Two nine volt batteries.  For six or more, they cost 64 cents each.  Yet, those two missing batteries created incalculable loss.

Everyone is asleep in that Bronx apartment building when, according to fire officials, a cord to a space heater catches fire and ignites bedclothes.  The residents of that room run into the hallway to alert other residents, but make the fatal mistake of leaving the door open, thus allowing the flames to spread. 

And the smoke detectors:  They sit, stuck to ceilings or walls or wherever smoke detectors stick, waiting.  What they wait for is a battery so that the burgeoning smoke will cause them to sound their alarm.  Sixty four cents.  Five minutes of time for installation.  Ten lives.  Instead of an immediate call to 911, residents try to put out the fire themselves.  One resident calls her husband first.  After the 911 call, it takes firefighters just over three minutes to arrive.

People toss children from windowsinto the arms of neighbors.  Jump themselves.  Fire escapes are not required in buildings of this size.  The only escape route is the blazing mahogany staircase.  Almost 150 firefighters  battle for two hours to get the fire under control.

One man, a taxi driver,  drives his cab when the fire starts.  It kills his entire family; a wife and three small children. 

In a matter of hours, this man's reasons for living are gone.  How does one make sense of this?  A series of human choices and errors which, alone, might not cause such tragedy.  Yet, strung together in this sequence, the consequences are tragic.  

On this scale the impact of choice is magnified.  But what about the small choices we make each day? To drive through the changing traffic light?  To ignore the crack in the windshield?  To leave the teapot on the stove for just one minute? To wait another day to return that phone call?

 Some of us have the luxury of a comfortable life.  We can attend to small things as they come up.  Others are so overwhelmed by the pressure to survive, they cut corners with these "little" things.  But how do any of us know when those minutiae will pile up and cause one great tragedy? 

We don't.  

What can be done is for us to make our days and lives meaningful to ourselves and to others.  We can help people.  We can keep our minds and our eyes open.  This is the only lesson (besides my having checked my smoke detector) I can glean from this awful incident.

If you would like to make a donation to the victims of the Highbridge Bronx fire victims, call 212-222-3882, or visit  AfricanServices.org

These are some of the victims of the Bronx fire.

All photographs are from the NY Times Website and are copyrighted by the New York Times. 

Floyd Landis, Tour de France winner 2006.

About 30,000 Orthopedic Surgeons from around the world descended on San Diego last week for the American Association of Orthopedic Surgeons annual meeting.  San Diego proved to be a superb venue for this meeting.  The weather was glorious.  The waterside convention center and its surroundings are lovely and boast affordable parking.  Attendees need not be limited to the food offerings inside the center, either.  There are plenty of great restaurants within blocks of the meeting.

There are terrific academic lectures, instructional courses and symposia (which are my favorites).  Physicians from across the globe present their research and discuss new ideas in our field.  It's an enlightening, if not overwhelming week.

What most impressed me, however, is my meeting Floyd Landis, winner of the 2006 Tour de France.   Mr. Landis underwent right hip resurfacing in September, 2006.  He had osteonecrosis of the hip after a serious crash injury years ago.  Floyd underwent two operations before the resurfacing procedure.  He told me that after his initial recuperation and rehabilitation, he is impressed at his level of function.  He's back in full training and will take part (not ride) in the Tour of California this Winter.  He's written a book about his innocence in the TdF and will promote it and his defense case during the tour.   

And, talk about coincidence!  My good friend, Doug, also met Floyd during a recent visit to NYC.  Floyd was kind enough to autograph a copy of High Impact Quotations, edited by none other than Richard "Dick" Pound.

Aside from the meeting, I was able to enjoy the fabulous San Diego weather.  I rented a Cervelo road bike from the nice folks at Nytro in Encinitias, CA.  Each day before the conference, I had a few hours to ride on a stretch of Route 101.  It's a gorgeous  road with breathtaking ocean views. 

These are taken at the base of the North Torrey Pines Road hill.  The surfers are out in force on this breezy, sunny day.

Claudette with serious helmet hair. A nice passerby snapped this for me.  Where does a girl find a mirror when she needs one?

Overall, a wonderful experience.  Even though my travel time practically equalled my time in San Diego because of the awful weather situation in New York and some serious flight delays and cancellations.  I made some great airport friends through that ordeal.  And I must send some kudos to the incredible gate agent who helped us on flight 265 out of JFK on Thursday.  You managed to handle a horrible 9 hour delay with grace and professionalism.  You are a credit to your organization!

