Friday, March 25, 2011

60 Orphans of Diquini

Mar 16

Today was club foot clinic with large general clinic.  We had a half dozen surgeries ending with a TSF on  older child with neglected clubfoot.  Ben and I also did a tendon transfer for severe spastic wrist flexion deformity.  We had a difficult reduction in a 7 y/o with a fractured distal radius.  Jeannie is extremely tired and not feeling well.  I hope she isn’t getting sick.  She has been trying to make our bare little room look ‘pretty with a nice mirror over the sink and a couple of very nice Haitian paintings that she got framed.  All in preparation for Tim and Summer(our youngest daughter and her husband) arriving tomorrow.  We inflated the air mattress and put up a mosquito net with Randy and Sam’s help.  We have a makeshift table with a hotplate.

Scott and I are anxious to get out and do some exploring with the pickup/taptap to be.  It may not happen since we have 13 cases on the schedule for tomorrow. We probably won’t finish until 2 or 3 in the morning.  It has been great having the C-arm working again.  We used it a lot today.  Jeannie tried to come down and work but after a few minutes had to go back and lay down.  It is a virus that has pretty well got her number.  I hope it doesn’t last long, especially with Summer and Tim coming tomorrow.

Mar 17

My prediction was off by a few hours.  We started by working on the spine case.  I needed to reposition the upper screws since I had put them in without C-arm and missed the pedicles with all four.  The bottom four were good.   Scott also wanted to try to get a better reduction.  It wound up nearly perfect!  I am anxious to do more of them now.  We kept cranking out the cases as the day and evening went on.  Scott and Ben did a CP with bilateral femoral and pelvic osteotomies.  Scott and Ben also did the case of the 7 year old orphan boy with the severe burn and knee flexion contracture and foot equinovarus.  It is one of the most complex frame cases he has ever done.  It involves an Ilizaroff frame for the knee connected to a TSF for the foot.  They started by excising the web scar and full thickness grafting the defect taking the graft from the opposite leg.  The flexion decreased from 110 degrees to 70 degrees. It really looks good.  I continue to be amazed at what can be done at this hospital with all of the equipment, implants and specialists coming on  a regular basis.   I gave up the effort at 2 am while Scott and Ben did one last case and finished about 4:30.  It was an exhausting day for most of us.    Summer and Tim got in with out problems.  It is so great to see them.  They brought the Doppler as well as a mountain of other things including some of our favorite food items.  It is a Godsend that they came today.  They were able to recover our patients through the night.   Tim normally works nights so it was no problem for him.  Scott leaves tomorrow.  No, we didn’t get to use the pickup again.  Nathan will try to get it registered and insured as soon as possible.

Mar 18

 I was so bushed most of the day yesterday.  I had a fairly long meeting with Nathan and Dr Simeone over the girl that died.  The parents came to the clinic area and wanted to know about the autopsy.  It is not possible in Haiti at this time to get autopsies.  They wanted to know if we were going to help them with the cost of the funeral(upwards of $2500 US).  A simple yes or no would have sufficed but Dr Simeone wanted to ask me about the details of the case and as typical, it took way longer than necessary.  The answer was 'no.'

We concentrated on the clinic in the morning and for some reason, the femur case didn’t get going until mid-afternoon.  Ben really enjoyed the case even though it was an infection.  He thought that we had really helped the patient by debriding the infection and removing the infected rod and then making and inserting an antibiotic coated IM nail.  He is so enthusiastic about everything in orthopedics.  Then we had the below knee amputation that needed revision to an AK (above knee amputation).  Ben had never done an AK.  Then we had the infected toe case.  We finished at nearly 9pm.  I certainly enjoyed going to bed a bit early.  Both Tim and Summer have already been a big help.  The AC finally got fixed in OR room 2.  We are now back in pretty much full operation.

