LA REMONTADA

The title translates to the recovery or the comeback. This is the term the Barca press, team, and fans have given to their next match - the return leg of the quarterfinals of Europe's top club soccer competition, the Champions' League.  And a recovery is what Barca needs if they are to stay alive in this competition.

We will not dwell on how Barca got into this mess (see the last few posts for that). Rather, we will hope that the last two weeks of stinging defeats will somehow awaken the slumbering giant that is Barca.

The team must give their all (and then some) tomorrow if they are to get past a determined and capable AC Milan side.  We, the fans, can believe, and we can hope, but it is time for these players to weave another tapestry, orchestrate another symphony, paint another masterpiece. Feel free to add your own metaphor.

I have no doubt that Barca will rise to this occasion. Win or lose, the team must come out fighting. Barca must remember what they are capable of and who they are. To quote a famous Catalan slogan: Som i serem (We are, and we will be)!

The defender Gerard Piqué also had a message for the fans planning to attend the game tomorrow in Barca's home stadium - the Camp Nou- "We need 90,000 people who believe that we can get through this. Anyone who thinks that we can’t do it, please give your ticket to your children or friends.”

Barca's former coach Pep Guardiola said it best at his first press conference when he was announced as coach. I am paraphrasing here, but he said, "We do not promise to win football titles. We do promise to play football that will make you proud of us."

Well said maestros. La remontada es posible (the comeback is possible)! Ara, ens enorgulleix (now, make us proud)!

THE LAST GOODBYE

Today, I met with one of my dearest patients - Mr. D we will call him - for the last time.  His cancer was out of control, and I had run out of treatment options to slow it down or relieve his discomfort. Mr. D's visit and this news made both of us reflect on our four year journey together to combat his metastatic prostate cancer and how we had arrived to this spot.

In 2009, Mr. D first noticed back pain. He attributed this to moving some appliances and thought nothing of it. However, when the pain quickly escalated, he went to the emergency room. He expected to find a slipped disk or a pulled muscle. Instead, x-rays showed that his spine was riddled with lesions concerning for a cancer. His PSA blood test was sky high, and a biopsy confirmed prostate cancer.

I met him after he received surgery to his spine to prevent damage to the spinal cord, and I began to manage his prostate cancer with therapies that lower levels of male hormones.  We got two years out of that initial treatment, but then his cancer began to grow. We next tried additional hormonal therapies and then chemotherapy, which led to a remission. Unfortunately, that remission was short-lived and we moved on to a newer, more potent hormonal therapy. All the while, the patient was able to spend time with his friends and live a "near-normal" life.

He loved to fish on the Columbia River, and he often brought a cooler to clinic for me full of salmon or sturgeon. It was the best fish I have ever eaten, and I am not just saying that out of sentimentality; it was really that good.

In the past year, we went back to chemotherapy - this time at a reduced dose - and then a new hormonal agent. The benefits were limited, and the patient presented to the ER last month with new and severe back pain. The cancer was back and was threatening his spinal cord. If left unchecked, paralysis and loss of bowel/bladder control were certain. Although his cancer was advanced, I felt that the benefits of aggressive surgical intervention were worth the small risk of death during the procedure. His spine was stabilized, and his back symptoms did not worsen. He was released to a skilled nursing facility and recently made his way home to the Coast.

Today, I spoke to Mr. D about the crossroads we were at. Another form of chemotherapy could be tried. However, I expressed my concern that treatment might make him sick and feeling worse than he already felt. I explained that we had reached a point where medicine and treatments could not make his cancer go away but that I did not want to give up on making his symptoms go away. I told him that hospice was the best chance to help him feel as well as possible for as long as possible and that hospice would allow his family members to go back to being his family members rather than medical care providers. In essence, I told him that he was going to die and that there was nothing I could do to stop it.

I paused. He reflected. The silence was deafening. I waited for him to speak. He said that he got four great years with treatment, and he thanked me for everything that I had done for him. He said that he knew this day would come but that that knowledge did not make today any easier.

