Fukuoka, Japan (2005 maybe?)

Across the big pond again to Japan. This time I took my son Seth, a junior high student who happens to study Japanese as one of his languages (other two are Arabic and Russian). Speaks, reads and writes Japanese at level two of four in the Standardized tests. I managed a Business Class ticket and Seth dessicated in the flying sardine can 13 hours Chicago – Tokyo. Sorry about that. Dues, you know.

I suspect that the airlines intentionally squeeze them into economy to promote their ridiculously expensive business class. It’s a Hell-hole back there. Like a torture chamber. Only thing missing is the weird organ music and rattling chains. But even so, a 13 hour trip is brutal in any kind of seat. After 6 or so hours there is no way to get comfortable in a seat that leans back a bit more. You’re still not supine so I can’t sleep anyway. No matter how you arrange arms and legs, pressure points appear quickly and you’re moving all the time. It’s just brutal.

But at any rate, we hit Narita late in the afternoon, cleared customs and were treated to a delightful traditional Japanese supper by Mr. Taniguchi of Respironics. We got a chance to wander around the Ginza for a while, even passed the Apple Store prominently placed on a main Ginza street. They must all be standardized. Looks just like the one in New York. A good night’s sleep and off to Kyoto the next AM on the Bullet Train.

Very safe, sleek, quiet and almost uncomfortably fast. Close to 200 mph (max speed 320 KPH). I’m told there’s never been an accident. We were told to sit on the right side for a great view of Mt. Fuji. It went by so fast it was gone before I could dig out a camera. Kyoto in record time to pick up my friend and CCM-L stalwart Dr. Satoru Hashimoto. Got a chance to tour his very modern and efficient ICU (see photos). Then off to Fukuoka and the meeting. Bullet train again…..zoom.

Hotel was beautiful and first class. Opening ceremonies were elegant. Foreign speakers were introduced formally. Met Dr Maekawa, the Chairman of the Meeting, a most gracious host. At this point, I had a full day to kill doing whatever I wanted. Several others were taking an all day formal tour but I usually prefer to sneak around myself. Seth took off like the wind and was seen shortly thereafter skateboarding with some other Japanese teens. His knowledge of the language enabled him to go wherever he wanted. He walked around town for three days from morning to night soaking up culture.

I took a side trip to Hiroshima. About an hour by Bullet Train from Fukuoka. I figured I better get over there since it’s pretty far out of the way for most visitors to Japan with limited time. The photos of what Hiroshima looked like (see my photo essay) are absolutely frightening. The bomb dropped on August 6, 1945 exploded about 600 meters above the (now) memorial building still preserved as a memorial. The rest of the museum archived many artifacts including a chilling melted wristwatch stopped at exactly 8:15 AM. I suspect the downward force vector spared the building from total destruction and the sideways vectors essentially flattened the rest of the city around it. An entire city flattened in a blink of an eye. 60 years later, Hiroshima is a teeming, thriving city. A testament to the ability of a people to survive and rebuild. That’s all I have to say about this rather emotional experience. The photos tell the story better than I can

Dinner for the foreign guests and some of the local physicians was very interesting. VERY traditional Japanese. Shoes off, squatting on the floor (ouch). VERY Japanese food…….variations on the theme of raw seafood. Now I have to say at this point that I just don’t do raw seafood. Satoru made it a little easier by asking in advance that some of my meal be broiled. That was a nice touch and, of course, it was fabulous. I did have some (raw) Pufferfish (Fugu) a fish with the potential toward toxicity that must be prepared by specially licensed chefs. It just tasted like raw fish to me. The treat of the day was STILL ALIVE squid sectioned in the middle for easy spearing of the corpus strips with chopsticks. It was right out of Hannibal. Literally eating live squid. Impossible you say? I have the videos to prove it (see end of my review). May be too intense for younger viewers.

But the best part of the evening was Seth. Of course all the foreigh guests had to stand up and introduce themselves (in English). When it came around to Seth, he stood up and did his intro in seemingly flawless, fluent Japanese. Every jaw in the place bounced on the floor. The spectacle induced instant estrogen storm in two of the young attractive nurses, who leapt and stuck to him like barnacles for the rest of the evening. Young American boys with long blond hair speaking fluent Japanese don’t wash up on the shore every day I suspect.

Next day was my talk. I had heard early that many attending the congress didn’t do well with written American English and I was admonished to speak slowly. I figured much of my slide presentation might go poorly understood. So I expended a fair amount of energy to have translated (by the World’s Smartest Woman- Elyse Hendrick) into Japanese. Her version was culturally corrected by Satoru (using a lot of his valuable personal time- I appreciated greatly). When it came time, the audience seemed visibly pleased that they could effectively share in the slide presentation. Professor Maekawa was spotted sitting next to my kid Seth in the back row, conversing in Japanese.

Back in the flying sardine can and home to sweat out the Jet Lag, which always seems worse going from West to East.

My impressions:

I found the Japanese to be a delightful people. Polite to the point of self effacement. I saw people almost get into arguments trying to shoo the other one through an exit door first. Curt bows are de rigeur for every occasion even for perfect strangers. I was very very appreciative of the hospitality they provided my son who I didn’t expect they would even see. Their critical care units are impressive. They (naturally) take impeccable care of their patients and their symposium was first class.

Darwin on going to Arabia

20/10/2006

1. Learn some basic Arabic before going, including reading numbers.

2. Do not, DO NOT, communicate , acknowledge, talk, or photo a woman with a veil. No, not, never.

3. Do not speak to a lady unless you have permission from her male brother, father, or husband.

4. Do not take a photo of anyone unless you have permission and then ask at least three times. Better yet do not take a camera.

5. Eat anything off the street that you see being cooked in boiling oil.

6. Do not go swimming in natural pools- belharzia.

7. You are a guest in their country , obey their rules.

8. No booze. NO alcohol, even if offered. Unless you are alone in your own room and plan not to go out for 8 hours.

9. But trinkets and stuff, like carpets and brass.

10. Do go to the homes of local people if asked. Be gracious and say thank you , when indicated.

I’ve scrupulously observed these rules — every one — while traveling in the Islamic world. I’ve been offered morphine, sex (all kinds), and other illegal things and always declined them. My rule is complete celibacy and puritan decorum when travelling in general and this a must, IMHO, in Arabic/Islamic countries. Morocco and Turkey have a reputation for hetero- and homosexual venues. My advice is DON’T. If you want some exotic Middle Eastern beauty go to Beirut and pay for it — and expect to pay well. Beirut, while it lasts, is truly the Pais of the Middle East.

Some added advice:

11) Avoid meat if you can and never buy any from markets that is not covered in flies. If there are no flies it means they’ve sprayed it with some ghastly pesticide (used to be Aldrin or Dieldrin) and you are about to get dosed! Pastas, local breads, and cooked vegetables and pastries are safer. Tahini (sesame) is wonderful.

12) NEVER invite anyone back to your room, male or female. This simply is not done and puts them in an awkward position. Most hotels will be segregated into local and tourist rooms (with cameras to insure this). If you want to show someone something (say a book or photo), or give them a gift, retrieve it from your room and bring it to the hotel lobby, or do so before you meet.