May 19

Another Sabbath is here.  What a wonderful experience!  No clinics or elective surgery.  Jeannie is feeling much better although I am sure is very weak.  We all took our time getting ready to go up the street to the English church service at the Adventist university.  Ben and I made rounds and the patients seem to be doing fine.

Steve, Ben, Tim and I decided to try out the pickup and see if we could get some pictures of the countryside.  We went up Diquini 63 which starts out paved but soon turns into a rutted rocky road worthy of a 4 wheel vehicle.  We had to stop several times as we climb steadily up the hill to let oncoming taptaps pass on the very narrow road.  We eventually arrived at a spot that Steve thought he recognized as an orphanage that he had been to on a previous trip.  It was a very steep climb to the tiny structure where Mary Lou keeps 15 of the cutest kids. They are all clean and seem well fed.  They have bright smiles and shyly respond to ‘como ou reley’(what is your name) and ‘ke la zhou’(how old are you?)

It is a difficult thing for me to say ‘au revoire’ and turn and slowly pick my way down the steep hill and leave kids like this.  We have so much and they have so little.  The pickup continued to manage the “going up” just fine but the “down” had its challenges.  The brakes definitely need some serious attention.  We were led by Wilson from the first orphanage to a spot on a hillside overlooking the hospital and the bay.  There was a nice breeze blowing.  We went on to one of the springs where there were dozens of people getting water for home use, washing clothes and bathing. It was very interesting.  We went on to Wilson’s orphanage and met about 25 of his 45 charges. They were all lined up on the roof and sang a song for us about how they had been waiting and why did it take us so long to get there.  It took a bit of coaxing but got most of them to interact.  They loved taking pictures with our cameras.  I got some good pictures of them drinking fresh coconut milk out of a freshly cut coconut.  I also got some pictures of several kids flying their kites.

Tuesday, March 22, 2011

Rebuilding Bones and Strengthening Relationships in Haiti with Dror Paley

Mar 12

Dror Paley (far right) and his team with Terry and Jeannie
Dr Paley and team arrived well before noon and we started seeing patients and then doing surgical cases.  Dr Paley put a miter TSF on a patient with a severe clubfoot deformity.  It is complex and will require a lot of attention to make sure the program is followed and works.  There tend to be collisions of wires and pins with connecting rods.  Those have to be identified and dealt with so that the program is successful.  Scott and I worked on the C-arm until nearly midnight but were unsuccessful at getting it working.  The service disk doesn’t seem to be working properly.  Scott has two more copies but they are in California.  We’ll try to have them sent to Summer who will be coming on Thursday.  Not having the C-arm means that some of the cases will have to wait.

Mar 13

A severe case of Blount's after correction
We had lots of challenging but interesting cases including severe bilateral Blounts disease.   A German ophthalmologist who works for CBM came in this morning to see me.  He injured his Achilles tendon last night while dancing.  It was a complete rupture.  I repaired it surgically today.  We finished the last case after midnight.  Dr Paley and Scott each did a side on a patient with severe Blounts even though we didn’t have C-arm available. They are both really talented surgeons.  Scott asks Dr Paley questions frequently.  Dr Stephen Mulder arrived today.  He is an anesthesiologist who practices in California.  He has been here before and has an interest in the orphanages.  He is 6 feet 9 inches tall.  He is a graduate of LLU.  We were on the campus of LLU during the 1977-1978 school year.   He is an avid windsurfer!  He lives and practices in the same town where Dr Nelson’s parents live.  He is very smooth and not intimidated by virtually anything.  He loves to read and has a great sense of humor.   I think we are going to have a good time with him.  He will be here for two weeks.

