Saturday, October 12, 2019

Swinley Forest Golf Club

The patrician Swinley Forest Golf Club has long been a course I wanted to play, but there is so much good golf around London that I was never able to fit it into an itinerary.

clubhouse coming back in
The picture perfect view of the clubhouse perched on a hill looking up the 18th fairway at Swinley Forest

Harry Shapland Colt describes his philosophy of situating the clubhouse on a golf course: "In selecting a site for the club house . . . it is highly desirable that the aspect from its windows should be attractive, so that the player may get a favourable impression when he first arrives, and may also get the greatest possible enjoyment out of intervals of rest. To achieve this result at its best, if possible, to create an atmosphere of large and unrestricted space, which is the most delightful contrast to the cramped and restricted streets and offices of a large town." On any scale or metric you use Colt was wildly successful achieving his goal at Swinley Forest, as this player, for one, was very impressed. The course was designed by Colt in 1909 and he famously referred to as his "least bad course."


  1st tee
The first hole from the elevated tee

The first hole is my favorite kind. It plays from an elevated tee down into a valley, with a wide fairway, and when we played it was down wind. It's good for the ego to start your round feeling like a stud.

  2nd from tee
The second hole from the tee

In addition to the hilly terrain, the second hole shows off another of the course's defining characteristics, which, like many courses in Surrey and Berkshire, is that it is covered in a sea of heather. The course is routed over land from the Crown Estate and carves its way through a thick pine forest. These heathland courses, with their large swaths of heather, add another dimension to the game's enjoyment. Golf courses are things of beauty to begin with, with various shades of green grass set off against blue skies and white clouds. Adding purple into the mix takes it to another level.

  3rd tee heather
Like his routing at Pine Valley, the third hole at Swinley features a Colt signature, a forced carry off the tee

  4th green
The uphill par three Redan-style fourth hole plays 198 yards tee to green. It's a difficult hole, but the image of it is so beautiful, it is borderline golf porn

Colt never used the term golf porn because that would be beneath a Cambridge educated gentleman, but he did design his courses to intentionally provide the golfer with a pleasing environment. From his book, Some Essays on Golf Course Architecture: "It is by no means so widely recognized that the "landscape" aspect of actual construction plays an important part in securing the popularity of a golf course. The appreciation of pleasant surroundings is often subconscious, and many golfers are no doubt under the impression that while they are playing they are entirely engrossed in the game. When the golfer has left a grimy city for a few hours' relaxation he wishes to find rest and pleasure in the scenery of the country."

  5th from elevated tee
The par five 5th hole plays from an elevated tee and not only features a forced carry, but also the strategic use of another of Colt's hallmarks, the dreaded cross-bunker


The golfer whose senses have been aroused by the stimulating environment that Swinley provides should not confuse beautiful with easy. The fairways tend to kick balls into the seductive purple plant, never to be seen again. Our foursome lost a significant number of balls in the lush plant.

  7th cross bunkers
The 7th hole also features cross bunkers set on a hill that sweeps from left to right. Your shot to the green is either blind or semi-blind and hit from an uneven lie

One of my favorite golf books, Legendary Golf Books of Scotland, England, Wales and Ireland profiled Swinley Forest and described it as "a gentle course for gentleman," and that's spot on. Part of the mystique of the club is its membership. Its aristocratic roots run deep, although we should all be thankful that, unlike in America, the tradition of these great clubs, although limited, is to allow visitor play. The book outlines how the club membership includes Dukes, Marquises, Viscounts, Earls and Lords, and the members tend to have been educated at either Eton or Harrow and Oxford or Cambridge. 

  9th from tee
The 464-yard par four 9th from the tee


There is a cute, tiny half-way house before you start the back nine. They have a home-made sausage roll there that is delightful, and the perfect cure for jet lag.

  12th from tee
The dog-leg left 12th, par 4 hole is one of the best on the course

Colt explains why he likes to use forced carries off the tee, "For testing the long driver, and also for putting a premium upon accuracy, it is highly desirable to include a considerable number of long optional carries in the round, and also to provide opportunities for the bold and straight driver to play close past the edge of a hazard which he cannot carry.  In all such cases it will be arranged that the player who has brought off the drive successfully should gain a substantial advantage over his more timid or less skillful opponent."


