DR Medical Mission 2026🇩🇴🩺

In March I participated in the MOCA WNY medical mission to the Dominican Republic. I will JUST write about the medical mission now and do the beach/resort/tourism posts later. This ended up longer than I planned but it covers the whole week rather than the daily posts I did about previous missions. It is 6000 words and a 30-minute read and much more enjoyable to read on a tablet or computer than a phone. Maybe once I retire I will figure out how to do these as an audio “blog” or podcast (but with photos).

For about 20 years MOCA has been going on medical missions; providing both gynecological surgery and primary care. They went to Africa for many years, but after Ebola they started going to the Dominican Republic yearly and also went to Cambodia once.

I was hoping to go on last year’s mission but it was the same weeks that Alex and I visited Japan. I did participate in the Meat Raffle last year so I was an expert this year at the big fundraiser. See the short post below (from January) if you haven’t read it yet.

Short and sweet Meat!

Over $10,000 was raised at the meat raffle and other donations help support the charity as well. Wegmans donated a lot of vitamins and OTC medications. Catholic Health System donated surgical and anesthesia supplies and medications. I paid for my own airfare and hotel but neither were very expensive.

Below are links to the MOCA of WNY information pages.

https://mocaofwny.wixsite.com/mocaofwny/about

About Medical Outreach & Community Assistance of Western New York

and here is a link to their FB page if you want to follow them for the future…

https://www.facebook.com/MOCAofWNY

To Donate you can mail a tax deductible contribution to:

MOCA of WNY 121 Sunburst Circle East Amherst, NY 14051

or electronically…

https://mocaofwny.wixsite.com/mocaofwny/donate

In the months leading up to the mission I tried to prepare well as I was going to be the only anesthesiologist on the trip. Usually there are at least two; both to split the work hours and in case someone has a medical issue. On one mission a nurse fell in the dark and broke her wrist, luckily she was just one of several RNs. I panicked in the DR when I ate a salad at a “non-resort” restaurant (forgetting the rules while trying to find a healthy appetizer on the menu). Luckily I did not get ill. I swam quickly away from some scary black sea urchins I saw on one of my open water swims (rather than getting close for a better look). Next year I am definitely talking someone else into coming, it will also allow me to work one day with the primary care team instead of at the hospital.

I spoke to the anesthesiologists from the last two MOCA missions, but they had been at two different sites, neither of which we were visiting this year. They had no ability to give general anesthesia the last two years. They used spinal or combined spinal-epidural anesthesia for all the cases. I was preparing for the same and assembled enough needles and spinal/epidural medications to do 20 cases. In case there was the ability to do general anesthesia I also brought a lot of airway supplies and the pharmacy provided propofol and dexmetetomidine for IV general or deep sedation.

When I learned that in previous years there was no ability to monitor End Tidal Carbon Dioxide (ETCO2), which has been a standard of care in the US for 40 years, I wondered about buying a portable device. Pulse Oximetry devices are now on watches as well as cheap finger clips being available (I used one on my Mt. Kilimanjaro hike) but a portable ETCO2 monitor for EMT use was a few thousand dollars. I did find a small, basic one meant for veterinary medicine on Ebay for only $200. I had bought a handheld ultrasound probe (it uses my iphone as the screen via Bluetooth) before my first medical mission a few years ago so I was well equipped.

In Fiji we had used the ultrasound to confirm that a pregnant woman’s uterus still had a fetal heart beat. And if there was a patient with awful scoliosis or morbid obesity I had recently been doing some practice with ultrasound imaging for spinals in my total joint patients. The ultrasound can also be used to find a vein in a very difficult case or to do a basic cardiac exam if someone had a loud murmur on a preoperative exam.

I was also planning to do ultrasound guided TAP (transversus abdominal plane) blocks for post operative pain control as I would not have any spinal morphine available. I had not done one in ten years but I reviewed them on YouTube. I printed out an information sheet (in Spanish and English) for our nurses and the local staff.

The “TAP Block” injection is the ideal and most recent solution to manage pain after abdominal surgery. It entails the injection of a local anesthetic near the nerves supplying the lower abdominal wall, guided by ultrasound. (1)
At the end of the operation, before the patient leaves the operating room, the injection is given. It is safer and lasts longer than other pain relief methods, usually providing pain relief for the first 12-18 hours after surgery, which is the most critical post-surgery period.

As a Mosaic Jetblue member I get two free checked bags so I could bring my supplies and and also a bag of vitamins and OTC medications, my extra suitcase weighed 48 pounds (with toys for children and sponge candy for the DR hospital nurses). I had Spanish and English copies of a letter from the DR minister of health in case my suitcase was searched.

For myself I just had a smaller suitcase and a backpack (and my tropical hat). Fifa would be left in the care of Alex, with some extra walks by my friend Mark on days they had both work and school.

About a week before the trip, MOCA’s physician contact in the DR sent me these photos of the just renovated hospital’s operating room.

WOW! Brand new equipment including a modern ELECTRIC bed and a new anesthesia machine. Based on that information I felt it was worth trying to bring a bottle of Sevoflurane (anesthesia gas) with me. A careful reading of TSA rules said that you are allowed to bring “medications” that are more than 3oz as long as you declare them. I took it out of my backpack before security and the TSA agents just opened it and did a “vapor” test. I didn’t even tell them I was a doctor or going on a mission trip.

I had assumed that most of the 30 people in the MOCA group would be on my flight from Buffalo to JFK and then onto the DR, but there were only a few of us. Through the group’s WhatsApp chat I located the other 5 people and introduced myself before our flight. A few people had actually gone down the day before (I would have done so if I had known) and others went on other airlines from Buffalo through Atlanta or Houston. There were also people on the trip from NYC, Miami, and L.A.

The only people I really knew in advance were Emme Nylander, MD (the gynecologist in charge of the mission, who I work with at Sisters of Charity Hospital in Buffalo and Daniela Señor who is the MOCA administrator (and would be my translator and assistant in the OR). I would later recognize a few people from the Meat Raffle and some nurses who I had worked with years ago but I am VERY bad at names and faces.

The early morning flight (Saturday 2/28) from Buffalo was on time and the one to the DR was delayed only an hour. I got some nice sunrise shots on the Buffalo to JFK flight.

Our connection was very tight so actually the delay was not bad, it allowed me a 30-minute terminal walk including a visit to the “secret” outdoor area at Terminal 5. I noticed that JetBlue finally has a premier lounge but my Mosaic 1 status is not enough use for free, one needs to be Mosaic 3 or 4 or pay $75.

On the JFK to DR flight (3.5 hours) I watched “One battle after another”; I had wanted to see it in an actual theater but it went to streaming before I could. I had no idea the plot would be so political and psychological (and a critique of our current political mess in the USA), the previews I had seen made it seem like a routine action film. I liked it a lot.

The DR is between Cuba and Puerto Rico. It is actually well east of Miami and is one time zone off. The capital (Santa Domingo) is on the south shore, Punta Cana at the far eastern end is the expensive, popular resort area. Puerto Plata on the north shore is a more modest area and has two cruise ship ports.

I got some nice photos of the coast and mountains as we were about to land, including a great photo of the city harbor. The grassy peninsula at the bottom has the original fort built to protect the harbor in 1577.

And here is the photo of me and my friend in front of it a week later when I visited the city.

I’m sorry for digressing into travel blogging. it is hard to stick to only the medical mission.

I sat in the front of the plane so I was one of the first people off and there was almost no wait to get through immigration (I spoke Spanish to the official) and later customs. There was an easy online form in advance that gave you a QR code that was scanned as you left with your luggage.

As our flight had arrived an hour late, by the time we had all collected our luggage two other flights had landed and a dozen of us were collected by the same hotel shuttle bus for the 30 minute drive to our resort. It was jungle hot (80s and humid) and the bus’s A/C was very welcome!

At the meat raffle, Emme had asked if I preferred for the group to stay at a nicer or more affordable hotel. I told her that I could afford nice but she should see what the students and residents wanted. When I got my booking info and saw that the 7 days (including taxes, fees, all meals AND alcohol) was less than $800 I worried about how cheap it sounded. But when I googled the resort and saw the photos I was very surprised!

I was checked in and settled in my nice, big, air-conditioned room before 5pm. There was a huge patio! It had a TV with many channels in both Spanish and English, I only turned it on to watch the World Baseball Classic (rooting for the DR of course). I think MOST of the people at the resort were Canadian (although there was a mix of locals, Europeans, and Americans as well. Since they can’t go to Cuba anymore and don’t want to deal with ICE in the U.S. to get to Florida, the DR is a great option for them. There were many cheap direct flights to various cities in Canada and at $99 a night, many were staying for 2 or even 3 weeks. A lot of Maple Leaf flags were hanging from windows and balconies.

We weren’t meeting for dinner until 7pm so I got in a short swim in the 80 degree ocean and briefly explored the resort on the way to eat. We ate in a nice corner of the very large dining room, with a view of the beach. There was a huge and varied buffet for every meal, and always a variety of seafood options for me. After dinner we had an orientation meeting.

We were given a brief orientation and told that the medical team would spend a full day Sunday at one of the rural clinics (they went to different ones every day) but the surgery team would not leave for the hospital in Guananico until 1pm Sunday. We would set up all our work areas and the operating room and evaluate the patients scheduled for Monday surgeries.

We had all brought the medications we had in our luggage (drug mules!) to dinner for Frank (a regional director of pharmacy for Wegmans), here he is with the ones for the first day’s medical team clinic work. He has been coming on the MOCA missions for many years.

The medical team spent the day seeing patients at a rural clinic.

The last day of the mission at the hospital we made a special video to thank Wegmans and their pharmacy director Gina. “THANK YOU WEGMANS”!

Video…

As I had Sunday morning off, I went for a long run and after breakfast sat in the shade by the pool and read my Kindle for a few hours. I noticed (and liked) that the resort was very multicultural with hispanic, white, and black guests interacting. In Buffalo a lot of cultural activities are very segregated still.