Tho' the story never ends
Let's celebrate
Remember a year in the life of friends
Remember the love!
Remember the love!
Seasons of love!

Oh you got to got to Remember the love! remember the love,
You Measure in love know that love is a gift from up above Seasons of love.
Share love, give love spread love Measure measure you life in love.

 
"seasons of love" from "Rent"

The New York City Marathon took place on Sunday, November 5, 2006.  More than 35,000 runners from all corners of the Earth participated.  Thousands of spectators cheered them on.  Even Lance Armstrong ran the race this year.

What this means for me as a cyclist is that, after having retired my running shoes after last year's race, I joined some of my cycling mates to marshal the race for wheelchair and handicapped athletes.  Marathon Day is possibly the best day of the year in New York City.  The positive energy is overwhelming

What this means for me as an orthopedist is that many runners in the marathon come to the office for myraid aches, sprains, pains, twists, cracks and clicks.   Most of these issues are benign;  they can be treated with rest, cross-training and over the counter medicines.

Some of them are not.

Our bones are made to withstand the forces of our activity.  They are remarkable in this quality. They do this through their material properties of strength and elasticity.  That is, they either resist the forces or bend to accommodate them.  Until they don't.

Fractures occur when the force on a structure exceeds its material properties.  Sometimes this happens because the force is too great; a car accident or a fall from a height.  In other cases, the material properties of the bone are changed;  there is a metabolic disease or age-related change to the bones so that they aren't able to stand up to everyday stresses.  Something so simple as stepping from a curb might cause a break. 

Finally, there are "overuse injuries."  The stresses themselves aren't enough to overwhelm the properties of the bone.  But, cumulatively, relentless sub-threshold stresses can cause failure of the bone structure.  When we place great, but not failure-level forces across our bones repeatedly, a "stress fracture" can occur. 

A person with a stress fracture may have normal xrays.  She may only have pain when she does high-impact activity.  She may have enough pain to cause her to go to see a doctor.  Sometimes the fracture is never detected and the person self-limits because of pain, the fracture heals and life goes on.  If symptoms cause concern, an MRI test or a bone scan can detect the injury and treatment can be rendered. However, if the offending activites continue, the bone could snap and require surgery or some other "drastic" measure.

Now our bones are governed by our physiology.  Unless there is something wrong with our healing process, bones will mend when treated appropriately.

But what happens when we overwhelm other systems?  How do we deal with the relentless sub-threshold stresses on our emotional skeleton?  There's nothing so definitive as an MRI test to tell us when we've reached the limits of our patience.  The pains related to stress fractures of this nature are vague and difficult to localize.

I've treated four patients in the past 6 weeks with real stress fractures of their bones.  One woman had fractures in both hips.  Another, in her foot.  A young boy had a break in his tibia.  Another young lady was unlucky enough to have had a stress fracture which cracked completely and required surgery.  All of these folks were under 33 years old.

In contrast, I cannot count the number of patients, mostly young women with small children, who come in for treatment of low back pain, neck pain, hand pain, knee pain, shoulder pain... the list goes on.  These women seldom have a concrete medical problem.  I believe the issues here are with the taxing of other systems.  Many of my such patients sleep only three or four hours per night because of work, house and child care duties.  Some have not had a day to themselves for years.  They are exhausted, stressed and overwhelmed and this shows up in the form of physical pains.

But how do I treat this?  My tool kit includes medicines, therapy and surgery.  Is there a way to fortify people so that they are more resilient?  Or do we just wait for them to break?

Namaste. 

 







On Sunday, November 5, 2006, more than 37,000 runners participated in the ING New York City Marathon. 

And then there were the scores of other athletes who did not "run."  They are the elite and non-elite wheelchair and handcycle participants.  Each year these athletes start the race about an hour before the official start and pass over the NY Marathon course at speeds of up to 26 mph on flat ground. 

Richard Rosenthal, a friend and member of the New York Cycle Club, organizes a group of cyclists to clear the way for these marathoners.

This year I was lucky enough to be one of those cyclists.  What an inspiration to work with this extraordinary group of "disabled" marathoners!

The New York Times wrote a bit about us here.

Congratulations to all of the runners, riders and helpers who make this day so incredible.  There are more of my photographs here.  In this photo:  many of the women volunteers.