13) Bring gifts. Gifts are VERY important. Important beyond all words and often money. What is a good gift will vary by locale. In Egypt in the late 90s thru 2001 the best gifts were any kinds of electronics; a CD player was simply fabulous. Cheap ($2.00) wristwatches were worth many times their value in cash.

14) If you know what is really in demand you will do better with barter than with cash. In Egypt old cell phones were very valuable If you can reliably find out what articles are most in demand you can leverage your cash into a small fortune in local goods.

15) Pornography is in incredible demand; the harder core the more it is desired. It is so constantly asked for and with such desperation it is like they are dying of thirst. DON’T bring any. NOTHING! Not even personal photos of the wife unless she is fully clad.

16) The Arab world is homosocial (and surprisingly homosexual as well). Men spend their social and quality time with other men; women are for breeding, cooking and cleaning. Men hold hands with each other and take long social walks together; they often walk with their arms around each other in the evening. Despite your (and my) incredible aversion to tobacco, the water wipe (sheesha) is an integral part of Arab male socializing. The tobacco is fragrant and fruit flavored; watermelon was my favorite. If you want to really talk with men on the street frankly and intimately about politics, religion, women, the West, etc., you MUST at least do sheesha with them. This means that in the cafe when the pipe is passed to you (no, you can’t wipe off the mouthpiece) you accept it and take a puff. I can’t say it won’t kill you, but if it does it will TB or something other than the smoke. The smoke is fragrant and when water filtered inoffensive to the airways; nothing like a cigarette.

17) Drink tea when it is offered. If you finish it fast you will be given another… It comes very hot in small glasses so don’t burn yourself. It is OK to refuse tea if a merchant offers it to you immediately, but if you have talked at all, it is rude. Tea is a great social lubricant in the Arab world; if you think the British use tea as social thing you ain’t see nothing. Even if the water is from the local sewer it will be served so hot it is almost certainly safe. AND, the tea is good. Coca Cola is also used in placed of tea in the summer. It is considered rude to refuse tea once you have a conversation going. The concept of “speed” and “time” are very Anglo-Saxon. There are few things that cannot wait and most do except prayers.

18) Do visit mosques and holy places. Always remove your shoes, observe silence and NEVER photograph; not even where it is supposedly allowed. If you see restoration underway or great beauty, praise it sincerely as it deserves. This is a greatly appreciated. Learn something of the history of the place; especially Islamic history; there is always a rich local history. Islam is rich in intrigues and poltical/family murders and a knowledge of this is considered sophisticated and opens up interesting conversation.

19) One of k’s most superb pieces of advice is to leave your camera home. I have absolutely zero photos of me in the Middle East and no regrets. If you must take it, keep it out of sight until you need it to take pictures of big things. DO NOT take pictures of small dwellings, large private dwellings, poor people, people on the street, or any kind of industrial or civic infrastructure (water plants, airports, factories, etc.). Make sure your landscape shots aren’t of picturesque little villages. Like k says, ALWAYS ask, ask again and then ask once more.

20) No shorts. Period. Use long sleeved shirts instead of sunscreen.

21) Imshi is the Arabic word used to shoo dogs away; it is deeply insulting. Use it with great care. Beware of some vendor telling you this is how to say “no” to beggars or persistent merchants. I was once pursued at night by young men trying to sell me sex (any kind with any gender I wanted) and it was only when I fixed them with steely eyes and said, “Imshi!” that they quit pestering me.

22) If you are going to be in one place for a time it helps to find and pay a highly qualified local guide; I used both those with university educations and those without (the latter being hereditary guides who were also certified by the state). There is always a local Western academic who has pretty much gone native; find him! He will be your guide to small villages where the arts and crafts will be superb and incredibly inexpensive and to artisans of exceptional skill. Alas, there is no substitute for taste and knowledge and most visitors lack that. Alabaster, carved stone, finely worked leather and brass all have wonderful intricacies of quality, workmanship and taste. One thing which I did not buy (and regret) is the magnificent gold and black silk embroidery, usually of verses from the Holy Koran.

23) Don’t buy rugs unless you learn something about them before you go — and I mean really learn. Visit some local rug merchants in Pitt! Also, realize that the knots are tied by small children. This is not necessarily an awful thing. They kids work about 4-6 hours a day and then are educated, albeit Madrassa-style. They learn to read and do numbers and are fed and clothed. It is best to go to the rug factories where you can see the kids at work AND see where the live and are educated. Keep in mind these kids would be out on the street and that is bad business almost anywhere.

24) NEVER, ever, reach for anything at anytime (other than to wipe your ass) with your left hand. This is considered vile behavior. I’ve been struck on my hand for forgetting this. There is no TP in most of the Arab (or 3rd) world and after a BM you clean up with a perineal lavage and your left hand. Historically, there has been no soap for handwashing either. One thing I learned from the Arab world was how to clean my bum and genitals properly after using the head. Since my 20s I’ve always kept a pitcher of water (appropriately labeled) by the toilets and carry wet wipes with me everywhere. I haven’t seen a skid mark on my underwear in 30 years! TMI, I know!

25) Don’t carry your wallet in your pocket and DO buy a money belt. Keep you cash, credit cards, and ID in the money belt inside your pants and next to your skin.

26) Don’t bring or wear expensive watches or jewelry.

27) Dress in conservative colors; browns and dark blues. Don’t wear expensive designer clothes or accessories; keep it simple and functional. A hat is must; I like the canvas collapsible type.

28) Unless you are k travelling in protected and elite circles theft is ubiquitous and always successful to some degree. If there is an in-room safe with a set-able lock you can use this for CDs, etc., but NOT for cash or ID. Passport stays with you at ALL times.

29) Trust your gut. Always decline to go anywhere where you have even a little suspicion.

30) Countryside trips in a hired car should be with a convoy or on the back of a motorcycle with a local academic or Arab you literally trust you life with. Wrecking a car to strip it, kill you, and take everything you’ve got is common; I came very close to this myself. If you have hired a car and the military wants a ride offer the front passenger space enthusiastically; just make sure he is an officer; preferably the commanding officer. Hire a late model car with airbags; one which the owner is relentlessly polishing and primping; it’s your best assurance of survival aside from the reputation of the driver/owner.

31) Shoes come off in homes (no matter how squalid) and in mosques and religious shrines. Wear a pair of heavy socks. Never hesitate to explain that you know you are about to enter a sacred space and with to know how to behave respectfully. Do as you are asked or do not go in.

32) Corruption is universal; baksheesh is the lubricant that gets everything done. NOTHING is free. Learning to be assertive about baksheesh (when to say f-off) is vitally important.

33) If you are going to be doing any intellectual tourism BOOKS will be a ticket to a great trip. Local Arabs intellectuals are desperate for Western books about their history, culture, and the like. My local Egyptologist literally cried when I gave him a copy of Kent Weeks’ book on the lost tombs of Ramses II’s sons.

Mike Darwin

Always fun to go to Brazil. I was there in the 80s with Peter Safar for a disaster meeting. Now the whole concept of disasters has changed and I we are talking about a lot of new things learned in the last five years.

