware container. The container is placed in a red and white Igloo Playmate cooler, and the team hurries back to the helicopter.
     Tillawi carries the heart, never losing contact with it. When changing his scrub suit, he keeps his foot pressed against the cooler side, like a baseball player leading off from a base. There is no joking now, just silent concentration of the unfinished business ahead.
     By the time the team returns to Loyola, the head of the cardiac unit, Pifarre, assisted by Dr. Henry Sullivan and cardiologist Dr. Mark Zucker, have removed the Jarvik. It sits on a table, looking very much like the tail light assembly from an old Buick. Reali is kept alive on a heart-lung machine, which circulates and oxygenates his blood.
     By 2:17 a.m., the donor heart is placed in Reali. Sullivan and Pifarre settle down to the task of hooking it up.
     Using pink thread and a tiny, curved needle, Sullivan attaches the loose arteries, a task that requires amazing dexterity because he holds the needle and thread with long tongs.
     "That's a nice fit," he says.
     At 2:24 a.m., more icy saline slush is poured over the heart, using a tool resembling a turkey baster. Ten minutes later, Sullivan looks up, gives a half-sigh, half-groan, and returns to work. It is the greatest display of fatigue or emotion any of the five surgeons display throughout the six-hour operation.
     Fourteen people hurry about the crowded operating room. A medical photographer snaps pictures. The blood suctioned out of Reali is "cleaned," impurities removed using a centerfuge, then put back into Reali. About 40 percent of his blood can be recovered this way.
     A sign of just how routine heart transplants are comes shortly after 3 a.m., when Sullivan jolts the new heart with a pair of small electric paddles.
     There is no commotion, no cheering. Just a pause as everyone in the room looks up at the crazy jumping of purple and green lines on the heart monitor hanging from the ceiling. The heart is alive and beating, after a fashion. The heart machine still continues to do most of the work, to reduce the strain on the heart. The work of the lungs is still done by a device resembling an oversized blender.
     For the next two hours, Pifarre stands over the heart, watching it, changing the level of fluids to alter blood pressure, reducing the work done by the heart machine, occasionally poking an inquisitive finger against the heart.
     "The heart is starting to take over on its own a bit," says Michael Wallock, a profusionist. "There's some nice ejection now."
     Ten minutes later there is trouble: irregular heartbeats. Pifarre looks for bleeding in the new sutures, and Zucker stares into the open chest, his hands on his hips, like a golfer considering a putt.
     At 4:05 a.m. the heart machine is shut down. The heart is beating on its own. At 4:16, nurse Elissa Bailey leans on a table and momentarily dozes, then snaps her attention back on the operation. A little before 5 a.m., Pifarre goes to tell Reali's wife, Dorothy, how the operation is going. Orderlies begin cleaning up the operating room. Three large hampers are filled with garbage—wrappers, towels, empty supply packages, gauze.
     At 5:10, the geared chest spreader is taken off. "Do you have a sterile peanut butter and jelly sandwich back there?" Foy asks, as he scrapes the chest bone in preparation for closing the chest.
     Heavy steel wires are threaded into the sides of the chest. Pifarre and Foy pull hard on the thick wire to draw both sides of the rib cage together.
     "He seems to tolerate it well," Pifarre says.
     "There was a little drop," Foy says, looking at the blood pressure monitor. "But nothing sustained or dramatic."
     The wire is bent and twisted along a 12-inch incision, then snipped off with wire cutters. The skin is closed, using surgical staples. Just after 6 a.m., the blue paper coverings are torn away from Reali, and he becomes a person again instead of just a draped chest.
     "Well, here's Peter," Pifarre announces, pulling open Reali's eyelid.
     "OK buddy, don't give up," Foy says. "Whatever you do. Not now."
     Reali is rolled to his room at 6:20 a.m., the surgeons accompanying him, supervising the tangle of tubes and wires.
     The next morning he is brought out of the anesthesia; his first thoughts are that he doesn't hear the Jarvik ticking, which he interprets to mean that either the transplant worked or he is in heaven.
     "I looked down there, and there was no machine powering me," he says, recalling the moment. "It was nice."
     Two weeks later, Peter Reali walks out of the hospital, with his wife and family. He returns weekly, to check for signs of rejection - the body's immune system battling the foreign heart tissue—a major obstacle in heart transplants. But, for now, Reali is doing well and is optimistic.
     "I feel good," he says. "Being home feels good. I go for walks; it's beautiful. My knees are a little mushy, but I go just a little bit farther every day. In a way, I'm glad it happened. It's something I won't forget."