Mar 14

Dr Blake Stamper and his team
We had another monster clinic today.  I got there later than I wanted to  because Dr Honore, the chairman of the board asked to see me for “one” minute.  It turned into nearly 45 minutes.  Most of the children that I have been saving up with complex deformities came in.  That is good because we certainly want to take advantage of Dr Paley and Scott’s surgical skills to correct these severe deformities.   In addition, Dr Spendey was in the ortho clinic when I got there to begin with a patient with low back and leg pain.  He was the Adventist pastor of her church.  It took about 30 minutes to assess him and lay out a treatment program for him.  I had hoped to already have several of the peds patients already seen and teed up for Dr Paley to examine.  Then a young patient came in with a displaced fracture of the distal radius that had just happened while playing soccer at school.  There went another 30 minutes while I examined him, gave him a hematoma block then did a reduction.  I had hardly seen any of the peds with real deformities when Dr Paley walked in.  I’m sure he must think I am one of the most disorganized orthopedists he has ever had to work with.  There were dozens of babies and children with almost every imaginable orthopedic deformity.  It was a “madhouse/zoo” experience.  We did get to see a couple of interesting patients before he had to go into the OR.  While he was doing his case, I tried to evaluate as many of the patients as possible and treat and discharge those that didn’t need to see him.  As I was in the midst of this I got word that the first patient that had a TSF placed for clubfoot was in serious distress.  The case had been totally uneventful.  She awakened from the anesthetic completely without problems and was taken back to her bed after appropriate monitoring. About two hours or so later, the nurse apparently found the patient unresponsive.  A full resuscitation effort was unsuccessful.  She was a happy 10 y/o with a very spontaneous smile.  I am not sure that having a PACU would have prevented her death, but it would have given us a chance.  We are all sobered by this tragic occurrence.  I am going to lobby hard with administration to have another highly trained nurse volunteer here full time until a training program is established and producing nurses of ICU quality.  Our orthopedic service is very busy and some of the cases are long and complex.  Having appropriate postoperative monitoring is essential to minimize these kinds of events.

Dr Paley also put an Ilizaroff bone transport frame on  Sunday.  He was here for such a long time with his ex fix and a wound vac to get his infected tibia to heal.  He finally healed the fracture and the infection as well.  His leg was very short so he was a good candidate for a lengthening.  It is really gratifying to see the final resolution of some of these difficult earthquake cases, especially the ones who spent weeks and even months in the hospital and to whom we bonded.

Mar 15
Some amazing things happened today.  I’ll get to them a bit later.  Today the surgical load turned lighter since one of the big cases had to be canceled due to an upper respiratory infection.  Dr Paley did a case of congenital pseudarthrosis of the tibia.  He has a series of more than 90 cases.  This condition has historically been one of the most difficult to treat in the field of pediatric orthopedic surgery. Even some recent reports in the literature indicate that the failure rate is very high in this condition with the amputation rate approaching 50%.  Dr Paley has had no failures in his very large series.  I did a couple of small cases today in OR 2 which has no AC.  The best way to describe the experience is “unpleasant.”  I won’t use the words to describe the experience in the worst way.

Scott took one of our Severe Blounts cases back to the OR today.  He and Dr Paley did the case “blind” since our Carm is not working.  The postop xrays showed several of the pins needed repositioning.  That means that we will not do any more of those kinds of cases until the Carm is fixed.

Dr Paley speaking to Societe Haitiani de' Ortopedie y Traumatologie
I had arranged with Dr Hans Larson and Dr Paley to meet in Petionville with members of the Haitian Orthopedic Society.  Dr Paley was to give a talk to the society.  The whole team decided to go.  We finished with surgery a bit early and all climbed into the back of a tap-tap.  We stopped at a Haitian art gallery on the way and found some very nice paintings.  The rest of the trip turned into somewhat of a Haitian nightmare.  The traffic was awful and we got stuck behind a diesel truck for more than an hour.  The exhaust fumes where enough to nearly kill me.  Then our driver and translator both got lost and we wandered around Petionvile for nearly an hour looking for the restaurant.  What should have taken about 75 minutes even with traffic took more than twice as long.  The unpadded wooden boards we were sitting on were not something I would recommend even to my worst enemy.  Forget water boarding.  Need info from suspected terrorists?  Put em in the back of a tap-tap in Port au Prince traffic behind a big diesel truck.  We’d have Bin Laden in no time.  You would only have one opportunity at it though before the liberals would have you arrested and shot for using extreme torture.