Going through airport security was the usual impeccably stupid and unrealistic boondoggle of ineffective measures specifically designed to waste time, make passengers uncomfortable and make would-be terrorists chuckle. Once on the plane, it was a pretty comfortable trip. I managed to finagle a Business Class seat, which for a trip this long is a Godsend. I learned to always sniff around looking for bargains and they are out there. Normally a Business Class seat on an overseas flight is unaffordable by mortals, but if you uncover a few rocks, some hidden bargains lie under them. I found this seat on a Delta Air Internet page in the fine print. Apparently they were looking to shore up their South American interest and ran this as a limited Internet special. Usual fine print making it improbable to actually use, but none applied so I got a bargain. Let me tell you, for a big trip, use of the First Class lounges and the Business Class amenities are a BIG deal. Looking back into the flying sardine can, I shuddered. Each passenger with an oar, chains on their legs and a big sweaty guy up front banging cadence on a drum.

Possibly the most beautiful geography in the world. Green mountains, shining beaches. Too crowded in 1999 and starting to see some of the long term effects of pollution but still breathtaking. Critical care czars Rubens Costa Filho and Joao Luiz Ferreira Costa, my friends and mentors, set up a dandy meeting to talk about the International implications of medical politics. Not surprising, we found that most of the problems are shared by the world, a fact we really didn’t know until we moved in next each other in the shrinking global village. Met lots of folks. Hung out on the beaches in my spare time and took a few pictures.

But the really important portion of the trip was, of course, a trip to……..Porky’s! (Porkao!) Literally translated from the Portuguese, Porkao means a “big” pig, and that’s what you turn into after you enter. Porkao is to gluttony as pina is to colada. As you await your fate, a small marker marks your plate position for the culinary delights lined up waiting for you. One side says “Nao Obrigado” (No, thanks, if one more molecule of food enters my stomach, it will be necessary to call the bomb squad and start evacuating the building” and the other “Sim Por Favor” (“Yes, I think my basketball sized stomach can accommodate some more, but only if you pack it in with a plunger”. You turn the marker to whichever side seems appropriate. The management assumes no liability for internal or external perforated viscous.

Every kind of meat I ever heard of, marinated with cheeses and other things I dare not speculate the nature of. Hannibal Lechter has been spotted there they say with a big grin. Pina Coladas so potent the chunks of pineapple spontaneously caught fire and when drunk, the liquid passed immediately out of your body and ripped through three lower floors before absorbing into the concrete. Crustaceans that were not only alive, but tapped out the Battle Hymn of the Republic against the plates. Is this fish fresh? It’s served with the hook still in it’s mouth. Coffee potent? Bulge your eyes out on stalks.

So, when you go to Rio……….the beach is nice and shopping is interesting, but remember two things. Eat at Porky’s if you dare, then bring only Arturo Fuentes (Dominican) cigars for Rubens. None of those cheap Cuban stinkers. He frisks you for them at the airport and you better have some or you might walk to the hotel.

It was very nice of Joao to offer an airport chauffer service and it was very much appreciated. The traffic in Rio is virtually nonstop and driving there resembles a fast paced video game requiring constant vigilance. It never seems to change. Bumper to bumper and fast, any time of the day or night. Claudia was at the hotel and we had a light lunch together. The hotel in Rio was right on Le Blon beach which was beautiful and the weather was perfect.

Rio has a reputation for being a somewhat violent place, but I must say I have never had any personal experience of that kind in three trips there over the last 15 years. I had several people in hotels and restaurants waggle their finger at me and advise no jewelry of any kind, no watches or especially small digital cameras. Thieves are quick, unpredictable and violent. They grab and run. In fact, I went wherever I wanted and never noticed any suspicious activity, but I didn’t wear my watch. I did flash my small hand size camera but kept it in my pocket when not in use. There was an article in the local paper one morning that two of the “Tourist Police” were busted shaking down tourists for money on a “we caught you with drugs scam”. Forced them back to their hotel to get more money to pay the ad hoc fine and were noticed by the hotel dick. So I do pretty much as I please there but I keep my eye out.

One of the interesting facets of Rio is the H. Stern* gem business. There are a lot of German surnames in Brazil, and my guess is that Herr Stern might have immigrated sometime in 1945 with one suitcase 😉 but he has certainly built an empire. You can’t walk ten feet without seeing an H. Stern sign. Top models in the Victoria’s Secrets tradition. Every hotel has a branch. Here’s how it works, in your room there is a packet form Stern including a free round trip taxi pass to the nearest major store. You get in the cab, get dropped off, take a tour of how gems are found and made and then after the tour (very first class), in order to actually get out of the building, you must pass through a very classy “counseling” area if you choose to maybe purchase a stone. You sit down and tell them what you saw that you liked and they bring out the smorgasbord. The stones I saw were quite nice and very reasonably priced, compared to buying them here. And they worked a deal with US customs that they are all duty free. Very classy arrangement and I bet Stern makes a LOT of dough.

Up the cable car to Sugarloaf, up the mountain to Corcavado (compliments again to Joao), up and down the beaches and then off to Recife. That was another three-hour plane ride, and I discovered that Recife is very close to the equator. It was HOT and humid and I tried to move from air conditioner to air conditioner. Ken Mattox and Tom Bleck were there and Janice Zimmerman and Derek Angus. We all had a great time hanging around the bar in the lobby. Off to the meeting, which was a 30-minute bus, ride. The opening ceremony was elegant and classy, with a nice presentation by native Brazilians in dance and music. At least three thousand people there, maybe more. Following day was my day to talk.

Beach at Recife isn’t anywhere in the league of Rio, but then there is only one Rio. Went to a local tourist area called Olinda with lots of 16th century churches and that was OK, but I have become churched out over years of travel and they all look the same to me. Had a great time with many friends in Recife and then back into the pipeline home uneventfully. Except for a run-in with Airport Security again. This time entering the USA. Got nabbed for a random spot luggage check. Glad it was this time since I had nothing of value to declare. They took a great interest in a decorative decanter of Brazilian booze. It was a porcelain figurine of three stalks of sugar cane, each filled with booze. Had a screw on cap and a liquor stamp sealing it. The idiots, whose job it is to know ALL the potential things tourists bring back couldn’t figure out what it was. Duhhhhh……liquor stamp over a cap. Name of the liquor on the side. Smelled like booze when opened. They thought it might be rocket fuel and it took ten minutes for them to finally get bored with it. Sleep well tonight, your trusty airport security guards are on the job.

The John Dundee Anesthesia Meeting in Belfast. I talked about inter hospital transports of critically ill patients, bedside EEG monitoring, and, of course, International medical politics. Very, VERY nice people.

First thing I do on arrival in a city I have never been to is put on running shoes and hit the bricks for a look-see. Belfast is a very friendly, busy, bustling city that doesn’t remind me of any city in the USA I can think of. People are happy to give directions and smile at strangers wearing Jimi Hendrix t-shirts. The “town” area isn’t really all that big and I traversed it all in an afternoon. Not much “artsy fartsy” shopping though. I got a nice wool sweater and some trinkets for the kids. Guys wear late Beatnik era garb. Women like clunky shoes and dark blue stockings.