I told him that it was a privilege to be his doctor, that he and men like him are the reason why I come to work everyday, and that I would be with him for the entirety of his journey. We hugged and fought back the tears. I helped wheel him out of the room. It was clear what each of us had meant to the other. Then, we said our last goodbye.

MES QUE UN CLUB

Today, Sandro Rosell, the President of Barca, held a press conference and affirmed his loyalty to the current manager. That man Tito Villanova is pictured above, and Tito is currently on leave receiving cancer treatment. Since Tito's absence, the team has experienced a significant drop in form.

To put this drop in form in perspective, one must consider the team’s record prior to Tito’s medical leave to treat an aggressive form of recurrent salivary cancer and the team's record after Tito’s leave. In the first five months of the season, Barca had only lost two matches; they were on pace to set the record for all-time wins in a season in the Spanish League. In the past month, and more specifically in the past four games, Barca has lost three matches. They have been eliminated from the Spanish domestic cup competition, and they face elimination from Europe’s most coveted club trophy – the Champions’ League.

There have been many reasons for this drop in form, which I reviewed last time. Chief among them is the lack of a leader and the inadequacy of Villanova’s stand-in, his assistant coach Jordi Roura.

Many of us had hoped that the club would name an interim, more well-qualified manager until Tito returns. Indeed, there are a host of former Barca players or coaches who would have gladly and ably stepped into the breach. However, at today’s press conference Rosell made it clear that this was Villanova’s team and that no temporary or permanent replacement would be made unless it were clear that Tito could not return. Rosell went on to state that if Tito recovered but Barca lost every trophy, then this season would be considered a success. This was coming from the head of a club that has won 75% of the trophies they have been eligible to win in the past 4 years.

Any other club would have taken a different route and either replaced their manager or temporarily relieved him of his duties. Football is a business, and those clubs would have been within their rights to make such a move. However, for Barca, football is more than a business, and Barca has always been mes que un club – roughly translated from the Catalan into more than a club.

Barca represents not only the city of Barcelona and the province (or to some country) of Catalonia. Barca’s play on the field and the club’s conduct off the field represents fair play, decency, beauty, excellence, and above all justice. To usurp the authority of a man fighting cancer who led them to the greatest start in the club’s history would have been an insult to the man and to the club’s creed.

I cannot say I agree with this discussion as a Barca fan since the team has been utterly rudderless in the past month. I told myself that if the club were to regain its form under a new interim manager, surely Tito would be pleased. However, as an oncologist and as a human being, I stand by the President’s decision. Life is about more than winning and losing matches. Life is about leaving the world better than you found it. Life is about putting people ahead of profits and plaudits. Life is about leaving a legacy of which your children can be proud.

Mes que un club. What an understatement.

THE END OF AN ERA?

In the span of one week Barcelona's season seems to have unraveled.  During those seven days, the team lost two huge matches. The first loss was to AC Milan in the Champions' League, and the second was to Real Madrid, their arch-rival. The latter match eliminated Barca from the Spanish Cup competition.

To put things in perspective Barca had only lost three matches all year long until last week.This slip in form and the severity of the defeats have led many to wonder whether this is the end of Barca's reign as invincible.

It may be too soon to pass that judgement, but I do believe that the current style of play- 10 men in attack with only the goalkeeper to defend has passed its prime. The previous incarnations of Barca were attacking teams as well, but those teams' success started and ended with defense and an affection for the ball that bordered on patronly.

If your opponent does not have the ball, they cannot score. If you give the ball away and immediately retrieve it, your opponent cannot score. Those principles have deserted Barca this season. Even though Barca continues to dominate possession, they too easily surrender the ball and do not have the same urgency in taking it away from their opponents.There are several possible explanations for this slip in form.

First, their coach Tito Villanova has been away from the team for over one month undergoing treatment at Memorial-Sloan Kettering in New York City for a recurrent salivary tumor. The emotional toll of the loss of their leader who is battling such a serious and life-threatening condition should not be underestimated.  This Barca team more than any other club is like a family.