I went back to my room and changed into my tropical doctor costume.

I joined some people for lunch (it was always easy to find our group as often we were in scrubs) and then we squeezed into the van for the drive to the hospital. There were usually a few more people than seats in the van, they set up cushions in the aisle. I always made sure to get there early to get a real seat (and wore my seatbelt, which I was glad of when the van once screeched to a stop, avoiding a lamb darting across the road to catch up with it’s mom and sibling).

It was only 22 miles but the drive usually took 45 minutes. While the first part was on a nice highway, the next part was hilly and winding with broken pavement. And the overloaded van had a low ground clearance so it drove very slowly on the bad sections. Cars and motorcycles were always zooming to pass us. Here is a video of the bumps!

Video

As soon as we left the coastal resort area the nation’s poverty was very visible. But of course poverty is much worse in Haiti (and Honduras where my last medical mission was). For comparison, USA is $90K and Canada $60K.

The landscape was very beautiful though and there were lots of cattle and other livestock. Most of the homes had a few banana trees and probably other fruit trees I didn’t recognize.

Guananico seemed to be a little more prosperous, there were nice houses along the main road (all with lots of gates and bars on windows) and some clean retail areas. Most of the side streets seemed to be unpaved, which must be awful in the rainy season (May to November).

There was the smallest possible ambulance in the parking lot. I wasn’t sure anyone over 6 feet would even fit in it. Luckily most people in central america (and Spain) are not that tall, I am almost average height there. But the ambulance and hospital were all very new and clean. They had only really re-opened a few months before we arrived, having been damaged in the last big hurricane to hit the DR.

MOCA had a dozen large containers of supplies that were stored in the DR in addition to everything we had brought with us. The surgical techs and nurses prepared all the supplies for the pre-operative area, the operating room and the recovery room.

One of the pre-medical students helped me unpack and organize all my supplies and medications. She was observing Ramadan, hard with the 12 hour days.

I had a list of medications that were left at the end of the previous year’s mission but had been told that many were expired. A pleasant surprise was that there were two full drawers of medication in the operating room.

Most of the Spanish names were easily translated. I did use Google to figure out what Adrenol and Adrenalina were exactly (norepinephrine and epinephrine). There was some fentanyl that I would add to the spinal blocks and some Valium that I gave one patient for sedation when I was almost out of propofol. IV valium hasn’t been used for surgery in the USA in thirty years as midazolam/versed wears off much more quickly and doesn’t hurt on injection.

I filled the empty spots with my medications that they did not have stocked.

Even though this hospital was recently renovated and had modern equipment it did not have pipelines of oxygen or suction (as in more developed countries). They had large oxygen tanks and electric powered suction machines. There were no iv infusion pumps for us so I used my math to figure out how to count drops of fluid as they had to do in the REAL old times. Propofol at 8 drops per minute (1 drop every 7 seconds) = 100 mcg/kg/min for an 80 kilogram patient.

The staff at the hospital smiled and said hola but there was almost no coordination between them and our group. JB (the DR physician who worked with MOCA) practiced on the other side of the island and didn’t seem to have a great working relationship with the local staff. Weeks before the trip I had asked JB to get me contact info for the anesthesia providers at the hospital (the website said they had done some orthopedic surgeries in January) but he never did so.

I tested the anesthesia machine and it seemed fully functional but the oxygen sensor was not working and I couldn’t find a replacement. The spanish interface was easy for me to understand. I only used general anesthesia for one patient who had a patchy spinal block, the rest got spinals or epidurals and sedation with propofol or valium.

While setting up, someone on the team found the cutest little lizard in one of the rooms. She was a good organic, non-toxic insect control system!

No patients showed up to be evaluated on Sunday, theoretically three women were supposed to be there for us to pre-op. We squeezed back into the van for the trip back to our resort.

Almost no one wore helmets on motorcycles, scooters or electric bikes even while sharing the bad roads with trucks, cars, and even livestock. I got a few family hazard photos, but this really scary one someone else in the group shared with us…

The trauma ERs deal with some horrific accidents and then limited orthopedic surgery options leave many people with lifetime disabilities we no longer see in the U.S. On my last mission in Honduras we took care of many people with old, untreated orthopedic traumas.

Instead of eating dinner at the resort we all went to a seafood restaurant on a lagoon a few blocks outside the resort. I had run around the lagoon on Sunday morning and seen the egrets that had all returned to the trees to spend the night.

The tiny kitchen was a little overwhelmed by our large group!

We all dressed nicely for dinner. At the resort when we had our scrubs on before or after the van/bus rides I often got asked about the mission by other hotel guests and the resort staff. I could manage in Spanish but the Quebecois had to use their accented English as “Je parle tres peu le Francais” is about all I can do now (it having been a decade since I was in Montreal or France).

I was lucky to have been at the first table to order and be served so I didn’t have to stay out too late. On the walk back to the resort I got this wonderful photo. The moon was almost full, the next night would be the lunar eclipse.

I only had time for a short ocean swim on Monday morning as I needed to shower and eat, and be in the van by 8am (and sunrise wasn’t until 6:30am). A cruise ship had spent the night at sea and would dock at the port next to the resort.

I always had a traditional DR breakfast and a fresh fruit smoothie; although they had the usual American options of omelettes, pancakes, etc. The hard boiled eggs and muffins were my lunch.

On the way to the hospital we stopped at a corner grocery store and a few people ran in to get snacks and drinks to leave in the break room at the hospital. The hospital had a cooler with filtered water as well to refill our water bottles.

Our first case on Monday was an abdominal hysterectomy, in the U.S. this would have been done laparoscopically or robotically. I used my Spanish “script” to interview the patient and talk to her during the epidural but Danielle was there to “translate” my Spanish 🙂

I gave all the patients Celebrex, Tylenol and Pepcid orally before surgery, to help with intra and post-operative pain and reduce gastric volume/GERD.

Without a pathology lab on site they looked inside the specimen to rule out any obvious abnormality.

We had no more gynecological patients but there was a woman in the hospital who was 40 weeks pregnant and had a “large” baby on ultrasound and she accepted a ceasarean section instead of trying an induction and trial of labor. All my patients gave me permission to take and share photos.

Neither her husband nor mom was “brave” enough to join her in the operating room but Danielle and I were there for company.

Even though it was late there was time on the drive back for a quick stop to get some beer, apparently a MOCA tradition (just Kola Real for me).

Before dinner I snapped this photo of a cruise ship heading back out to sea. Back in Buffalo a few weeks later I talked to an OR tech who had been on a cruise that stopped there the following week (out of Fort Lauderdale

After dinner I walked to the beach and got this photo of the full moon.

The MOCA group arranged to stop at the gazebo overlook at 7am before breakfast to see the eclipse but this would turn out to be too late, by then it had set behind the mountains to the west of us across the bay. I shared my photos from my early run with everyone.

The Worm Blood Moon would be the last total lunar eclipse until 2028 (a year I am desperately looking forward to!!!)

Alex got this next shot while walking the dog at home in Buffalo. It doesn’t show in the photo but the dark part was RED, “blood moon”.

I was reading a book about a Navy Seal recently and he would tell his daughter when he went on missions to look at the brightest star in the sky and he would also at the same time. Alex and I were looking at the moon at almost the same moment from 2000 miles apart. ❤️

The 5-mile run took a long time with all the photo stops so I only had time for a 5 minute shower and then hurried through the resort to wolf down a hearty breakfast.

Daily driving photos…

I was photo bombed while taking my morning selfie!

After arriving at the hospital on Tuesday we learned there were no patients for us and after waiting until 11am we would end up heading back to the resort. I voted for us to all go to the village clinic and help the medical team but …

Both the mom and baby and the hysterectomy patient were doing well. The TAP block seemed to have worked well as the patient didn’t need any narcotics until after midnight.

I wandered outside the hospital for a while and said hi to the people at a tiny food stall at the bus stop on the street. I also said hola to the adorable cattle. Meat IS murder…

Driving back to town, there were some police officers checking vehicles. It was apparently fairly routine for any cars heading away from the direction of the border with Haiti (which was about 80 miles west of Guananico). We Yanquis were just waved past.

Even though our surgical volume was low, the medical side of the MOCA mission was very busy every day at rural health clinics. Here are some photos from the week. Many of the adults and children they saw had not been to a physician in years. They put flouride gel on childrens teeth, checked hemoglobins and gave out vitamins and iron. Patient’s were discovered to have hypertension and diabetes (both silent killers) and hopefully would be able to get continuing treatment. They also talked about health care to several school groups. The DR does have a public health system and it is getting better every year.

They diagnosed several kids with major medical issues and arranged follow up evaluations at the pediatric hospital in the capital. There was also a Haitian woman who was 4 months pregnant and had some lateral abdominal pain. The gynecology residents were concerned about a possible ectopic pregnancy. Her husband who was Dominican didn’t want to bring her to a hospital because the goverment hospitals report illegal Haitian immigrants and they are deported. The next day MOCA arranged for them to come to the hospital and be seen by us, not the local staff, and using my handheld ultrasound they happily found that she had an intrauterine pregnancy and likely just a painful but normal expanding uterus.

This is a long public health article about the DR system. Only read it if you are REALLY interested. In summary…. Since 2001 they have been expanding a universal public health system but people in rural areas still have limited access. Middle class people in urban areas often have private insurance and use private offices and hospitals with better quality and less wait times.

Universal Health Coverage in the Dominican Republic: Lessons Learned and Future Directions

Back at the resort I had a light lunch and then another ocean swim. I found some small coral heads this time and saw a dozen small tropical fish and a few hand sized ones and more of the scary black sea urchins. Before dinner I read my Kindle and enjoyed a mock-a-colada on a lounge chair listening to the waves.

On the swim map you can see that I tried to swim out over the outer reef but as the tide was too low I couldn’t do so without getting cut up by the reef which was only one foot below the surface.

