Saturday, March 30, 2013

THE SHIELD OF GOLD, "No Money, Just Meat"

Since we started out, our firm has handled hundreds of cases, many fairly routine, some rather unusual.


One day, a very large, gruff-talking man came to our office and plunked down an armload of steaks, shrimp, lobster, and lamb chops. Before he told us what he wanted, he made his financial terms clear, “no money, just meat.”


Actually, this big, boisterous, Danny-DeVito-type guy, twice DeVito’s size, said to me, “I got no money, just meat…and looking at you, you look like you eat meat.” He didn’t have to be a detective to figure that one out, as I had added at least a few pounds since leaving the NYPD.


As you might guess, he was a butcher. His wife was carving him up in their divorce battle, and she was trying to get even more money from him by claiming to be too disabled to work to help support herself. He knew she was faking. He needed us to demonstrate that to the court.


Well, it was more meat than I needed, certainly, but the case was interesting, and we took it.


The next court date for the hearing on the divorce was only a couple of days away, and our challenge was how to show that his wife was lying, if so.


The day of the hearing, I got to the place where she was living with her new love, and I watched the front door to observe them, coming out to go to court. Her claim had been that she needed a walker or cane or crutches to get around, and therefore was very limited in what work she might be able to do.


It was 7:30 in the morning when I observed her and recorded her, as she came out of the door, walking normally, followed by her boyfriend, who was carrying the crutches. The woman went down the stairs without the crutches, which the boyfriend tossed into the back seat of the car, as she walked nimbly to the car and got in. They drove off, and I followed.


When they got to the courthouse, it was a different story. The boyfriend took out the crutches, and the woman came out of the car, put the crutches under her arms and limped up to the courthouse, looking like she was in quite a lot of pain. I recorded it all.


On my cell phone I called my client’s attorney, who was in the courthouse, and I told him what I had on video, suggesting he have the hearing suspended to the afternoon so that we could present the video to the judge. That is exactly what happened.


When the judge saw the video, our client won the case. The butcher was pleased, so pleased that his thanks to us ended with, “Want any more meat?” We passed.


THE SHIELD OF GOLD, by Lenny Golino and Douglas Winslow Cooper, is a memoir published by Outskirts Press, available from OP and from and in paperback and ebook versions.

More about Lenny Golino at .

More about Douglas Winslow Cooper at .

Friday, March 29, 2013

TING AND I, Retirement Inflation Hedges

Ten years of retirement and part-time management of Tina’s care have gone by pleasantly. I’ve enjoyed writing this book, and it has been a distraction from minor problems. I have come to grips with the fact that I will never read all the things I want to read. There is no end to it. Time to make official my switch from passive to active: I’ve just changed my “business card” by adding “Freelance writer” below “Physicist, retired,” and on the back of the card I've put information about this book and our website.


In the past few years, TV and radio commercials have been touting the purchase of gold as a hedge against the possibility of severe inflation in the near future. Makes sense, so far as it goes. In the recent past, the price of gold has risen precipitously, suggesting that the perceived value of the dollar has been falling and the perceived value of an asset that should not lose its intrinsic worth has been rising. Of course, the demand for gold could be a fad, a bubble. We’ve been there before, with housing and—before that—with the "dot com" boom and bust, along with Enron. Not quite as bad as the Dutch tulip craze centuries ago, but bad.


Real estate, like gold, is likely to rise as the value of the dollar declines, though many other factors are involved. We have a home we own without a mortgage. If I were really convinced rampant inflation was imminent, I would take out a mortgage at current low rates, figuring to pay it off in the future with devalued dollars. Hating to be in debt, I haven’t chosen this course, even though it would be a hedge against inflation risk.


As investments, bonds are likely to lose value if inflation accelerates. The behavior of stocks is less predictable under these conditions.


It occurred to me that returning to work part-time, thus staying employable, is another way to hedge against future inflation. Wages tend to go up as the value of the dollar declines. I am looking for ways to work at home, probably as a technical writer, possibly as a copy writer, possibly doing light statistical analysis.


We’ll see.


I gave away hundreds of copies of Ting and I, sold less than a hundred so far. Have co-authored two more books and edited another and have several writing partner clients currently active. Established another site/business,

Thursday, March 28, 2013

TING AND I, Money, Medical Care, Retirement

“Love of money is the root of evil.” But how about just liking it?

For my first twenty years, my family was frequently short of money. A paramount factor in many decisions was, “How much will it cost?” There were four children, and a fifth much later. Though “Papa” had a law degree, he preferred to be a salesman, despite its ups and downs. I remember in the late 1950s helping him one Christmas Eve to install an aluminum storm door for a customer, in the bitter cold. Not long after that, he went back into law, going through a partnership or two, getting a position with New York City in a Kingston, NY, branch, making a bit of additional money with a part-time office in downtown Rosendale, NY, population a few thousand. I knew I was never going to be in sales, nor in law. I decided I would look for something in the white-collar professions that would bring in at least a middle-class income without drama.

Money narrowed my choices of college to attend. Applying was expensive for us. I would need a scholarship. M.I.T. required the scholarship application to be in a month earlier than the regular application for admission. I was accepted to M.I.T. but applied a few days after the scholarship deadline and therefore would have to wait a year before becoming eligible for the scholarship aid I would have otherwise been very likely to get. That taught me that deadlines can be crucial. At the interview for Cal Tech, I was told I was likely to be admitted if I did not need scholarship aid to attend, but not likely if I did need it. I was not admitted. Tuition and some expenses were covered for Cornell, so I went there.

Money influenced my decision not to join a fraternity, though it was not the sole factor. My job at the Cornell dining hall was low status, with whatever consequences that involved. That was not a big issue for me. If it is not what you know, but whom you know, my contacts there were of little future value.

The time away from studying or playing was regretted. I obtained a better part-time job, through physics friends, at the cyclotron, which eased money worries considerably and often gave me quiet study time while there.

My dear Tina was not interested in me for my money, clearly. I always remembered that. When my first marriage and a subsequent engagement did not work out, I knew that if Tina still loved me, it would not be for my floor-through condominium apartment in Boston’s Back Bay, nor my faculty position at Harvard, nor my media appearances. Tina had loved me when I had nothing other than myself.

When I decided no longer to be a millionaire, meaning no longer to be married to C, I wondered how many other people would have made the same decision. Was it foolishness to toss away being rich?

A year or two after the marriage broke up, say mid-1982, I knew for sure that I could no longer afford to live where I was living. Slowly my bank balance was going down. As a single person with a 2,200-square-foot apartment on Marlborough Street, I was losing ground. Harvard support personnel once complained, “We can’t eat prestige” in their campaign to get higher wages.

I understood. Some of my faculty colleagues came from moneyed families and their salaries were not key for them. While married to C, I had been in much the same position.

Although some professors developed lucrative consulting businesses, I had not. My associate professorship was barely adequate for a married person with a small family living in the suburbs and inadequate if one wanted to live nearer and send the kids to decent schools. If I were to remarry, it would mean moving. Once Tina and I decided to marry, early in 1983, I started to look for a new position. Eventually, I received offers of full professorships at the Illinois Institute of Technology and the University of Cincinnati and a research position at IBM’s Watson Research Center at Yorktown Heights, NY.

Any of these would provide an adequate standard of living. It would put us close to Ted and to Tina’s ex, one advantage and one disadvantage. Cincinnati was part-way there, while IBM seemed most likely to be willing and able to afford the kind of crushing medical expenses sometimes associated with multiple sclerosis, where the patients live a long time and need a lot of care. That’s just how it worked out, and we thank IBM for its generous policies.