Music scene is a little on the “alternative” side for me but listenable. Usual artists from the USA come there. James Taylor in late June. I ripped a few Britney Spears posters off some walls. One band I heard in a small club sounded like early U2. Pub life is remarkably different than “Bar” life in the USA. They are “homes away from homes”.

I (we) got a dinner invite with the Lord High Mayor of Belfast, hand penned in Old English script. Then they broke the vile news. “Black Tie”. The color drained from my face and I started backing away slowly…..”Er, sorry….I don’t do that sort of thing….”. “Nonsense, Luv……you can hire one right across the street”, whereupon I was marched over there by henchmen and the foul deed was consummated with alarming rapidity.

Now, the Lord High Mayor of Belfast doesn’t just cruise into a room with a hearty “how-de-do”. His Nib’s Royal Precursor bangs loudly on the rim of the entry door with a large multicolored jug and solemnly pronounces his arrival. His nibs then enters with much aplomb draped with the accouterments of his office. He looked just a little line Henry VIII minus the toe pillow and after a polite patter of applause, his entourage headed STRAIGHT FOR ME!!, and it wasn’t easy to find me because I was hiding in the corner.

“And this……is Doctor Crippen from the United States…….he’s wearing brown shoes and has no cufflinks….”. “Uhhhhh….”. But in fact His Honor was VERY affable and engaged me in conversation for a fairly long time, during which he offered some observations about Northern Irish politics that seemed honest and straightforward, and he seemed genuinely interested in knowing my impressions of things. It was a pleasure to meet him, even in a tux and brown shoes.

The dinner opened with a very formal string quartet “.( “Hey, you guys know Hotel California?”.) “Say, who’s that young blond woman with Doctor Crippen…..Hmmmm, she looks about 26. Isn’t Doctor Crippen’s wife Blond? Yes, but I think she’s somewhat older than 26”. “Ummmm…..that lady has some kind of bust……….”

And speaking of busts, when Doctor Crippen’s authentic wife sees the film at eleven on CNN, Doctor Crippen will reside in a Motel 6 and drive to work in a 1961 Volkswagen while the formerly authentic wife takes the kids to Rio twice yearly (First Class) for vacation).

On a more cheery note, Belfast and it’s inhabitants were great. I give them four of five Mega-Shipyards.

In 1988 I was in Armenia after the earthquake with a team from The International Resuscitation Research Institute of the University of Pittsburgh led by Dr. Peter Safar. I wrote a paper after this experience which reflected a lot of the lessons learned. I don’t think I ever actually published it.

It was our observation that victims of this disaster fell into four discrete classifications:

1) Those killed outright, or expected to die within a few minutes from irreversible injury processes,

2) Those sustaining serious trauma, trapped in rubble, and who would require difficult, time consuming manipulations to be extracted, followed by advanced life support maintenance until they could be transferred to a tertiary care facility for surgery and intensive care.

3) Those potentially survivable if rendered immediate first aid of a simple nature, such as stopping bleeding, stabilization of fractures, maintenance of airway until further care can be accessed.

4) Those with minimal injuries trapped in “cells” where they would have some protection from further trauma until ultimately rescued at some time in the future.

Victims in class 1 were obviously unsalvageable as pointed out in current ATLS protocols. Victims in class 2 who were severely injured to the point where sophisticated life support was urgently necessary ultimately proved non-salvageable since there was no immediate followup technology available to support their hemodynamics. This would be particularly true for victims requiring CPR. The time spent on this classification of victims in the early stages would not justify taking time away from others who might sustain more benefit and expending fewer resources. Even if ultimately extricated, they would not likely survive transport in a mandatory “scoop and run” milieu, and would tie up critical care systems in secondary and tertiary areas, with only marginal probability of survival.

Victims in class 3 stood to reap the most benefit using the least formal technology. This means that the most benefit for the greatest number might be accomplished using a system of brief but effective first aid, given by uninjured bystanders to stabilize those most likely to survive extraction and subsequent transfer after triage. Victims who could be stabilized by initial LSFA might be accessed by “secondary sweep” teams sometime later and transferred out to secondary centers for titrated care. LSFA is expected to save lives primarily when started within seconds or minutes of impact. Advanced Trauma Life Support is expected to save lives primarily when advanced airway control, IV fluid loading, and oxygen inhalation are begun during extrication. This requires an effective, preexisting organizational structure that can provide immediate alert that a disaster has occurred, and can communicate this information through secure communication links. This must result in rapid deployment of the most appropriately trained personnel with the necessary supplies and equipment to the disaster scene.

Following the initial stabilization efforts by uninjured bystanders, and the secondary “sweep” of the area by the search/rescue teams, attention must then be turned to those in class 4 who are trapped in “cells” of rubble and debris. Such victims are placed in a position of “natural selection”. By the nature of their situation, they would either survive until extrication or they wouldn’t, their fate dependent on engineering rather than medical technology. If they survive the initial hours after the event, they have not only the potential to wait until advanced rubble clearing technology can be transported to the scene, but actually may be protected from further injury during subsequent aftershocks. If their position could be determined, by dogs or advanced search technology, they could survive until rubble could be removed under the guidance of structural engineers. Speed is still of the essence since the rubble could shift at any moment.

“Disaster reanimatology”, in the ideal setting, begins with immediate LSFA by uninjured co-victims, before, during, and after extrication of easily accessible, critically injured victims. For this to be effective would require a significant percentage of the population to learn the six basic steps of LSFA: 1) airway control using the head-tilt and/or jaw-thrust and/or manual clearing of the mouth and throat; 2) exhaled air ventilation (mouth-to-mouth or mouth-to-nose) ; 3) external hemorrhage control by compression; 4) positioning for coma; 5) positioning for shock; and 6) rescue pull without adding injury. Some ATLS measures such as administration of oxygen and intravenous fluids can be begun when the injured victim’s face or an arm is free. ATLS should be augmented by secondary triage and rapid transport with life support of potentially salvageable victims to the most appropriate hospitals for definitive surgical care and PLS. The closest functioning hospitals in an earthquake may be far from the disaster area. A key factor in earthquakes is accessibility of victims, i.e., search and rescue. Engineers should design airliftable extrication devices that do not injure those buried (rescue engineering).

Beginning at the site of the event, victims who are judged to be salvageable should be stabilized rapidly using quick, efficient first aid designed to stop the progression of the effects of traumatic injury long enough to transport the patient to a secondary site. Upon reaching the secondary site, in a safer position, out of the way of rescue technology, victims can be given more substantial stabilization pending their transfer out to more sophisticated centers, where more diverse procedures may be available. As transported patients proceed away from the center of the event, more and more are discharged after appropriate treatment. As the progression continues, only the most seriously injured patients actually reach the tertiary care facilities in major cities. The level of specialization and technological innovation should increase as one travels outward from the center of the disaster scene. Part of the protocol for choosing patients most likely to benefit from transfer to the nearest secondary center would be the likelihood of surviving the transport after basic first aid stabilization. The point is getting as many potential survivors as possible out of the area to another place where they can be triaged and then treated. Stacking victims would not be out of the question. Accordingly, triage should be designed such that simplest modalities should be available at the center of the disaster, and treatment/stabilization should become more diverse as victims are shipped outward from the scene. The hallmark of efficiency and effectiveness in such circumstances is simplicity and mobility.

