HAPPY HOLIDAYS!

This is our little one's performance from her school's holiday show. Enjoy!

THE SOCIAL NETWORK

Kathleen and I saw "The Social Network," the new movie about the origins of Facebook last night. While I have not seen many of the presumptive Oscar nominees, I can safely say that there will not be a more compelling and contemporary film shown this year.

The movie is fictionalized, but it is based largely on facts/interviews with the major players. We will never know for certain what motivated Mark Zuckerberg, Facebook's founder, on so many occasions in the film, which is part of the film's charm. Some see Zuckerberg as a social misfit merely seeking to best all those who have wronged him or made him to feel unwelcome, but this is a superficial analysis.

While Zuckerberg clearly appears to have some difficulty relating to people, it is clear that he understands the power of relationships and how to capitalize on our desire to "relate" to people. If he did not, there would not be half a billion Facebook users.

The film made me as a former Facebook user (I quit after one year), think about what that site means. For me, it is an invention of the electronic age that makes it acceptable to be boastful, malicious, audacious, and downright juvenile. While people have always demonstrated these traits, Facebook gives the ordinary person a voice onstage with a megaphone. Fundamentally, most humans crave this. They need to be heard, and they are heard loud and clear day in and day out on Facebook. In that way, they want exactly what Zuckerberg may have wanted when he made the site.

This brings me to my final point. If everyone is yelling what they want whenever they want, when does all of this cease to be music and become noise? I found that I liked the people with whom I was "friends" less and less with every status update, every comment, and every tagged photo. It was not so much over-exposure to these individuals as underexposure to anything resembling a real and deep connection that made me leave. In he end, I wanted my real friends back (most of whom were not members) rather than my "friends."

In many ways, I think Facebook makes its users forget what real friendship is and that "seeing" your friends everyday does not compare with being with your friends... even if your contacts are only through email, phone calls, or face-to-face connections once every decade. I, for one, will take friendships over social networks any day.

Consider this shared.

BLESSED

I have been attending on the inpatient service this weekend, which always makes me a little introspective. This weekend was particularly busy, and my fellow, who is quite good and who never complains, seemed a little put out. I reminded her that any of the 11 patients with incurable cancer on our service would trade their ills for hers in a heartbeat. This seemed to resonate with both of us.

Here are some of the many reasons why I feel blessed.

A BEACH IN SAN FRANCISCO WITH MY FAVORITE PEOPLE















THE BUDDY SYSTEM AT ARBOR (Nicholas and Alex, his Senior buddy whom he reveres, are pictured)



MR. CLAUS



THE KIDDOS AND THEIR SOCCER-LOVING DAD







Enough said.

VIVA BARCA!

This week, the two greatest football clubs in recent years faced off. It was a match between the much beloved Football Club Barcelona and their arch rivals, Real Madrid. Barca, as Barcelona is known, has the motto mes que un club, or more than a club. Indeed, they pay Unicef for the rights to place the Unicef name and logo on their jerseys, one of the most lucrative pieces of advertising space in the world. The Real jerseys on the other hand are emblazoned with the logo of an online betting site called bwin.com. Hopefully, you are appreciating the difference between these two clubs.



Leading up to the game, there was a lot of trash talk, particularly from the Madrid side. However, once the teams took the field, action spoke louder than words.

To say that the outcome was surprising would be an understatement as both teams came in with winning streaks and had dominated their recent opponents. However, this was a one-sided affair, and the Blaugrana (Catalan for blue and deep red, which are Barca's colors) were the dominant team. No one could have predicted a 5-0 victory, but that is exactly what we saw. All five goals are shown here.

The contrast in scoring was only overshadowed by the contrast in playing style. Madrid seemed listless and confused while Barcelona put on a show- yes, a show. Seeing them pass the ball, occupy space, and work as one unit was a wonder to watch.



While my favorite player Lionel Messi (shown above) did not score a goal, he set up three of his teammates and drew attention and fire from Real. He was the hero to the anti-hero of Real, Christiano Ronaldo, a Portuguese bad boy who at one point in the match shoved the Barcelona coach. Ronaldo, however, was held scoreless, and the best man did win out in this showdown.