Waste not,

Want not.

Make do.

Do without.

This old New England advice fit Tina’s temperament and mine.

Warren Buffett emphasizes living below your income, as we did. Our cars were usually second-hand or bought at the end of the model year. No expensive vacations, no second homes, no smoking or drinking or gambling. No expensive hobbies or tastes.

We had a head start with the money I made on selling the Back Bay condo, and we used that to buy our Bedford Hills, NY, condo for cash. We sold that at a profit and bought the Millwood, NY (Ledgewood Commons) condo, also for cash. We sold that at a near break-even price and then bought the Ramsey, NJ (Jean Street), home for a lot of cash and a mortgage that we paid off in a few years. We sold the Ramsey house at a profit and paid cash for the Lake Osiris property, at a substantially lower price than we’d been paid for the Ramsey home. We improved the insulation at the Lake Osiris house and eventually put in vinyl siding. One of our house transformations caused a neighbor to ask, “Did the bank approve of your doing that?” Paraphrasing Louis XIV of France, I was happy to reply, “I am the bank.”

Years later, I read the book, The Millionaire Next Door, which recommended a lifestyle we had already adopted.

Along the way, from Cambridge to Lake Osiris, some interesting things happened, money-wise. An ex-girlfriend of mine solicited C and me to invest $5,000 in sugar futures, nearly a sure thing, she said. The amount was one month’s income, more or less, and we bought in, thinking we’d either make some dough or get this woman off our backs permanently. She made a 20 percent commission, we later learned, and we lost all the money when the price of sugar did not rise far enough, fast enough. She never called again, though. She later became a lawyer.

A financial advisor recommended South Shore Publishing, then the stock dawdled along doing nothing much for a few years. Suddenly, the executives of the company became eager to buy out the stockholders and take it private. Against strong share-holder resistance, the executives prevailed. Surprise, surprise: the next year the company began making substantially larger profits, greatly raising its value. Creative bookkeeping can cover a multitude of sins.

After I left Boston, the woman in the couple occupying one of the floors above us in the Back Bay was found to have embezzled a lot of money from her academic employers.

With the hubris of a physicist but the wariness of one who has at least felt poor, I looked into the various systems suggested for beating the stock market. Most did not hold up under scrutiny. John Casti’s book Searching for Uncertainty: What Scientists Can Know about the Future contained a captivating chapter, “Meanwhile at the Casino,” on efforts made to beat the market, generally without success. However, it showed that the top-rated 100 stocks (Group 1), of Value Line evaluations, produced truly remarkable gains from 1965 to 1989, the last year available. Plotting the performance of Groups 1 to 5 (highest=rated to lowest-rated segments of the market) produced graphs that looked like dose-response curves, with Group 1 doing much better than Group 2, which did better than Group 3 (roughly breaking even) which did better than Group 4 (losing) which did better than Group 5 (losing even more). The evidence seemed convincing.

I was persuaded. I put our “speculation money” (roughly 5 percent of our net worth) into ten or so of the Group 1 stocks. I then followed Value Line closely, sometimes having to change my investments because they fell out of Group 1. For whatever reason, as the investment disclaimers always note, the past did not necessarily predict the future; and for ten years or so, I did no better than did the Standard and Poor’s Index of the 500 largest-capitalization stocks. If you can’t beat ’em, join ’em. I got out of Group 1 and put that money into an S&P 500 Index Fund, where it sits today, almost unwatched. Diversify, diversify. Current thinking on investing emphasizes diversifying, as accurate prediction eludes all but a very few.

With Phil about to graduate from high school in June 2000, it was a logical time to make a move, retire early. Texwipe, the family-owned company for which I worked, was being sold to the conglomerate Illinois Tool Works. The new owners might or might not be emphasizing selling their products on the basis of the technical characteristics of their materials (they did not, as it turned out) and thus might or might not need a physics Ph.D. and statistical quality control guru as their Director of Contamination Control (they did not).

Did we have enough money for me to retire at 58? The advice we received was that one needed an income of about 80 percent of one’s pre-retirement wage, which we could almost do, and we might not need quite as much, as we were moving from more expensive Ramsey, NJ, to less expensive Walden, NY. Tina was paraplegic at this point. We had a home health aide 35-40 hours per week on the weekdays. I handled the evenings, overnights and weekends. Long-term care insurance, bought during an open-enrollment period at IBM (Hancock could not disqualify us because of MS), covered most of the aide’s salary. We could and did retire with minimal financial uncertainty.

At 62, in 2005, I took Social Security early. In case the rules would change, I wanted to be “grandfathered in.”

As mentioned above, Tina’s 100 days in and near the Critical Care Unit in 2004 cost about a half-million dollars, covered by IBM’s retiree medical insurance. Every year of our in-home nursing care since 2006 has cost about one-third of a million dollars, again covered by IBM. By now, without that coverage, we would have been devoid of savings, though our pensions (TIAA-CREF, Principal, Fidelity, Social Security) would have provided income. Despite the medical insurance coverage, the not-covered elements of Tina’s care have sometimes used half our annual income: deductibles, co-payments, disposables–for example, $1,500 per year for disposable diapers---and on and on. Sometimes the insurance reimbursements fell two to three months behind, amounting to $50,000-$75,000. What would people with less savings do? To its credit, our current provider, United Healthcare, has generally kept the delay to a month.

Now, because of our ages, Medicare covers much of the direct medical costs. If we became officially poor, Medicaid would provide some services, far fewer than we now have, only what they decide we should have. Some people have suggested to me various ploys, including divorce, to make Tina officially poor enough to get Medicaid. No. No. No.

The lesson: “Provide, provide” as a Frost poem urges. No one else is going to bail you out. Being on the public dole puts you at a big disadvantage. Even family members are not likely to help much.

Wednesday, March 27, 2013

TING AND I, Pornography

In my elementary school days, the Riverside Drive in NYC phase, the search in the apartment building cellar for return-deposit bottles would on occasion produce a dividend, an issue of Esquire magazine with a nearly naked woman, the source of much fantasizing. In later years, Esquire was supplanted by Playboy, but I had moved on.

As a married man, I have avoided the ever-more-explicit photos available on the Internet, not seeking them out and moving on rapidly if they cross my path. In one of my few agreements with ex-President Jimmy Carter, I believe it is disloyal to lust after any other woman than my wife, even if nothing more comes of it. Sadly, we hear of men “addicted” to Internet porn, another negative consequence of the sexual revolution, now exacerbated by enhanced communications technology.

Unfortunately, as a society we are sex-saturated and sex-obsessed. It is irritating to me to see that even the female news presenters on the programs I watch are wearing tops designed to emphasize and display cleavage. Emphasizing that aspect of your “talents” in a newscast seems to me to be a kind of cheating, something like surreptitiously putting alcohol in someone’s health drink. One nightly cable commentator often arranges to show us the scandalous things being done by others....

Just as we frown on conspicuous displays of wealth, or at least some of us do, we should frown on other displays likely to arouse envy, arouse desire that cannot be legitimately fulfilled. We don’t want to go too far in the other direction, either. I recall a recent cartoon with a census-taker interviewing a resident:


“No, we’re British.”

