WHAT'S THE WORLD'S BIGGEST ZOO?

While we were looking at the website of the National Zoo in D.C. tonight, Nicholas said, "Dad, you said we could look up the largest zoo in the world!" I asked him, how he proposed to find that out. He responded, "Let's "google" it!"

That we did. It turns out that the Berlin Zoo has over 1500 different species of animals and appears to be the largest zoo (based upon number of different species) in the world. We will not be doing that zoo anytime soon.

When I reflect upon my own facility with computers versus Nicholas', I am amazed. I grew up with computers and am pretty savvy, but it is incredible to see Nicholas' generation's familiarity and dexterity with computers.

Perhaps because of the omnipresence of technology, we purposely chose the Arbor School for elementary school for Nicholas because they neither have laptops in the rooms nor a computer lab. Conversely, their focus is on acquiring critical thinking skills rather than information gathering skills.

I have a feeling we will be "supplementing" at home on google.com, sesamestreet.com, etc, etc, etc..., but finding out what questions to ask seems way more important than acquiring the answers on the web... or elsewhere.

DONE

The yard sign may now come down. Done.

ONCE IN A LIFETIME

In my lifetime, we will have health care reform. This piece by Paul Krugman summarizes the momentousness of this occasion and what it took to overcome the opposition this past year. Anything I could write on this matter will pale in comparison to Nobel laureate Krugman's words, but I will try.

I will be traveling to D.C. in 2 weeks with Kathleen and the kids. I had contacted our Congressman Earl Blumenauer, who voted for the reform measure tonight, to arrange for a tour of the White House. Sadly, that will not be possible as all the tours are full, but his office did offer us the chance to tour the Capitol. After this historic vote, I think that tour will be much more meaningful for me and for the kids one day.

I hope Nicholas and Cate will read in their future text books (which will not be in Texas public schools thank God!) about these amazing March days in 2010 when the Democratic Party, on its own, did what every other Congress and President had not had the strength or courage to accomplish: to make health care an inalienable right. After this, accomplishing anything else will seem like icing on the cake...


In the next few days after President Obama signs this bill into law, I will take down the above sign from my yard and pack it away. However, just like when I packed away my Obama '08 sign, I will remove this sign with infinite joy and endless faith in the capacity of Americans and Government to do the right thing and get the job done... once in a while... or at least once in a lifetime.

THE LAST GOODBYE

Yesterday, I went to the funeral of a patient who recently lost his battle with prostate cancer. Surprisingly, it was the first time I had attended a patient's funeral. Mr J. was one of the first patients whom I met 3 years ago after starting at my current hospital, and he touched me in so many ways. He had metastatic prostate cancer when I first met him that had progressed despite having been treated with most of our approved therapies.

On that first meeting, he and his family were packed into a small examination room in the seventh floor oncology clinic when I entered. I explained to him that without treatment he had approximately 6 months to live, but that, for the average patient, the median survival with chemotherapy was 18 months. The family began crying. As I handed out Kleenexes all around, they smiled and said, "Don't mind us! We are an emotional group. We even cry at Safeway store grand openings." With that, gravity gave way to levity that day and in most of our other visits, which were always punctuated, however, by his and his family's tears when they thanked me for all I was doing for them.

Mr. J. enrolled in 3 clinical trials and constantly talked about how he wanted to give back to others. Even if these experimental treatments did not benefit him, he hoped the results of these studies would benefit others. Additionally, he requested information about donating his body to science through our medical school's cadaver program after he passed away. He signed up for this, too.

Approximately, 3 years after I first met him, it became clear that he was too sick for more treatments and that we had reached the limits of what medical science could do to make him feel better. I told him and his family, that he taught me a lot during our journey together: about selflessness, about hope, and about courage. He went on hospice in December and died last week.

At his funeral, the officiating pastor, his son, passed a microphone to anyone in the church who had something they needed to share. After reading the back of the funeral program that asked that the guests make donations to my research program in lieu of flowers or any other gifts, I was overcome by Mr. J's final act of altruism.

I recounted my first meeting with Mr. J and that first joke which I heard from him about Safeway. I shared my view (despite many of my non-oncologist friends' incredulity) that I had the best job in the world. Had it not been for cancer and had I not chosen to be an oncologist, I never would have met Mr. J. I never would have seen how much one could love one's family as he did. I never would save seen how brave and selfless one man could be. I never would have had the opportunity to come to the church today to see how much a man could be loved. I never would have imagined the doctor, the man, the husband, and the father I could strive to be... if I had not become an oncologist... and if I had not met Mr. J.

I felt a wave of emotion sweep over me, my eyes well up with tears, and my voice begin to crack. I finished my remarks and sat down knowing that I had sad a proper goodbye to a patient who had given me far more than I could have possibly given him.

I ALWAYS DID LOVE TREES!

So, we finally decided on a school for Nicholas. He is going to the Arbor School. It is a K-8 school in Tualatin, Oregon, which is about 25 minutes drive from our house. We thought long and hard about what we would be sacrificing by not signing Nicholas up for our neighborhood public school, which is a 3 block walk from our house, r/e the community and proximity of classmates, but ultimately we felt that the Arbor School would be the best choice.

When we went for his assessment, I joked that we should just follow the Toyota Priuses ahead of us to get there, which turned out to be correct. It is a very progressive (read liberal) school that seeks to teach its kids to think for themselves and to expand their world view. It does so without pretension and with a great deal of care and joy, and it's philosophy closely matches one described in a recent piece from the New York Times by a leading educator from Williams College.

When we asked Nicholas what was most important in choosing a school, he listed 4 things (his words, not mine- and yes, he is only 4): 1)great teachers, 2)great kids, 3)great toys, and 4)a peaceful environment. In the end, it was the the Arbor School, which met all those criteria, by a landslide.