Dr Dror Paley, Dr. Nau, and Dr. Hans Larsen
The meeting with Dr Larsen and nearly 20 members of the society and several orthopedic residents turned out to be outstanding.  Dr Paley gave an excellent talk on the history and politics of limb lengthening.  The talk(in French) was very well received.  The question and answer period went on for nearly an hour.  Dr Paley wants to come back and put on workshops so they can learn the latest techniques in lengthening and straightening. I had a great time getting acquainted and talking to the Haitian orthopedists.  They all really appreciated the opportunity and want us to do it more often.  Dr Larsen told me he is working on an arrangement to have Haitian ortho residents rotate here at HAH!  That could be a great help for us with the tremendous volume of work we have here.  I offered to teach arthroscopy to any of the orthopedists with an interest.  They are all interested in the total joint program that we will have.  It was a really valuable evening.  A real “bridge builder.”

The whole team had a good dinner at the restaurant afterward.  We all expressed our appreciation to each other for the opportunity to work together at HAH.  All of the team members have a strong desire to return and do this again.  Dr Paley and team live in W Palm Beach and it is a short trip for them.  We made it back about midnight to find that Scott and Ben had worked on the C-arm after finishing the cases they took back.  They re-soldered the wires(correctly this time), re-calibrated the potentiometer with an ohmmeter and it now works perfectly again.  Praise God!  Now we can go full bore again with our cases(if the AC ever gets fixed in room 2.)

We tearfully said ‘goodbye’ to the Paley team.  They had an early morning departure.  Our lives continue to be incredibly enriched in so many ways.  The team members are very skilled and extremely hard working.  Of course, meeting, learning from, and working with Dr Paley is a priceless experience.

Friday, March 18, 2011


Mar 7

The all night flight from Southern California got us in to Port au Prince at 10:30 in the morning.  I was a bit “fuzzed out” when I got to the hospital and started to work.  I met Dr Blake Stamper and his team from Arizona.  Dr Stamper came with this same team to HAH about 6 weeks after the earthquake last year.  The anesthesiologist with the team is Dr Antoine Louis-Jacques.  He was born in Port au Prince.  He did all of his medical training in the US and is the chairman of the surgery department in the hospital in Bullhead City, Arizona where Dr Stamper and the other members of his team work.  He encouraged Blake and the others on the team to come last year and to return again this year.  Tara, Shelley and Charley all work in the OR with Dr Stamper.  There were still patients to see in the clinic as well as surgical cases so it was back to work.  All of the Stamper team are hard chargers and work very well together.

Mar 8

Several patients didn’t show up for surgery since it is Mardi Gras.  We still had a good sized clinic and did several cases.  Emmanuel made a special request today.  He has a family member who lives quite a distance away who has a nonunion of a fractured femur.  I scheduled him for surgery several weeks ago and ordered 2 units of blood.  He hasn’t been able to find the four donors that the Red Cross requires to provide the 2 units.  He asked me to help.  After talking it over with Lynne, I decided to donate a unit myself.  I really enjoy working with Emmanuel and respect him.  Since we had a bit of extra time in the afternoon, we all went in the ambulance to the General Hospital where the Red Cross blood bank is located.  After donating the blood, I had some time while they were cross-matching for our patient.  I went out on the street with one of the translators and bought some fresh peeled oranges.  They were super sweet.  The parades had started for Mardi Gras.  I had a great time getting pictures.  There were tons of interesting characters.  There were historical figures, people in funky costumes, girls dressed like cheerleaders and many different kinds of musical groups.  Guys dressed up in costumes cracked whips.  Even little kids got in on the action.  I can make a whole album of the photos.