Second, the fill in coach, Villanova's assistant Jordi Roura, has been present in body only.  He lacks the skill or experience to manage the best club in the world against some of the best opponents in the world. The line-ups have not been chosen wisely. Substitutions have been poorly chosen or not made at all. There have been no tactical adjustments mid-match. As a result, the team's play has suffered. 

Finally, the team must be physically spent. They have played one match every three days for the past six months. I play one game per week, and often have discomfort for two to three days afterwords. I cannot imagine how taxing Barca's schedule must be - especially since Barca's competition is among the best in the world and since many of Barca's opponents commonly kick and abuse the Barca players.  None of these reasons are excuses for Barca's poor form, but they are explanations.

This brings me to the key question at hand:  is the Barca era - that has run for nearly four years - now over? It may be too soon to say, and it is almost comical that we are having this discussion since Barca sits 12 points above its nearest rival in the Spanish League and 16 points above its arch-rival Madrid. The League title seems like a forgone conclusion, but Barca has never been satisfied with one trophy per season. Anything less than winning all possible competitions - and winning with an attacking flourish - is viewed by players and fans alike as a disappointment.

I think we will know the answer to whether Barca's era of invincibility has come in the next two weeks.  If they can defeat Real Madrid this weekend with a convincing victory, then the jury will still be out. Moreover, if they can come back in the second game of their two game series against AC Milan and win by the necessary 3-0 scoreline, hope will be restored.

These victories will only be possible if Barca returns to its supernatural style of play- greedy possession of the ball, precision passing, and lethal exploitation of their rivals' mistakes. It will take focus, coaching, and shifting lineups to achieve this goal. Without these three elements - particularly without coaching - "success" for this club will not be possible. The Barca team is made up of many of the best players at their positions in the world, but these players are human. Despite what the pundits would have us believe, these players do not coach themselves, and these players break down. If one needs proof, one need look no further than the past seven days.

I am hoping and praying for a turnaround. Visca Barca, and we await your speedy recovery and return Tito!

AFFIRMATION

Today was the 57th Presidential Inauguration and the second for Barack Hussein Obama, the 44th President of the United States. This Inauguration was not as well-attended as his first one in 2009. However, this Inauguration felt bigger and more important because it represented the affirmation by the American people of the first President of color - a man who has been forced to endure endless attacks for the past 5 years.

We can ponder the question of why one would want to continue in such a position amidst such rancor and partisan divide another day. Today was about how this nation's vision and its course have been irrevocably changed by this singular man - President Obama - and the countless Americans who believed in him.

I remember when I first saw Barack Obama in 2004 in Boston on that summer night. I was in our basement in Baltimore watching the Democratic Convention when they announced the next speaker - a young State Senator from Illinois. His speech was a mere 18 minutes. However, in that keynote, Senator Obama reminded us how we are all tied together in this fabric called America. He reminded us that we Americans have more similarities than differences. He reminded us that what binds us is not government or corporations... but ourselves and our communities.

During that speech, his words moved me to forget who was delivering the message, how he looked, and what his name was. So resonant was that message, that I thought the speaker was speaking only to me. At the conclusion of that short speech, that I knew that this man would be President one day. Did I think it would happen four years later? No, try 20 years later. However, sometimes the arc of history bends a little more quickly than it did before. These are the times that we find ourselves in. This is the moment we find ourselves in.

Movements come and go. Presidents come and go. What remains, however, what endures in our spirits are these moments. Moments when that which we thought impossible becomes possible, when the future looks brighter than the past, when our world seems a little more light than dark, more hopeful rather than pessimistic.

Let us savor this moment, but let us also seize it! As President Obama said today, we will be judged by history by how we treated the least among us. We are a nation of doers not takers! We have a lot of work to do. We face great problems.  However, this man, this President is up to that task.  Let us each affirm our faith in him by doing all we can do to keep moving Forward because we are all in this together.

HEAVEN IS BARCELONA PERIOD.

I write from somewhere over the Western United States. I am on my way back from a truly memorable trip to Barcelona, aka Heaven.

This trip had its ups and down. Hey, anytime, one travels 18 hours to a foreign country, there are bound to be some ups and downs. However, with the exception of the stale air on the plane and the Vega General, or general strike, the trip was nothing but pleasure.