I was reminded during this match, that soccer can be quite beautiful. Watching those eleven men work masterfully as a team was like watching an orchestra in action. These days, no one plays better than Barca, and I look forward to many more years of watching this team's sweet music.

THE KING'S GARDEN

Last week, Nicholas' class invited the parents to the "opening" of a restaurant. Some kids had suggested the name Burger King, but given that the menu was comprised largely of food from the earth, the name King's Garden won out.

After doing a mini scavenger hunt in his classroom with us, Nicholas and his classmates lined up and headed over to the Arena, the site of the King's Garden. Later, Kathleen and I walked in with another couple, and the dad and I spoke for several minutes. Nicholas waited patiently by the wall with the other "servers." I caught sight of an eager look in his eye, so I headed over. I found him wearing an apron he had sewn by hand that had a name tag he had made with his name spelled on it (correctly). He approached us and said, "May I show you to your seats?" Then, he walked us over to a table and sat us down.



He first told us about the menu and then used his pencil and order pad (shown above) to write down our requests. Within a few minutes, he returned with 2, make that 3, carrot muffins with white chocolate chips, 2 granolas, and 2 fruit salads. He lingered to eat with us, but he also freely moved about the Arena where the breakfast was held.

This contrasts with just one month ago. At that time, Nicholas routinely squeezed my hand more tightly whenever we saw a teacher or student he did not know at school while we walked the grounds on the days I dropped him off. Many days, there was a palpable sense of anxiousness in him. However, the King's Garden was quite different. I saw our little boy so at ease... so in his element.

At the end of the "opening," all the kids came together and sang a song. It was amazing to see these 5-7 year olds (both of the "primary" classes are mixed age classes made up of kindergartners and first-graders) singing and smiling in unison. Nicholas' solo rendition is reproduced below.



The last line of the song stills gives me goosebumps whenever I hear it because I know how true it is for our little guy.

Something great is definitely inside of him and Arbor!

ASK (ENOUGH) AND (SOMETIMES) YE SHALL RECEIVE

This weekend we went to Tacoma for the day to visit Kathleen's sister and to check out the Point Defiance Zoo once again. On our last visit, I caught a brief glimpse of one of the zoo's prized animals- an aardvark. Mr. Nicholas, however, was not so lucky. Therefore, one of our goals for this trip was to see the aardvark.



When we got to the zoo, we attempted to find the aardvark and approached two young zookeepers. They said that the aardvark had just starred in a show that we missed and that he would not be out again that day. This was despite the fact that I explained that a certain five year-old was dying to see him.

However, I was not deterred, and I was not going to be denied. Therefore, several minutes later I approached another zookeeper and explained our situation. He was more sympathetic and immediately used his walkie talkie to call the keeper in charge of the aardvark. A few minutes later he came and told us where to go to see the aardvark and mentioned that we owed him big! I thanked him and headed off with Nicholas.

We were met by one of the original young zookeepers who was taking "Tilly" (as in rototiller) out for his walk. It was an amazing sight to see, particularly given the fact that only eighteen U.S. zoos have aardvarks. Nicholas was excited, but I must confess I was even happier to see this animal.

After we parted ways with Tilly I told Nicholas that one does not always get what one wants. However, I also made it clear that one certainly would not get what one wanted if one did not ask for it! Here's to Tilly... and to perseverance!

HEREAFTER

Tonight, Kathleen and I saw "Hereafter," the new film by Clint Eastwood. There are too many levels on which this film grabbed me to enumerate, but at its core this film is about making and maintaining connections. As I write this, I am listening to the soundtrack composed by Clint Eastwood, which I purchased as soon as I got home. That is the true measure of a film- that one longs to experience its message again and again and that this is achievable by listening to its score.

While "Hereafter" does focus, naturally, on the hereafter, the film also resolutely reminds us of the power of connections in the here and now. There are 3 principal characters. Matt Damon plays a young man in San Francisco named George who had a near-death experience that left him with psychic powers. While his entrepreneurial brother views this as a gift, George views this as a curse that drives people who come close to him away. Another main character is Marie, a young French television journalist from Paris, who has a near-death experience during a tsunami in Southeast Asia. Her life and her perspective are turned upside down by the glimpse of the hereafter that she had during this event. Finally, a young English boy named Marcus loses someone he loves dearly, and Marcus longs for a chance to speak with this lost soul again.