Tuesday, March 26, 2013

TING AND I, Computer Glitches, Viruses, Formats

Computer Glitches

Computer crashes and computer viruses threaten my literary efforts. It was merely death that Keats feared would still his pen,

When I have fears that I may cease to be

Before my pen has glean’d my teeming brain...

Now that I have Carbonite backup service (free plug for a good company), I no longer fear crashes. When our elder son gave me a new computer, I was able to get all my older computer’s files by logging on to my Carbonite account. Nice.

Last night, for instance, my computer screen was filled with a blue background with superimposed scary warnings from a company telling me that a viral infection threatened my computer, needing immediate attention, which their service would provide. The headline is “WARNING! YOUR’RE IN DANGER!” A few clicks later, I was asked to give credit card info to get a virus removal program. That made me suspicious. The misspelled word in the headline added to my suspicions. When nothing I tried got rid of this malicious program dominating my screen, I found a way to get to Google, which led me to lots of information about this Malware. More reading convinced me that Malwarebytes’ Anti-Malware was the product I needed, and it is free. Worked beautifully. Thanks. A free service deserves this free plug, too.

Technical Formats

Do you have a useless collection of vinyl long-playing 33-rpm records or of eight-track audio tapes? Betamax videotapes? Manuscripts on discs no longer usable or in formats no longer readable?

The fear of becoming unable to regain material “lost” this way has me writing this memoir with Wordpad, a program that puts it into plain text format, file extension “.txt.”

I have used plain-text word-processing programs whenever I could in the past. Often they lack features that a sophisticated word-processing program has, but the advantage of continued future access outweighs those considerations for me. Midway through the project, I switched to Microsoft Word, with many more features and the capability to create .txt files if I need them. As Polonius advised, one must neither be the last to shed the old, nor the fist to embrace the new.

Tina likes to have photographs taken. I do not. No doubt she liked the results of these in her earlier years. I did not. I prize the beautiful photos we have of the younger Tina. Mine, not so much. My best photo was taken when I was 17.

We have taken our photo shots during our marriage primarily with Polaroid instant film, no longer readily available. Our sons use digital cameras and get some beautiful results. I wonder if the formats they are saving them with will be available when they want to see them again, decades hence. We still have our photo albums. Hard copy is (nearly) forever.

Monday, March 25, 2013

TING AND I, Pitfalls and Potholes in Marriage

“Bait and switch” refers to the selling tactic of seeming to offer one thing, but ending up providing another, inferior, item.

I have heard a number of instances where this tactic led to marriage. The courtship was wonderful, the post-wedding period something else. A bit of “company manners” might be expected before, and “letting down one’s hair” might be experienced afterward; but the stories I’ve heard go well beyond that, more like fraud. It may be an important reason why about half of first marriages end up in divorce and about half of second marriages end up likewise. There was no such deception in Tina. The magnificent human being I thought I was getting is the person I have been married to for 27 years.

Another flawed approach to marriage is domination of one partner by another. Sure, in different situations one must decide, and then the other person follows; but consistent domination is demeaning and destroys the love one began with. Those countries where women are little more than servants to their husbands victimize half the population directly and all indirectly.

Tina is too precious to waste in such an environment.

A third flawed approach is that of the overly assertive woman. She speaks to a man the way men do not speak to each other without expecting a fist fight to ensue. “A soft answer turns away wrath,” I think the Bible says. So true. Tina has mastered this, or perhaps it is just part of her DNA.

Men can be obsessed with their careers, women less likely so. Women can be obsessed with their children, men less likely so. The best life involves a balance rather than the maximization of a portion. Tina and I have striven to do just that.


Sunday, March 24, 2013

TING AND I, Pre-Nups and Trusts and Trust

My first marriage, like most first marriages, did not involve a pre-nuptial agreement, even though my wife, C, could be expected to be worth tens of millions of dollars eventually. My second marriage, unlike many second marriages these days, didn’t involve a “pre-nup,” either—despite there being children from Tina’s first marriage and some moderate net worths involved. Where children or substantial fortunes, or both, are present, some agreement on what to do in the case of another divorce seems prudent, though terribly unromantic.


I have observed the downside of such agreements among our contemporaries. In one instance, it seemed to me that the fussing over relatively small matters reached the point where one or both of the parties became disillusioned with the other, although they did marry anyway, a sad result of an excessive concern about money and things. With so much else at stake in marriage, it is a shame to put such an emphasis on material things. Granted, with divorce now as common in second marriages as in first, all too common, some provision for that possible outcome does need to be made.


To protect her from herself or from me, my first wife’s resources were largely tied up in a “trust,” some of which became available when she turned twenty-five. An arrangement like this seems to make sense, in that you do not want to make an immature person prematurely rich, for her own well-being, if nothing else. Still, note that “trust” really means “distrust.” For my part, I did not look deeply into her financial situation, never wanting to be beholden to others or wanting to be awaiting a payoff sometime in the future. When a big check did come in one year, we celebrated that her “ship had come in.” We may have taken a vacation that year. I still worked at the university over the summers.


Money bequeathed by parents for a severely handicapped offspring raises similar issues. The person controlling the money must be someone who can be trusted to have the trustee’s interests at heart and to have the knowledge and wisdom to do what is actually for the best. The implied distrust of those involved in the care of such offspring creates something of a psychological problem for them. What makes sense rationally has, again, its emotional drawbacks.


If I react toward you as though I think you are likely to cheat me, you will probably behave differently from how you would have responded if I acted as though I trusted you. Depending on my character, one approach is better than the other. You have to decide whom you are dealing with.


Saturday, March 23, 2013

THE SHIELD OF GOLD, "The Dog Ate My Retirement"

You’ve probably heard about the kid’s excuse for not being prepared for class, “The dog ate my homework.” In this chapter, you will learn how a dog radically changed my retirement, though he did not actually eat it.


I retired after 21 years on the New York Police Department. Often a policeman retires after only 20 years, but I stayed an extra year and then decided I really had had enough. One of the old timers once told me that I would know when it was time to go. How right he was!


Things were changing. We were getting a new type of recruit, younger, and in some ways less educated, despite what their school records might indicate, and some even having prior arrest records. As a detective, one of my responsibilities was to read all the reports generated by the police in our precinct each day, and this averaged about 50 reports a day. It was painfully clear to me that the quality of these reports was declining. Somehow, despite their many years in school, these new recruits often did not know how to write.


Five of us retired at the same time, including a sergeant and my captain, for whom I was pretty much his right-hand man.


I went to the pension section at the Woolworth Building in Manhattan and sat with a retirement counselor, discussing various options, going over what my financial situation would be in retirement, including accrued vacation and other details.


On the day of retirement, our “gang of five” went there together, turning in our shields. What struck me was how little impact that action seemed to have. The response was essentially silence, no one else seeming to care, much like the silence that greeted me when I graduated from the Academy some 21 years before.


They have you turn in your official shield, and they compare it against a special mold that is designed to check that it is the official shield, not a duplicate. The duplicates are made to be just slightly different from the originals, with the difference almost invisible to the eye. Once the shield checked out as official, it was then tossed into a box with many others.


That was it: no handshake, certainly no brass band, nothing. It was a bit like turning in the expired license plate on your car to your Department of Motor Vehicles.


We then went back to the precinct to finish the rest of the day. Back at the precinct we did not go out on any calls. Perhaps like the last day of a war, none of us wanted to be in an altercation in our last few hours officially on The Job.


As I drove home that day, I still felt I was a member of the NYPD, on vacation. That feeling lasted for another few weeks, when it hit me that I really was out.