Mar 9

We had another big clinic today, even though it is Ash Wednesday and a holiday.  Being Wednesday, meant lots of babies and little kids and their moms for the clubfoot clinic.  Dr Kaye Wilkins came for the clubfoot clinic.  He is a professor of orthopedic surgery  and pediatrics at he University of Health Sciences in San Antonio, Texas.  He has many academic publications to his credit.  He has made many trips to Haiti in the past two decades.  He has been instrumental in establishing quality clubfoot treatment in the country.

We worked in several surgical cases as well.  Ben Chen, third year ortho resident from Loma Linda, arrived today.  He gets high recommendations from Dr Nelson.  This afternoon, both Dr Adrian and Lucia arrived from Santo Domingo.  Scott had already arranged for them to come for his special clinic and surgeries with Dr Dror Paley starting March 12.  They came early to help with cases, especially the spine fracture.  They brought a lot of materials with them including the irrigation bags for arthroscopy and my set of instruments for doing anterior cruciate ligament reconstruction.  They wasted no time in going to work.  Dr Wilkens had 3 clubfoot cases that needed tendoachilles lengthening.  They did them after the clinic and the other surgeries were done.  It was a treat for me to be able to get acquainted with someone of Dr Wilkens’ stature in the orthopedic academic community.  We talked for quite a long time after he finished the cases.  He gave a very generous donation to the Haiti Indigent Patient Fund.

Mar 10

Today was a very productive day.  The clinic was very large especially for a Thursday.  Fortunately, the PA who is here on his own from Connecticut took care of many of the cases.  He is a really big help for us.  Blake, Ben and I wouldn’t have been able to finish our surgeries until much later if we had been tied up much of the day in the clinic.  We did a total of 8 cases and finished before 6:30.  Having Dr Adrian here is terrific.  We ran two rooms all day.  I worked with Ben and did the peds cases while Blake did the adult cases.  Blake’s team is outstanding!  Dr Louis-Jacques  is a very careful well trained, experienced anesthesiologist.  His caring way and ability to speak to the patients is very comforting to them.  Charley, Tara and Shelley are all hardworking and very good at their work.  Having them here is a terrific relief for Jeannie.  Now we also have Lucia back from the DR.  She came a couple of days early to work with me on the spine stabilization that we have planned for tomorrow.   The two teams worked together on the last case since it was bilateral.  The nine y/o boy was born with a very rare case of tibial hemimelia with associated femoral bifurcation.  He has scooted around in the sitting position all of his life.  We did through the knee amputations since the deformities were so severe that no reconstruction was possible.  Having the prosthetics program here is extremely important.  Now he can be fitted for his artificial legs and be able to walk upright.  He and his mother have been looking forward to this for months since they decided to have the surgery.

Mar 11

We were able to keep two operating rooms going again today.  Blake and team did several cases while Ben and I did the L1 spine fracture and then followed with the femoral nonunion.  They each took several hours.  I was able to see several clinic cases in between the surgeries.  Three patients with a total of 4 spatial frames came in for followup.  They are all doing well, including the 9 year old girl with the bilateral Blounts disease that Dr Michael Vitale and I operated on in January.  We sadly said goodby to the Stamper/Louis-Jacque team.  I am hopeful that we will be able to work with them again sometime before our year here is up in November.  Tomorrow both Dr Paley and Nelson will arrive.  We are planning a productive 4 days of limb deformity corrections.

Tuesday, March 15, 2011

Return to Haiti & LLU Reunion

Feb 27

It has been some time since I have had an overnight flight.  It isn’t my favorite thing to do.  I did get a bit of sleep on both the leg from LA to Miami and then again on the one to Port au Prince.  Yesterday was totally quiet here.  Nathan and Amy won’t be back until tomorrow.  The new team arrived this evening.  They are from Asheville North Carolina.  Mark Hedrick is subspecialty trained in foot and ankle.  He was here last year for a week and our paths crossed briefly for a day or two when I was here.  He is a partner of Ken Graf who was here during my absence of the last two weeks.  His PA, Jamie was here with him as was Chip a rep for Smith and Nephew.  Chip knows Scott and brought a lot of replacement parts for the TSF.  Our anesthesiologist is Irma Williams.  She also lives in Asheville but doesn’t practice there.  She had a break between stints in Texas and elsewhere.
Irma worked for several years as an Ortho PA and then studied medicine with the intention of becoming an orthopedic surgeon.  At age 45 she finished her internship and discovered that she was considered “too old” to do an orthopedic residency.  She decided on anesthesiology and here she is.  She has been a lot of places and done a lot of interesting things.

