Today!

The Problem With God (Kindle Version only so far) is now available for purchase on Amazon!  Paperback to follow in about 3 weeks.  Why wait?  Great excuse to buy yourself a Kindle for the holidays.  You deserve it!

Click here:  www.amazon.com/dp/B00HBTZE2C

Pageflex Persona [document: PRS0000039_00025]

The Blurb

The Problem With God

Book Two of The Claddagh Trilogy

What if dying is the easy part? Father Zimmerman knows all about Life, and Death, and God, and Salvation. He’s seen it all, lived and fought through wars and worse. Now, as a Jesuit priest teaching “The Problem of God” course to Georgetown undergrads, he’s used to being the one asking the tough questions. And grading the answers. But Life is so much more complicated than he imagined. So is Death.

When the woman with no name falls from a bridge, Zimmerman has the fleeting impression that he’s witnessing an angel falling to Earth.

He’s wrong about that, too.Pageflex Persona [document: PRS0000039_00025]

GSW Head: 22Nov1963

During my training, I spent a couple of months at Parkland Memorial Hospital in Dallas. Parkland has always been a leading institution in trauma care and I was there to learn from the best. It was, of course, the hospital that cared for President Kennedy when he was assassinated fifty years ago today. I still clearly recall that day decades earlier, and the pervasive sadness that followed for weeks thereafter. It was a sudden and tragic wrenching of the world for all of us, even those too young like myself to fully comprehend what had happened or why. Actually, the most harrowing part of the whole ordeal is that none of the grown-ups seemed to know why, either. I recall still the sense of confusion and of becoming unmoored from our previously happy lives.  Whenever I confront this event, I still feel a deep sense of loss and unease.  We still don’t know why.IMG_1278

Parkland does not shy away from its history in this event. I worked for two months in the large Emergency Department, lovingly referred to as “The Pit.”  It was still run by the surgical residents.  When I was there, I worked in the same resuscitation rooms where the victims that day were treated.  A plaque recognizes the event.  During my rotation, I had the privilege of listening to one of the participants relate the events of the tragic day.  His story, as I recall it, follows.

The work in the Pit was steady, as was usual for a Friday.  We were all aware, of course, that the President was in town, but nobody gave the fact a moment’s thought.  We were just doing our usual work when a clerk came over to tell me that she had just gotten a call saying that the President was being brought over by ambulance.  It was 1963–there was no radio communication between the hospital and the ambulance services.  She didn’t know who had called or if it might be a prank of some kind.  I called over my Chief Resident to tell him about the phone call.  “What do you want to do?” I asked him. “Should I call the attending?”

“We better wait and see,” he said.  “Probably somebody’s idea of a joke.”

So we waited.  When we didn’t hear anything more, I went back to taking care of the minor injuries that was the usual fare in downtown Dallas.  Suddenly, the PA announced that a trauma was at the dock.  I looked at my chief, who had suddenly become very pale.  We positioned ourselves to receive the patient and the big double doors burst open.  A patient on a stretcher was pushed in rapidly by an army of ambulance technicians.  My chief stopped them to assess the patient, a middle aged white male with an obvious severe gunshot wound.  With relief, he announced, “It’s not Kennedy.  Take him to Trauma Bay One.”  The nurses wheeled the man into the resuscitation bay and we began our assessment.  None of us recognized the victim to be Governor Connolly.  As we were working, somebody announced through the doorway that a second victim was arriving.

“You take it,” the Chief said to me.  I ran out just as another victim was wheeled into Trauma Bay Two.  I bent over the man to see President Kennedy, the back of his head nearly shot off from a severe gunshot wound.  I started the resuscitation protocol.

Within minutes, attending surgeons of every specialty flooded into the emergency department.  We were quickly pushed aside.  Amidst a flurry of activity, Kennedy and Connolly disappeared up the elevators to the operating rooms.  The chief and I sat at the desk in the Pit.  The ER was quiet and empty of patients, as they had all been removed during the crisis.  With no patients to care for, we all just sat, many of the staff crying.  I just stared at the trail of blood that was still on the floor leading out to the elevators.  “Somebody should clean that up,” I thought.