While I could afford not to work, I decided that life would be more interesting if I maintain some kind of work activity. My partner and friend, Joe, and I first went to work as security guards at a high school in an affluent suburban area nearby. It was terrible. The work was boring. We got no respect from the rich brats, whose behavior was often worse than the poor kids we had known from our work in the Bronx.


A mutual friend of my partner and me was the Director of Security for the Orange County Community College, and offered us security jobs that paid almost twice as much as the high school positions had. Our NYPD pensions limited us in such a way that we could only work 30 hours per week on this job. The people were nicer, the work more interesting, the setting more attractive. And yet…and yet…it was not challenging enough, not exciting enough.


I could feel myself becoming less mentally sharp, almost as though my brain were stagnating. I needed to do something more intellectually stimulating, more difficult, more challenging.


I next started working with local private investigator companies, doing investigations. As they found what my skills and experience enabled me to do, they tended to give me their harder cases. They could not handle these themselves, despite the high prices they were charging their clients. I realized that I could do private investigation work better than these competitors by being my own boss, charging people less money for it. Perhaps it was time to go into business for myself.


It was the dog that finally got me out on my own, however. My dear wife several times saw a pitiful dog chained in a rundown yard, with a crummy doghouse, often without water in his dish, a heartbreaking example of neglect, even cruelty.


The dog’s chain was only a couple of feet long. His area was filthy. We talked with the local animal control officers several times without success. I finally called their supervisor and volunteered to do whatever I could to help.


The supervisor appreciated my concern, and told me that the problem was that there were no investigators on the staff to assist in the animal control activities. A true investigator would have sanctioned Peace Officer status, to allow investigation. I asked if I could volunteer right now. She was delighted, and so I did.


It’s an interesting fact that New York State agricultural laws allow an SPCA Peace Officer more power in some ways than local police have. In the case of this maltreated dog, the owner was dating a local politician. The papers that we submitted became “lost.” We had the power to move the case from Newburgh’s jurisdiction to Goshen‘s. Although the dog had a reputation for being vicious, when I approached him gently, with a dog treat, he allowed me to put a leash on him and bring him back. We got the dog removed from the site and adopted. I felt so good about the resolution of this case, that I decided I needed to go back into active investigating, and I set aside the security work.


I had become registered as an SPCA state-authorized Peace Officer, and I started an SPCA investigative unit that now has three volunteer investigators and staff. As we got more help for this activity, I phased out my involvement with the SPCA and began my own private investigations agency, Gold Shield Investigations, LLC.


So, in some sense, that poor dog did indeed bring me out of retirement. I have continued to be pleased with being much more active than I was during my brief retirement.


I might add here that one of the things that I have recently enjoyed has been writing this book, and I am hoping that those of you who read it will find it worthwhile.



This is an excerpt from THE SHIELD OF GOLD, by former NYPD detective Lenny Golino and Douglas Winslow Cooper, published in 2012 by Outskirts Press and available from OP and from and in paperback and ebook formats.

Golino heads Gold Shield Elite Investigations,
Cooper aids authors through









Friday, March 22, 2013

TING AND I, Relativity

From Ting and I: A Memoir of Love, Courage, and Devotion

“Sharp knives make the meat more tender,” the waiters and waitresses at Kent’s Steak House in Atlantic City were exhorted by signs posted in the kitchen, in the latter part of the summer of 1961, when I worked there as a busboy to supplement the money I had made at Camp Merry Hill. Keep those steak knives sharp! If you had to fight to cut up your steak, you concluded it was tough rather than that the knife was dull.

Our conclusions about reality often depend on what tools we bring with us, physically and mentally, to evaluate it. We see the world “through a glass darkly” and this shapes our beliefs and thus our behavior. This should humble us and also make us skeptical of the seeming confidence of others, many of whom are frequently wrong, but rarely in doubt.

Our motives shape our perceptions and analyses, too. “Where you stand often depends on where you sit.” Different positions in life give different views, have different payoffs, different risks.

When solving a problem, it is best to have a wide range of “instruments” available, whether these be actual tools or mental models. “When you have only a hammer, every problem looks like a nail.” I tend to hoard “stuff,” thinking someday I’ll find a use for it. Occasionally, I do. Of course, one must be sure never to run out of duct tape.

Not only scientists, but all of us, need to test our perceptions and conclusions against outcomes. When interpreting the motives of others, we are confined to what they say and what they do. “Watch the feet” or “actions speak louder than words” we are wisely advised. Another maxim is “do not rely on the good words of someone who is seeking something from you.” If they love you, they are likely to be thinking more about giving to you than about getting from you.

Tina has proved to be as promised, and I hope I have.

Wednesday, March 20, 2013

TING AND I, Caregiver Sleep

“Sleep [that] knits up the raveled sleeve of care ... Chief nourisher in life’s feast,” Shakespeare wrote in Macbeth.

Getting sleep in the caregiver role is not easy, even when you have plenty of help in giving that care. My year of lying beside Tina as the overnight nurse helped get me into a pattern of sleeping lightly, waking easily several times per night. When that phase passed, I still did not sleep well, even upstairs in my own bed, likely due to a combination of minor medical problems of my own and underlying anxiety about Tina’s condition.

Why not take a pill? Years before Tina’s near-death, I did. Sometimes they worked, sometimes not. One night during that critical hospitalization, I took a couple of Tylenol PMs and slept soundly. Too soundly, it turned out. In the middle of the night they called me to tell or ask something important about Tina’s care. Whatever it was, I responded plausibly, but remembered it only vaguely when I awoke. That’s too dangerous to let happen again, I thought. I no longer take anything stronger than milk before bedtime.

The Bard wrote, “to sleep, perchance to dream ... there’s the rub.” Several dreams lately have been of my being in jeopardy, with people ignoring it or leaving me to face it alone.

To keep from being sleep-deprived, another dangerous situation, I take frequent naps during the day. I have read that they are almost as effective as the same amount of time spent in regular sleep. They are pleasant, so much so that one wit described being awake as “that unpleasant time between naps.”

Monday, March 18, 2013

TING AND I, Temporary Insanity

During this period of hydrocephalus my thinking was sluggish, my memory poor, my emotions and their display (affect) confined within a rather limited range, rarely very happy or sad, but mellow, instead. It was not as enjoyable as feeling sharp, but it was not so bad, either. Unfortunately, it could lead to permanent brain injury or even death.

After the surgery, I had an invasive examination of the urinary tract at the office of a urologist in a nearby city, and that cystoscopy gave me a bacterial infection that was curable and a viral infection that was not. Next time, doc, make sure your assistant has sterilized the ‘scope. The bacteria were of the type usually associated with nosocomial (hospital derived) infections. The virus was common to urban areas especially.

The urinary tract infection caused by the post-op cystoscopy (they had put a flexible endoscope, a light pipe, where men are not designed to have one be put) gave me powerful delusions: I was not sure where I was, and –although mellow–I was sure that one of my favorite nurses was killing people and putting their bodies in the big boxes that I had along the wall of my room. I never opened the boxes, but I did leave an obstacle in her path on the stairs to warn me if she were coming. Amazing!

The nurses got me to the hospital, where I stayed several days, recovering rapidly. The final delusion led me to believe that on the day I was scheduled to be discharged, September 28, 2008, there was going to be a general change of hospital personnel. You see, they were really all members of the Polish Secret Service, watchful allies of ours, and they were scheduled to rotate to different hospitals that day. It never made the newspapers, and I came to doubt it a day or two later.