  12th green closeup
Not only is the 12th demanding from tee to green, the putting surface is more than challenging 

The 12th green demands respect because of all the movement on the surface. The putt I left myself  had so much borrow in it that it exceeded my credit limit and I hit it on too low a line, leaving it woefully distant from the cup. The greens at Swinley Forest were pure, and the rest of the course was in top condition as well. The club's policy is that you can take preferred lies at all times. Is that wrong, especially if you are a golf purist? Maybe if you're Jack Nicklaus competing in a PGA tour event. For the rest of us, it shouldn't be a bother. As the expression goes, when in Rome do as the Romans do. It is, in fact, the club's rule, so honoring their tradition provides an enjoyable day's golf.

Rhododendrons thrive in this part of England, due to the fertile mixture of soil that they call Bagshot sand. It contains flint, grey sand, clay, and black soil and it is rhodo heaven, allowing the plants to grow to enormous proportions, sometimes as large as a house. The examples seen behind the 12th green are some of the smaller ones in and around the course. 

  15th green 2
The 15th green, with its multiple tiers, shows that Colt doesn't give the golfer any respite when they are using the flat stick

  IMG_2008 
Happy is the golfer that is greeted with this sign for a day's golf 

The club's 2008 history, The Swinley Special, describes the club as follows, "Swinley has always been an extension of the country house party, the City boardroom and the regimental mess. There are no handicaps and no medal competitions, just golf with friends." Dogs are also encouraged at Swinley Forest. The club is an anachronism and still operates as if they were in the Edwardian period, and that is a big part of its charm.

I liked Swinley a lot and with each additional Colt course I play I appreciate his genius design abilities even more. Putting aside the mystique of the club and the idyllic setting, the golf course taken on its own is one of the best. If you can't relax and enjoy the game at Swinley Forest, you should be playing tennis and not golf. Colt was right. Swinley is his "least bad" indeed!

Post Script

I splurged in the pro shop and bought a nice navy blue fleece zip-up vest with the Swinley logo on it. I plan on wearing it when I'm visiting the city so I can channel my inner Goldman Sachs or J. P. Morgan investment banker look.

Thursday, September 19, 2019

My Purity of Essence Returns!

There is a scene in the movie, The Bucket List, where Morgan Freeman and Jack Nicholson are lying next to each other in their beds in the oncology ward reviewing what's on their respective bucket lists. I dreamed about doing many things during "the Troubles," and now that I am able, have decided to pursue my own bucket list, which includes many non-golf related items, and some additional golf pursuits. The odds of my cancer staying in remission are high if it doesn’t come back within the next year, so my timing is perfect. God willing, I will live a long and productive life. In not, there are no do overs, so my thought is that it's the perfect time to pursue my list with zeal. In the best case scenario I'll live to a ripe old age and my kids will have to work harder because I’ll blow through their inheritance!

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Back in January I started to plan a trip to the British Isles in anticipation of getting better, with some new bucket list courses on the itinerary. At the time, it was a stretch and both “the wife” and my oncologist would roll their eyes when I told them what I wanted to do. Even as late as July it was touch and go, I was still having blood transfusions three times a month and the fatigue wasn’t flagging. I had faith and determination that I would go on my trip. Low and behold because of the wonder drug I took in August--Rituxan--my blood counts returned to normal, (specifically, my hemoglobin, which went above 14!!!), and with them my energy levels. I know, what other blog is so exciting that you can learn about medicine and your precious bodily fluids while reading about golf, but such is my plight. Stanley Kubrick and Sterling Hayden would be proud.

So it was that I was able to fly across the Atlantic on September 2nd, wearing my respirator mask and wiping every surface in sight down with disinfectant wipes. I must say that my routine was very effective at keeping people away from me in the airport, and the poor woman in the seat next to me on the plane was so frightened that I got all the elbow room between us on the seat divider.

As you know if you have been following my travails, I have had world-class care and my medical team has patched me up and brought me to a good place. The body is healing and I continue to make great progress every day. It was in Scotland that my spirit was restored as well. Even though I am of Italian-Irish heritage, my spiritual homeland is Scotland. I find every minute on Scottish soil invigorating and just love everything about the country, especially the people, the scenery and the language and accents. We just don’t have teahouses, filled rolls, Sunday roasts, brambles, and rolling hills punctuated with old stone walls in New Jersey. It was in the Kingdom of Fife that my soul was renourished and my mindset shifted from that of a patient to that of a hopeful survivor.