Lines

Quote

“She taught him that the lines on the road were just paint.”

                                                        The Problem With God

                                                         Evan Geller

Why I Don’t Carry

The reason I don’t carry a gun has nothing to do with my political views, the NRA, or the second amendment of the Constitution.  It has nothing to do with the fact that my professional life has involved caring for hundreds of victims of gun violence.  I’ve operated on a lot more people that have been assaulted by McDonald’s fries and bacon cheeseburgers than guns.  There are three reasons that I don’t own a gun.  These reasons are fact, are unassailable arguments against my owning a gun, and almost never come up in discussions of gun ownership.  The three reasons that I don’t own a gun are:

i.    Guns only work when you pull the trigger.

ii.   Guns only do one thing.

iii.   I have children.10120753-shooting-with-handgun

Very early in my surgical training, I was standing next to one of my fellow residents in the OR locker room as we changed out of our scrubs at the end of the day, both getting ready to head home.  We were working at an inner city hospital in the late eighties, the place and time of a significant peak in gun violence.  During summer on-call nights, I remember sitting on the loading ramp of the ER hanging out with the cops and paramedics, shooting the breeze and listening to the steady pop of handgun fire from across the city, the occasional tat-a-tat of an Uzi; some of it sounding like just a block or two away.  It was Mogadishu, but with more snow and great Coney Island hotdogs.  Anyways, I remember being in my first year as a resident and standing next to this second year as we got ready to leave, putting my keys back in my pocket as I noticed the other guy take a small handgun from his locker shelf and tuck it into his pants.  I was shocked.  I don’t think I had ever seen a “regular” person with a gun before.  “You carry a gun?”  I asked him.

“Yeah,” he said, slamming the locker.  “You don’t?”  I shook my head.  “Well, good luck with that,” he said.  As he left, I considered the fact that we were working  in a very dangerous area, that my apartment a ten minute drive away was in an equally dangerous neighborhood, that one of our surgical attendings had his Camaro stolen twice in the past six months from the hospital parking garage.  Just that day, there had been another newspaper article on the rising frequency of carjackings on the expressway I took home to visit my parents.  Actually, I thought, he might have a point.  The night before, I had been forced to circle my apartment building for twenty minutes, because when I pulled into the parking lot three dudes with Uzi’s slung on their shoulders were standing in my parking spot conducting a business transaction.  One of the guys had politely suggested that I come back a little later, and I had taken his advice.  Maybe having a gun wasn’t such a bad idea.

I briefly thought about the concept of owning a gun.  It certainly wasn’t difficult as a physician to get a concealed carry permit.  But after further consideration, I realized that for me, a gun would be a mistake.  At that time, I came to my conclusion based upon Reason Number One:  Guns only work when you pull the trigger.  If you are carrying a gun, you have to be willing to use it.  And by use it, I don’t mean pulling out your piece and waving it about at a possible assailant, saying “Back off, asshole, I’ve got a gun here.”  That doesn’t work.  That will get you killed.  Carrying an unloaded gun doesn’t work.  That will get you killed.  No, if you decide to carry a gun, you have to be prepared (ie., trained and practiced) and willing to shoot a person.  If you are not prepared and willing to shoot a person, you are worse than foolish to carry such a device, because the other guy must assume that you are carrying your gun because you are prepared and willing to shoot him with it.  He will act accordingly.  Which, by the way, also applies to any interactions with cops that you might have while carrying.  If you carry a gun and you are pulled over for a traffic violation (see my previous blog post Trunk Full of Human Tissue), you must maintain both hands on the top of your steering wheel, window down, and greet the friendly officer with the statement “Good evening, officer.  I have a loaded handgun under my seat for which I have a license.  I will not move my hands from this steering wheel until you tell me to do so.”  And say it all with a smile, or else you may be shot dead for speeding.  I know this, because a driver was killed in my city during my residency under just this circumstance.  Carrying a gun is a responsibility that must be carefully considered.