Tina’s staff performed as desired; they did not need my constant vigilance. I was very appreciative. During the latter part of this mental incapacitation, I asked one of my staff to take possession of my handgun, a 9mm revolver I had obtained (with proper paperwork) shortly after the O.J. Simpson jury returned its “not guilty” verdict in his obvious killing of two people. One really could not rely on the cops, who come after the crime, or on the jury, too easily swayed by prejudices and ignorance, to be reliable deterrents. The expression among some gun owners is that they would rather be tried by twelve jurors, in the case of shooting someone, than be carried by six pall-bearers, if killed for the lack of a weapon.

There have been occasions out here in the country, especially in the winter, when the Lake Osiris population is down, when I have come downstairs with my weapon (and its muzzle-mounted laser pointer) to investigate possible trouble. My mother fears I am going to gun down some Girl Scout cookie-monger. Don’t come at night, dears.

Having been heavily dependent on my intellect, I regretted the dimming of it during this period but found a certain tranquility that offset the loss. Perhaps that is how one feels with Alzheimer’s. Having mental quickness and emotional responsiveness restored was better, still, more fun. My past delusions have made me more sympathetic to those who cope with them regularly. They were scary, with no offsetting benefits.

Sunday, March 17, 2013

TING AND I, Our Prospects

Despite the dire prognosis given in June 2004, Tina has made it through an additional nine years. Her spirits are good. Her general health is sound. Granted, a severe respiratory infection could be fatal, but she has survived a few of those already.

Current research in multiple sclerosis centers on prevention and repair, with progress being made on both. Prevention involves keeping the immune system from attacking the body itself, specifically, from attacking the myelin sheath that covers and insulates the nerves. For other autoimmune diseases and for many other conditions, the behavior of the immune system is critical, so there are multiple opportunities for breakthroughs concerning autoimmunity to occur as research continues on all of these.

Repair involves replacing the scarred myelin with new myelin. Another route would be to encourage the growth of alternate neural pathways. Here, too, much research activity is underway. Stem cells from Tina’s own body, for example, might migrate preferentially to injured sites, without triggering a damaging immune response. This has been demonstrated in mice.

Neurological improvement would need to be followed up with much physical therapy for Tina to regain some of her previous mobility. Neurological improvement might also diminish cognitive losses she has suffered.

Barring a lethal infection, Tina would be expected to live into her 90s. Her father, despite poor nutrition in childhood, lived to 88, her mother to 95. In America, women live longer than men, Asians live longer than whites, who in turn live longer than blacks. These trends are all in Tina’s favor.

My own mother is 94 now. My medical problems are few and not severe. My insomnia puts me at some added risk. The hole in my head with a tube to my gut (a shunt to deal with hydrocephalus) cannot be figured as an advantage. I expect and want to live much longer, with Tina.

“Together forever” is our dream.


Robert Frost wrote:

Nature’s first green is gold,

Her hardest hue to hold.

Her early leaf’s a flower,

But only so an hour.

Then leaf subsides to leaf.

So Eden sank to grief.

Dawn goes down to day.

Nothing gold can stay.

Yet Tina and I have been in love for 48 years, together and apart. As her father said at our wedding, “Love conquers all.” As one of those it conquered, he would know.

Robert Browning took a different position from Frost:

Grow old along with me!

The best is yet to be,

The last of life,

For which the first was made.

We agree with Browning.

Saturday, March 16, 2013

THE SHIELD OF GOLD, Through a Cop's Eyes

Sometimes reporters would refer to us as “heroes,” a nice compliment. I have done some brave things, but I do not consider myself a hero. Most other firemen and cops would likely tell you the same thing. We did our jobs. We did what we were trained to do. True, if most other people did it, a plumber or a teacher perhaps, they would be heroic.


Even so, I can remember an occasional colleague who could not quite measure up to the demands of our task, especially that of the robbery-homicide detective unit, where serious crimes led to heartbreaks. I had one new addition to our unit whom I had to send back to headquarters, as he was stunned on one of his first days with us by what he had seen, a senseless killing that was the result of a gang initiation, done at a time when his own son was becoming implicated in gang activities. It hit too close to home.


Home is where the heart is, and I had to be careful not to bring my job home with me, to be careful to be “Dad“ not “Detective.” Generally, I succeeded. Some days I even brought home a sense of accomplishment and satisfaction. I am rather quiet and polite on and off the job, but it would be a mistake to interpret niceness as weakness.


Members of the NYPD did what we did because we thought it was right, and because it was our job. Over time, we gradually lost most of the friends that we once had. Part of this was due to the strange hours that police work often required, giving us night shifts or days off in the middle of the week, when friends and acquaintances were not available for socializing.


Then, too, like medical doctors and some other professionals, we had a rather specialized field that gave us a unique perspective on much of human activity, a perspective not easy for those not on The Job to understand. We tended to spend our social times with other cops.


As for my neighbors, some knew that I was policeman and others were unaware of it. I tended to keep my being a detective pretty much private. I didn’t wear a baseball cap with the NYPD logo or sweatshirt with the logo or a shield or any jewelry that showed my affiliation. The necklace that I wear under my shirt has a charm that is a tribute to my being a fine father, rather than for being a detective.


What did I tell the neighbors? Occasionally, I half-jokingly referred to myself as a “zoologist,” because I sometimes dealt with animals. On rare occasions, I called myself a “proctologist.”


One reason for choosing such privacy was that I didn’t want my professional affiliation to color all my interactions with people I dealt with outside of work. Another important reason was that not being obviously a cop could give me an advantage in certain situations when dealing with criminals.


Some individuals, especially when drunk, choose to cause trouble with a policeman just to show how tough they are. I had no need to prove myself to such people. If the would-be troublemaker was unaware that I was a policeman armed with a gun, I might be able to surprise him. The gun was generally kept hidden, partly so that no one would be tempted to go after it, partly to give me the advantage of surprise, if necessary.


I even carried two wallets. One wallet contained my police identification and shield. The other had my routine “civilian” materials, such as driver’s license and cash and credit card. In case of a holdup, I would allow the perpetrator to take the civilian wallet, then surprise him with my gun and his arrest.


One of the most difficult parts of being a policeman is delivering notification of the death of an accident or crime victim to the next-of-kin. It never became easy, but at first, as a 26-year-old rookie policeman, I found it particularly difficult. Whether the death was due to natural causes, accident, or crime, we were notifying the family because it happened suddenly. Especially hard was telling a parent about the death of a child, as I remembered how my mother would wait up for me at night when I went out after school. I could imagine the concern that other parents had for their children.


Now, as the father of two daughters, one only 22 years old, when I don’t know what’s happening with my girls, I wait with a scary film running through my mind, replaying many of the unfortunate things that I can recall happening to other people’s children while I was with the NYPD. I never want to have a policeman come to my door to deliver a death notice.


There’s no good way to deliver a death notice. Whenever the notification was to people in our precinct, we would do so in person. Typically, we would be reporting a stroke or heart attack, a horrific accident or crime. I tried to choose my words carefully, consistent with the seriousness of the situation, but avoiding the most dramatic words that might apply.


Where possible, I would try to make a gradual transition to the terrible news. I would introduce myself, then talk about an incident, an accident, or a crime, typically indicating that the victim had been sent to such-and-such hospital, where an all-out effort had been made to give the best of care, unfortunately without final success. If true, I would emphasize that the victim endured a minimum of pain.