Feb 28

The clinic was so big and the going was fairly slow at the start.  Emanuelle asked if he could send some of the non-urgent patients home and have them return tomorrow.  We had several patients that needed dressing changes and vac changes under anesthesia which limited us to just one orthopedist in the clinic for much of the day.  I saw many interesting cases including a child with severe knock knees.  It is probably a case of rickets.  I took pictures as well as a video of her walking.  I am going to have her come to have her surgery when Dror Paley and Scott are here in a couple of weeks.  We scheduled about 10 cases out of the clinic.  A patient with a displaced tibia fracture came in as well as another with a displaced ankle fracture.  We already had a full schedule for tomorrow so we put them on for Wednesday.  Our last case today was a BK amputation on a relatively young diabetic.  The patient lost quite a lot of blood and we only had 500cc of plasma expander in the hospital.  There was no blood available either.  His pressure dropped significantly and things were tense for a bit.  He then stabilized as the case finished.  Mark and I both stayed with him until midnight and he seemed stable.  I was pretty wired so did a few emails and checked on him again about an hour later.  He was making good urine and was stable.  I’m glad that these 18 hour days are not the norm.

Mar 1

We had several more cases that went somewhat slowly and a large clinic.  Everyone is putting in a lot of work and I really appreciate Mark and his team.

The saga of the Carm continues.  I turned it on to check and make sure it was ready for the cases tomorrow and the “bad iris pot” error message came up.  It won’t finish the boot up.  What a disappointment, especially with the cases we have with Dr Hedrick here this week and the upcoming visit of Dr Paley.  Many of those cases are Carm dependent.  We new the iris potentiometer wasn’t in good shape after our work on it when Scott came down that one day the end of December.  The machine was working perfectly well after the calibration.  JJ told me that it worked perfectly well for Ken Graf the whole time I was gone and they used it a lot.  I will have Jerry Daly get a new potentiometer and Scott can bring it down when he comes in a few days.

Mar 2

The cases went more quickly today and we got a lot accomplished.  Mark and I finished the day with a tibial SIGN nail.  He hadn’t seen one before so we did it together.  I had hoped to show him the perfectly done procedure, but sadly it was not to be.  The fracture was several weeks old and needed to be opened to get it reduced.  Everything went fine until it came time for the distal interlocking screws.  I struggled to get them in and finally took a portable xray since the C-arm isn’t working.  One of the locking screws was in but the other wasn’t, so I repositioned it.  Dr Hedrick was very kind to indicate that he learned more from a case that required some struggling.  He is an excellent surgeon and I would like very much to work more with him in the future.  It is really great to have these subspecialists to learn from.  I hope he and his team are able to come again.

Mar 3

I had an early flight out today, leaving Dr Hedrick and team.  I have my 40th class reunion on Saturday night and then I have a Haiti report to give to a group on Saturday afternoon.  I’ll return with Jeannie on another all night flight on Sunday.  Jeannie picked me up at  nearly 11pm.  It was great to see her and have her in my arms again.  She is so important to me and I miss her dearly when we are apart.

Mar 4, 5 and 6

APC  Loma Linda California  I was able to make arrangements with Jerry Daly for some needed supplies and had a good meeting with Andrew Haglund.  We are staying with Rick and Linda.  Shane and his family had lunch with us on Saturday.  He is going to come down and help me in April.  The orthopedic CME meetings were on the topic of orthopedic infections and were very good.