The film was powerful to me simply because of the depth of humanity that these three characters exuded. I was reminded of past relationships and friendships and just how much it is possible for one to feel and yearn for others. I was reminded that despite how impersonal and mind-numbing life can seem, it is also beautiful...if only we will take the time to look around.

I was reminded of this last week while on a run through the neighborhood. I am someone who looks straight ahead or at my GPS watch for my splits when I run, and I have been known to miss many a beautiful sight. However, during this recent run, I gazed skyward, and my glance was met with the most beautiful clouds I have ever seen. No, they were not lined with silver. Rather, they seemed to be framed in gold due to the way the sun struck them. A picture from the backyard post-run is shown below.



As I watched "Hereafter" and these characters, especially young Marcus, I felt a yearning to see and be with my own children and my own parents. Shown below are Cate and Nicholas in the Halloween costumes they wore to a party we attended before we went to see this movie. Cate went as a koala bear, and Nicholas went as "my daddy."





This movie also made me long for my friends. I am a lucky man to have too many friends to list, but you know who you are.

I know that one day I will have to say goodbye to you all. While, I am still not sure whether I believe in a hereafter where we will all be re-united, I do know that it is within my power to tell you now how much you mean to me. So if you are reading this, please know one thing- at the darkest times, at the lowest points (and there were many), you all reminded me why life was still worth living. That is a truth that I may take with me to the hereafter but it is also a truth that does remind me, on a daily basis, to live in the present.

Life is a gift, but we are given it... until further notice.

THE AMERICAN

Amid all the polarization in this country and fear of the other, there is also reason to believe that we may move past the vitriol one day and perhaps become a nation that looks and feels like a Benneton ad. I was reminded of this after a conversation with Mr. Nicholas.

Earlier this week, he had a play date with a classmate whose family is of Danish descent. The little boy's nanny picked up Nicholas and the little boy from school and took them to the little boy's home. After Nicholas got home, I was curious about whether the nanny was an au pair from Denmark, so I asked Nicholas if the nanny was American. He gave me a confused look and asked, "What is an American?"

This question made me think about myself. I am of Indian decent and was born in Canada. I immigrated to this country at the age of 11 and became an American citizen at the age of 30. However, for as long as I have been here, I have thought of myself as American. Whatever that means.

I am glad to see that to Nicholas the concept of being something- Indian, mixed race, or American- is quite foreign. Here's to Generation N(icholas)!

CHOICES

I come from the school of thought that goes something like this: My way or the highway. That is how much of my medical training was set up, and I have to say that it was a pretty damn good way to train because their way was almost always the right way.

This brings me to parenthood, in which the trainees (aka my kids) are not quite so willing to follow one's lead. To say that Cate has her own ideas about what she wants to do and when she wants to listen is, well, an understatement. Thus, even I have resorted to giving Cate options on almost every matter. I am told that this gives children (and people in general) a positive feeling about picking one of the two options you have given them.

Sometimes, however, mistakes still get made. When I try to counsel Cate, I ask her, "Was that a good choice or a bad choice?" Normally when she has made a poor decision, Cate says, "Bad choice." However, sometimes when she has made a particularly fun choice that may not have been the best choice, she responds to the same question with the answer, "Happy choice!"



In these situations, when I look at that beautiful smile on her face, her point of view comes across loud and clear.

WAITING FOR SUPERMAN

Kathleen and I recently saw the documentary "Waiting for Superman." While the critics have been divided on the merits of this film, we found it to be incredibly riveting. This film shines a light on the American public educational crisis, and it highlights the failures of many schools to adequately teach and inspire children and their parents alike. However, the film does offer solutions and places most of the emphasis on those who champion high standards and teacher accountability.

While there are a few highlight reels with the original Superman from the old TV series, the real heroes in this film are the educational reformers. They include Mr. Geoffrey Canada. Indeed, the title of the documentary is taken from Mr. Canada's own experience as a child growing up in New York City waiting for Superman to come to solve his neighborhood's problems. However, at an early age, his mom informs him that Superman is not coming and that the problems of his neighborhood have no easy solution.