Fortunately, the press of our other work usually meant that shortly after having to give such notification, I would be involved in a very different and often engrossing activity as part of my duties.


THE SHIELD OF GOLD, by Lenny Golino [PI and former NYPD detective] and Douglas Winslow Cooper was published in 2012 by Outskirts Press and is available from Outskirts Press,, and in paperback and ebook formats. See Golino's site

Dr. Cooper assists would-be authors in writing and publishing their books. See

Friday, March 15, 2013

Together Forever...At Last

Fear separated my beloved Tina and me in June 1964. Courage reunited us, in marriage, twenty years later.
Tina Han Su and I fell in love in February 1963 at Cornell University.

I met her when she joined the half-dozen of us in the introductory Chinese class. Tina had started the class mid-academic-year because– as you might guess from her name– she is Chinese-American and had already learned some of her parents’ native language at home. I was taking Chinese to fulfill my language requirement with something more interesting than the French and Latin I took in high school.

Tina and I enjoyed our Chinese class together six mornings a week, at 8 a.m. Often she and I then went for tea at the student union. I found her to be not only beautiful but intriguing, considerate, thoughtful, artistic…. She was a pre-med freshman and I was a junior majoring in physics. Each been “stars” in our small-town high schools, but each had to work hard to do well in this much more competitive Ivy League milieu.

Cornell was scenic and challenging, though a somewhat cold place. We provided our own warmth. We went hand-in-hand wherever and whenever we could…around campus, down to Ithaca and back, over the bridges across the gorges, sharing breakfast while looking at Beebe Lake, attending an occasional concert or lecture.

There were few Asian students on campus. Inter-racial couples were rare, but we experienced no hostility…at most an occasional stare. We had many mutual friends.

Apart that summer, we returned for my senior year, Tina’s sophomore year, knowing we might have only our three semesters at Cornell in which to be together. For my birthday in December 1963, she wrote:

Dearest Doug,

You asked me what I would think of these sixteen months a few years from now. My reply–now, after one year, after fifty years:

She then quoted much of John Donne’s “A Valediction: Forbidding Mourning,” one of my favorite poems, the poem that I later read to Tina at our wedding in June 1984.

In it, Donne likens the connection between separated lovers to a draftsman’s circle-drawing compass, its moving foot representing the lover who must travel away, while the central “fixed foot” always leans and “hearkens after it.” The poem ends, in our case prophetically,

    Thy firmness makes my circle just,

    And makes me end where I begun.

Why didn’t Tina and I get engaged, in 1964, or even get married? In 1964 such marriages were much rarer than now. In the 1960s, some states still had laws against interracial marriage, “anti-miscegenation” statutes. We feared that our mixed-race children would not be accepted fully by many members of either race.

We were 20 and 21 years of age, too young to marry with confidence. A long engagement might have been feasible.

Both sets of parents were against our pairing, for reasons ranging from the practical to the ethnocentric. Tina was an obedient Chinese daughter. I was less obedient, but I did value my parents’ greater experience. Our marrying would have caused much family dissention.

If marriage to a successful Chinese professional who loved her would be better for Tina and eventually better for any children she would have, it seemed selfish of me to stand in the way. Tina felt the same about me and my best interests.

I had been Tina’s first love. We parted in June 1964, still in love, but afraid to marry.

Where’s the “gutsy” part of our story? By February 1983, nineteen years after we parted, I had been married and divorced, engaged and disengaged. I had reason to believe that Tina’s marriage of fifteen years to a university professor of Chinese extraction had not been going well. Passing through Chicago, where they lived, I called Tina. I had to know whether she still felt for me the love I still felt for her. “Nothing has changed for me in twenty years,” she replied.

We were ecstatic. We communicated by telephone and mail. Soon, Tina told me she was afflicted with multiple sclerosis, though her symptoms were then minimal. I read about MS and was shocked: there was a substantial probability that she would become quadriplegic and ventilator-dependent. My poor, dear Tina! I spent a sleepless night considering whether I could handle such an outcome, decided I could, determined I would, and the next day– by telephone, not having seen her in sixteen years– I asked Tina to marry me, and she accepted.

Gutsy? “Love casteth out fear.“

When we met a month later, we were both delighted with the person each had become, both glad we had made our commitment.

We married in June 1984, twenty years after having parted. Our wedding rings were inscribed, “A dream come true.” Even our parents now approved. Tina’s father’s wedding toast was: “Love conquers all.”

We have had twenty-eight wonderful years of love-filled marriage. The mixed-race aspect has not caused significant trouble. Step-parenting has gone very well.

Health? For the first decade, Tina could walk slowly, drive adequately, enjoy life fully. Then, in 1994, breast cancer struck, treated successfully with a mastectomy and some chemotherapy. Later that year, MS finally took away Tina’s ability to walk. With some help, I cared for her at home.

Twenty years into our marriage, in 2004, Tina nearly died from an MS exacerbation that led to a raging systemic infection. After 100 days in the critical care unit of our local hospital, Tina was dangerously weak, quadriplegic, permanently dependent on a ventilator, not expected to live more than a few months, given the choice of “home or hospice.”

We chose home, with around-the-clock skilled nursing care, and we have had the gift so far of eight additional very happy years.

Engraved on the gold heart charm I gave Tina for her bracelet in celebration of our 25th wedding anniversary is our motto: “Together forever!”

We have never regretted our “gutsy” choice, to pledge to marry…sight unseen.


For illustrated version, see


TING AND I, Brain Surgery for Hydrocephalus

“Ask the man who’s had one.” No, I’m not going to give advice on brain surgery, but I’ll tell you my experience.

On September 4, 2008, a surgeon made a hole in my skull and then ran a tube from my head, under my skin, connecting my brain’s right lateral ventricle to my peritoneal cavity. My forehead now permanently looks like I have just bumped into something. Still, I am grateful to modern medicine and especially Dr. Michael G. Kaplitt, M.D. and Ph.D., Associate Professor of Neurological Surgery at New York Presbyterian’s Weill-Cornell Hospital. Without this operation, I was going downhill, toward dementia and death.

Dr. Kaplitt impressed me from the start. Direct, honest, confident without seeming arrogant, he explained what needed to be done. I felt my head would be in good hands.

As a newborn, I had nearly died of hydrocephalus. If not cured or subsiding spontaneously, this leads to convulsions, retardation, death. Within the confines of the brain / spinal cord system circulates a fluid, the cerebral spinal fluid (CSF) that is necessary for temperature and chemical management, for the health of the brain. Tiny pores at the top surface of the brain allow the fluid to flow through the brain, to two cavities, the lateral ventricles, then to a third cavity, then to a fourth cavity (fourth ventricle) and on to the spinal cord region, from which it later returns. The fluid is sterile, preventing infection. The flow is about a half pint (250 mL) per day, normally just seeping into the blood circulatory system. And eventually excreted.

If the channels through which the CSF flows out of the brain though the ventricles are too small, or if CSF production is too great, pressure builds up in the ventricles, which in turn press the outer portion of the brain against the inside of the skull, damaging the outer portion of the brain if allowed to continue too long. Those crucial convolutions and folds become flatter, almost ironed out.

In adults, there’s a “classic triad” of signs indicating that CSF pressure has become elevated: urinary incontinence, short-term memory deficits, and problems with walking (gait irregularities). Making diagnosis difficult is the fact that each of these signs can have other plausible causes. All three together pointed to hydrocephalus, with which I was diagnosed in the early summer of 2008.