Barcelona is truly a special place unlike anywhere else I have ever been, and this trip did not disappoint. The weather was temperate. The food was delectable. The football was magnificent. The women were beautiful. The people were welcoming and down to earth. The art was masterful. The metro was clean, prompt, and efficient. In sum, the city was breathtaking in every way.

When I try to think of a city that resembles Barcelona, I am truly at a loss.  Sure, there are many other lovely European cities, but none comes close.  In my opinion, the city that comes closest is of all places Portland. Why? Plain and simple it is because of the shear passion and authenticity of the people in both places.  People care about the land in each place, People care about respecting other cultures and ways of life different from their own in each place. People have civic and regional pride in each place. However, Portland can only be considered a lighter, wetter version of Barcelona because of the greater diversity, history, and majesty of the Catalan capital.

One finds one's self drawn to people and places at various stages in one's life. For me, this is my Barcelona stage, and I do not see it ending anytime soon.  Summer family trip anyone? Sabbatical anyone?  I kid you not.  If I were ever to leave Portland, Barcelona would be the top of my list because of the focus on quality of life, work-life balance, peace, and pursuing one's dreams and aspirations.  

Only people like the Catalans that have suffered as much as they have under Spain and others can truly appreciate the value of life. Only a place influenced by so many different cultures and customs could be so tolerant.  They have seen tyrants, despots, dictators - all Spanish - rule over their land and repress their language and ways of life. It is that history as a backdrop that shapes the Catalan independence  movement. This quote from Napoleon sums up the Catalan people better than anything I could dream up: “Courage isn't having the strength to go on - it is going on when you don't have strength.” 

On November 26, one week from today, we will see what the Catalan people decide when they vote for the new regional government.  I, for one, will be watching.

However, whatever the people decide, I will remain a fan of the city by the sea named after its founder  the Carthaginian leader Hamilcar Barca.  

OLD TALE IN A NEWTOWN

Two days ago 20 beautiful first graders and 6 brave teachers lost their lives. No, this was not a school bus accident or a case of a communicable disease. It was another scourge, however, that took these lives - gun violence.

A deranged young man - it is always a deranged young man - gained access to his mother's vast arsenal. He first took her life. As if that were not tragic enough, he next forcibly entered her workplace - Sandy Hook Elementary School in his hometown of Newtown, CT.

For all we know he may have even once been a student in this same school. However, this did not deter him from brandishing a semi-automatic rifle and terrorizing the entire school and this community.

One can only imagine the screams of those young victims and the cries of those who fought to protect them in vain. The violence of that sound would be deafening. The violence of that sound would surely be seared into our collective consciences. The violence of that sound would surely not fade.

Sadly, the same had probably been said after Columbine, Blacksburg, Tucson, and Aurora. Yet each time, we have moved on. We have forgotten. Our will to have a constructive dialogue on this subject has always waned. Our collective disgust has always subsided. Our pledge to the victims and their families has always been empty.

Yet, Newtown feels different. Newtown is a moment that feels just like its eponym. We have the chance to make things better this time. To make something of this tragedy, to turn carnage into courage. The politics are never convenient or easy. They were not in Gettysburg in 1863. They were not in Selma in 1965. And they will not be in Newtown in 2012.

But the slaying of innocents comes at a time when a lame duck Commander-in-Chief who happens to be the father of two young children is in office. That man, Barack Obama, spoke in solemn tones on the day of the shooting and even more so at the Memorial service tonight. In his tears and through his eyes and words, I heard resolve. I heard empathy. I also heard a call to arms - not against those who fired the guns or who make them - but against ANYONE who would stand in the way of making this society safer for children and citizens, alike.

There can be no greater purpose for a society than protecting its children, he said. They are the most vulnerable among us. Yet, they are also the most important because they are our future. To paraphrase the historian George Santayana, any society that is not willing to protect its future is doomed to repeat the failings of its past. What will it be America? Let the names below be a constant reminder of exactly what is at stake.