When I considered the implications of Rule Number One, I realized that it was stupid for me to have a gun, because I wasn’t willing to use it.  Oh, I know what we all think, that you’ll find yourself in a situation where a Bad Person is spraying bullets at a busload of nuns and you’ll pull that gun out and blow him away, saving the day for all.  But I knew better, and I still know better.  Malice of intent is not an obvious condition. If you have a gun for protection, you have to be willing to shoot first.  It is not a straight forward equation.  Consider the following more likely scenario:  You are walking to your car in an empty parking garage after a long day at work, your family waiting for your return home.  As you approach, you see a man standing next to your car.  You are carrying your gun.  You yell, “Hey!  Get away from my car.”  The guy just looks at you with a defiant and threatening expression.  Do you: 1. Say to yourself, “Screw it, I’m going back inside and getting security,” or  2.  Pull out your loaded weapon and aim it at the individual.  Perhaps you choose option number 2, hoping that your show of force will convince the guy to leave peacefully, preferably by raising his hands in the air and muttering something apologetic.  But what if that doesn’t happen?  It’s pretty dark, maybe the guy doesn’t see your gun.  Maybe he didn’t understand your warning because your voice has become a falsetto, or he’s not an English speaker, or he’s hard of hearing.  What if the dude instead bends down?  Is he reaching for the twenty dollar bill he saw on the ground and that’s why he’s next to your car in the first place, or is he now removing a loaded gun from his sock?  How long are you going to wait to find out before your shoot?  At what point do you feel sufficiently threatened to pull the trigger?  Because if you say that you will wait until the other individual has decided to persist in his threatening actions despite being warned with your raised gun, that you will wait until he straightens up and points his own gun at you, that you would wait until he starts to approach you in a threatening manner despite your repeated warnings, then you should not be carrying a gun.  You will die.  If you have a loaded gun, you must be prepared to use it at some point before you are fatally threatened, or you are just making the situation more dangerous for yourself.  I realized with great certainty that I would never be able to shoot somebody just because I felt threatened.  Which meant that a gun in my hands was worse than useless–it was dangerous. Bad idea.  If you are carrying a gun, you will have to decide to pull the trigger. You also will have to spend the rest of your life living with your decision, right or wrong.

The second fact is that guns are designed to do only one thing:  Kill the person they are aimed at.  These machines are very effective.  Trust me, as I am an expert in this regard.  I have seen the effects in great detail and on many occasions.  Do not believe, when you decide to pull the trigger of your gun, that the result will be anything other than a loud noise and the other person being suddenly dead.  If you don’t believe me, please ask any police officer, federal agent, or soldier.  Even the most skilled and practiced professional does not claim to be able to disarm, incapacitate, or neutralize the threat of another individual by shooting to wound.  And you are not a professional: If you shoot at someone, you’re going to kill him.  You will spend the rest of your life living with the knowledge that you killed a person. Not comfortable with this fact, buy a Taser or carry pepper spray instead.

Finally, it is a fact that I have children.  If you have children, your child will find your gun.  It is inevitable.  At some point, your child will know you have a gun, will know where the gun is kept, will know where the ammunition for said gun is kept, will know where the key to the trigger lock or gun cabinet is kept.  Do not kid yourself into thinking that your weapon will be a secret or completely secure unless it never enters your home or car.  You may realize this fact and choose to address this challenge head-on, teaching your children gun safety, that it is strictly forbidden for them to touch the weapon without your permission.  Admirable, but not always sufficient, I’m afraid (see “Children and Guns: The Hidden Toll,” New York Times Sept 28, 2013 http://www.nytimes.com/2013/09/29/us/children-and-guns-the-hidden-toll.html) .  Children, particularly children of the male type, will feel a strong urge to disregard your rules.  If you were once a male child or are the parent of a male child, you realize this fact.  Not only will your child be aware of your gun and capable of obtaining it, loading it, and discharging it in your absence despite any and all of your efforts to the contrary, your child may at some point have the desire to do so.  Of course, you say, I would never have a gun in the house if my child were in any way mentally or emotionally unstable.  This, sadly, is a fallacious argument.  Your three year old son is capable of discharging your gun but is not mature enough to consider the consequences.  Your teenager is emotionally unstable by definition.  If your child were to develop a mental illness, you may not be aware of this fact until it is too late. The first warning sign of your child’s depression may be the sound of a gunshot from their bedroom.  You may not be aware of your child’s mental instability until you hear his name on the local news.  If you have children, a gun in the house is dangerous.  Period.  You may choose to reduce that risk by taking all appropriate measures, but you will never eliminate it.  Of course, the same thing applies to that bottle of prescription pain killers that you have on your bathroom shelf.