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My home base in Scotland, the former home of the Duke of Fife, built in 1596

I also love to drive on the opposite side of the road and through roundabouts. It was on a beautiful morning when I was driving from our base in St. Andrews to our round at Kingsbarns that the pall of my troubles lifted. Mozart was playing gently on the car radio, I was with my good friends and we are rolling through striking countryside dotted with bales of hay glistening in the humidity-free, crisp air. It was magic and I could feel the weight of a year and a half of stress lifting. It was good to be home. 

back road

Our round at Kingsbarns, one of my favorite courses, was rejuvenating. I had an Italian caddie, Romano, and he and I were simpatico. My soul mate and I were in synch on everything, and this Renaissance man was born to read putts. As a result, I had the best round of golf I played in at least 10 years as we shared stories of our favorites foods, regions of Italy, and golf courses. Since being sick I have set my intention every morning when I wake up to embrace life to the fullest, living large and appreciating everything I have been blessed with. La dolce vita!

 1st green
The opening hole at Kingsbarns

I will be posting a half dozen or so new posts over the coming months highlighting new courses, including two English beauties that are among the best I have ever played.

Tuesday, July 30, 2019

Double Eagle Golf Club

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Double Eagle’s fierce looking logo

I’m back to posting about new golf courses, having just completed one of my most satisfying rounds ever. The combination of being healthy enough to play, teeing it up at a captivating club, and doing so with friends, is a winning combination.

I still can’t fly, so “the wife” and I happily made the eight hour drive from New Jersey to Columbus, Ohio, for my first post-apocalypse outing to meet up with some fellow golf fanatics.

Two years ago those of us who completed playing the top 100 golf courses in the world decided it would be a good idea to get together occasionally to play, so we formed a club: the aristocratically named Global Golf Centurions Club. A handful of members were getting together and I was invited to join. My destination was the Double Eagle Golf Club. Double Eagle was not on the top 100 course list that I played, although for eight years it was ranked in the world top 100, with a peak ranking of 74 (note: statistics provided by the inimitable genius and MIT graduate Paul Rudovsky).

I timed the trip perfectly, juggling infusions so that I had peak energy for the round. The weather also cooperated, it was in the high seventies with some light cloud cover, enough to allow the UV index to dip low enough so that someone who takes 22 pills a day to ward off bad things can go into the sun, albeit with long pants, long sleeves, two gloves, a big straw hat and SPF 50 (which has the viscosity of thick glue and dries looking like white paint) on the face. Visualize a ghost who is dressed like he’s going to appear on Green Acres and that’s me when I play these days, but at this point in my journey I don’t need to worry about getting style points.

The Golf Course

Double Eagle is one of the most unique places I have played with its combination of optimum course conditioning, a noteworthy routing and exclusivity. There are not many members, and the course flies the below the radar. Our caddie told me that they usually have less than ten groups playing per day; if there were twenty total golfers on the course when we played it was a lot. The 340 acre property is also enchanting and feels like a wildlife sanctuary with broad expanses of wild flowers throughout.

The course plays 7,300 yards (6,500 from the members tees) and is eminently playable. The key design characteristics that stand out at Double Eagle are: 1) No two holes in the same direction; 2) The fact that approach shots to greens often have to carry over a ravine or swale or plantings/flowers; 3) The greens are usually elevated and have closely shaved areas around them, and; 4) The design forces you to have to think backward from the green to decide what kind of shot you have to hit. A lot of courses are said to be shot makers courses, but I found this to be a dominating factor to take into account while playing here. It did not seem to be a bomb and gouge layout because of the trouble in front of the greens. On more than a handful of holes you have to lay back and not hit with maximum power so that you position yourself with the correct club to the green, or so that you are not out of position on a dog-leg and block yourself out of the best approach.

  1st hole approach best

The approach shot on the opening hole at Double Eagle

The first hole is indicative of the playing style at Double Eagle. It is a par 4 of 390 yards with an approach over a particularly deep swale.

  Flowers Near 1

Flowers near the 2nd tee shows off the pleasing setting of Double Eagle

The course setting is idyllic and it achieves a degree of isolation that only a handful of courses achieve, i.e., Pine Valley, Yeamans Hall, Morfontaine, and the nearby The Golf Club are notable examples. This type of real isolation is rarer than you think. Many great courses are not isolated, for example, San Francisco Golf Club, East Lake, and Los Angeles Country Club are within cities (or in the case of Pinehurst or North Berwick, within villages or towns) and the nearby urban environment is omnipresent when you play. Others have houses around them, like Wentworth and Winged Foot. Even some of the top of the heap tracks have roads running through them, like Merion, Maidstone, Shinnecock and Pebble Beach, even Cypress Point.