Wednesday, March 4th, we knew we had a vaginal hysterectomy scheduled, as she had been seen the day before, and we also would do a tubal ligation.

I had noticed on our arrival that the large oxygen cylinders were not strapped to the wall. This is a huge risk in a country that has earthquakes and hurricaines. If that tank falls over and the regulator breaks off, the cylinder can become a missile and go through a door or wall or a person! It was something I had read about in a book about “Anesthesia in the Developing World”, before going on my first mission.I had Daniela write a note explaining the issue and hope that someone dealt with it by now. The plastic bottle below was a “sharps” container. The third photo is of my “emergency” drugs, all the same as I would have set up in the U.S.

Both patients had spinal anesthesia. They recovered very quickly, here is the tubal ligation patient barely an hour after surgery enjoying rice and beans and chicken with her sister and mother at her side.

I am glad that everywhere I work in Buffalo has electronic medical records as my handwriting seems worse every year.

The medical team at the clinic had another busy day and saw a nice rainbow.

On the drive “home” we saw a yard full of goats, sheep and pigs.

Thursday morning was our last drive to Guananico and I guess I finally had stopped taking photos from the van. But here is one from before leaving and outside the hospital when we arrived.

We did just one surgery on Thursday and then spent a few hours packing all of our supplies back into the storage containers.

I had some people help me go through all the old medicines. Anything very expired we threw out, the ones less than a year expired we donated to the hospital pharmacy and the unexpired ones we packed away for next year. I tried to carefully record what we packed away.

And then the sad farewell photo….

I left all my scrubs at the hospital, including from the last day, so… casual wear for last van ride.

The wind was strong in the afternoons and as the tide was low it wasn’t a good time for an ocean swim so I instead had some gelato and iced coffee and read my Kindle on the beach.

I had been reading a great historical fiction novel about the DR in the end of the dictator Trujillo’s thirty year reign. It was recommended to me by another physician on the mission. It is about the Mirabal sisters (code-named las mariposas, the butterflies) who were active in the underground resistance against the dictatorship.

If you don’t want or plan to read it, here is a link to their story. Their family plantation was very close to Puerto Plata and I saw murals of them on many schools I drove past. There was a woman at the pool with a tattoo of three butterflies on her leg. If I was in the DR longer I would have visited the memorial and museum.

https://www.britannica.com/biography/The-Mirabal-Sisters

I knew a lot about Trujillo’s awful reign (he was as bad as Batista or Baby Doc and, like them, supported for decades by the CIA and State Department) from another book about the DR I read four years ago.

Llosa is a Peruvian author who won the Noble Prize for Literature and I just randomly read his great historical novel about the awful regime. After it fell there were very bad times afterwards as (like in 18th century France) there was so much violence against all the professionals of the ruling class that it took decades for the universities and goverment to recover. I listened to a generic “history of” book, it really seemed like it was written by AI. I never knew that the U.S. army occupied the DR from 1916 to 1924 to prevent populists from taxing or taking the U.S. owned fruit and tobacco and sugarcane plantations. In 1965-1966 the U.S. again intervened to prevent the installation of a socialist goverment after Trujillo’s death.

This summary was written by Adriano Espaillat, the first Dominican American U.S. Congressman, in 2022.

After the murder of Rafael Trujillo, Dominican Revolutionary Party founder Juan Bosch was elected president. Bosch was toppled by a military coup just seven months into his term, and the Dominican Republic plunged into political turmoil. On April 28, 1965, President Lyndon B. Johnson ordered troops into the Dominican Republic through “Operation Power Pack” to protect American lives and property in the Dominican Republic.³² President Johnson, however, also declared that he had taken this military action to prevent the establishment of a “communist dictatorship.”³³ Similarly, the U.S. Ambassador to the Dominican Republic William Tapley Bennett, Jr., described how intervention was necessary to “prevent another Cuba.”³⁴On April 28, 1965, more than 22,000 U.S. troops, supported by forces provided by several member states of the Organization of American States initiated a military intervention in the Dominican Republic.³⁵ Ultimately, 42,000 American armed forces were deployed to the Dominican Republic and remained there until September 1966.³⁶ More than 3,000 Dominicans and 31 American servicemembers lost their lives.³⁷

This audiobook was about the Caribbean cultures that were thriving and advancing before 1492.

It was a little too academic but it was informative. I was VERY distressed to learn that they ATE manatees!!! But I guess several thousand pounds of meat floating just below the surface would be very tempting to someone in a canoe with a spear who was sick of eating fish and root vegetables every day.

A month before the trip I read a very good book about the last 30 years of American immigration policies for refugees from Central America and how they have created our current disastrous situation.

Friday was a “free” day for us. There were a lot of day trip tourist activities available as there was a huge industry set up to entertain the thousands of cruise ship passengers who arrived at the ports several days per week. Most of the people on the mission had been to the DR so many times that they had done all of them already; so the “official” MOCA activity for the day was a day at a fancy beach club. As we were already at a beach resort and I would be spending another four days at a different all inclusive beachfront hotel, I found a fun day trip for myself. (travel tip: always book these excursions yourself on the Viator app or the operator’s own websites… the hotel lobby prices are almost double).

We hiked up a jungle trail for about 45 minutes and then slid down rock slides and jumped off waterfalls. Very fun and exciting.

Hiking in my water shoes was a little challenging.

I had my GoPro attached to my life jacket so got some good action videos. Here is one of a slide and one of a cliff jump.

The “traditional” Dominican lunch at a restaurant afterwards I could have skipped (clearly oriented to cruise day visitors) but it was an interesting group. Some of the young American women were in nursing school and actually heading to Santa Domingo to do a several week clinical rotation/mission at a women’s prison there.

I had a great massage at a nearby Spa in the afternoon.

The last night we ate at the Italian Restaurant/Steak House.

It was actually RAINING on Saturday morning for the first time other than a few stray sprinkles and one overnight rain a few days earlier. Everyone else headed to the airport while I was picked up by a driver I had hired to take me to see La Isabela archeological site and museum. Columbus built the first European settlement in the Americas in 1493 on his second voyage with 13 ships, 1500 people and European livestock.

I hope you enjoyed this lengthy report. Please share, comment, subscribe (FREE) to my blog.

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Last day in DR :(

My 11 days in the DR have come to an end. I had a great time both with the medical mission and my recreation days. I have 30 minutes to write before my plane to JFK leaves. The very small airport here (POP) has a wonderful view of a mountain. It is also very close to the ocean.

I went to sleep early last night and for the first time since getting here had trouble sleeping. My brain was fired up with concerns about my personal and our nation’s “issues”. I have heard almost no details about the war, the first airstrikes were the morning I left the U.S. but I did hear about the Ayatollah being killed and us losing a bunch of soldiers and a few $B in aircraft. I watched no TV the last 2 weeks except for a few World Classic Baseball games, go DR (3-0 so far).

I had a nice 40” swim in the pool, I had to share it with one other swimmer.

I would have gotten in one last ocean swim but it was low tide which here is not so great for swimming as the reefs are very shallow and close to shore in some places.

I had a healthy breakfast, it has been hard to not gorge at EVERY meal of endless buffets at the all inclusive resorts.

I went for my last tropical beach stroll and collected a few small shells. There are not a lot of big ones here on the North coast of the DR.

Then I packed. It was very easy as I did not have the 40lbs of medical supplies I traveled here with. I had to inflate my swim buoy and some plastic bags to fill all the space.

My driver Tobi collected me at 10:30 (he had driven me to La Isabela for the day on Saturday and into Puerto Plata one day).

On the way we chatted some more about the city and country. I took a few random photos.

I got a nice photo of this tree and it reminded me that I wanted to know what kind of tree it was. There are a lot of them here and even from a great distance one can see the bright red flowers amidst the green hills.

The iNaturalist app gave a quick ID

When I did my waterfall hike/slide adventure many of the trees were nicely labeled and indicated whether they were native or introduced species. This one was brought over from Africa, like Bananas and Coffee. Cocoa, tomatoes and corn went the other direction.

Just as we were about to turn into the airport there was a brief delay ….

…. To get to the other side of course 🙂

There are LOTS of cattle on the Island as they have become a replacement for all the land that used to be used to grow Tobacco.

The cute little airport is very clean and new looking. There are less flights than before Covid changed the airlines preference to mainly Santa Domingo or Punta Cana now.

There were some giant fans to cool us as the terminal check in area was wide open to the parking lot.

I was there very early and was quite disappointed there was not a coffee shop in the airport for a last cup of the wonderful Dominican Cafe. There was a bar that had an espresso machine… and of course Pizza and Burgers for the American tourists.

Both of the resorts I stayed at had many Canadians and Dominicans and some Europeans, but not too many Americans. The flight to JFJ though was all loud Americans. Just like my flights home from Fiji and Japan, I was amazed how noisy Americans are after spending a few weeks away from them.

I deleted FB from my phone for the trip to avoid getting news from Trumpmerica but I did post a few photos most days that also shared to FB.

Today someone texted me this annoying comment from 5 days ago they saw on my FB feed.

YES! I wanted to be thought of as a Canadian and not a supporter of fascist, racist, imperialist, mysogonist Trump!
I don’t comment on his pro-Trumpy, MAGA misinformation so why does he feel the need to pollute my post with his 💩!

Plane boarded on time and I almost finished up but had to wait for the JetBlue WiFi to kick in to post.

Bye bye DR ….

Please share, comment, “like”, subscribe (free). I tried to keep this short and plan for my blogging about the rest of the trip to NOT do one for every day. Instead I’ll just do one about the medical mission, one about the DR, one for my tours, etc.

DR mission preview

It is Wednesday 3/4 and I am taking a few minutes to write while we wait for the latecomers (it is 8:15 and we were supposed to get in the minibus at 8).

I am going to dump a few photos here and then write on the way in Notes app as cellular service in and out on the 45” drive and the WordPress app needs internet. Will post the writing later when I have good service.