So that is why I don’t carry a gun.  You are encouraged to come to your own decision, no problem.  Just don’t ask me to let my kid have a sleep over at your house.

A Hard Place To Live: part one

I haven’t lived in New York my whole life.  This is important.  New Yorkers–that is, those individuals born and raised in NY–are a special breed.  [Pause for definition:  New Yorker–an individual born and raised, having attended Public or Catholic school through high school, in one of the five boroughs. Usually Queens or Brooklyn.  Sorry Upstaters, you might as well have been raised in Pennsylvania, or on the Moon.]  Even if they have moved away from NY for long periods of time, these individuals return prepared; armored, fortified, energized, dauntless.  Nothing about living in NY fazes these folks.  For those of us who have adopted NY as our home, however, it is quite a different story.  Despite residing on Long Island for close to thirty years now, I continue to wince on an almost daily basis.  I wince at drivers deliberately driving through red lights in the middle of the day–because they’re driving a school bus.  I wince at airport cops who bang on my car and call me things that would get you hit over the head with a beer mug in a Dallas bar because I had the nerve to slow down to pick up my daughter who’s standing right there with her luggage.  I wince at the high school counselor that explains to me that “You gotta realize that maybe college ain’t for every goddamn kid just because they got a doctor for a parent, you know?”  Real New Yorkers never wince.  Rule Number One:  Never show fear.Guggenheim ext

New York is a hard place to live.  Real New Yorkers do not appreciate this fact.  When informed of this unassailable truth, the New Yorker looks at you with a mixture of confusion and pity.  “You from Jersey?” they may ask.  But they really don’t care about your answer. Rule Number Two:  Only New Yorkers can criticize New York.  They don’t understand that both parents need to work two or three jobs, have Sis watch the kids almost every day, and put the weekly groceries on the credit card just to survive here.  They have no clue that they could be living in a four bedroom McMansion with a live-in maid and two acres in 98% of the rest of the country for what they’re spending to barely make ends meet with the mother-in-law living in the basement and paying rent.  She does, however, make her own sauce and have dinner ready almost every night.  Real New Yorkers wouldn’t consider moving, because there is no where else in the world to live.  Visit, sure.  Maybe even for a few years.  But not live.

In New York, one assumes that the car facing you at the red light will make a left in front of you as soon as the light turns.  That if you want your groceries bagged, maybe you should reach over and put the groceries in the bag, why don’t you?  That if you allow more than ten inches between your car and the car in front of you, somebody will cut in, maybe two cars and a bus, and that this process will continue until you realize that you are actually getting farther and farther away from your destination. That if you want to get over to take that exit, you are going to have to just close your eyes and turn the wheel as you listen for the sound of screeching metal.  Rule Number Three:  Never make eye contact.

New Yorkers don’t realize that there is no help in this environment.  On the expressway, signs are either positioned to appear just beyond the exit you needed to take, or are rendered illegible by graffiti, or have rusted to the point of pointing in slightly the wrong direction.  No matter how intelligent you are or how long you stand staring at the changing big board in Penn Station as throngs stream about you like so much spawning salmon, you will not get on the right train, and therefore you will be at least forty minutes late for your appointment, and when you do arrive you will have sweat stains under your arms and your collar will be two sizes too small for your neck.  New Yorkers don’t realize that you could’ve gotten the six blocks cross town quicker by walking than by sitting in the back of a taxi that moves less than eight feet in thirty minutes despite blowing its horn continuously as the driver yells an unceasing stream of something unintelligible which you eventually realize is his hands-free cellphone conversation and not directed at you at all.  They don’t realize this because New Yorkers don’t take taxis in New York.  Rule Number Four:  If you don’t know how to get there, you have no business being here.