Because of his own life experiences and his work as a teacher who battled the establishment, Mr. Canada was inspired to found the Harlem Children's Zone, a 97-block area in New York City in one of the poorest and toughest neighborhoods in the nation. In this zone Mr. Canada has built charter schools, public schools that receive taxpayer funds but that are not bound by teachers' union rules and other potential obstacles to achieving educational excellence. Despite the location and due to his "crib to college" approach, many of Mr. Canada's students defy the odds and go on to college.

Another person featured in the film is the former Washington, D.C. Public School Superintendent Michelle Rhee. Ms. Rhee was brought into office with a reformer's spirit, and she had one simple goal: to make D.C. public schools better. She did not let anything stand in her way, including the D.C. schools' bureaucracy and the teachers' unions. One of the saddest parts of the film is when Ms. Rhee offers the teachers and their unions a chance to have merit-based bonuses and the opportunity to earn over $100,000 per year. This would be in exchange for giving up tenure, or the right to have a job no matter how well one teaches. The unions, sadly, do not even let this come up for a vote. The mayor of D.C., Adrian Fenty, who was a big supporter of Ms. Rhee, just lost his re-election bid last month. Shortly thereafter, Ms. Rhee was forced out, too. Another "win" for those adults who think that bad is good enough for our kids.

However, the real stars of this film and, sadly, the real losers in this film are many of the children who are featured. The director follows 5 of them who live in places ranging from Los Angeles, New York City, Washington D.C., and the San Francisco suburbs. In all cases, their local public schools are failing. One option for all of them is, you guessed it, high-performing charter schools in the area, including Mr. Canada's Promise Academy in New York City. Every single family is eager to go to one of these schools not only because their neighborhood school options are poor and because these charters are free but also because their is hope in these schools: hope for college and hope for a better future than what these kids' parents have. Alas, these kids are not the only ones with such dreams. Hence, in every school, acceptance is left to a lottery.

I will not spoil the ending for you, but it is clear that in the greatest nation on Earth, some 56 years after the Brown vs. Board of Education decision, we still have a public educational system of separate but unequal. There are many reasons for this, but chief among them are the lack of a true interest by adults to guarantee that every child in America has the best teacher and the best environment in which to learn. This is the feeling that I was left with last year when I visited public (and several private) schools in Portland, including our own neighborhood public school in an affluent part of town.

At the end of "Waiting for Superman," I could not help reflect on how lucky we are to have the means to send Nicholas to the Arbor School. Superman has not visited there. Rather, Arbor is great simply because everyone there believes that a child's education comes before anything else (period).

Before Arbor, I used to think that you could love your school, but now I know that a school can also love you back! Knowing that many kids and their families, who are just as deserving as us, are still waiting for that brought a tear to my eyes as we left the theatre that night...

HI, I'M CATE!

It is hard to believe that it has been 2 years since our little Cate was born. She came to us one week late and without drama (thank God) on October 14, 2008. A lot has happened in her lifetime. We saw the United States elect its first biracial President. We saw the world financial markets (along with her and her brother's 529 plans) tank. We saw partisanship like our country has never seen and the emergence of the more racist, radical wing of the Republican party.

However, we have also seen a lot of joyous things. After about 6 months of "colic," Cate began to sleep better. At 9 months, she began to walk. At about 18 months, she began to communicate effectively with words, and there has been no stopping her since. She is someone who clearly had a lot on her mind that she could not convey to us early on, and it has been a pleasure watching her express herself.

She is running circles around the other kids at school, and Cate is probably the most empathetic (she holds the hands of the smaller kids at her school and offers them her muslin blanket aka "muz" when they are sad), intelligent (she already knows how to count and knows her ABCc), and coordinated (she can kick a soccer ball amazingly well with both feet) child I have ever met. And, as you can see from the pictures below, she is a cutie and has an amazing sense of style!





Lately, she has been offering her hand to people, and, when they take it, she says, "I'm Cate!" An example is shown below. So sweet!