      —Originally published in the Sun-Times, July 17, 1988

This shock reduced Nancy Pelosi to quivering jelly: State of the Blog, Year Seven

Boat; Castro, Chile.

     Ooof. 2019. In the books. Almost.
     Here at everygoddamnday.com, we ... well, stumbled forward, along with everyone else.
     Last year's Facebook fall-off documented in State of the Blog, Year Six continued, reaching a nadir—I hope—of 49,645 hits in March, the first month below 50,000 since 2016. 
     With the autumn, however, some new dynamic kicked in. Now the numbers are rising again: December broke 72,000 hits. It can't be a surge in readership; more likely Web crawlers from China, bots from Russia, some other technological explanation. My estimate is that 25 percent of my traffic are machines of one sort or another; then again, that is probably also true for everyone else. Robots talking to robots. 
     The surge brought this year's monthly average to about 55,000 hits a month; last year's was 65,000. 
     So no cultural force, this. Yet still a creative endeavor—I almost said "literary endeavor" but that would be putting on airs. And it is a commercial proposition, thank you very much Marc Schulman, as Eli's Cheesecake returned to run holiday ads for the seventh consecutive year, and I put up covering editorial fire that actually seems to have resulted in orders.
    I'm not the person to judge; I hope the blog did not too much mimic the general deterioration of our country and world under the nihilistic right wing nationalist madness which I'm not pollyanna enough to believe is going away in 2020. I'd put my chips on settling in and beginning to get serious about squelching dissent. Maybe that's the dim view. But all the optimists in my family are back in Poland in a pit, and I consider pessimism a survival strategy. 
     That said, we had our fun.   
     In January, we used the freer standards of the online world to parse "motherfucker" after an exuberant congresswoman used it to refer to our illegitimate president.  In February, EGD listened to Trump's State of the Union address and saw the clear outline of his 2020 victory which 10 months has only made seem more prescient.
     "Trump is going to win in 2020," I wrote. "He is going to roll the disorganized, bickering Democrats ... the whole anthill going in a hundred directions, unifying only to utter a quavering Charlie Brown shriek of 'How can we lose when we're so sincere?' after it's all over." 
    Still sounds about right; though of course I'll be grateful to be mistaken. 
    In March, my visit to Bob and Peg Ringham resulted in an in-depth piece on a common yet unfamiliar ailment, Lewy Body Dementia. 
     April might be the cruelest month, as T.S Eliot claims, but it found me in South America, and I ran 14 diary entries, my favorite being this, on experiencing tango in Buenos Aires. In May we had lunch with Goodman artistic director Robert Falls and got pulled onstage at The Second City.  June reminded us that, loath our current administration as much as you like, it is more par for the course than freakish departure from American history, and sadly, "we are not better than this." 
    In July I kept the blog going despite being in Northwestern Memorial Hospital for four days, having my spine cracked open, an experience I began documenting toward month's end. In August I broke my rule against modest proposals and advocated landmarking the sign at Trump Tower, which, like all such efforts, went nowhere. In September, we went to see rugby played in Lawndale. In October we chatted with the editor of The Economist.  November I managed to piss off the administrators at the elementary school at the end of my block by writing a whimsical piece about all the kickballs floating in their drainage marsh. 
     Which leads us to December. I wrote 6,000 words on sleep apnea, a tome which must have broken Mosaic Science, since Wellcome Trust shut down the web site after my article's publication. A coincidence, surely. I went back under the knife at Northwestern Monday morning, and have a few days of old surgical columns lined up. After that, I promise nothing. 
    Looking back over the year, like so much of American current events, I think we can say we survived, and are doing the best we can, and there are moments to be proud of, scattered amidst the gathering dread. History books will either note that patriotic Americans resisted our nation's slide toward despotism, or we'll all be tarred as the running dog effete liberal cowards who gnashed our teeth in frustration at the glorious rise of The Donald. Assuming that his successor, President Donald Trump Jr., allows history books. The battle to determine which it ends up being is still in full cry. 