It’s a great town, of that there is no doubt.  The people are the best in the world.  But it is a hard place to live.  Rule Number Five:  You have to want to be here.

Never Say Oops in the OR

 

As a first year surgery resident, you don’t get to do much operating.  Mostly minor procedures and the simplest OR cases, especially the ones the more senior residents have no interest in, like removing skin lesions or biopsies, that sort of thing.  One of the most common surgical procedures left for the first year residents was the insertion of the chronic indwelling venous access catheter, an implanted device to facilitate infusion of medications, long term antibiotic therapy, or long term IV nutrition.Minolta DSC

This was not only a straightforward procedure, it was a very common procedure at the main University hospital we trained at.  Our service performed this operation over a dozen times a week.  As such, it wasn’t long before even the first year residents felt comfortable in the procedure.  And as first year surgical residents, it wasn’t much longer before we were feeling pretty cocky about our skill in performing this seemingly straightforward procedure.  Of course, as first year residents we had not yet internalized one of the most important tenets of all surgery:  There are no small operations.  Even the most routine procedure, the most mundane biopsy, can go horribly wrong if not approached with the respect deserved by every patient.

Towards the latter part of our first year, the residents spontaneously devised a kind of competition.  As we got really experienced in the procedure, it got to the point where we could  comfortably complete the operation in less than fifteen minutes.  When it went well, that is, which was about 95% of the time.  A couple of us were so “good” that we could occasionally complete the entire operation in about seven minutes.  So an informal competition started up amongst the first years, a hypercompetitive lot by nature, to see who could complete the operation the fastest.  It got to the point where the real objective of the resident was to have the catheter in and be suturing the closure before the attending finished scrubbing, so you could tell him when he walked in not to bother gowning up.  Attendings loved not bothering to gown up.  More time for coffee and chatting up the nurses.

It’s not hard to see where this is going.  The operation of inserting a chronic venous access catheter has nine distinct steps for its successful completion.  I know this, because as we first year residents began operating faster and faster, we managed to screw up each and every one of them.  As was the tradition in our residency program, every time a new screw-up was committed, it was named for its original perpetrator.  My class was instrumental in naming every possible screw-up related to chronic venous catheter insertion.  For the decades that followed our completion of the program, an errant first year resident could be heard being admonished by his attending not to “pull a Geller” or any one of the numerous other maneuvers we invented.  (A complete list of all the named maneuvers is available upon request, but I must pause here just to mention the Schwarma maneuver, in which the very last stitch at the conclusion of the operation is deftly passed right through the catheter, necessitating starting the procedure all over from the beginning.  Schwarma was asked to leave our program after his first year and went on to father many children during his career as a cruise ship physician.)

Step one of the procedure involved introducing a long, large-bore needle into the subclavian vein, a very large vein (about as thick as your little finger) that lies just under the clavicle (collarbone) in the upper chest as it carries blood back from the arm to the heart.  Unfortunately, this was a blind procedure in those days, made a bit more challenging by the fact that the subclavian artery, a large pulsatile structure carrying the entire blood supply to the arm, lies immediately adjacent to the target vein.  And the lung, an organ that really doesn’t like being stabbed by needles as it tends to collapse like a punctured balloon, is located immediately behind the target vein.  Inadvertent puncture of each of these anatomic structures had been accomplished thousands of times by countless surgical residents for decades.  We, therefore, were already trained in the precautions necessary to avoid these structures.  We were much more creative.

As I said, back in those dark old days of my training, this was a “blind stick.” (Currently, technology has progressed to allow real time ultrasound guidance of the procedure.) As a blind procedure, the surgeon is reassured that he had struck the correct anatomic structure with his needle by seeing the gentle return of dark red, venous-type blood from the hub of the needle when the syringe was disconnected.  It was appropriate, however, to quickly cover the hub of the needle with your finger so as to prevent air from being  sucked into the low pressure venous system.  This is called an air embolism and can immediately lead to a cardiac arrest or stroke.  This was to be avoided, having already been done many times as well.  One afternoon, towards the end of our first year, one of my first year colleagues named Dr. Sweetness was performing this procedure, smoothly and confidently proceeding before his attending came in the room.  Actually, he had begun before his attending was even in the operating suite, not that unusual at the time but a sign of cockiness for a first year resident.  Sweetness was pretty cocky at this point, as were we all.  Dr. Sweetness inserted the needle and was immediately rewarded with a flash of blood.  Rather than carefully consider the nature of the blood return, however, he immediately assumed it to be venous and clamped his finger over the hub of the needle.   Like I said, he was moving pretty fast.