Wednesday, blogging while riding in our mini bus to Guananico.
The bus ride is 45 minutes of winding roads up and down hills. The first 15 minutes is nice highway then 20 minutes of bumpy semi paved roads. My Garmin watch congratulates me for “stair climbing” every few minutes. Then the last 10 minutes is through the town of Guananico to the Municipal Hospital which is beautiful, newly renovated and very air conditioned. Our van has 15 seats but the first few days we had more people and they had cushions they put on the aisle floor.
Trip has been great so far,nice coworkers, friendly hotel staff and lots of Canadians at our hotel because they can’t safely go to Cuba or USA anymore. I hear French a lot and there are 🇨🇦🇨🇦🇨🇦Flags on a lot of balconies.
Will write more after mission is done (I have 5 R and R days after at a different beach front resort 5 miles south).
At Hospital now (9:30) seems like we will have one tubal ligation patient and one for a hysterectomy.
Will do spinals for both and hopefully tap blocks at end for post op pain control.
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Shark Valley 2026

Whenever we are in FL (usually visiting my mom and uncles in Boca Raton) Alex and I try to spend one day at the Everglades National Park. Mostly we visit the Anhinga and Gumbo Limbo trails at Royal Palms near the Homestead entrance (where the main visitor center is located). There are usually a lot of alligators there in the dry winter season. Once we drove all the way south to the Flamingo Marina area on the edge of the Gulf of MEXICO and saw manatees and a crocodile. Alex really appreciates that every year we drive the one to two hours each way to see the REAL Everglades NP and not just an airboat ride in western Fort Lauderdale or a touristy “Seminole” village with alligator “wrestling”! I am amazed at how few people we know have gone to the Everglades NP despite their many visits to Miami or Fort Lauderdale. It is as amazing a NP as Yellowstone or Yosemite. There are always lots of tourists there with European accents, they appreciate nature more than typical Americans.

On the northwest coast is the ten thousand islands region where I want to kayak the “wilderness waterway” some day.

A great book about the Everglades in 1900 in the 1000 islands is:

This year we returned to Shark Valley to do the 15 mile bike ride there (our 4th time I believe) as we hadn’t done it in a few years.

There is a paved path for the touristy open tram buses that most people choose. They get a nice narrated tour by a ranger and stop to get photos of animals (from the comfort of their seats).

We prefer the bike option as we get to spend as much time as we want watching wildlife and getting photos. It is totally flat so even on the heavy single-gear rental bikes it is not that challenging a ride unless very hot.

It got close to 80 by 11am but it was partially cloudy so rarely did we bake in the tropical sun for too long. The wind picked up from the north as the day went on so we had a lot in our faces on the second half of the loop.

We left my mom’s at around 6am and even with a stop at a post office and Starbucks we were lined up at the gate with a few other cars at 8:15, they open at 8:30. It is a much shorter drive from Miami if u r ever there.

You can now reserve a bike rental on -line but it is only necessary on weekends or holiday weeks.

I didn’t notice until riding that my bike had fat, knobby tires and their’s skinny road tires. So I got a better workout 😉

The bikes were very comfy with their upright seated geometry. We had baskets to carry our lunch and water and I wore a backpack also. There is no water available on the pathway so we brought a lot.

I got this cool shirt on a previous visit. Alex was disappointed they don’t sell them anymore … I’ll probably just give them mine … 😉 They take good care of my vintage T-shirts (like my 1994 L.A. marathon one!)

People always ask “where are the sharks?” 🦈 to the rangers.

We headed out on our bikes at 9am sharp and once out of the parking area we saw almost no people on the whole 1st half of our ride. A few people passed us on their own bikes (going fast and NOT stopping to see every bird or reptile), for locals it is a nice car free 15 mile route.

We saw a few nice birds right away.

And then our first gators….

In past years many gators were in the grass right on the edge of the road and their tails often on the bike path (like in the tram photo). This year they were all in the water or a few feet off the path. The water was lower than usual so they had more space on edge of the canals, swamps. One year after heavy rains, water actually went across the path in places (but only an inch or two deep).

They are very docile and used to people, bikes and trams. You are supposed to stay 15 feet from wildlife in the NP but as the bike path was only 10 feet wide …? If u get too close to one for a photo they hiss to warn u away!

🐊 language tips …. 🙂

The chance of being attacked by an alligator on dry land is almost zero.

Alex told me this joke when I said that one nice wide area of the canal looked perfect for swimming laps.

“How do u know if there is an alligator in a body of water in Florida?”

“If the water is wet!” 🥁 🥁 😂

And I am ALWAYS careful … 😉

We saw a lot more turtles than on any previous visit and more varieties.

Flower munching pair!

We saw several of the soft shelled variety swimming but they were all just below the surface and I couldn’t get any great photos. Here is a stock one.

We could see them well with our polarized sunglasses but I forgot to bring the special lens for my iPhone camera.

Always use polarized for fishing or wildlife viewing 🙂

It had been very foggy on our drive down (burning off just as we arrived) which left dew on the huge spiderwebs.

With the sun shining we could see hundreds stretching into the distance.

Having been at the “bug” zoo the day before at Butterfly World we kept our distance ….

Alex said this was their favorite gator as she was sleeping 🙂 (photo by Alex).

We saw a lot more birds, the only one I didn’t get a good photo of was a big hawk who flew off with a critter two crows were dining on.

Great short video of a heron dining on sushi!

Spearfishing !

We saw a lot more gators on the first half of the ride (several dozen) and after a while we didn’t stop riding unless they were very close to the path or special (like the babies).

Babies!

The newborns have bright stripes and peep like chicks but the ones we saw this year were older. Some were already on their own and a few near mama still. The mom keeps an eye on them for almost a year and by then they are big enough to not have many predators. Of course the invasive pythons can eat even big gators, deer, etc.

As we got close to the turnaround tower we saw a couple on bikes talking to a ranger and saw a big “gator” on the edge of the road.

She was actually a big old crocodile (one of only 2 living at Shark Valley). Notice how her teeth are outside her mouth, the “crocodile smile”.

Crocs are more aggressive (especially the saltwater Australian ones).

We stopped for lunch after climbing the observation tower.

Great views and some nice information.

After a nice lunch in the shade we walked a short distance down a trail where we had once seen a gator lying right in the center and had to turn back.

For the ride back we only stopped a few times for the most interesting stuff.

Riding back with the vast grasslands in all directions always makes me feel like I am in Africa and it would not seem strange to see a giraffe or elephant in the distance. But luckily no lions dashing out after us! They have panthers in the Everglades (same really as cougars or mountain lions) but they are nocturnal.

15 miles in 4 hours did not set any speed records but we are avid photographers and took a long lunch break and short hike as well.

A totally perfect day!!!!

Garmin has auto pause … so 2 hours of actual pedaling.

As I doubt I’ll post anything else of our week in Florida here are some more nature photos from our week in Boca Raton.

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Short and sweet Meat!

I am going to try to QUICKLY write a post about the MOCA Meat Raffle I volunteered at on Friday night. It is Sunday morning at 5:30 am, and I am in my seat, with only a few minutes to write before the plane begins to move.

The flu epidemic seems to have peaked in New York State last week, but I am still wearing a mask on these flights (the only person on the plane) as I did when I flew to NYC in December. I don’t mind the funny looks from others; if anyone asks me why I’m wearing a mask, I’ll say I have cancer and shut them down.

Here is information about MOCA:

About Medical Outreach & Community Assistance of Western New York

Their last several missions have been to the Dominican Republic, doing gynecological surgeries. I wanted to go last year, but it ended up being the same time as when Alex and I went to Japan. I volunteered at the Meat Raffle last year. It was the first one I had been to. It is a VERY Buffalo experience. They exist in a few other regions of the U.S., but not many.

A meat raffle is a popular fundraising and social event, especially in the US Midwest (Minnesota), New York, Australia, and UK, where people buy tickets for a chance to win cuts of meat or meat trays by having their numbers drawn, often from a spinning wheel, with proceeds typically benefiting charities or local clubs. These events, originating from WWII British rationing, are social gatherings held in pubs or community halls, featuring various meats like steaks, ribs, or sausages as prizes, and sometimes include other raffles like 50/50s or themed baskets.

https://en.wikipedia.org/wiki/Meat_raffle

Even though I don’t eat meat, I had a great time volunteering last year. I told all my friends who hadn’t been to one to come this year, but only managed to entice 4. But there was a big turnout, and it raised $14,000 for the charity. There are MANY meat raffles every weekend in Western NY. They often raise money for people with medical bills, charity organizations, kids’ sports teams, etc.

The tickets were only $15 and included free beer and soda. The majority of the money raised, though, comes from people buying raffle tickets and hoping the spinning wheel lands on their number. Most people bring a meal to share with their friends, everything from fancy charcuterie boards to pizzas.

This photo is of Emma Nylander, MD (in front of Arty “party”), thanking everyone for coming and supporting the charity.

Before we got started, several of us separated the “funny” money into packs of 20.

Like last year, I volunteered to handle the meats rather than running around the tables and selling raffle tickets.

For each raffle round, I would bring out the meats and make sure the correct winners picked up their prizes.

Any meat not won in a round was returned to the walk-in freezer and then brought back out for the grand finale.

I bought 3 tickets for the finale and won a huge pork butt that I will bring to Big Big Table next time I volunteer there. My friend Mark won a bag of frozen shrimp. My other friends struck out 🙁

They also had many baskets and silent auction items to raise money.

If you want to donate to the charity and help provide desperately needed medical care to impoverished women in the DR, here is the link. Thanks.

Donate

Big Big Xmas Eve!

After finishing my post about the Buffalo Special Olympics Polar Plunge a few weeks ago, I wanted to quickly write about Big Big Table (to encourage year-end donations). But of course, LIFE! Despite the absolute shitshow our country has become over the last 11 months, I read several optimistic, heartfelt commentaries this week by writers I respect. I am still sceptical about the future of our nation, our species, and our planet, but I was inspired enough to find the energy to write.