It was a very Trump year

     Another year done, almost. Whew. And what a busy year it has been, packed with newsworthy stuff, So without further ado, the top 100 news stories of 2019:
     1. Donald Trump impeached in the House for withholding military aide to Ukraine in an attempt to pressure its president to gin up dirt on a political rival.
     2. Donald Trump said at a rally in Pennsylvania: “Our country is full. We don’t want people coming up here.”
     3. Donald Trump’s Secretary of Defense resigned.
     4. Donald Trump abruptly left a NATO meeting after other world leaders laughed at him.
     5. Donald Trump’s Secretary of the Navy was fired over his objections to the president undercutting military discipline.
     6-99. More lies, resignations, slurs, boasts, all involving Donald Trump.
     Sure, other stuff happened. But even mentioning it seems beside the point.
     Do you get tired? Tired of the tramp tramp tramp of Trump Trump Trump? I know I do. His fans seem to love him. They are indignant that anyone could continually pay critical attention to the president of the United States.
     So the country is cleft in two: half entranced, half disgusted, both sides belligerent and baffled at each other. Can you imagine a simpler recipe for disaster? Sure, the economy is bright, now, but that’s like marveling at the pretty red glow when your house is burning down.
     Speaking of which, No. 100 ...
     But first, with the year ending, apologies and thanks. Apologies for so much focus on Washington — it seemed necessary — and thanks for bearing with me.
     For those who love Trump, yet still read this, when you gripe—“Why are you so hard on our beloved president? I hate you” — remember that your loving him is what lawyers call “inculpatory” — it incriminates you, round these parts.

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The ’10s? The Teens? Decade defies labels

 

   My rule of thumb at the paper, when asked to do something, is to always say Yes, unless I can't do it. Then I decline. Because I like to be useful, and have learned that the topics I'm drawn into are typically subjects I might not otherwise tackle. So periodically I've been working on our new, very successful special magazines and wrappers, happily writing about subjects from driving exotic cars to Illinois manufacturing.

    In Sunday's section wrapping the front page, I was asked to parse the decade that has just gone by, with emphasis on the Obama/Trump dichotomy. That I did, more in sorrow than in anger. 

     It says something about both the dominance of social media and the fading iconography of eras that I didn’t realize a new decade is upon us until I saw a meme on Facebook at Halloween.
     “Just a friendly reminder,” it announced, above four slim women in flapper dresses, “The ’20s start in 60 days.”
     Right. They do, don’t they? Those 60 days have dwindled to a handful. Then it’ll be the ’20s, again. Will they roar? The last ’20s sure did, a growl of prosperity and sexual liberation and music so loud that we still remember it all a century later. Followed by the grim ’30s. The wartime ’40s ...
     In the 21st century, that pattern broke. What do we even call the decade years that just expired? “The Teens?” I never did, and I lived through every minute, so far. MSNBC is going with “Decade of Disruption,” which might be true — Amazon and China both muscling aside old powerhouses, America and Britain stumbling badly — but that won’t be flying off anybody’s lips.
     And the 10 years before that? “The Aughts?” Even worse. And what was the flavor of the ’00s? The Post-9/11 Decade? Maybe. But even then, nowhere near the instant emotional impact of “The ’50s” or, the ultimate, “The ’60s.”
     Then again, the period between 2010 and 2019 was particularly schizophrenic, given that about halfway through it Barack Obama, a most careful, reserved and thoughtful president, did his mic drop and ambled out of public life, exiting stage left. Immediately replaced by Donald Trump and his parade of clown cars, tripping over themselves and into power from stage right, calliope at full wheeze, ushering in what can only be described as perpetual pandemonium.
     What will history call that decade? “The Troublesome Teens?” America is sorta old for a stormy adolescence at this point. “The Trump Triumph?” Could be. “The Pre-War Years?” Let’s hope not.

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