Step two of the procedure is to insert a flexible  guide wire through the needle into the patient’s venous circulation, actually passing the wire near the chambers of the heart.  I should digress at this point to mention that it is important not to insert the entire wire into the vein, but rather to hold onto its end.  My fellow resident, Dr. Napoleon, failed on one occasion to follow this simple rule.  He neglected to maintain control of the end of the guide wire, which he smoothly and accidentally introduced completely into the patient’s vein, where it proceeded to pass downstream into the heart and lodge there.  This trick, thereafter known as the Napoleon maneuver, necessitates immediate abandonment of the planned operation and stat consultation with a cardiologist for percutaneous fluoroscopically guided extraction of the rogue guide wire.  This also required a very embarrassing conversation with the patient and his family, a conversation that never failed to upset the attending surgeon.

But I digress.  Sweetness smoothly introduced the guide wire and maintained control of its end throughout.  He did not, however, appreciate the fact that he had introduced the guide wire into the subclavian artery, not the vein.  In and of itself, this would not be remarkable, for as I mentioned, this particular maneuver had been done literally thousands of times.  Usually, however, the operator was immediately aware of the error when, upon removing the syringe from the end of the needle, bright red blood (not deep purple as it should be) sprayed like a fire hose into your face.  At that point, the surgeon need only fight the urge to curse or say “Oops”  (“Never say ‘Oops’ in the OR”) and remove the needle from the wrong vessel, then to hold pressure until the body’s natural tendency to recover from our screwups takes effect.  No permanent harm, no foul, as they say.  Unless, of course, you don’t realize what you’ve done.

This particular patient also had the unfortunate combination of low oxygen saturation in his blood stream and low blood pressure introduced by the inexpertly administered anesthetic provided by the first year anesthesia resident.  Therefore,  Sweetness didn’t realize he was in the artery.  Not just in the artery, though.  As luck would have it, Sweetness had managed to enter the subclavian artery extremely close to its takeoff from the aorta.  You know the aorta, the single largest blood vessel in the human body that carries the entire output of blood from the heart.  It tends to bleed very vigorously and fatally when injured.

Now, even that would probably have been kind of okay, if Sweetness at any point realized what was going on.  But this was a blind procedure, the usual cues had been taken away by his equally youthful anesthesia colleague, and Sweetness smoothly and confidently proceeded; still with no attending in sight.  Step three of the procedure is to gently and smoothly pass a dilating catheter over the guide wire, called an introducer.  The introducer is a gracefully tapering, somewhat flexible plastic straw that serves the function of gently stretching a hole in the wall of the blood vessel so that the catheter can be introduced.  I say ‘somewhat flexible’ because it is actually quite stiff–it has to be to perform its function.  It is, therefore, necessary to introduce this device with some degree of trepidation and finesse.  Sweetness had the finesse part down pat–it was the trepidation that was missing at this point.  Sweetness smoothly and expertly passed the introducer over the guide wire, a maneuver that he had performed without incident almost a hundred times before.  On this occasion, however, through a combination of bad luck, rushed technique, and inexpert assistance on the part of his anesthesia colleague, passage of the stiff-walled introducer device caused the root of the subclavian artery to be torn from its origin on the aorta.  This, of course, resulted in a large tear in the aorta.  The patient, already quite ill, proceeded to hemorrhage massively into his chest cavity.  The attending surgeon walked into the operating room just in time to see his patient, supposedly there to undergo a relatively minor procedure, receiving CPR on the OR table.

Oops.

Jumping the Shark

The NY Times (Aug 30, 2013) reports a battlefield armor manufacturer is now marketing bulletproof inserts for children’s backpacks.