It seems clear that advanced technology has little place in the initial few hours after a major disaster. While ATLS can be administered by paramedics under physician guidance via radio, resuscitation surgery requires medical-surgical reanimatology teams including an anesthesiologist or nurse anesthetist and a general surgeon with experience in traumatology. Such surgical reanimatology teams would have to be assembled quickly and transported to the disaster zone as rapidly as possible. Local/regional specialists could be mobilized most rapidly, if they are available. They may need to be equipped with mobile operating room gear and supplies, and ideally they should be airlifted by helicopter. Alternatively, they can utilize functional hospital facilities close to the disaster zone. Probably this technology can do little if they arrive later than 6-12 hours after injury. In the past, aid across borders has come late, with no impact on immediate life sustaining. Although well meant, this aid is often in the form of specialized skills, equipment and supplies that are not needed then. There is little reason to have “specialists” directly in the disaster zone. High technology at the scene is difficult to mobilize and apply under confused and difficult circumstances. Specialists should provide services at areas equipped with the necessary technology to maximize their usefulness for patients previously triaged.

Transportation was a critical element for the evacuation of the injured to intact treatment facilities. Approximately 154 km. of roads were disrupted by the quake. Remarkably, they were repaired to operable conditions within 2 days. The key issue is making “transportation” work. Again, a minimum of technology would be available, so the idea of “scoop and run” would certainly apply here. Due to mass confusion and traffic problems ground “transportation medicine” technology would be exceedingly difficult, if not impossible, to mobilize in enough numbers to be meaningful. Victims requiring sophisticated critical care support systems would have to have a survivability index high enough to be supportable by conservative airway protection, IV fluid repletion, direct pressure applied to bleeding sites, and stabilization of fractures until the arrival of mobile critical care support teams, who could extricate, treat, triage and transport.

Martial law should be imposed immediately by an armed, authoritarian faction, presumably the military, which is highly mobile and authoritative. Particularly, traffic control must be immediately established by these same factions to facilitate transfer of patients to secondary centers. This was not done soon enough in Leninikan, and roads quickly clogged with relatives trying to get to the scene, severely obstructing medical transfers.

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The ESICM meeting in Berlin was a treat because it gave me a chance to see Berlin again after an absence of almost 16 years. Last time I was there was 1988 and I got the nickel tour of (then) East Berlin from an East Berliner. An anesthesiologist married to a Russian woman who chose to live in the East, even after both his sons escaped to the West. I met him in Moscow and subsequently lost touch with him (pre- Internet).

In 1988, I crossed over through Checkpoint Charlie. They took my postcards of West Berlin, tore them up and threw them in the trash. It was about as intimidating as crossing into Moscow in those days- viewed from all angles in a blazingly lit cubicle by an armed soldier in a smoked glass booth. You got the feeling there was a trap door and if the soldier didn’t like what was on your passport it opened and you were never seen again.

The Eastern side of Berlin was so radically different than the West that it was startling. It really was grey, drab, and full of old Government buildings and two cycle cars that smoked like chimneys. But the East Berliners were very sociable and we had a nice meal and some Rumanian wine as I recall. It was quite a sight watching the Russian guards pour over cars looking for escapees stuffed into engine compartments under garishly bright yellow light.

Now, it’s all changed. The hotel I stayed at is on the former eastern side near Alexanderplatz. It’s all been built up and refurbished. Sometimes it’s hard to discern what was on the East side and virtually all traces of the Wall have been eradicated, save a few feet here and there with some art saved on it. In 1988 it was VERY omnipresent and stood out like a huge meandering keloid scar. Then came the Pink Floyd concert and it’s all gone, relegated to chunks for tourists to buy for their desks.

Connection in Frankfort where ripping off tourists is an art form (shared by many others I’m sure). A small bottle of orange juice and a donut- US$9.00. I refused to pay it and got a shrug from the vendor. Lufthansa Airlines hasn’t changed either. They lost my luggage just like they did when I was in Brussels when I was a Fellow in 1986. Naturally, the suitcase was on the next plane from Frankfort, which arrived in Berlin at noon. Finally delivered to the hotel at midnight. Teutonic efficiency 😉

The lodging was, however, majestic. It had the most incredible thing I have ever seen ensconced in a hotel. A HUGE fish tank in the lobby, about 50 feet in diameter and extending from the lobby to the 5th floor. Hundreds of colorful fish languidly floated by. For nine bucks you could rise on a platform in the middle of it, seeing fish over 360 degrees. It was really quite spectacular. Prices were about average for Europe I think. Taxis were VERY expensive. Food was excellent and priced about the same as here. The hotel was very westernized but had two double beds pushed together. No matter how you reclined, you eventually sank into the split between the beds. TV was all non-English and the only thing to watch was CNN.

Now comes the hard part. How to criticize the meeting fairly. I always used to get a kick out of car magazines “reviewing” new cars. Funny, they never came out and said a new model was a dog and should be all collected and dumped into the ocean. That’s because they accepted lucrative advertising from all the car makers. So each and every car they reviewed was just a gem. Oh well, CCM-L doesn’t accept advertising dollars from anyone so they get a brutally fair evaluation.

This meeting the ESICM symposium was not up to contemporary standards, in my humble opinion. The mileage of others may vary. The line for registration was endless because they only had two registrants working. In one of the talks I attended, there was a decided lack of focus. The moderator allowed the panel to meander around ad lib, offering up personal observations on things that diverted from the thrust of the subject. Panel members didn’t seem to be “experts”, rather local doctors relating anecdotal experiences from their country or culture. Talks are supposed to be an authoritative examination of a subject that teaches the audience something, asking the audience to get involved before the Q & A time at the end splits up the focus, diffusing the take home message.

In addition, the microphones didn’t work so audience kibitzers had to come to the podium and use the speaker’s microphone. That definitely didn’t work. Panel members all craned their necks to see slides on the screen, creating an atmosphere of discomfort. There was a huge line to get into one room because all those in the room for the previous talk had to file out one by one through one half of a two door exit. Then those entering had to file through the same door. It took 15 minutes.

However, they did do one thing that I think has potential. All attendees had a computerized ID card with a chip in it that they “swiped” at the entrance of each talk. And to get into areas of the meeting. So those looking at that data could tell who was going where and doing what. This data may very well yield some useful information on how to manage logistics in the future.

All considered, I enjoyed Berlin. The ESICM meeting wasn’t the Thrilla in Manilla but I did get some useful things out of it. ESICM meetings have been better in the past. Perhaps they will learn something from this that will improve future events. I give it three of five souvenir chunks of the wall.

Here are some observations about Palermo that may be of use to you (your mileage may vary).