2nd green elevation best

The approach to the par five second shows the elevated green with closely mown areas in front

The 475 par five, dog-leg second doesn’t have a low point or hollow on the approach to the green but it is elevated with shaved areas. Its challenge is a stream running through the midpoint of the hole, forcing the golfer to have to think through how far to hit both their first and second shots to make sure they don’t end up in the middle of the flora that surrounds it. There are also alternative fairways to choose off the tee, split by massive bunkers, adding to the strategic nature of the challenge.
  3rd hole

View of the approach shot to the 3rd green at Double Eagle

The par four 3rd hole returns to the theme of a green protected by a ravine. I’ve probably played 200 or so courses that have ever been ranked among the top in the world. As I go about my travels I keep track of certain characteristics so I can compare them. One category I track is the best greens. To date I have only listed five on my website and in my book as having the best greens: Augusta, Winged Foot, Carnoustie, Peachtree and Camargo. The reality is that almost none of these top courses have bad greens, but these five stood out to me as being exceptional. Double Eagle’s greens, like the rest of the course, are impeccable, and I am adding them as the sixth course on my list. It was difficult to find grain on the greens and they rolled very true, although I found they almost always broke less than they looked like they would.

  6th back
The 505-yard par five 6th hole looking back from the green, with a little stream guarding the approach against loose shots

The course was designed and built in 1992 by Ohio native Tom Weiskopf and his partner Jay Moorish. I am too young to have followed Weiskopf’s career but he sounds like a fierce competitor with a fiery temper, who played at the game’s highest level. He was a winner of 16 PGA tour events including the 1973 Open Championship at Troon. A steely combatant, three of his PGA tour wins were achieved by beating Jack Nicklaus by one stroke. Moorish apprenticed under Robert Trent Jones for four years and worked for Nicklaus Golf Design for ten. This dynamic duo had their peak year in 1992, designing Loch Lomond in Scotland (another course I love) the same year they designed Double Eagle. Their other noteworthy works are in Arizona: Troon North, TPC Scottsdale and Forest Highlands.

  7th approach best

The tight approach to the 360 yard seventh hole, my favorite on the course, requires a precision shot, as does the drive to the small fairway

Tom Doak mentions in his Confidential Guide that the bunkering style here is similar to San Francisco Golf Club and Riviera, although I didn’t notice that at all.

8th par 3 best


The 8th hole, a par 3 of 180 yards, shows the forced carry/ravine theme and the blissful setting

I found the course to have three distinct feels to it. The first eight holes are the most distinctive holes on the property and the ones I liked the most. This part of the property also has the most elevation change. Holes 9-14 play over a flatter part of the property, although they are still quite interesting. The final four holes bring water into play and represent a challenging finish. I personally liked the front nine more than the back.

Like at Loch Lomond, Weiskopf and Moorish maintain the design philosophy of continually changing direction. The course plays along every point on the compass and no two holes go in the same direction, an underrated principal in golf course design. One of the courses that Weiskopf admires and that influences his design is Muirfield, which, similarly, has great variation in hole directions.

  15th hole 2

The green on the challenging 15th hole shows the generally flatter nature of this part of the property

The 15th is a Cape-style par four of 440 yards, with a fairway that sweeps to the left, and the golfer has to decide on the tee how much of the lake to cut the corner on. Water also comes into play on the par three 16th as you shoot at a perched green, and greenside on 17 and 18.

Tom Weiskopf is credited with the introduction of the modern drivable par four into course design, and it is his signature. I do remember the split fairway 14th hole at Loch Lomond is a gem of a drivable par four. At first blush the 17th at Double Eagle doesn't seem drivable at 340 yards, but once you look at the nuances of the hole it becomes apparent that for a stud it's possible to land a ball on or near the green off the tee. The hole's defining obstacle is plain to see off the tee: three large trees splitting the fairway, with the more generous portion being on the left and a narrow sliver of fairway on the right. You have to decide if you want to go left or right of the trees from the tee, and if you go to the right, it’s only about 300 yards to the large green, although that choice brings into play the water that juts into the fairway near the green. The 17th gets several accolades from George Peper in his book the World’s 500 Greatest Golf Holes, notching up rankings in the categories of ‘best short par four’ and ‘holes most nearly impossible to get on.’