(http://www.nytimes.com/2013/08/30/opinion/statehouse-swagger-in-the-gun-debate.html?hp)

Angina Bicycle Club

I love riding my bike.  Just finished riding, enjoying that special glow after a vigorous spin around the University Campus.  Just sitting here, wondering if the chest pain is really anything serious.The orange-red bark of a Madrone evergreen tree

Ever since I was a boy, I have loved riding.  It was always something that I could do well enough so that there was no fear or anxiety attached to the effort.  It was, actually, effortless.  There was no consternation over which team I’d be on, or whether these were the guys I was playing with during that embarrassing game when I passed the basketball to the guy on the other team just because he yelled “Here!”  It was unadulterated fun, combined with the fact that I could go places.  Even though it was the suburbs of Detroit, so everywhere I went looked pretty much like everyplace I’d been, it was still great to ride as far away as I could before it started to get late and I’d have to turn around.  I’d often leave in the morning and just ride all day, alone or with friends, just picking a direction at random and riding, stopping for nourishment at the Dairy Queen.  [Note for younger readers:  This was the early part of the last century, when the only thing offered by DQ was soft serve “ice cream” in three flavors:  White, Brown, Twisted (combination of white and brown).  They were called “flavors” but really they all tasted the same, just different colors.  Jimmy Hoffa is preserved in a vat of the stuff in a basement in Rochester Hills.]

The geography of Detroit was unique in that there were almost no hills at all.  Whatever hills I did encounter in my youth were inevitably downhill,  long stretches that allowed miles to roll by without the need to pedal.  Detroit area winds were also uniformly favorable.  I cannot recall ever encountering a headwind.  The wind was always at our backs, always cool and refreshing.  It didn’t rain in Detroit on the weekends back then.

I don’t recall ever actually getting tired.  We came home because it was late, or some TV show was coming on in an hour that we couldn’t afford to miss because it would never appear again in our lifetime.  Our parents didn’t notice when we left and didn’t notice when we returned, unless by some miscalculation we were late for dinner or were thought to be cutting the lawn all afternoon.

Bicycling is more difficult now.  Though my Cannondale carbon fiber Lampre Caffita Team road racing bike weighs less than my socks, for some reason the combined weight of the bike and rider is now far more difficult to get moving than that old sixty pound Schwinn I used to ride as a teenager. As I leave, I feel obligated to announce to my wife that “I’m going for a ride now,” just so she’ll know to listen for sirens in the neighborhood.  I also am careful to inform her of my safe return, mostly so she can release the open heart team at the nearby University Hospital from standby status, but also so that she can see how thoroughly exhausted and sweaty I’ve become because I’ve been riding my bike.

Geography has become my enemy.  My house is always several hundred feet higher when I return–it must be, because all the hills go up, never down.  Any brief downhill stretches are either over pavement too broken up to allow the enjoyment of momentum or are interrupted by red lights.  Lights will not turn green unless I have been trapped in my cleated pedals and fallen over, having mistimed the light.  This is accompanied by the sound of car horns.  Occasional recommendations to buy a car or ride on the sidewalk.  Ha!  There are no sidewalks here, sucker.

The real problem now, though, is the lack of oxygen.  I’m not sure if it has to do with global warming or the Denveresque elevation of Long Island, but after twenty minutes of riding I’m breathing like Yaphet Kotto in Alien, just before he gets eaten.  And it’s always about a hundred degrees outside, except when it’s way too cold.  And the wind–I mentioned the wind, right?  It’s a strange circular wind that’s always straight in my face in gusts of like eighty miles per hour, going and coming back.  But it’s an oxygen-poor wind.

Still, I love to ride.  I just never had to worry so much before.  Like my biggest worry (I have a list in my mind entitled “My Biggest Worry.”  It currently has eighteen items.), which is that I’ll die in the next ten minutes, still dressed in these ridiculous Spandex riding shorts and my LiveStrong! bicycling jersey.  We have volunteer firemen here in this rural, mountainous part of Long Island, no professional paramedics.  I just know if they find me dead in this outfit, these guys are posting the picture to their Twitter feed.  Not the way I want to go, or go viral.

I think I’ll take an aspirin now.  It couldn’t hurt.