Monday, March 14, 2011


Terry and Jeannie returned to WI and the United States for a brief sabbatical and his first locum tenens work at Appleton Medical Center. Here are some updates from that trip. More from Haiti soon!
Feb 10-23  Ah!  Winter in Wisconsin.  What a change from the tropics.  It was a delight to see my partners again.  They have been so incredibly supportive of me taking this year to work in Haiti.  We were able to spend some quality time with Dr Erickson and his family.  His wife, Mary had a high risk pregnancy with twin babies.  Fortunately all went well and they are thriving.  Mary has kept us highly entertained with her blog.  Both Dr Smith and our new partner, Dr Ken Kleist are doing well.  I assisted Dr Kleist on a total knee replacement and was very impressed with his surgical skills.  He is fellowship trained in joint replacement.  He is a tremendous addition to the Thedacare Orthopedics Plus team.  Dr Smith left for the orthopedic academy meetings in San Diego a couple of days after I returned.

Overall, the time in Appleton was very good.  I was able to do some elective surgery and saw patients in the office and covered the ER and took call for my partners.  Many coworkers were very interested in the Haiti project and I spent considerable time answering questions.  Many are interested in the coffee table book that we are producing to raise funds for the work here.  Dr Erickson and his wife gave an extremely generous donation to the project.

Wisconsin did manage to impress upon us its ability to make wintertime a real event.  Over 13 inches of snow fell in a blizzard accompanied by 40+ mph winds.  It was a real old-fashioned storm.  The snowplows were out in force and life continued without much disruption.  I was able to enjoy a lot of no-cost exercise keeping the driveway and sidewalks clear.  The 5 foot snowbanks were a testament to the effort.  I gauge much of my caloric expenditure in terms of “cinnamon rolls earned” which puts the activity in a very positive light.  Jeannie and I indulged at a couple of our favorite restaurants several times.   I was also able to make it to the tennis center several times and burn more calories and get my endorphin “fix.”

Now we are off to Portland Oregon for a few days.  I will be able to meet the graphic arts designer who is laying out the coffee table book and give input that might be helpful.  We will have a couple of days with our daughter, Summer, and her husband, Tim.
Feb 24

Portland greeted us with very cold, wet weather.  It was welcome for us.  We had hoped to have some good snow conditions on Mt Hood for at least one day of snowboarding.  It turned out to be classic.  It was one of the best snowboarding days that Jeannie and I have ever had.  It was our snowboarding season for the year and it was as good as it gets.

Feb 25

What an enjoyable day this has been.  Tim and I played tennis for a couple of hours at an indoor club close by.  Tim is slowly improving.  If he would take the time to really work on his game, he would improve faster and undoubtedly dominate me.  It is a great workout and we enjoy spending time together.  David and his wife Alyssa came over and we talked about the book project.  He is the graphic designer who is doing the layout and design of the book.  He has  a great sense of humor.  Steve and Heidi then joined us for dinner.  We all had a great evening eating soup and salad and bread with dipping sauce.  Jeannie and I are really taking advantage of all the good food.  We have both put on several pounds during this trip.

Feb 26

It is so nice to have another Sabbath to enjoy.  I really enjoyed going to church with Jeannie.  The Happy Valley church in Portland is very friendly.  Tim had arranged with the pastor to have us up in front and talk about Haiti.  We introduced the coffee table book project as well.  It has been really great to have a couple of days with Tim and Summer.  Jeannie and I both have to leave later this afternoon.  Jeannie will be in southern California with Bob and Carolyn and plans to get together with several good friends for a few days.  I fly to Haiti and work until Thursday, then return to join Jeannie in Loma Linda for the Alumni Postgraduate Convention for three days.  I want to see as many patients as possible and get them ready for Scott and Dror Paley on March 12.  Our medical school class celebrates its 40th reunion this year.  It will be great to talk to friends we haven’t seen in years.  I hope a lot of them come.