  17th

Three mature specimen trees on the 17th provide quite a defense on a short par four

  17th backward

The 17th as seen from the green looking back, showing the split fairway, although there is water on the left short of the green isn’t visible in the picture

The challenging 18th, a par five finisher of 525 yards, is another example of how the course rewards precision over length, where just bombing a couple of shots is not the optimal way to play the hole.

  18

The third shot to the 18th green needs to be played with exactness or you’ll be watching water splash as your ball sinks to the bottom

The Club

Our round was leisurely and idyllic, the only sounds were leaves rustling gently in the wind and birdsong. The combination of having a pristine golf course to ourselves during the height of the summer, with perfect temperatures and a light breeze is tough to beat. With respect to Mark Twain, this was not a good walk spoiled. It was a round to remember. As there was no one else remotely near us, we played a fivesome at a comfortable pace. In addition to the world-class golf course, the club also has one of the best vibes of any I have visited. It is a peaceful enclave from the outside world and a club you’d want to be a member of in a minute. There is no pomp and circumstance and it has a laid back feel. Getting the right ambiance (exclusivity without pretension, and a focus on golf and service) is a tricky thing that doesn’t happen that often, but when it does, you know it. I rank Double Eagle among a very select group of clubs that have the whole package and that make you truly feel like you are at home away from home. [San Francisco Golf Club, Maidstone, Somerset Hills, Myopia Hunt Club and Los Angeles Country Club being the others in the U.S.]

I was also fortunate to do an overnight stay in the lodge and it brought back fond memories of staying at dormie houses and club housing at other great clubs. There is nothing like it in my book because you don’t have to rush off anywhere and can immerse yourself in the experience. It is a joy to lose track of time and to stay up late into the night talking golf with likeminded nuts.

The fact that Double Eagle is not currently on Golf Magazine’s top 100 world list is a travesty, this course screams to be back in its appropriate place among the best; it is better than at least 20 courses I’ve played that are on the list. Serious golf fanatics should put Double Eagle on their bucket list of courses to play.

We all have our own thing that helps define us. My thing is traveling to play golf and enjoying not only great courses, but also the camaraderie and joy of a stag trip. Thank you to Mark, Paul, Mel, Tom and Keith for making my return to the golf world so special. It’s hard to articulate how good it was to get back into my routine and to re-enter the bubble! I can’t wait to do it again. Next up: a return to Myopia Hunt Club and the Country Club. Hopefully I can peak at the right time again and hope that the pros at both clubs aren’t scared off by the frightening look of my thick white sun-screened face and will let me play.

I would note that my opinion has evolved and that Ohio is a serious contender for the best golf state in the country. I have previously boasted about how great New Jersey is, anchored by the #1 course in the world. It’s also hard to make a case against California, and Long Island carries New York into final contention in any conversation. Collectively, though, the courses of Ohio are as good as any. Consider just those in the Columbus area: Muirfield Village, Double Eagle, The Golf Club and Scioto. Add on Camargo, Inverness, Canterbury, Kirtland, Moraine, NCR and Firestone, and if I were betting at poker I’d go All-in with that strong a hand.

The club has such an enjoyable culture because it was established in the benevolent dictator model followed at other unique courses. It was the brainchild of local boy John McConnell. If you thought steel magnates went away in the 19th century with the likes of Andrew Carnegie, think again. McConnell was a legitimate steel magnate, founding Columbus based Worthington Industries. A real-life Horatio Alger story, McConnell started out by borrowing $600 worth of steel using his 1952 Oldsmobile as collateral and built the business into a NYSE traded company, making himself wealthy along the way. God Bless America, the land of opportunity! His passions included golf, and he founded the club with the right attributes to be a special place to enjoy the game and the great outdoors.

McConnell has since passed away, but in my mind, he left a lasting legacy here on how to do things right. Like when Bobby Jones and Cliff Roberts set up the Masters, no detail was small enough to be overlooked. There is not one thing at Double Eagle that I can find fault with. That doesn’t happen often. McConnell set up a near perfect club that amplifies nature in a setting where golf is a true joy to play.

It’s good to be back!

Thursday, July 04, 2019

Returning to Golf!

