From what I hear, San Francisco is going to be the perpetual site for SCCM meetings from now on, at least in the foreseeable future. If that rumor is true, get used to creative homeless hooks and Alcatraz. I guess it could be worse but I will REALLY miss cruising for art and food in the Bourbon Street area.

Pound for pound, San Francisco can easily compete with other SCCM sites, even though they insist on having the meeting in the dead of winter where the weather can be iffy. Alcatraz is a MUST SEE. Self tour with a cassette deck. It was VERY interesting and worth standing in the ferry line for. Walking around Chinatown is fun. There are lots of shops with interesting things. Many interesting places to see within walking distance from the hotel district including the famous trolly cars. Be careful walking around aimlessly else you inadvertently enter the “Tenderloin” district which borders the hotels; a place you don’t want to go. Go in small groups and look like you know your way around. Stragglers looking lost stand out, especially in the Tenderloin.

Homeless types have the best hooks in the country. One had a sign that said: “Don’t need food….need dope….why should I bullshit you?”. Another Classic on Market Street, a shower, shave and a suit on this guy and he could have doubled for most Fortune 500 CEOs” “Got some change for a Nice Jewish Boy?”. It’s right tout of that movie “Airplane, where the protagonist has to literally fight his way through the airport full of creative panhandlers.

Street musicians are SERIOUS. One guy on the corner of Fisherman’s Wharf had THREE stacked Korg synthesizers, electronic drums, four speaker cabs and a portable gasoline powered power source. He sounded like Keith Emerson with more equipment than Black Sabbath brings to town. The streetlights dimmed when he hit the chorus.

Good places to eat and hang out. Check lout a place called “Infusion” which is about a five minute cab ride form the Convention center. Jazz and blues bands in the loft, greasy specialty drinks called “infusions” that look like martinis but contain home brew flavored vodka innards. Pretty good food and music. Of course, John Lee Hooker’s Bar is nearby and has great blues bands but no food. A place called “Left of Albuquerque” up on Union Street has pretty good Mexican food. But the undisputed greatest (Ethnic) food in San Francisco, and probably the rest of the country (and I have looked) is an authentic Russian place on the 5000 block of Geary called the Russian Renaissance.

When you walk into this place, you leave San Francisco behind and enter an absolutely authentic Moscow bistro, with all the trimmings. You know you are in a real Russian place when you start ordering delicacies and find out they don’t have any, even though they persist on the menu. I once went through an entire menu in a Leningrad restaurant just like the “Cheese Shop” routine from Monty Python only to find that the only thing they had was boiled beef and potatoes. But they did have great food. The Stroganoff was the best I’ve ever had in the USA. And the Chicken Kiev was great. AND they have black caviar at affordable prices. $46.00 for FOUR OUNCES. Now, it ain’t Beluga (currently $84.00 per ounce and increasing daily) but it was very high quality, served with blintzes and I gobbled it down with both hands, gently nursing little stragglers onto a knife edge with a magnifiying glass. Then the fun started.

Right across the room was a birthday party for some local yokel and a huge table was set for about 50 people. Now, for those of you who have never been to a real Russian celebration feast, it is a sight to behold. The table is piled high with food, goodies, CAVIAR….. and lots of ethanol bearing liquid, including industrial strength, high octane Russian or Armenian cognac. Once the party gets going, everyone…and I mean EVERYONE has to offer a toast……with cognac…….and sipping isn’t allowed. After the toast, the stuff is swilled in one gulp…………..then the next toast occurs randomly and so on. Whoever is left standing wins.

In the past, it didn’t take me too long to figure out that the chance of death from ethanol toxicity looms large and increases exponentially if you aren’t acclimatized to it. Russian cognac is MUCH higher ethanol content than the French stuff, as high as 150 proof. Watching Bad Vlad Kvetan slip silently to the floor and turn purple strengthened my resolve to survive on at least once occasion. A neat trick is to secret a bottle of cola between your knees, surreptitiously pour the cognac on the floor and replace it with cola. Might save your life.

At any rate, once the partygoers started getting tanked and began to ease out to the dance floor, huge mounds of caviar beckoned unprotected. So, being a hound for the good stuff, I kind of sleazed over there and sort of mingled. My fractured Russian used to get me by in Airports, hotels and restaurants and I managed to get positioned close to the biggest caviar mound…….even got a dance to “Moscow Nights” with some unsuspecting woman who thought I was a visiting Brighton Beach accountant.