This is a hospital owned by Italians, staffed by Italians and part of the Italian culture. We are guests here. My

There is no problem walking around Palermo. It is safe and secure. You can get a (one day old) USA Today down the street at the newsstand in front of the big cathedral. However, be VERY careful crossing streets, pretty much a death-defying act. Scooters come fast from nowhere. Scoot quickly across the street and don’t ever trust traffic lights. The hotel will draw you maps of nice places to eat that are walking distance. Get to know the American nurses too. They all know where to go. Dining in Palermo is problematic as virtually none of them speak any English and the menus are all in straight up Italian. You won’t have a clue what you’re ordering and will most probably end up with a big cold dead fish with an apple in its mouth if you take potluck. Do not tip anywhere, including cabs. I think it is a very good idea to bring some kind of a hand held computer with Italian phrases and menu items translated to English and vice versa.

There are numerous walking tours around Palermo that are very serviceable for photo taking. If you are a photo nut, make sure you have a camera with no shutter lag. Photos of people and things present instantly and will not wait a few seconds for the shutter to activate after the camera computer thinks about the exposure for a while. The food and Sicilian wine is excellent. They don’t have any liquor stores and liquor is pretty rare. If you like a drink before retiring, BYOB. The dining room at the hotel is on the top floor and has a spectacular view of the city. Very formal and expensive. Finding stores for sundry items such as toothpaste and the like are very rare. Bring EVERYTHING you need.

Driving in Palermo is a bit more problematic than in Pittsburgh, but not impossible. There are rules of the road in Palermo are different Because there is a lot of competition for vanishingly small road spaces. There are rules, and the inhabitants of Palermo know those rules and you don’t. It is a lot like being on a race track. You’re going fast and six inches away from the next racer, but everyone is trained and experienced doing that so it works. The rub comes when you put someone not trained and experienced on the same roadway. So, when you drive, simply follow the flow and pick your battles wisely. If you and someone else are competing for the same space, don’t back off too quickly. They can smell fear, and if they do, they’ll take advantage of it. Be carefully aggressive. Many times if it’s a draw, the other car will flash their lights at you and that’s your cue to go for it. Don’t hesitate or someone else will get it. Watch out for scooters who will do almost anything to gain an advantage. They are aggressive but very savvy and will not take impossible chances. They will look out for you.

The rental car guy will pick you up in front of the hotel at the appointed time and drive you to the rental car place where you will do paperwork. Then they will point you in the right direction and hive you maps showing you the route. First you will get on the major highway leading to Catania. Never mind the route number, just always look for signs leading to Catania and you will be on the right route. See the map. STAY OUT OF THE LEFT LANE. There are several species of left lane inhabitants. BMWs, Audis and Mercedes will be traveling about 120 mph. Ferraris and Porsches will be doing about 140. Superbikers might hit 160 and they go by so fast they’re blurred. You’ll hear them before you see them. High-end automobile drivers are merely arrogant. Superbike riders are wild eyed crazy and afraid of nothing. None have any sense of humor about you being in their way. Don’t force duals for right of way with vehicles going twice as fast as you.

As you proceed west, you will actually go around Catania and head North to Taormina, which you will see from the highway and get off at the exit. Taormina is built entirely on the side of a mountain and is spectacularly beautiful. Expect to have a major hassle finding your hotel and very narrow congested streets. You will probably get real time directions by phone from the hotel desk. Once you arrive, there is no place to park and they hotel will take care of your car. Then walk around to your heart’s content, take lots of pictures and buy knick-knacks. Dinner in open-air cafes that have a phenomenal view. Sleep off your full bottle of wine and then hit the bricks in the morning to see Mt. Etna. The map will lead the way. You can get as high as the major lava beds and a good view of the smoking crater, but if you want to go to the summit, it is a formal all day tour. Then follow the signs back to Catania and head North to Messina, where you will see the Italian Mainland and then head west along the Northern coast back toward Palermo. About halfway you are forced to get off the Interstate and on to a two lane running along the coast which is quite beautiful and you will arrive in Cefalu, which is beautiful and you should stop and hoof around a bit. Lots of touring motorcycles on this route.

Then you will get back on the Interstate and arrive in Palermo again where danger lurks. The map will show you the street to exit the Interstate that allegedly goes straight to the hotel. Seems simple enough. And you will see the sign for that street from the Interstate. But when you exit, there are five ways to go and no street signs so the real chances of getting the right street are about 20%. If you turn onto the WRONG street, you will be instantly lost in Palermo, and let me tell you, lost in Palermo is seriously lost. No one speaks English, there are no English signs and street names are hard to discern if they exist at all. I spent about an hour touring Palermo in traffic before I finally found something that looked familiar and discovered the hotel by dumb luck. Then I found out that there is a 24 hour phone number for the hospital interpreters that you can call anytime and get advice for anything in English. This will save you. I highly recommend this trip. The following Saturday, a trip to Corleone for obvious reasons is in order, about an hour from Palermo. Get your photo taken at the Corleone city limits sign. Agrigento is said also to be very beautiful if you have time.

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Sicily is rugged, lush and beautiful. Mountains shrouded in clouds. The Airport is sparse by contemporary European standards, but clean and functional. Hot and humid, even in May. Palermo is very third world in that there are no big office buildings. Streets are narrow and crowded. Lots of old churches and historical artifacts abound. But I wouldn’t call it poor. Seems to be a lot of industry and industrious people on their way somewhere. Reminds me a little of parts of Belfast I think. Also parts of Prague.

The people are very nondescript and adhere to no stereotype. Most males don’t look like Al Pacino. I’m told that born and bred Sicilians are darker complected and darker skinned than garden variety Italians, but I don’t see a definite trend. Females are however very female. Italian women have learned the gentle art of making the best use of whatever female accouterments they happen to be endowed with, and that’s the truth. I have figured out that it’s very useful to know just a few routine phrases in Italian. I’m working on: “You’re soooo pretty and I’m soooo far from home…..”

To my ear, Sicilians speak standard Italian. Pretty much like Tommy Chong does it on “The Pope: Live at the Vatican” track from the Cheech & Chong album. It is also true that Sicilians talk with their hands, especially in minor traffic disagreements. These scenarios really have to be seen to be fully appreciated. Rapid-fire double-jointed hand gestures integrated with facial expressions ranging from shock and disbelief to homicidal rage to suicidal depression. Tonal voices ranging from Harvey Fierstein to Mariah Cary and beyond. And they have a lot to be upset about. If there is any semblance of traffic regulation, I don’t see any evidence of it. Sicilians drive with their horns. The louder the horn, the more respect it gets. The longer the horn is on, the less likely the driver will back off for anything. Getting from point A to point B is simply a matter of bullying, honking, brief stops to insure opponents are fully appraised of the driver’s ire, mid road u-turns to arrive at a destination and opening the back door to pour the terrified passenger out onto the sidewalk.