It has been a while since I provided an update, so the 4th of July seems like a good time. First, thank you all for your kind words of encouragement. All-in-all I am doing well and am still in remission. Every day is a blessing to be enjoyed.

Peddie 
My home course, 7th green, twilight, July 3, 2019

One of my goals is to play golf again as soon as practical and I’m giving it a real go. One big side effect of a bone marrow transplant is fatigue, and in my case, it is sometimes acute because my red blood cell count keeps dropping, and will do so until my blood type changes to my brothers. As a result, I have to time my forays into golf with precision so that I pursue the game when I have maximum energy. Since I need a blood transfusion about every ten days I have to calibrate my golf escapades with an appropriate hemoglobin count, which limits me to three potential days a week.

I have approached the task with my usual gusto, primarily hitting balls and trying to get back my swing after such a long hiatus. I lost a lot of strength laying around for a year so I have to adjust to the ball traveling a shorter distance. As if I don’t have enough going on I also thought it was a good time to take some lessons to at least make sure I’m practicing the right things. Oy Vey, I forgot how hard it is to make changes, but I think it was the right decision because I plan on playing golf for a long time.

 I also have a side effect called chronic GVHD which prevents me from being in the sun, so I am limited to cloudy or rainy days, or playing at dusk or twilight. The great news is I’ve gotten to play, sometimes walking three or four holes, sometimes taking a cart for nine holes. And it feels fantastic to be playing again. I am fighting this insidious disease so hard for family, friends, and myself, and having something to strive for and dream about helps beyond measure. There is still nothing like hitting a crisp iron shot from the fairway on a beeline to the flag, or hearing the ball drop to the bottom of the cup on a thirty-foot twisting putt! As is my nature I sometimes push too far. I went out one Sunday at sunset with my red counts low and had to lay down on the fairway between shots to catch my breath. “The wife” accuses me of sneaking out and says that I’m insane and what I’m doing is too much, and I’m sure my doctor would not approve, but I’m thrilled to have a do over, and it beats laying in a hospital bed.

Mine is an interesting life right now, with exaggerated highs and lows. When I’m in a down cycle I can only muster enough energy to lay on the couch and speak at the same volume Marlon Brando did in The Godfather. Hitting bottom is never fun. One slow afternoon I was almost to the point of desperation from boredom and I began dreaming of going to a Michael’s Store to pick up some materials to start a craft project – then luckily, I woke up in a cold sweat.

I am planning a special trip to Boston to meet some friends in August and hopefully to play a little golf (hoping for heavy cloud cover) and to get a dispensation to ride in a golf cart for courses that otherwise don’t allow it. My doctor also has a couple more tricks up her sleeve for stubborn cases and she will soon give me a wonder drug (Rituxin) that should accelerate my blood type changeover and continue my path to recovery and sustained high blood counts.

As the tee shirt says #lifeisgood.

Wednesday, April 24, 2019

The 2019 Masters and Update

First, thank you for all the nice comments, tweets, emails and messages, I appreciate them. I made it back to Augusta National. A little fatter, more haggard and fatigued than normal, but none of that matters, it was a dream come true again! Praise the lord for all he has blessed me with.

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The fat boy returns to Amen Corner

We got to follow Tiger for a couple of holes, although it is so difficult to do with the crowds following him like never before. 

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Tiger practicing on the 17th green

It was great to catch up with friends from all over the world and to see the perfect property again. While the wife was off buying stuff in the best retail merchandising operation in the world I snuck in a pimento cheese and egg salad sandwich. Although I'm only allowed to technically eat food that's been freshly prepared within the hour, I correctly bet that Augusta's food operation was safe and they wouldn't poison me. 

The highlight of the trip was that "the wife" got to stand a few feet from her boy on his nemesis hole. It doesn't matter than his game is off the boil because he's "so cute."

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Spieth on the 12th

I got spectacular news yesterday when my transplant nurse removed my PICC line after being in my arm for 50 weeks, and gave me the all clear to play again. I already have a blister on my finger from hitting too many balls this morning! Looking forward to getting out a playing a few holes (in a golf cart for now) over the coming weeks.

Friday, April 05, 2019

My New Augusta National Quest - Post 7 - "The Remission Road Trip!"


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This home bound golf fan has studied the 2019 Masters program from beginning to end

I have a very gracious friend who lives in California who serves as a gallery guard at the Masters and he gives me his tickets every year for the practice rounds. “The wife” and I are setting out on our road trip to Augusta tomorrow to attend the practice rounds. Technically she doesn’t even call it the Masters, she says “we’re going to see Spieth.” She has a minor obsession with the young man and was heartbroken to learn that he got married last year.