As I have watched her grow, I have felt a stronger attachment to Cate. I want to keep her safe, but I also want her to dream big and to reach for the stars. I always said that if I have a girl, I hope she is someone like Mia Hamm- gifted, down-to-earth, and kind- unlike many women with whom I interacted while growing up.

While I do not know whom Cate will be when she grows up, I know she is already a wonderful child. I look forward to watching her become the amazing adult I know she will become.

Here's to Cate!

THE STATE WE'RE IN

Today at school, Nicholas was assigned the task of selecting a book to share with his class that our whole family loves to read. While Kathleen, Nicholas, and I love the book "The Scrambled States of America," we were not sure whether Cate loved this book. Therefore, we decided to read it tonight. The book is about the fifty states deciding to switch places so that they may see a different part of the country. Two of the states, Nevada and Mississippi, meet and fall in love. I will not spoil the ending.

Wait, you people are not going to read "The Scrambled States of America."

At the end, the states say goodbye to each other and go back to their spots. Some states are more upset than others, and Nevada says to Mississippi, "I'll never love another." I think we can safely say that Cate liked the book, although love might be too strong a word.

After we finished reading this book, Nicholas looked me in the eye with a straight face and said, "I love my school so much. I'll never love something better than it." Arbor it is, and "Scrambled States" it is!

ARBORFEST 2010

Yesterday we went to the annual Arbor School school-wide party called Arborfest. I am still recovering as I write this because it was a very full day.



Nicholas and his class were in charge of a booth they named the Pretzel Palace, in which they sold homemade pretzels. When I say homemade, I mean that they got wheat from the school, ground it, and (I suppose) milled it in some way to make flour. They then made dough, and the teachers baked the pretzels. The kids were in charge of greeting the customers, asking them for their orders, and making change... with the teachers' assistance. The pretzels were yummy, and I hope to put Nicholas to work in the kitchen more often!



The rest of the afternoon consisted of innumerable treats: lemon peppermint sticks (i.e. a homemade peppermint stick stuck into a lemon), caramel apples with sprinkles on top, homemade zucchini bread, etc , etc.



There was real food for lunch, entertainment, and a silent auction. For the latter, the goal of any donated item was to create a greater sense of community. Thus, rather than giving a gift certificate to a restaurant, one donated dinner at one's house. We bought 2 pairs of season tickets to the Portland Timbers soccer team, and I donated 1 pair of the seats. The seats went for more than we paid, which we were glad to see because all proceeds go to the school.

Before we left, we watched a classical guitar concert played by some of the older Arbor students. At one point, Cate ran on the stage. We, which is to say Kathleen, quickly pulled her off stage. Without missing a beat, a student, who must have been all of 10 years old and who must have sensed Cate's boredom, smiled, turned to Cate, and gave her a little doll with which to play. Needless to say, Cate spent the rest of the concert occupied and that child is going in our will. You cannot make this stuff up, people!



Here's to Arbor!

HAPPY BIRTHDAY TO ME

There are days when I am ungrateful or full of self-pity, but today is not one of those days. I turned 37 today, and I have more to be thankful for than I can describe here. However, I will give you a short list.

I am thankful for the fact that I have clean drinking water. In lieu of gifts this year, I donated my birthday money to an organization called Charity Water, which digs wells in communities around the world that have no access to clean drinking water. Consider donating please! Their work gives new meaning to the phrase, "Drill, baby, drill!"

I am thankful for these two children, who light up my life.



I am thankful for my wife who puts up with me and who is an amazing mother.



I am thankful for my health and that I am currently injury free and able to partake in my new love, soccer! Viva Barca, my favorite team!



I am thankful to have the job that I do, wherein I am fortunate to take care of amazing patients with prostate cancer while trying to improve our understanding of their disease through laboratory/clinical research.

I am thankful to have such great parents and brother and sister, whom I do not see as much as I would like.

I am thankful for my amazing friends. The true measure of a friend (you know who you are) is clearly someone who remembers to call you on your birthday even when they have no reminder from Facebook, which you quit because it disgusted you. I digress. My friends have truly made me the person whom I am, and without them, my life would be very unfulfilled.