Big Big Table is a “pay what you can” cafe. Amazingly, it is the ONLY one in New York State and one of only a few dozen nationwide. A few years ago, I saw a story on TV about one in another city and just assumed it was more common, as such an excellent idea.

In 2024, my friend Scott nominated Big Big Table as the charity partner of the year for our Buffalo Triathlon Club. One of their board members attended our spring members’ meeting and spoke about the charity. Many of us brought food items from the “wish list” to donate, and the club made a significant financial donation at the end of 2024, using proceeds from our annual banquet. One of our magnets is still on their fridge.

I went to the cafe a few times, bringing a few friends and my nephew from Boston when he visited Buffalo. The food was delicious, and it was nice to support a great cause simply by eating there. In 2025, I decided to start volunteering there, but they had to close temporarily in the spring. I was told that after five years, they were going to reboot the organization, and I should keep an eye on the Facebook page for updates.

https://www.bigbigtable.org/about-us

At the end of summer, I was happy to see they had announced their annual “gala,” so I bought a ticket.

It was a fun event with a great band. They thanked the new corporate donors and introduced the staff.

A few weeks later, they reopened.

Here is a news story that aired at the time.

https://www.youtube.com/watch?v=dXQi5oIDmoU

I did my first volunteer shift on October 30th. I was assigned as the kitchen helper. I spent some time washing dishes and helping the chef, but most of my time was spent cutting up a large box of eggplants donated by a grocery store. The chef planned to make babagounesh with them the next day. I felt like my work was needed (I was the only volunteer that day) and appreciated. The cafe can be run by the chef, the volunteer director (Morgan), the executive director (Karl), and the guest services employee (Terrell). Ideally, though, the executive director would not have to work all day in the cafe, since he has many other administrative duties, and the volunteer director would not have to staff the counter herself.

Here is a news story that was shown on the Spectrum channel this week.

I told them that I would work once a week from noon to 3 p.m. On some of my other days there, I was one of several volunteers, but the only one again on the afternoon last week. I also got trained to run the iPad ordering system and serve meals, and even helped prep “fancy” desserts. I also translated one day for a family from Puerto Rico.

While most people offer to do a small task to “pay” for their meal, many also give a few coins or a dollar or two. And every time I have volunteered, there has been one or more customers who surprised me by saying they wanted to pay the recommended $16 for the meal or even more by cash or credit card. It is gratifying to be able to treat people (who may rarely experience it) with dignity and serve them well-prepared, healthy meals in a restaurant setting. The staff and volunteers are people who commit their time (or their whole careers) to a cause I believe in, and I always feel energized after spending time with them.

Here are some photos of meals from a few different days. The chef creates tasty, healthy meals from whatever foods are donated. They always have a vegan option and one or two soups. An excellent local patisserie (The Fig Tree in Kenmore) has been donating desserts, and there is a farm-to-table partnership, as well as local grocery stores that help.

I always get a meal to take home for dinner! I am also learning a lot about cooking from the chefs (the original one has left for another job, and they are using some fill-ins until a new full-time person is hired).

To donate, here is the website link:

https://www.bigbigtable.org/give

If you are in Buffalo, please stop by for lunch sometime. The Cafe is two blocks north of Kleinhans Music Hall. Check the website or Facebook page to confirm they are open that day, as hours are limited until a new chef is hired.

https://www.facebook.com/BigBigTable

They are currently looking for a larger site, as the current cafe can only hold 20 people. It was actually at capacity for a while last week, and people were asked to come back in 20 minutes.

DON’T be a GEORGE this year. Give to a real charity!

And FIGHT for the rights of the least powerful members of our society, the hungry, the disabled, the immigrants!

Polar Plunge 2025

On Saturday, December 6th, I participated in the Buffalo Polar Plunge fundraiser for our local Special Olympics organization. I plunged into Lake Ontario in February 2023 with the 716Ruck group, but I missed it the last two years because of travel and other conflicts. That was actually not too awful; the water was only 35, but the air was almost 40, and there was no wind.

Open-water, cold-water swimming, and plunging into lakes or just tubs have become more popular. Here are some articles. I have swum in San Francisco Bay and a chilly pond in London. I did brief cold plunges in Iceland, but then jumped right into a hot tub. PLEASE

https://theconversation.com/why-wild-swimming-is-better-for-your-mental-wellbeing-than-open-air-pools-251971

https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/cold-plunge-after-workouts

When I saw a month ago that I would be home for the Polar Plunge event, I quickly signed up. I donated $50 myself, and donations from my nephew B and my friend J got me over the $125 minimum needed to participate. I didn’t make a considerable fundraising effort because I need to save that effort for my upcoming medical mission to the Dominican Republic in March 2026. You can still donate to The Special Olympics at the link below. They had several thousand Plungers over three days and raised $700,000!

https://events.nyso.org/site/TR/Plunge/POLARPLUNGE?pg=personal&px=1105061&fr_id=3314

I sent out a few requests on Facebook for people to join my “Team,” but it was only a few weeks out, and I got no takers. A few months ago, I formed my own Facebook group for people interested in swimming in Lakes Erie and Ontario after September, when all the official Triathlon club swims end. Feel free to join it even if you don’t swim or live elsewhere.

https://www.facebook.com/groups/1156604206529124

The Facebook page photo is of Lake Ontario at Porter Town Park on a windy day. A few people chose not to swim at all that day or stayed close to the beach. Rough water swimming doesn’t bother me as long as the water isn’t too cold. I’ve swum in water as cold as 47 degrees (while it was snowing). During Covid, when the pools were closed all winter, I was eager to start swimming in the spring.

The weather forecast for Saturday called for a balmy 35 degrees, with some wind off the lake and a little snow. Registration was from 11-1 and the plunge at 2 pm. I arrived at 12:20 and was surprised by the massive number of cars filling several parking lots. I was well bundled up except for my feet in just water shoes, and it didn’t seem too frigid on the 10-minute walk to the registration area.

A lot of people were “tailgating” as if it were a Buffalo Bills game. There were grills, fires, and tents, and a LOT of alcohol being consumed to steel people for the cold.

Registration was quick and efficient. They were out of all sweatshirt sizes except for small and XXL. There was an option to scan a QR code and have a medium mailed to me, but I just took a small one, which actually fit me fine. They were very nice sweatshirts! I took off the one I was wearing and put it on for a photo. The Beach bathrooms were open as changing rooms, but the plumbing was off for the winter, so they had porta-potties lined up nearby.

There was a giant warming tent, and I got some coffee and looked around. There were many people in great costumes. The bigger teams had assigned tables and were having picnic lunches and LOTS of alcohol. At one end of the tent, a local radio DJ fitness woman kept everyone fired up. The most popular costumes were Santas and Polar Bears.

After finishing my coffee and deciding not to buy any Special Olympics merchandise, I walked the 10 minutes back to my car to put away my sweatshirt and get my bag of towels and my boots. By then, it was 1:15 pm, so I decided to walk down to the beach to take some photos and enjoy a walk on the sand. However, as soon as I walked past the dunes that had shielded the parking lots from the beach, the wind was HOWLING. I fought the wind to climb to the top of a dune to get a photo of the waves crashing into the beach.

I forced a smile for the selfie while thinking, HOLY Crap! The windchill must be like ZERO degrees….

I then understood why there was NO ONE on the beach only 30 minutes before plunge time! I quickly returned to the warming tent and found a seat to wait until the last minute like all the other smart people.

It was now very crowded in the tent, which was great because of all the extra body heat.

They announced awards for the top fundraising teams and individuals. Special Olympics is such a great charity. A woman in the Buffalo Triathlon Club has a lovely son with Down Syndrome. I had to keep a close eye on Fifa one day to make sure she didn’t steal his breakfast sandwich at the lake. Next year, I need to see if she wants to get more BTC people involved. As people started to leave the tent, I saw that all the Polar Bears were wearing official Special Olympics shirts.

Such a great sentiment! I wasn’t trying to win anything, but I had set a goal of staying in the water for at least 88 seconds as December 6th would have been my late father’s 88th Bday. It was always easy to remember as the day before Pearl Harbor Day. He would have just turned 5 for that epic day.

Having not done the Plunge before, I didn’t realize until I heard people talking that, at 2 PM exactly, the “parade” from the tent to the Lake would begin, led by Special Olympics ambassadors carrying the torch and banners. As I didn’t have anyone with me to be my “towel holder,” I stripped down, set my towels and clothes by the exit, and asked someone to take my “BRAVE/Stupid” photo.

The wind was howling, and I don’t think I’ve seen the Lackawanna windmills spinning that fast in a long time.

I found a spot where the dunes provided a little shelter from the wind and waited to join the parade.

After getting a quick video, I joined the march. I had put on my after-swim robe over my bathing suit, so I had to drop it along with my towels on the way to the water.

As we neared the water, the parade stopped; the people at the front had reached the starting line and were held up there for a few minutes. It was cold for a few minutes while we stood there. Still, the energy was tremendous; people were jumping, yelling, and dancing to stay warm. A few minutes later, we saw the earliest people running out, so we marched into the water.

I didn’t have my phone for photos at the time, but there was a nice video on Facebook, and I even made a cameo just as the videographer cut to people exiting the water.

https://www.facebook.com/search/top?q=polar%20plunge%20for%20special%20olympics

With the prolonged heavy surf, the water was thick with mud and sand that immediately stuck to the skin. I was planning to walk slowly out to my waist and then submerge to my neck (I wore a hat, so no swimming). I didn’t get a good photo, but try to imagine a line of a dozen cold-water rescue folks in brightly colored dry suits, standing waist-deep about 50 feet from shore. You were clearly not meant to go past them, and as soon as the first waves splashed my body, the wind chill was awful. I didn’t even get past waist-deep before my legs and feet were in excruciating pain. At least I did better than the people who ran into knee-deep water and then right back to shore.