Europe, especially Italy, has a great love for motorcycle racing, a sport only seen in Speed Channel reruns in the USA. It’s highly publicized here. The current world superbike circuit champion is an Italian, Valentino Rossi, and he is a national hero here. Rated a half page photo in the newspaper when he won his last race and I walked into the hotel room, flicked on the tube to find him midway into winning the French Grand Prix. He’s unbelievable. Poetry in motion (210 mph). Speaking of speed, they have what appear to be something like “roundabouts” in the UK, circular paths where vehicles enter at one of several entrances and exit at one or more others. What happens in between bears no resemblance to Newtonian physics. Instant death to those unacclimatized. Stay away from them. Foreigners have entered weeks ago and have never been seen again.

The hospital is absolutely beautiful and state of the art. They only do transplants (heart, liver and lung) and also some high-risk cardiac and abdominal procedures. Critical Care (anesthesia based) Fellows come from training programs mainly in Italy. Patients come mainly from Italy I’m told, but I note some Arabs and denizens of the Pacific Rim hanging around. I am also told that all this expensive stuff is provided gratis to Italian citizens supported by the National Health Service. At least one Italian-American told me there is a cash on the barrelhead deal available for foreigners, but I am told that isn’t so here.

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Watching girls (known as young women in the USA) seems to be the National sport in Italy. The entire population actively participates in it. Females go very far out of their way to dress in manners that show off whatever attribute looks best. Males gawk with wide eyes and open mouths. They usually also offer up some comments as to the quality and quantity of the attributes in view; comments that would get American males jailed immediately. These remarks are met with tosses of the head and uplifted noses. These females are about as unaware of what’s hanging out as Jackie Bisset was as she cavorted in the cold briney for “The Deep” in a one millimeter thick white t-shirt. It’s quite a bit of fun to watch.

Otherwise, I strongly recommend being VERY careful being a pedestrian in Palermo. Instant death awaits unpredictably. There is no safe passage, even the sidewalks. Traffic pays absolutely no attention at all to any rules of the road. There is no guarantee that a green walking signal will not be breached. The best course is to actually run, not walk across any road as quickly as possible, even in a walking light. Motorscooters come out of nowhere and they ignore everything in their paths.

Motorized two wheeled vehicles are a big part of the traffic in Palermo because petrol costs around US$6.50 per gallon. You don’t see any Hummers or SUVs in Palermo. Most of the cars are tiny and get good mileage. But there are a lot of motorscooters and motorcycles and every one of them is what the British calls “filtering” through traffic. Up over sidewalks, in between lanes and cars, through alleys and at high rates of speed. The mix consists of everything from tiny mo-peds that whine like sewing machines to the Kings of the Road.

Not too often, but notably you’ll hear the searing howl of a Japanese four cylinder superbike engine. Nothing sounds like that but a four cylinder superbike engine. A leather clad, Shoei helmeted sportsman laying on the tank, weaving in and out of lanes at 6000 RPM in third gear, a sneer on his lips, ain’t afraid to die, they get instant respect. Everyone gets out of their way instinctively as the aura of death-dicing hangs heavy in the air. And as Richard Pryor once remarked: “Death ain’t fussy…more than happy to jump down YOUR throat if you get too close”.

Live fast, die young and leave a lot of surgical residents to experience placing lines.

Flying into Marrakech was greeted with just a little free floating apprehension. I don’t know why. It was instantly apparent that it was very….for want of a better word….”foreign”. It was VERY different, and I was on edge. First time ever I got all my luggage x-rayed and physically searched coming into the country. I have no idea why. They weren’t looking for alcoholic beverages, as this area seems remarkably different than the area I was warned about by Mike Darwin. Every hotel had a bar, but alcoholic beverages were quite expensive. Probably supply and demand.

There is al least one five star hotel in Marrakech and they are trying to improve the tourist trade, but it’s a pretty tough sell. rather hostile environment for people that like limos and playing golf. They dammed up the only water supply to provide extra water for the tourist trade and this had the detrimental side effect of decreasing the water table downstream in the desert and so now the nomads are dying out quickly. Seemingly small ecological changes generate huge unplanned consequences.

Trip into town assured me that this city was VERY different than most of the other areas in the world I never paid much attention to. There was no readily apparent variation on any European theme, even though there is a strong French heritage. The hotel was located on a narrow, winding street barely wide enough for a small motorscooter. It was, small, dark and full of intrigue. Mercifully air conditioned although their systems are not terribly efficient. It was unusual but clean and tidy. I hid out the rest of the evening.

Morning spawned a nice breakfast on the roof, with fresh squeezed orange juice and a loud call to prayer over a loudspeaker from a nearby mosque. I was picked up by the driver for the trip over the Atlas mountains to Zagora, the jumping off place for the Sahara, and incidentally, the last outpost of the original French Foreign Legion. But my love life was OK and I had no interest in joining, so I passed on the opportunity. The mountains were very impressive, high passes with no protection on the side of the road for the several thousand foot drop on either side. Myriads of open air vendors with huge stacks of fossils and geodes. Hundreds of trilobites, fossil shells some four feet in diameter, all found in the area. First time I ever saw red crystal geodes. On closer exam though, it was apparent that the vendor had poured food color into them to get the color. It was a long trip full of switchbacks. About eight hours to Zagora.

The weather changed rather dramatically from Marrakech to Zagora. The temperature in the dead of August in Zagora is said to be recorded at 142 F in the sun. Usually around 110 F in the desert. ever a cloud. A monument in the center of town states that the original caravan route from Zagora to Timbuctu (Mali) is 52 days by camel. You can see from the photo that the desert runs right up to the city limits. But the real Sahara starts just after a small mountainous ridge just outside Zagora. It takes about four hours to get over it by Jeep, and then I met my camels.

Camels are truly curious beasts. Said to be capable of about 50 km on a drink of water. Also said to be mean and nasty. Mine weren’t. They seemed resigned to their duty as ships of the desert and never gave anyone a hard time. Getting on and off one is like a roller coaster ride. If not careful to roll with the punches, they’ll toss you right off. When actually walking in the desert (clopping) there is a rhythm that must be accommodated to, and once settling in, I think it is more comfortable than horseback. The full Lawrence of Arabia outfit including headset is mandatory to preserve every molecule of water possible.

The desert does not exude a pall of death, rather an absence of life. There is a difference. Life is plausible in the desert if the requisite conditions are met. But the desert doesn’t care one way or the other. The desert does not give any assistance or advice. Life or death only occurs according to the whims of those willing to wager on seemingly small omissions in logic quickly thaqt generate huge consequences. The desert is just there. It cares little or naught as to the welfare of passers-by. You decide what you will make of it, and the range is possibilities is extensive. I was impressed by the desert in every respect and I maintain a healthy respect for it.

At about noon, everything stops and the camels are hobbled to prevent them running off. They wander off to find any shade possible and the humans do the same. No one, man nor beast ventures out into the sun from noon to about four pm. It’s rough out there. No clouds (no moisture). Just shimmering off the sand. The Sirocco comes up abut three and can be fairly heavy wind. The amount of blowing sand is not usually considerable, but it can be. Sandstorms are fearsome and I’m glad we were not involved in. The Sirocco usually blows out about seven and we stop about eight to make dinner off a small propane stove and ready for bed.
Sleeping under the stars is over rated, even though the temperature becomes much more comfortable at night. A very slight wind cranks up about midnight, just enough to get sand in every orifice. Since there is no light pollution, the stars are bright enough to read newsprint by. First time I have seen the Milky Way in years. the photos tell the rest of the story. Most definitely an experience to remember. Happy to see Zagora again after three days, and another six hours back to Marrakech by jeep.