Tonight, we mailed back letters in "thin envelopes" to the other private schools at which Nicholas was accepted declining positions there. However, I did make the case that they were great schools, too, and that we would be looking at them again for high school. I mentioned how I knew it would be competitive to gain admittance, but I also said that we have one amazing son...

DR. SUNSHINE

Today, I got a little bit of a wake-up call from a patient, Mr. F. I generally pride myself on being a positive doctor (though not necessarily a positive person when the white coat is off), and I try to speak honestly with patients while still giving them a sense that they are not alone and that there is still the possibility of multiple, small victories in life. I like to tell them that if prostate cancer were a race, it would be a marathon and not a 5K race and that many of them are at the starting line. Most seem to emerge from their visits hopeful and thankful.

Mr. F, on the other hand, said I always sounded like Dr. Doom. This was based upon the fact that whenever he asked about the possibility of a cure or making his metastatic cancer go away, I quickly seemed to redirect the conversation to the reality of the situation: his cancer, while possibly controllable for several years, was likely to eventually progress. He said he did not feel as though I was overly negative, just not as positive as I could be. I listened carefully and said that I thought he was right.

In the course of talking to patients about their disease and outcomes, I do err on the side of honesty and shy away from "sugar-coating." It is what I would want if I were the patient, but I now realize that I must do a better job of individualizing my delivery, rather than sticking to my "script." Mind you, I do try to tailor the conversation to the individual patient and family and their needs, but what I say and how that is perceived varies from person to person, depending upon the page on which he/she finds him/herself.

Dana Jennings, a prostate cancer "survivor" and writer for the New York Times writes today about how cheap and inadequate words are to describe what a cancer patient experiences in his piece entitled, "With Cancer, Let’s Face It: Words Are Inadequate." He closes with this line:

"So, no, cancer isn’t a battle, a fight. It’s simply life — life raised to a higher power."

Words by which to live...

THIS IS WHAT TRYING LOOKS LIKE

Today we received a package in the mail from OES, one of the schools to which Nicholas was accepted. It contained a stuffed aardvark named Aardy, which is their mascot.

By the way, this is what trying hard and engaging prospective families (especially those with animal savants) looks like.


Aardy, you will be glad to know, has been safely tucked away in the closet until we make our final decision...

Stay tuned!

AARDVARKS, AND EAGLES, AND TREES! OH MY!

Tonight we received word from the private elementary schools to which we had applied for Nicholas (OES "Aardvarks," Catlin Gabel "Eagles," and Arbor School (pictured above)- I have made up the nickname "Trees.") One was a thick envelope, one was rather thin, and another was in the form of a phone call. However, the result from each was the same: ACCEPTED.

It has been 2 long months since we started this process (although it feels like 2 years have elapsed). During this time, we filled out applications to 3 private schools, each of which had an average of 8 essays, went to 5 open houses, and did 4 school tours. Additionally, Nicholas had a student assessment at each of the private schools. It was exhausting, but going through this clearly revealed to us what we value in our children's education and the environment in which we think Nicholas would learn best.

The schools all had their strengths and their weaknesses, and none was perfect. However, the most glaring difference was between the public and private schools. While the private schools, for the most part, bent over backwards to be accommodating or to answer our questions, we found that the leadership at the public schools had a "yes, we can't" attitude, in which attempts to woo us or inspire us were non-existent. Mind you, I was not looking for someone to give me preferential treatment, but I did want them to try to convince me that their educational environment was better than anything else in the city and why. The public schools did not even try, which made me concerned about how much they would try to engage us, respond to our concerns, and go the extra mile for our kids if we had enrolled there. I realize that these conclusions are based upon very little information and little more than my gut instinct, but, in the school choice game, I think one's gut is everything as there are no clear predictors of a great education save great teachers, which are not easy to identify as a prospective parent...

In his piece entitled “Getting In," which I read several years ago in the New Yorker and which I was compelled to re-read during our time on the "circuit," Malcolm Gladwell writes about how elite Ivy League institutions have traditionally marketed themselves and selected applicants. He quotes a social scientist who believes that they rely on “selection” effects, which roughly translate to: “you don’t become beautiful by signing up with a (modeling) agency. You get signed up by a modeling agency because you are beautiful.” Conversely, he describes the Marine Corps as a “treatment” effects institution: “It’s confident that the experience of undergoing Marine Corps training will turn you into a formidable soldier.” The former philosophy speaks to what an individual can do for an institution, while the latter philosophy speaks to what an institution can do for an individual. I now believe that Mr. Gladwell’s description of educational options represents a false choice as some schools truly defy this mold.

We were not seeking a school looking for perfection, and we do not wish to perfect Nicholas. Rather, we were hoping that he would be selected for admission at a school that considered his gifts and challenges as a soon-to-be kindergartener and which would positively influence his development. We hoped that he would matriculate in a school that valued learning, both about one’s self and about one’s place in and responsibilities to this world, and that valued diversity of opinion, experience, and background rather than a pre-conceived ideal. We believe that we found at least 2 schools that fit this bill.

Indeed, we were been struck by the degree to which staff, graduates, and parents, with whom we spoke and interacted from these 2 schools, uniformly seemed to espouse this philosophy: what can both the school (embodied by its students and staff) and the individual student (and his/her family) do to ensure that they both thrive?

It was amazing to find schools where we believe Nicholas may grow into the young man whom he has the potential to become and where the success of his education will not be measured in standardized test scores or Ivy League admissions notifications [although those would be great, too :)] but in the content of his character and the ability to think for himself and discover his own calling in life.

Now, we just have to decide....