Everything in San Francisco is expensive. I was told that a small two bedroom walkup apartment in town runs US$2600.00 a month. Hotels run about US$230.00 per night and that’s with the convention discount. A three minute phone call to Pittsburgh to tap the Pitt server for Internet access cost US$20.00. You could drive to Canada for the cost of a five minute taxi trip. Food is outrageous. A simple breakfast at the Nikko is US$17.00. My guess is that is is at least a US$2,000.00 trip for the week all things considered, but I don’t know if there is any realistic way to conserve much of it. You can’t get anyone to attend major meetings in Elk Springs, Indiana where Motel-6 rooms goes for US$26.00 and they leave the light on for ya.

Considering the cost, SCCM meetings have never had a reputation as world class educational events. It’s not a great big secret that a lot of folks use the SCCM symposium as an excuse to renew friendships, scope out fun locales to visit, sample local cuisine and then maybe attending the meeting as a guilt afterthought. However, I must say that this is definitely changing for the better. This year, there were a number of talks that I thought were right on the cutting edge. This year, there were stimulating discussions on where we are going politically, issues of billing and manpower allocation, the Leapfrog initiative as it pertains to demand and reimbursement for critical care services, and lots on end of life issues. I particularly thought the medical ethics courses have been needed for a very long time.

And San Francisco’s a fun cruise-around. A trip down to the nearby Monterey – Carmel area is always in order. The 17 mile drive around Pebble Beach is world class beautiful real estate. A walk around the town of Carmel shows off lots of great art galleries and other fun stuff including actor Clint Eastwood’s lunch spot the Hog’s Breath Inn, where he sometimes actually hangs out. Cable car rides down to Fisherman’s Wharf are unique and great photo ops. The wharf is famous for really fresh seafood and street musicians with more hardware than Black Sabbath brings to town. Great food. Russian Renaissance on Geary is a must see for authentic Russian food. Demonicos on the Monterey wharf is the best seafood in California, I think. Lots of little places with live bands……… it was a great walk-around.

I often wonder who selects speakers and presenters for the SCCM symposia. I still see a great many of the same faces year after year, many with no particular special expertise on their subject. Some have mold growing on them. I suspect one has to be well connected with the SCCM political ministry to get presentations. But I guess that is pretty much the way it is everywhere. I continue to look for obnoxious young people with non-linear viewpoints who have never been anointed at the foot of the red leather chairs. I think it is getting better though. It needs to. Fisher giving lectures on primal scream therapy is a little much.

The CCM-L Endowment to attend SCCM recipient, Dr. Michael (Sasha) Karakozov from Petrozavodsk, Russia, arrived without incident and was treated to a royal tour of the area by Dr. Bob Fink and his family. Bob deserves an exceptionally loud huzzah and pat on the head for his hospitality. Dr. Karakozov had a once in a lifetime experience and will go back to Russia armed with an awesome amount of new knowledge. CCM-L is proud and pleased to have had the opportunity to further meld the global critical care community. Many kudos to Bob Fink and his family. If we get some money again this year form outside sources, we’ll consider it again.

The CCM-L Social on Tuesday night fizzled, but that was to be expected. Most folks have other things going on with family and friends and there is really no time such an event can be scheduled that doesn’t interfere with something. Everyone promises to attend but most get tied up with other things, which is to be expected. I thought 8 pm was an optimum time but later realized that this put most folks right in the middle of their dinner plans. If I had started earlier, people would be getting back from the meetings and getting ready for other evening activities. Later would see folks too tired to attend yet another obligation. A small but enthusiastic contingent did show up and a good time was had by all. Dandy Don and I tried to do some guitar playing, but the backup tracks weren’t loud or articulate enough through a small powered speaker, our Pignose amps were too blarey and each of us were improvising against the other (typical for musicians), creating a cacophony of noise that didn’t work. Maybe next time we’ll find some real acoustically correct equipment.

The Views from the ICU exhibit was definitely a big hit (see photos). I got very enthusiastic reviews from many of those who saw it, and the Ortho-Biotech people were very pleased. They are planning on continuing the exhibit for the upcoming meetings and have asked that we now start collecting photos of critical care teams doing bedside care. I will be announcing more about that later.

So all in all, it was a fun trip and I got a lot more than I have in the past from the sessions. The only downside was the phenomenal expense that effectively puts it out of reach for a great many providers who could make good use of the educational experience. If there is any way to fix that, I have no idea how.

I give it three out of five cable car clangs.