Here's to hoping that this 38th year will be as great as the last, and here's to hoping that I will remember each day all the many things for which I should be thankful.

FIRST DAY OF KINDERGARTEN

Today was the first day of kindergarten for Nicholas Joshi Alumkal. He wore his backpack and carried his lunch bag. He also proudly showed everyone his "summer garden" that he grew (and decorated) over the summer. (Yes, he had homework and a reading list prior to the first day of kindergarten.) He is in a mixed age classroom with first graders called "old hands" and kindergartners called "new hands," and he was quite excited that his main teacher Lori will be joined by a boy teacher in training named Toby. He also met Vivek, the "old hand" from his class who will be his buddy, or "first mate" today. Yes, I know it is cute. Picture an eco-friendly Hogwarts, and then you will be able to visualize the greatness that is the Arbor School.

As you can see from these videos and pictures, today was filled with excitement, but they do not do justice to how happy we are and how proud we are of him.

























I cannot think of anywhere else I would want him to be than here. Here's to the next 9 years!

KIDS CHANGE EVERYTHING PART II

So, the splanchnic denervation (the procedure to deaden the abdominal nerves involved by the patient's tumor) worked. We discharged him, but not before I had a chance to tell him in front of his parents what an amazing mom and dad he had. He said he could not agree more, and, with that, we said goodbye and good luck.

KIDS CHANGE EVERYTHING

There is no doubt that having children changes one's perspective on life. However, I was not aware of how much it can also change one's perspective on work.

Today, on rounds in the hospital, we walked into the room of a man my age with metastatic, incurable pancreatic cancer. He was admitted with severe pain despite prior cycles of chemotherapy and a PCA (patient-controlled administration) pain pump. The latter is a device that allows the patient to hit a button to dispense high doses of intravenous narcotics on demand. The Heme-Onc fellow and nurse practitioner on the team who had met him before said his body was a shell of its former self, and it was clear that he had lost a lot of weight. He had lost so much weight, in fact, that it hurt him to lie for prolonged periods on his back or on his side due to the lack of any subcutaneous fat.

This morning he was in visible pain and said that his hospital bed, which had been changed to a more comfortable air mattress the night before, was unbearable. He begged us to send him home after a planned procedure to essentially abolish the abdominal nerves that his cancer was compressing. We explained that we wanted to ensure that he was stable after that procedure and that we did not want to discharge him too soon only to have him get re-admitted several days later. He pleaded with us, at which point his mom, who was also in the room, tried to convince him to stay while also trying to advocate strongly for us to help make her son comfortable.

I could see the powerlessness in her eyes, but, in them, I could also see how she would have been willing to give her own life to save his in a heartbeat... if only that were an option.

This patient's situation. This family's situation made me think of my own son and my own daughter and how sick I would feel if were in that mother's position facing the prospect of having to bury my own son. I have never cried on rounds, but I struggled to hold back tears and quickly excused myself after we were done comforting them.

Kids change everything.

When I got home, I gave Nicholas and Cate big hugs. I was extra patient and extra fun tonight because I was reminded how precious they are and that life is (to quote my former Chairman of Medicine Dan Foster) "until further notice."

THE FIRST GOODBYE

Tomorrow is Nicholas' last day at Alder Street Learning Center, the pre-school which he has attended for the past three and one-half years. It has been an amazing school, and we feel fortunate that Cate will remain there for at least the next three years.

Tonight we decided to write out thank you cards to three of his teachers- the center director Linda, who is an amazing teacher, his current teacher Nicole, and his former teacher Norma, who has reached him in a way that I can only dream of approaching one day.

The card to Norma is shown below.



Its contents included the following words (along with a Starbuck's gift card and the picture below):



"Dear Norma,

I love you so much. I love you because you stay with me until the end of the day, and you always love doing stuff to me that is so silly.

There's a lot of other stuff that I do not have room for, but I love you because you are my friend and my teacher.

I hope I have another teacher like you because you're my best teacher I have ever had at school!

Love,

Nicholas"

The choice of the sloth for the cover was mine, but the words were all his. Cue the kleenexes please. Sniff. Sniff.