I shivered and panted as I toweled off, put on my robe, and took off my water shoes. I pulled on my sweatpants while holding onto a railing, but even though I had pre-treated my boots with baby powder, it was tough to put them on, as my frozen toes spasmed and pointed in all directions. Eventually, I maneuvered my feet snugly into them, but they never warmed up. I had to take off my robe to put my sweatshirt on, and then when I walked to the shoreline to get a photo, everyone had already left the water, even the lifeguards.

Everyone walked, or stumbled, back to their cars and the warming tent. I slowly walked back to my car, shocked by how awful I looked in the mirror, so I took a selfie.

And if the parking lot full of tents and grills reminded me of a Bill’s game beforehand, it was even more so afterwards, when it took me a full 30 minutes to get out of the crowded parking lot. Next year, I will know to park as close to the exit as possible. Even with my heated steering wheel, seat, and heat on high, I was still frozen when I got home. I took a hot shower and an epson salt bath!

Even better would have been if my neighbor had been home; she keeps her hot tub at 104 all winter! It is nice on snowy evenings.

The next morning, I went to a 90-minute Hot Yoga class (108 degrees, 50% humidity), quite the extreme difference!

And in the afternoon, I watched the Bills’ snowy, windy, cold game on Sunday. With enough alcohol, people can tolerate a lot of COLD.

PLEASE Subscribe, Like, Share, Comment!!!! And…. local people next year join my “Team”, you don’t even have to get wet, you can help fundraise, tailgate, and towel hold!

Music, Politics and Peat!

Just found this unfinished post from a month ago today, 11/26/25 !

Argh! It has been a full month since I last wrote. I wanted to do a blog about the summer and fall concerts I enjoyed. Then I meant to do a blog about the No Kings rally in Buffalo, but I have been so busy that it just never got done. Now I have a somewhat quiet day at work supervising only two CRNAs and will use my extra time (now that our last patient is in the operating room) to write!

It is the day after the election and I am elated about the huge anti-Trump turnout at the polls! Mamdani won in NYC and a black woman is now mayor of Albany.

July 4th, 2025

Just found this on phone today !! 11/26/25

I received this emailed article today from Anesthesiology News, I copied and pasted so I can share without the paywall blocking you.

U.S. Healthcare in 2025

By Henry Buchwald, MD, PhD

‘Dependence begets subservience
and paves the way to tyranny.’

—Thomas Jefferson

This is the black box warning for the state of U.S. healthcare in 2025. In my previous writings on this subject in “Healthcare Upside Down: A Critical Examination of Policy and Practice” (Springer, 2022), and General Surgery News (December, 2023), I focused on the statistics of the clinical outcomes of our current healthcare system: U.S. life expectancy is 26th of the 38 countries in the Organization for Economic Cooperation and Development. Infant mortality is 51st in the world, lower than all the Western European nations, Canada, Australia and New Zealand. The overall U.S. mortality rate is 150th of 227 nations, within the 35% highest of all rated nations. Similar numbers exist for the other five universal healthcare criteria.

Yet we pay the most of all nations for our healthcare: $14,000 per person annually, or 17% of the gross domestic product (GDP), compared with $6,000 per person, or 10% of the GDP for comparable nations. Roughly 60% of the costs of U.S. healthcare are met by the government, that is all taxpayers, fitting the primary definition of socialized medicine; 30% are paid by private insurers; and 10% are out-of- pocket payments, such as copays, uncovered services and others.

Of the top 10 Fortune 500 companies, five are in healthcare. About $5 trillion is invested in healthcare annually, with an average profit margin of 3.5%, yielding $40 billion in profits for administrators and shareholders. The CEOs of these companies, even the not-for-profit ones, rarely have annual incomes less than $10 million, with some as high as $25 million. The smart, wealthy and relatively healthy investor will never purchase private insurance; they collect their eligible government subsidies when qualified and meet their healthcare expenses through a fraction of their returns on investments, even profiting at times from the insurance payments of middle-class families that find it prudent and responsible to purchase health insurance.

Healthcare is a right, not a commodity. But even if it were a commodity, the basic tenet of a business is that a company that provides inferior goods or services at the highest prices cannot survive, but ultimately will lose out to competition. Yet the U.S. healthcare system is fairly unchallenged. In this thesis, I draw attention to that enigma. In addition, U.S. healthcare is unfriendly to its customers, the clients—formerly referred to as patients—and this system denigrates the actual healthcare providers, previously known as doctors.

Most people wish for a doctor–patient relationship apart from that available in emergency rooms or urgent care centers. They would like sustainability, availability and personal attention when they need healthcare. If patients recognize that the doctor assumes responsibility for their welfare, they will, in turn, offer the doctor their trust. This reciprocal accord has been a hallmark of good medical care and outcomes; this accord is, unfortunately, absent from today’s healthcare.

Today, initiating, or attempting to maintain, medical care starts with a phone call to an office practice or clinic. A robot answers the phone and tries to persuade the caller to call 911 instead. If this suggestion fails, the caller is given a list of options from which to choose by pressing a number on their phone. That done, there is often a prolonged interval of bad music before another robot, as cold and impersonal as the first, will ask further questions of the caller or tell them to call back another day. If the potential client/patient answers this robot’s questions satisfactorily, a human voice might answer, but only after another stretch of bad music. This is the first interrogator. The first and only concern of this individual is how the client is going to pay. If the client proves financially qualified, they will be passed on to a doctor’s assistant, possibly a nurse, who will now assume the interrogator role. The caller’s personal, occasionally intimate, information must now be revealed in a conversation the client had hoped to discuss with the doctor. If the prospective client/patient refuses to answer a specific inquiry, stating that they will only discuss that with the doctor, they can be refused further progress by the gatekeeper. Is this forced, mandatory interrogation of the patient by a stranger not in violation of HIPAA?

In this introduction to medical care, and from thereon, the client/patient is immediately, without their consent, referred to by their first name. This universal assumption of intimacy in today’s healthcare is, to my mind, not a sign of empathetic commonality but the imposition of inferiority on the client/patient-a status of servitude in the upcoming relationship.

In the healthcare facilities’ business model, client/patient outpatient visits are made to fill open, usually 15- or 30-minute time slots, with physicians or nurse practitioners who are available and have the least clientele. Requests for particular doctors can be denied by the intake staff, stating that the desired provider is not taking new patients. Requesting to have a fairly urgent visit with the provider first seen by the client/patient can be scheduled so far in the future that it is unreasonable for the patient’s needs.

After an interval wait in the examining room, the client/patient will see an assistant who, after addressing the client/patient by their first name, will sit at a computer terminal and take a complaint history, as well as ask a compulsory set of questions. This person, or a second assistant, will then record the client/patient’s blood pressure, pulse and oxygen saturation, and leave, stating that the doctor will be there shortly. The doctor, in today’s system, will sit in front of the computer console; briefly review salient computer-recorded data; possibly do a cursory physical; discuss the problem with the client/patient; and order multiple laboratory, radiology or other tests, services or consultations. The visit is completed by the client/patient being given a printout of instructions. All this takes place within an allocated time slot. FFew client/patients have ever experienced the transient doctor spending their time together face-to-face, or holding their hand as a comforting, empathetic gesture.

Hospitalization of a client/patient follows a similar, impersonal business model. The actual referring physician may lose control of the client/patient to the physician on-service. Night events are managed by hospitalists. The floor nurses spend more time with their computers than with the client/patients. There are today even instances of surgeons on clock-monitored shifts in performing an operation. In major surgery institutions, an assembly-line system is in place, with surgeons going from OR to OR without time for a preoperative or postoperative visit with the client/patient or their families—a time-consuming task assigned to others.

Administration encourages admissions to hospitals, and, on the other hand, early hospital discharge. At the beginning of hospitalization, money is made by laboratory services, consultations and therapies. If the admission is for surgery, that money-generating event occurs before or early, during admission. Recuperation, pain and comfort control after surgery are accelerated because the hospital bed can be used for more lucrative activities. Referral to an affiliated in- or outpatient, income-producing rehabilitation facility is an alternative.

For the most part, physicians serve an integral role in the current healthcare system. Most physicians in urban settings, including surgeons, are now employees of a healthcare conglomerate. They have elected for a job, an employer–employee relationship, rather than living the responsibilities and hardships of independence in pursuing a calling. They have accepted the prescribed clinic hours, divided in-hospital management, and impersonal assembly-line model of providing care to clients/patients. Further, they have agreed to having administration make some of their practice decisions, such as what drugs are preferred, and which operations are approved and which are not.

A recent, almost unbelievable, egregious violation of medical practice was the imposition by a healthcare payor of a time limit for OR anesthesia. If the operation lasted longer than anticipated, the cost of the anesthesia would have become a client/patient, or provider, responsibility. After some hue and cry, this mandate was rescinded. However, it may only be a prequel of what is to come and what will be tolerated.

The great majority of today’s physicians accept this denigration of the ethos of our profession in exchange for prescribed working hours, limited and scheduled night call shifts, planned vacations, extended maternal and paternal leave, paid-for insurance, retirement benefits and additional perks, as well as freedom from billing and other administrative chores. This generation of physicians is concerned with achieving personal and family quality of life. They justify their belief in this system as actually resulting in better medical care. The statistics of the ever-increasing rate of physician burnout and early retirement do not support that conclusion.

In his farewell address, former President Dwight D. Eisenhower warned the nation of the dangers of the military–industrial complex, if left unchecked, to our democracy. The healthcare industry lobby influences our legislature, which is mostly composed of lawyers. Although most law firms insist on 50 hours annually of pro bono work from their attorneys, the federal government lawyers have passed four laws severely limiting that same right to doctors: the Anti-Kickback Statute of 1986, the Stark Law of 1989, the False Claims Act of 1863-2009, and the Civil Monitoring Penalties Law of 2015. Convictions under these edicts include monetary damages, jail time and loss of licensure. The language of these acts is applicable to waiving a copayment, not charging indigent patients and providing professional courtesy medical care to another physician’s family member (an actual requirement of the Hippocratic Oath). Thus, a mechanic at an automobile company can fix a neighbor’s car after hours, but a hospital-employed physician may not offer free medical advice to their neighbor after their designated work hours.