Next day, off to the “souk” (big shopping den) in Marrakech. Again , the photos tell the story without much narrative. Never saw any Americans but there were lots of French tourists and some Spaniards. Marrakech is a natural for the French since it’s fairly close and with it’s French heritage, everyone on Morocco speaks the language fluently. Very little if any English spoken, so eating at restaurants is a hit or miss proposition. Pick something at random and hope it’s amenable to American taste buds. Lots of things to photograph, again very non-European. King cobras just hanging out on the edge of blankets minding their own business. People walking by ignoring them. Countless rugs. I purchased one for my office that I think is stunning. Weave so tight you cannot get a needle through it. Brilliant colors. They say the women that weave them can only do four rugs in a lifetime and their eyesight goes by age 40. Again, the photos tell the tale better than I can in verbiage.

Several reflections. This was a VERY stressful two week trip for a guy my age to do by myself. In retrospect, I should have broken it up into two trips. It was stressful physically and emotionally, and much of the stress came from flying, airports, hotels and endless waiting for everything. I got some recent photos from my medical school graduating class of 1976 and I was flabbergasted. those guys are OLD and hey look OLD too. Snow white hair and they look old and retired. Many are. And they’re dying like flies too. I refuse to believe I am like that, but I definitely cannot do the same things I could do at age 30 in the same time frame and I must accept that. Damned lucky to be doing any of them at all.

I did not bring a laptop, and in retrospect this was a good decision. I didn’t really need one. Anymore, there is an Internet Cafe on every corner of every city in the world. And my cell phone worked everywhere. What I did bring was my iPod and that was just perfect. I had the entire first season of “24” on it, and I treated myself to two episodes a night before sleep. There was no TV of any kind in Morocco and the Spanish TV had nothing in English. Evenings would have been pretty boring without Jack Bauer and the Counter Terrorist Unit. Ambien was my friend for sleep. I also found out that the new Ambien CR (controlled release) did not work at all. Straight up Ambien 10 mg worked reliably every night and there was no after-effects. Travelers Diarrhea was also my companion, and in retrospect I should have taken some Cipro along to start early. Resolved without any problem.

I knew Dr. Negovsky fairly well in the late 80s. He was getting pretty long in the tooth then, definitely dead today.

He was not only a really serious researcher (Father of “Reanimatology” in the former Soviet Union), but politically savvy as well, having won the “State Prize” several times and survived Stalin’s purges in the 50s. I was in Russia with Dr. Safar enough in those days to make it worth my trouble to learn some rudimentary Russian, and I could get along fairly well in restaurants, hotels in airports. Negovsky could speak English about as well as I could speak Russian but we managed to communicate. The only time he ever talked to me about politics was in the relative safety of his tiny apartment, after some vodka. He predicted the end of the Soviets quite a long time before it actually happened, but always managed to keep his head down.

I always gave him a bottle of Remy Martin cognac on departure (purchased at the local hard currency kiosk). I have some pictures around of me and him, but I think they are still in color slides. I have also several books autographed by him, one of whom I may give Mike Darwin if he wants one for his collection.

Educationally speaking, one of the more interesting things I managed to do was get inside and walk around Moscow University unfettered. There were guards everywhere in the Soviet days and they considered it a place where foreign tourists were excluded unless they were on a formal tour by Intourist, where you saw only what they wanted you to see. The building in one of the seven that were designed by Stalin in the 50s, so I’m told. Very much Stalin-esque in their personality. The building in the inclosed photo is not the University. it’s the Hotel Ukraine where I usually stayed, same design. The statue is real, and out in front of the University. University education was free in the former Soviet Union and open to any country that was politically aligned with Russian politics. There were a lot of Cubans and some Africans there as well as home grown students.

My friend Dr. Alex Tsipis of the Botkin Hospital in Moscow got me in and we wandered around for a while inside. It looked very much like schoolrooms of the 30s and 40s in the USA. All wood, desks were wood top, that lifted to reveal a big space for books and belongings. Graffiti on the wood tops, an ink well to hold bottles of ink in the right hand corner. It was run down and smelled old and musty. No they didn’t have any “Go MOSCOW U” sports t-shirts. I ran into Tsipis again in Tblisi, Georgia in the early 90s schlepping a patient back to Botkin for HBO therapy. I wonder if he ever got out of the Soviet Union. He always hid his car’s windshield wipers so they wouldn’t get stolen.

The titular head of the Reanimatology Department in the late 80s, early 90s was Dr. Semenov, shown in the photo. I doubt he’s still there and have not heard from him in years. Dr. Semenov was a very nice guy and always had a lot of questions about life in the USA. I wonder if he ever had a chance to visit. He had a limo service that took him back and forth from work. His wife wore a full length fur coat of some variety and was a pretty strong vodka drinker.

The Russians were all pretty committed vodka drinkers, but they got rationed in the amounts they could have. All the good stuff was exported. So they had a little theft thing going with local drug stores (Chemists). They’d cruise in, point a pistol up the nose of the pharmacist and demand all their clonidine. Not as odd as it seems. Clonidine extends the effects of ethanol metabolism, so a fifth of rotgut vodka lasted three times as long. Happy days!

No more or less formal dinner in Moscow was complete without a number of toasts at the end, usually using Armenian cognac, which was pretty god but fairly potent. Russians drank the hard stuff all the time and were tolerant to it. They could, and frequently did drink large amounts. Americans, especially me, would keel over quickly after about twenty plus toasts for everything from world peace to the wonders of Beluga. So I kept a bottle of Pepsi between my knees, dumping the booze on the floor and refilling my cup with cola. Otherwise, they’d carry me out feet first. Of course, really high grade caviar was a staple at these things, and they served it up in foot high piles. This is where I developed a very expensive taste for Beluga. An unleaven cracker piled high with authentic Russian Blue Label Beluga and some egg yolk is so sinfully good I’d risk the integrity of my immortal soul for it.

It was like cheap heroin in Vietnam. When they came back to the USA they found out what the real cost was. Same with Beluga. After the Soviets collapsed, there was no one to enforce poaching laws along the Ukrainian Caspian shore. So the local citizenry dynamited the sturgeon wholesale, pulled them up on shore, ripped out the caviar in buckets and sold it on the Finland border for hard currency. They basically wiped out the supply in a few months before the authorities started shooting poachers in the head and leaving them on the shore for the pelicans again. Now the price of Beluga is somewhere near $200.00 an ounce, if you can find it.

One night Dr. Semenov’s wife threw all caution to the wind and imbibed some really serious amounts of vodka and cognac over a fairly short period of time. She then passed out Clockwork Orange style right into the pasta, face first. They carried her out feet first and the party continued unabated. “Zu droozhbu (to friendship!”. Zu Mir (to peace). And so forth.

Darwin is going to Moscow soon to commune with his cryonics friends and I will demand a concerted review of the trip for CCM-L with photos.
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