Looking back, I thought some of the symptoms in milder forms were present as much as a decade earlier. I sought help after I had I fallen twice, but it had already become clear something was wrong when I had difficulty getting in or out of my car and, even before that, occasional unusual urinary urgency.

Tina’s neurologist, Dr. Baradaran of Middletown, NY, listened to my recitation of symptoms, did some simple tests, had me get a CT brain scan, and very somberly gave me the bad news: hydrocephalus, requiring brain surgery. I sought second and third and fourth opinions, with the same diagnosis, prognosis, and prescription: I needed a hole in my head, a valve to control cranial pressure, and a tube to my abdominal area for the overflow.

We found Dr. Kaplitt, and had it done. Amazing technology, really, with a valve that can have its pressure setting adjusted using magnetic force applied externally, without breaking the skin. I just have to stay away from MRI equipment and from those magnet-based scanners they use in airports and courthouses. Bumping that portion of my forehead on something hard would not be a good idea, either.

My deep gratitude to my surgeon for the successful operation and subsequent fine-tuning of my ventricular-peritoneal shunt will not keep me from relaying a joke, probably created by a nurse, about the pride of some surgeons:

“What’s the difference between a surgeon and God?”

“God knows that He is not a surgeon.”

Wednesday, March 13, 2013

TING AND I, Hospitalizations

During the seven years since Tina’s crisis, we have had an additional few hospitalizations, generally for a week each, and generally associated with an infection of some kind. Respiratory infections are the most dangerous, but urinary tract infections can also become systemic and life-threatening.

If the infective agent is a virus, not much can be done to fight it except to support the patient as her immune system battles to save her life. Combating secondary bacterial infection is often required, too. A bacterial pathogen is likely to be susceptible to antibiotic treatment. A mild broad-spectrum antibiotic might suffice, though often one needs a stronger drug tailored to the specific type of organism, Gram-negative or Gram-positive, staphylococcus or pseudomonas, etc. Medicine that can be given orally (by gastric tube, in Tina’s case) is more easily administered than medicine that needs to be given intravenously. In Tina’s case, several such IV treatments have left her arm and foot veins too fragile. That’s why a chest-level port will be needed.

When she is hospitalized, we have our own nurses accompany her, doing as little or as much as the hospital staff is comfortable with. This is expensive, as our insurance does not cover this second layer of nurses; but it assures that her special needs are understood and receive attention. It provides continuity of care for her and continuity of employment for the nurses.

Tuesday, March 12, 2013

TING AND I, Trips to the Doctors

We see a pulmonologist four times a year, a throat surgeon four times a year, a general practitioner as needed, typically several times a year. If something is amiss, there will be tests and scans, hither and yon. We bring our most recent records. We record the results of the visit in a book dedicated to doctor visits.

Each trip requires the life-support equipment. Each trip is an adventure, because if the specialized van breaks down somewhere, we’ll have major trouble. The van’s lift requires electric power, without which Tina is trapped in the van. If the van’s doors jam, the same problem results. Even if we get her out, what next? Call 911 and transfer her to a stretcher and take her home. Don’t forget to bring the cell phone.

The consequences get more serious if we are brought to a halt during a summer trip. Heat is very hard on MS patients, as it aggravates the deficiencies in the insulating properties of the myelin covering the nerves. In the winter, cold is the threat. We try to schedule most of our trips for the spring and fall, the more temperate seasons.



The doctor trip from hell would be one where our special van breaks down on a lonely road in the winter or the summer, with an electrical failure. No heat, no air-conditioning, no power lift for entrance or exit from the van, with Tina stuck inside. As I write this section on April 25, 2011 we had just had a somewhat less than hellish trip.


The multi-specialty doctors’ practice in Middletown is about twenty miles away, typically a forty-minute ride, plus loading and unloading time. We allocate an hour each way. For this trip, we had originally scheduled back-to-back appointments with two doctors in the group, a pulmonologist and a new gastroenterologist, to save us from having to make two trips. A few days previously, we were told we had to postpone one of the appointments, because Medicare does not pay for two doctor visits to the same practice on the same day. We put off the pulmonologist for a few days.


The van’s motor started up well, despite not having been used for a few days. The horn was strangely anemic. The power lift rose more slowly than usual in getting Tina into the van and descended more slowly in delivering her to the doctors’ parking lot. An electrical problem? Stay tuned.


We waited almost an hour for the gastroenterologist. When we saw him—presentable, articulate, speaking rather good English, though a bit too softly for my poor hearing—it became clear that Tina’s feeding tube was not going to be changed then and there, as we thought it would be. No, no. You can't have fed her within five hours of the procedure (which itself is often done by nurses and takes about five minutes). No one had warned us of this. Furthermore, they had no gastric tubes on hand. You have to bring your spare, then they use it and give you a prescription for one or two more. No one had told us this, either.


When I explained the inconvenience of making two trips, the doctor informed me about the Medicare reimbursement rules, emphasizing that he would not lie for us and claim we had come a different day. Charming. I might have said I would not lie for him and tell someone else that I thought his practice was well run, but I did not. I’m more charming than he is, surpassing a low standard. We used this man because his predecessor gastro kept us waiting a couple of hours without a warning of any kind. What is it with the gastro guys?


After making a new appointment for a week later, we packed up our gear to take our van home. I turned on the ignition—and nothing happened. No gauges moved, no radio came on, certainly no starter motor was motivated. Dead. We tried jump-starting, with the help of the kindness of strangers. No luck. I called AAA. The van’s electrical system was too complex for local garages, because of the power-lift modifications for the wheelchair. We called an ambulance and got Tina into it, transferring her from wheelchair to stretcher and folding up the wheelchair to squeeze it into the vehicle. We had wanted an ambulette (wheelchair, not stretcher) service, which would take us all and leave Tina in her chair, but the listing in the Yellow Pages was not sufficiently clear.


Much waiting ensued. Tina, our nurse, and I all were patient. We were in the temperature-controlled waiting area of the office building containing the medical practice, safe and sound. We had two oxygen bottles with us. Nothing really bad happened. Of course, nearly a thousand dollars in ambulance and towing fees were put on the credit card. It’s only money. Better yet, it’s only plastic.


In a few days, we were scheduled to return to the same practice, this time for a pulmonary check-up. We could hardly wait.


Postscript: We junked that van and bought another, newer, used van, one whose exit access was not dependent on electrical power, so that we could get Tina out of it even without battery power.

Monday, March 11, 2013

TING AND I, Emergency and Pain Management


The first page of the three-holed binder we used for our nursing information, charts, and shift reports has had a list of instructions–and telephone numbers–to assist rapid decision-making in the event of an emergency. We have discussed a few scenarios with the staff. Rapid onset of respiratory infection and fire are the two paramount risks. We choose nurses who are strong enough and well enough to drag Tina out of our home on their own in case of a fire during the few hours a day I am typically not at home.

Most critical is providing two paths for air flow to Tina’s lungs, so that if one is blocked, she still gets air. The tracheostomy tube that goes into her throat is curved, so that it extends downward inside the trachea (windpipe). Inside it has a small balloon, the “cuff,” like a tire inner-tube, that surrounds it. This means there are two paths for air: through the tracheostomy tube in her throat or around the tube to exit normally from her windpipe to larynx, mouth, nose. Depending on the degree of inflation of the cuff, much, little, or no air flows through the space between the cuff and the inner wall of the windpipe and on to larynx, mouth, nose. Full inflation seals the cuff to the wall, keeping any fluids, such as saliva, from flowing into the lungs, a benefit. Full inflation prevents air from going to the vocal cords, greatly limiting the patient’s ability to communicate. Full inflation means that any blockage of the trach tube cuts off air to the lungs, a dangerous condition. We use partial inflation of the cuff, giving us two ways for air to get to and from the lungs, through the trach tube or around the cuff, somewhat raising the risk of aspiration of fluid into the lungs, but lowering the risk of asphyxiation.