Some physicians have opted out of today’s healthcare system. A few with established reputations have managed to remain independent and only accept payment up front, leaving the patient out-of-pocket or to fend for themselves to collect retroactively for their care from their health insurance companies. Others have taken ownership in a hospital, and therefore reaped the system’s managerial benefits. In wealthy communities, a new class of practitioners has risen: the concierge doctors. For $2,500 to $25,000 annually, potential patients can pay to have a personal doctor who will answer their phone calls, see them at the patient’s convenience and take responsibility for their medical needs. This payment is independent of the concierge doctor’s charges to their client’s insurance—government or personal—for the actual care they provide.

There have been a few attempts by physicians or their group practices to fight the current healthcare status, usually without success. Physician organizations, for example the American Medical Association and the American College of Surgeons—formed to promote education, set standards and provide networking—have not taken, individually or jointly, strong positions in opposition to the business–healthcare complex. The most cogent reason imaginable for this lack of involvement is that the greater percentage of their younger dues-paying members have embraced or yielded to the current system.

Our country’s inhabitants, in one way or another, have exhibited the age-old response to this healthcare system: Don’t make trouble. If trouble is to be made in the future, I believe it will have to come from organizations, labor unions, encompassing professional institutions; or even one or more billionaires offering a successful business model that, at a reasonable cost, benefits the consumer—all of us as patients, sooner or later.

Paying to grovel should not be the American way!

Dr. Buchwald is professor emeritus of surgery and biomedical engineering, and the Owen H. and Sarah Davidson Wangensteen Chair in Experimental Surgery, at the University of Minnesota, in Minneapolis. His articles appear every other month.

I am constantly disgusted that more than 50% of health care “spending” goes to administration, advertising, lobbying, and stockholders. If we just switched to Medicare for all and eliminated direct to consumer drug advertising there would be more than enough money to provide good, accessible health care to every person in the USA. The super rich could purchase extra care for cash like they do in Europe but with 95% of the population under the same health care umbrella there would be continual support for its existence.

72 hours in Boston

It has only been five days since I returned from Boston, so this is one of my most promptly written travel blogs.

Buffalo’s endless summer continues. It is expected to reach 80 degrees today and remain sunny throughout the week. In a few hours, I am heading down to Hamburg to do some Stand-up Paddling (or mostly on my knees, unless Lake Erie is flat as glass, like it was on Saturday when I swam there).

I got a short GoPro video of my friend Mark. I was hoping to get some good fish photos, but I only saw some minnows.

Writing outside is a luxury I won’t have for much longer, so I am settled with some Tim Horton’s iced coffee and The Grateful Dead playing. Fifa was out for a little while, but then asked to go inside. Maybe too hot for her fur coat.

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Sunday, September 21st. Buffalo to Brookline.

I visit Boston almost every year for Passover in the spring and then for either Rosh Hashanah or Yom Kippur in the fall. My sister L lives there, and my mom always flies up from Boca. My nephews J and B are always there, and usually my kid comes too, but they couldn’t get off work this year.

There are fewer direct flights on JetBlue than in the past, so I had a very early morning flight there. I wasn’t planning to wear a mask for the flight, but there was a child with a hacking cough by the gate, and luckily I had a mask in my backpack. I had gone to a concert a few days earlier with someone who tested positive for Covid the next day, so I didn’t want to take any chances. I had received both the Flu and COVID vaccines two weeks ago at Wegmans, but I had contracted the Flu last year, and it wasn’t very pleasant despite being vaccinated. I was the only one on the flight with a mask, and I could pick out the MAGA-Trumpers as they did the eye-roll when they saw my mask. Of course, I could have been someone with a bone-marrow transplant or protecting THEM from my cough, but they would still glare.

The flight was smooth after a 30-minute delay waiting for it to be fueled. I got a nice photo of the Hudson River near Troy, NY. And then some good approach ones into Boston.

The weather was perfect on Sunday, Monday, and Tuesday!

I am always so happy to see my favorite nephew, SNOOPY.

He loves chasing his toys! A few days earlier, he had been barking furiously on the back deck, and L and G saw a COYOTE crossing the backyard. We have always had them in Amherst, but they are definitely spreading more across the northeast. Romeo and Juliet are big celebrities in NYC.

I was supposed to attend a New York Mets game with my Albany Med classmates, Chris, James, and Peter.

My campervan being held hostage made my planned journey from Buffalo to the Jones Beach 70.3 IM race, then the Mets game, driving to Boston for Rosh Hashanah, and then back to Buffalo impossible.

I guess just as well, as I missed the tough 2-3 loss to the awful Nationals. I had seen Chris and James in Albany in April at our 35th reunion, and would see Peter in Boston. And of course, the Mets lost yesterday when a win would have gotten them into the playoffs! I am more of a Yankees fan, but I try to support the Mutts also. The Yankees won the last game of the season yesterday, but damn, Toronto also won, so the Yankees lost the division and now must play the Red Sox tomorrow in the wildcard playoff. (why is it ALWAYS the Red Sox).

The Mets game wasn’t on TV, so instead I watched the now-awful Patriots football game with the relatives.

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Monday, September 22nd. Walden Pond.

I have visited Walden Pond at least a half dozen times over the 35 years my sister has lived in Boston, but I had never swum in the pond. Since I have started incorporating open water swimming (OWS) into my travels, I checked on my last visit and found out it is allowed to OWS in Walden Pond. But the weather was not good the day I had available last time. This year, the weather was perfect, and the website reported that the water temperature was 68 degrees.

It was an easy 30-minute drive north (against the rush hour traffic), and parking was only $8! If I lived in Boston, I would be there at least once a week (on days when not swimming in the ocean).

While adding the sign photo, I saw something move in front of me, and it was a cute squirrel heading across the lawn. I have also seen a big dragonfly, some small, whitish-yellow butterflies, and some bees and grasshoppers.

It was only a few minutes to walk from the parking lot (next to the visitor center) across the street and down a trail to the lake. I saw a cute chipmunk! 🐿️

Two people were swimming in the lake, one canoe, and a kayak. There was also a group of five young people in sweatshirts sitting on the beach in the sun (the air temperature was only 55 degrees at 8 am).

I could tell when I stepped in the water and splashed my face that it was well over 68 degrees, probably more like 72. I had only planned to swim for 30 minutes, but the water was so warm and clear, and the day so perfect, that I completed a full loop of the entire lake and then took off my wetsuit to swim another 15 minutes in just my Speedo. I saw many minnows, bluegills, and a few small bass. The people in the canoe were fishing in the center of the lake; maybe the bigger fish were out there. At the north edge of the pond is “Walden Cove,” which is very close to the site of Thoreau’s cabin. He would bathe daily in the pond and get his drinking water there. In today’s disastrous world, I think two years in a small cabin by a pond would be amazing (except in the depths of a New England winter…).

Before I took off my wetsuit, I had seen a swim buoy not moving by the shore and swam over to investigate. There was a guy in a wetsuit with just his head out of the water, pointing a GoPro at the shore. I thought maybe there was a turtle on a rock, but it was actually a Green Heron.

I typed “green heron” into my Mac Photos app, and it found this photo I took in 2004 in the backyard at Royalwoods! AI is one step closer to “Terminator”.

I went back to the car and put on some clothes for a short hike. I had brought my pocket Thoreau that I have had for decades. I read it occasionally on my van trip across the country in April 2022.

Black Hills National Forest

The back cover says that all the proceeds went to support the site, so I am getting my money’s worth!

After I got out of the water, I noticed several more swimmers, and a few more were heading down to the lake as I started my hike. The temperature had warmed a bit, and the young people had stripped down to swim trunks and bikinis and were wading in the pond.

It was a pleasant flat trail along the north shore of the pond. I saw a lot of chipmunks, one even ran just past my shoe.

I saw a few people, but I mostly had the same solitude as Thoreau. I was the only one at the cabin site.

The site of his cabin is very much in line with his beliefs. There are just simple wood and stone markers.

I loved how the cabin was just a few hundred yards from the pond on a slight rise. In his book, he mentions how the view of the pond changed over the seasons. I walked down a short path to the edge of “Walden Cove”, where I had seen the bluegills while swimming.

The path back through the woods was tranquil except for the sounds of birds and chipmunks. The trees were very tall and varied.

At one point, I heard a lot of skittering and saw two chipmunks playing a game of tag. One of them finally paused long enough for a photo.

I liked this VERY rustic bench.

There were some nice interpretative signs along the trail.

The replica of the Thoreau cabin is located right next to the parking lot by the visitor center, making it accessible to all visitors.

I thought it seemed VERY cozy. And if I were able to live in a van for two weeks, two years here would be great. I really liked the writing desk.

I hadn’t been to the visitor center in many years and was excited, but then I was disappointed to see how small it was—basically just one room.

I found the log history very interesting. It marks key publications by both environmentalists (Rachel Carson, E.O. Wilson) and civil rights leaders (Gandhi, MLK Jr.).

There was a giant map of the world on the wall with information about critical nature preserves and a visitor book where one could write about one’s own “Walden” (or “own private Idaho..? “).

Thoreau was a powerful advocate against slavery in Massachusetts and also against the Mexican-American War.

All men recognize the right of revolution; that is, the right to refuse allegiance to and to resist the government, when its tyranny or its inefficiency are great and unendurable. But almost all say that such is not the case now.Henry David Thoreau, “Civil Disobedience” (1849)

#resist

Unjust laws exist: shall we be content to obey them, or shall we endeavor to amend them, and obey them until we have succeeded, or shall we transgress them at once? Men generally, under such a government as this, think that they ought to wait until they have persuaded the majority to alter them. They think that, if they should resist, the remedy would be worse than the evil. But it is the fault of the government itself that the remedy is worse than the evil. It makes it worse.Henry David Thoreau, “Civil Disobedience” (1849)

#trump=fascist

“Much has been said about American slavery, but I think that we do not even yet realize what slavery is. If I were seriously to propose to Congress to make mankind into sausages, I have no doubt that most of the members would smile at my proposition, and if any believed me to be in earnest, they would think that I proposed something much worse than Congress had ever done. But if any of them will tell me that to make a man into a sausage would be much worse—would be any worse—than to make him into a slave—than it was to enact the Fugitive Slave Law—I will accuse him of foolishness, of intellectual incapacity, of making a distinction without a difference. The one is just as sensible a proposition as the other.”

― Henry David Thoreau, Slavery in Massachusetts

#blacklivesmatter

There is a small theatre that shows a 15-minute movie about Thoreau and his legacy. Gandhi studied Thoreau’s writings on Civil Disobedience while protesting racism in South Africa as a young lawyer, and then incorporated them into his philosophy to liberate India.

From “On Civil Disobedience,” by Mohandas Gandhi
July 27, 1916

“There are two ways of countering injustice. One way is to smash the head of the man who perpetrates injustice and to get your own head smashed in the process. All strong people in the world adopt this course. Everywhere wars are fought and millions of people are killed. The consequence is not the progress of a nation but its decline. Soldiers returning from the front have become so bereft of reason that they indulge in various anti-social activities. One does not have to go far for examples. Pride makes a victorious nation bad-tempered. It falls into luxurious ways of living. Then for a time, it may be conceded, peace prevails. But after a short while, it comes more and more to be realized that the seeds of war have not been destroyed but have become a thousand times more nourished and mighty. No country has ever become, or will ever become, happy through victory in war. A nation does not rise that way, it only falls further. In fact, what comes to it is defeat, not victory. And if, perchance, either our act or our purpose was ill-conceived, it brings disaster to both belligerents. But through the other method of combating injustice, we alone suffer the consequences of our mistakes, and the other side is wholly spared.

Gandhi during the Salt March, March-April 1930.

This other method is satyagraha. One who resorts to it does not have to break another’s head; he may merely have his own head broken. He has to be prepared to die himself suffering all the pain. In opposing the atrocious laws of the Government of South Africa, it was this method that we adopted. We made it clear to the said Government that we would never bow to its outrageous laws. No clapping is possible without two hands to do it, and no quarrel without two persons to make it. Similarly, no State is possible without two entities (the rulers and the ruled). You are our sovereign, our Government, only so long as we consider ourselves your subjects. When we are not subjects, you are not the sovereign either. So long as it is your endeavor to control us with justice and love, we will let you do so. But if you wish to strike at us from behind, we cannot permit it. Whatever you do in other matters, you will have to ask our opinion about the laws that concern us. If you make laws to keep us suppressed in a wrongful manner and without taking us into confidence, these laws will merely adorn the statute-books. We will never obey them. Award us for it what punishment you like, we will put up with it. Send us to prison and we will live there as in a paradise. Ask us to mount the scaffold and we will do so laughing. Shower what sufferings you like upon us, we will calmly endure all and not hurt a hair of your body. We will gladly die and will not so much as touch you. But so long as there is yet life in these our bones, we will never comply with your arbitrary laws. ”

Martin Luther King, Jr. learned and incorporated the philosophies of both men.

Nelson Mandela studied Gandhi and incorporated his anti-colonial philosophy.

https://thenonviolenceproject.wisc.edu/2024/03/16/investigating-the-meaning-and-application-of-civil-disobedience-through-thoreau-gandhi-and-martin-luther-king-jr

Thoreau is also known as a key member of the Transcendentalist movement in Concord, MA. Here is a little synopsis.

Birthplace of the Movement: Concord is considered the hub and birthplace of Transcendentalism, a uniquely American philosophical and literary development.
Core Tenets: The movement championed the inherent goodness of man, the profound importance of nature, and the power of individual intuition over strict logic and reason.
Key Figures:
- Ralph Waldo Emerson: Known as the father of Transcendentalism, his work Nature (1836) was a key text for the movement.
- Henry David Thoreau: Author of Walden, he explored the connection between man and nature in Concord’s landscape.
- Bronson Alcott: A key figure who influenced the movement, and father of author Louisa May Alcott.
Intellectual Hub: Emerson, Thoreau, and the Alcott family lived within a few miles of each other in Concord, forming a tight-knit community for discussion and writing.
Influence of Nature: The natural beauty and landscapes around Concord, such as Walden Pond, were central to the Transcendentalists’ philosophy, serving as a source of inspiration and a place for spiritual connection.
Literary Output: The collaborative environment in Concord led to the creation of influential works that shaped American thought, literature, and philosophy

https://www.britannica.com/event/Transcendentalism-American-movement

The last time I visited Concord, I went to the Sleepy Hollow Cemetery and explored “Authors’ Ridge”.

Interestingly, Thoreau was influenced by Hindu philosophy… as The Dude says…

Hindu Texts: Thoreau borrowed and integrated concepts from Hindu scriptures, especially the Bhagavad Gita and the Laws of Manu, into his work to articulate his views on the divine and nature.
Transcendentalism: Indian philosophy resonated with the core beliefs of American Transcendentalism, particularly the idea that the divine is within nature and the individual, and that a spiritual life is paramount.
William Emerson: His friend, William Emerson, was influential by translating Sanskrit texts, introducing Thoreau to Hindu literature and the concept of the divine within nature.

Integration into Thoreau’s Work

Walden : In Walden, Thoreau employed Hindu imagery and structures to express his biophilic view of nature.
“Theatrical Performance” Theme: He used a common theme in Indian philosophy where worldly activities are like a theatrical performance, with the transcendent soul acting as a witness, as described in Walden.
Nature as Divine: Thoreau elevated nature to a divine status, similar to God, by integrating religious structures to appreciate it.

Conceptual Parallels

Monism: Thoreau’s interest in Hindu philosophy was monistic, aligning with the belief in a single, underlying reality.
Pandeism/Pantheism: His rejection of a separate God, in favor of God being present in the world, aligns with the pandeistic or pantheistic approach found in Hinduism.
Jnana Yoga and Karma Yoga: Thoreau identified with the concepts of Jnana Yoga (the yoga of wisdom) due to his intellectual pursuits and Karma Yoga (the yoga of selfless action) through his renunciation of worldly pursuits.

On the drive home, I stopped to pick up the chopped liver (none for this pescatarian!) for Tuesday’s Rosh Hashanah feast (and some hamantaschen). Waze took me through Cambridge, and if I had more time, I would have visited Harvard Yard, where I haven’t been in decades. I drove right through Boston University as well, and hundreds of college students were enjoying the summer weather.

The house smelled great when I got back, as my sister and mom had been cooking.

Snoopy snuggled on the couch with me after I walked him.

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I ran out of writing time the other day. Had an incredible afternoon SUP on Lake Erie while my friends Michael and Mark swam. 82 degrees and water still 68. The end of summer on America’s North Shore!

Tuesday, September 23rd. Brookline, Boston, Sharon.

My college (Johns Hopkins) friend Alan lives in Brookline Village, just two miles from my sister. He is a runner, and we often manage to run together in the morning when I am in Boston (or coffee if the weather is bad). He asked if 7 am was “too early,” and I reminded him that I am an anesthesiologist and triathlete! Al is an endocrinologist at Boston Medical Center. He went to medical school in Buffalo, so I also get to see him when he attends reunions here. His son and my kid are the same age.

We ran a slow, chatty 3 miles to the hospital, being careful not to get hit by Boston’s rush-hour drivers and avoiding all the people walking to work on a perfect fall day. I didn’t take any photos until after saying goodbye to him. I didn’t plan to run so far, but it wasn’t until after I looked at my phone map that I saw my run had been a perfect straight line East, so there was no “shortcut” back. Luckily, I had brought a water bottle with me and was able to refill it at a park.

I found the original Brigham Hospital tucked in behind the huge current campus. It had a sad display about opiate deaths.

Snoopy wanted to play as soon as I was back!

I spent a few hours working on my essay/post about John Cage and Zen. Lisa’s coaster was very appropriate.

My mom and sister looked very nice when they returned from the temple.

When my child was young, we used to attend services with them, but now I only enter houses of worship for weddings, funerals, or Bar Mitzvahs, or as a tourist.

Relive made a very short video of my run.

https://www.relive.com/view/vr63e39Rk8v

Peter, my classmate from Albany Medical College, lives about 45 minutes south of my sister, and I try to see him whenever I’m in Boston. As the weather was so glorious, I suggested we take a short hike rather than having our usual meal or coffee. On Google Maps, I found a big green area between Brookline and Easton. It was the Moose Hill Audubon Refuge in Sharon.

I arrived first and went inside to pay the $4 entry fee. I also bought a bottle of maple syrup that they make themselves for my sister.

There were miles of trails to choose from, but we took a short one to see a fire tower.

There were several old rock walls.

The fire tower was locked, and the trees were so high at the summit that we had no view. Foxboro/Gillette Stadium would have been to the NE.

When I got back, the table was set, and Snoopy cuddled with his furry friends.

We were 10 people for dinner, but the only photo I got was of Snoopy.

I guess we were having such a good time that we all forgot to get a group family photo. Here is an archival one from April 2025.

I got lots of food selfies at least. L had salmon for me as I don’t eat cute 🐑.

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Wednesday, September 24th: Boston to Buffalo.

I had an early flight back. It was a little rainy.

I saw on Facebook that I was going to get back too late to see the replica Erie Canal boat begin its journey from Buffalo to Manhattan to celebrate the 200th anniversary of the canal.

I had seen the Seneca Chief being built in a shed at the waterfront a few times over the last two years. They used traditional materials and methods.

Once we got a little west of Boston, the skies cleared, and it was sunny in Buffalo.

Home is where the pup is!

U.S. Healthcare in 2025

From “On Civil Disobedience,” by Mohandas GandhiJuly 27, 1916

From “On Civil Disobedience,” by Mohandas Gandhi
July 27, 1916