We have tested our ventilators and have assured ourselves that when they are off, Tina can still inhale and exhale through them. Off, they do not assist, obviously, but they are not stopping the flow, a critical concern. They have built-in batteries, and we have back-ups for them, but if some electrical fault should cause them to stop, Tina could still breathe.

In various places around our house are stored plastic gallon jugs filled with tap water. We usually drink bottled water, as our well water is mediocre. When we lose electrical power, and even when we fire up our gasoline-powered generator, we do not have electricity for the well pump. Water for cleaning and flushing quickly becomes an issue. We once had a 95-hour (four-day) outage, when our gallon jugs were very useful.

The gallon jugs of water could be useful against a very small fire, and we have fire extinguishers in each kitchen, by each exit door.


Before her near-death exacerbation and aspiration pneumonia in the spring of 2004, Tina rarely complained of any pain associated with MS. This MS exacerbation that cost the remaining use of her arms and hands and nearly cost her life also left her with painful contractures of the elbows and wrists.

The primary doctor at the hospital active in her care, Dr. Richard Walker, an internist and pulmonologist, agreed with me that we must give her protection from this pain, as it made moving her for in-bed care traumatic and threatened her will to live. The solution was morphine, and I was adamant that she be given enough, even if risky, to protect her from pain. He agreed.

For seven years now, we have been able to shield her from that pain. In a few instances, a shortage of morphine or an oversight has left her unprotected. The resumption of that pain proved the need for the continuing pain coverage.

Morphine sulfate solution became harder to get in 2009. We switched to morphine sulfate pills, water soluble, thus also capable of administration through the gastric feeding tube. We hadn’t realized they would be half the price of the liquid. Instead of costing us $420 per year, it is $210 per year. Since IBM pays four-fifths and we pay only one-fifth, the liquid was actually costing a total of $2,100/year; so using the pills instead saves a thousand dollars per year. The other advantage was that the pills constituted one-eighth of the total daily dose, and thus were given every three hours. The morphine solution was one-sixth of the total daily dose, given every 4 hours. More frequent doses in smaller amounts help preserve a nearly constant level in the blood, and nearly constant pain protection.

Tina gets five other prescription medications at various times of the day and six feedings throughout the day with a balanced nutritional fluid. She also receives cranberry juice and yogurt, along with a host of vitamins and minerals. She is in robust health, needed if she has to fight off viruses, for which there is little available effective medication.

All of this is kept track of with “charting,” listing of each item, its time of ingestion, day by day, the nurses initialing what they have given. A similar set of documents chart the treatments, from bathing, to diaper-changing, to care for the gastric tube site to care for the tracheostomy site, etc.

Frequent monitoring of crucial vital signs—blood pressure, pulse rate, blood oxygen saturation, heart rate, respiration rate and volume—has helped us catch incipient infections rapidly. Still, an attack of pneumonia once developed within only a few hours, and we had to call 911 and the emergency medical technicians to rush her to the hospital, forty-five minutes away.

Intravenous antibiotics given through a triple-lumen catheter placed in her upper chest, saved her life. A couple of other times, intravenous lines threaded from her arm to a major vein in the chest were sufficient. The irritation of those veins that occurred at that time means that the next time, we will have to re-install a port surgically. It all gets a bit scary.

Several doctors have told us she has been receiving exceptional care at home. We call it TLC, “Tina-loving care.”

Sunday, March 10, 2013


Nicely presented at

TING AND I, Home Care Medications and Nutrition

By our seventh year of home care, we were using the gastric tube to administer the following medications, vitamins, and foods the indicated number of times per day: morphine sulfate* (eight), Carafate (sucralfate)* (four), Baclofen* (three), balanced nutrition liquid* (five), protein supplement* (twice), Prozac* (once), vitamins B6, B12, C*, and MgO, K, Ca* (each once), Fe (twice), yogurt (twice), Benadryl* (twice), Proloprim* (once), Ativan* (once), cranberry juice (once), aspirin* (once).

None of these was given against doctor’s orders. Those with asterisks were prescribed; some were available over the counter. Keeping track of these was done by a matrix, a “chart,” with rows being the items and their timing and the columns being the dates, with the intersection initialed by the nurse giving the item. Each chart noted the four chemicals to which Tina is allergic. A similar chart was developed for the many treatments needed regularly.

We had doctors’ orders for another dozen medications on a PRN (as needed) basis. This way, we were not asking the nurses to give Tina something not medically authorized.

In feeding, there are two easy ways to go wrong: too much food or too little. For Tina, we started with five cans of a 250-calorie balanced-nutrition drink. With the yogurt and juice, the total was nearly 1,400 calories. After a year or so, my 125-pound love had gained definite chub. Creases had formed in the skin on her back, and they were getting irritated. We cut back by one can a day to four per day, about 1,200 calories in all. Two feedings with whole cans were replaced by two feedings with half cans plus water. Slowly, the former sylph returned. At roughly 4,000 calories per pound of weight gained or lost, losing ten pounds should have taken about

(10 lb) x (4,000 cal/lb) / (250 cal/day) = 160 days,

probably not too different from what transpired. Physicists love equations.

My mother represented the other way to go wrong. She ate like a bird, a fussy bird, at that. In three months she went from about 125 pounds to about 110, a loss of 5 pounds per month. A similar estimate indicated she was getting 5 x 4,000 / 30 = 700 too few calories a day. I summarized this for her: “Eat or die!” She started eating more. “Eat and live!” became the rallying cry.


Powerful medications rarely have only one effect on the body. The other effects, “side effects,” one hopes will be benign or mild. We have to be watchful for them, especially during the early applications of a given medicine.

Tina is allergic to a few meds, and these are prominently listed at the top of each medication scheduling chart. If a new drug being started is related to any of these, we watch with particular care.

From the various nursing and medical handbooks, one can read a listing of typical, unusual, and rare side effects, with some highlighted as serious. In home care, the prescribing physicians are relying on nurses and family to detect such adverse reactions.

Less obvious is the interaction of two or more drugs to aggravate the side effects of each. We noticed Tina was losing her hair, which would have been very upsetting for her. We spotted two of her drugs that had this as a rare side effect. Combined, apparently, they were more of a problem. Checking with the doctor, we dropped or found a substitute for one of the drugs, and this problem went away. Surprisingly, one or more of her medications has led to a lovely waviness of her hair.

Drug interactions are hard to detect and probably more common than most people think. The number of combinations goes up rapidly with the number of drugs. For drug A and drug B, there is only 1 combination, AB. For A and B and C, there are 3 combinations: AB, AC, BC. For A and B and C and D, there are AB, AC, AD, BC, BD, CD, six paired combinations. For N drugs, each new drug adds (N-1) more pairs. Note, too, that three or more drugs lead to sets of triadic combinations: A and B and C and D have: ABC, ABD, ACD, and BCD. No wonder surprises turn up! We traced Tina’s only seizure episode to such a three-drug combination.

Did I mention that physicists love equations?