So, even though he has been playing poorly of later we will be following Spieth, which I’m perfectly happy to do. Just being on the hallowed grounds is a privilege. I expect we'll be sitting in grandstands far more this year than in prior visits, but I’m thrilled to be there at all.

One unintended consequence of having cancer is that you get a lot of mail. Over the last ten months I’ve gotten at least a half dozen bills, statements, disclosures or explanation of benefits documents per week. Stacked end to end, all the papers related to my treatment measure over 6 inches in height. Contained within that half a foot of paper is $1.4 million of bills related to medical treatment, the cumulative cost so far. The $1.4 million includes 54 days spent in the hospital, 22 bags of red blood received through transfusions, 36 outpatient visits to the hospital, two emergency room visits, 72 visits from my home nurse and 5,230 pills. Sound like a burden? Truth is it’s a blessing. I’m alive and feeling good.

And my cancer is in remission.


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I will be following Karen around the course as she follows her boy

How do I know all the statistics above with such precision? “The wife, Karen.” We all deal with stress in different ways. I personally just let go and turn myself over to the care of the professional and assume that they are skilled in their ways and that god has a plan for me, and that worrying over every little thing isn’t really going to change the outcome. “The wife” is the opposite. She kept notebooks throughout my hospital stay writing down the name of everybody who came into the room. She grilled every doctor, nurse, and pharmacist and had them explain every single thing and every side effect. She keeps spreadsheets of all the pills I have taken. Not only can she tell you that I’ve taken 5,230 pills, she can also tell you the specific dosage and what time of day I took them, bless her soul.

I am also enrolled in an FDA trail for a drug called Gilteritinib that has shown promising results in keeping my particular type of leukemia at bay. Modern medicine is full of miracles. And miracles don’t come cheap. The list price of Gilteritinib is $360,000 per year and I am beyond blessed that I don’t have to pay out of pocket. While disruptive tech companies that let you order pizza without getting off your couch or to hail a taxi faster get a lion’s share of the press attention, recent advances in medicine have been even more dramatic. If I had gotten this dreaded disease 25 years ago my outcome likely would have been very different. And advances coming in the next regarding 25 years in areas like immunotherapy, genomics and allogenic cell therapy promise even better, more advanced medicine, something I think is important to keep in perspective when skeptics tell you have bad everything is. Truth is, it's a fabulous time to be alive.

They say there are no atheists in foxholes. Well, the same is true for those being treated on an oncology floor in the hospital (or in the case of Penn, the dozens of floors). There is a lot of faith and praying golf on. It is by far the most egalitarian environment I have been in. There are no Republicans or Democrats, you don’t notice or care about someone’s skin color, ethnicity or background. You just have empathy for your fellow sufferers and admiration and trust in the people caring for you. Can cancer ever be a good thing? I don’t really think so, but it has changed my outlook on life and given me the perspective to see things very differently now.

I don’t know if technically you can get PTSD from a long and traumatic hospital stay, but sometimes I do feel traumatized. My self-prescribed treatment for curing it is to visit the Augusta National Golf Club and to soak up the Masters with “the wife.” We’ll keep you posted along the way. Karen has her notebooks and spreadsheet at the ready. I’m sure I’ll be able to tell you how many miles we drove to and from Augusta and how many steps we took while on the property!

Monday, March 25, 2019

My New Augusta Nation Quest - Post 6 - "Freedom"

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I'm getting closer to the technicolor of Augusta . . . 

Returning home after a traumatic hospital stay is a big deal. I’m trying to mentally shift focus and it’s more complicated than I thought it would be. My white blood cell count yesterday was 4 (which is good) and I have an appointment with my doctor tomorrow at 10:45am. My focus now is to break through and establish a new normal. I don’t want to be a patient any more, I want to live an everyday life, spend time with family and friends and play golf. There was a time when a 4 represented a good score on a two-shot hole and when 10:45am represented a tee time, and not a clinical exam time. I want my old life back. Seeing the lush green rolling hills of North Georgia and smelling pine needles would be the ultimate shock treatment to allow me to hit the reset button and get that done. It would certainly be a stark contrast to the muted grays and browns of a hospital environment and a step up from smelling bleach all day.

Having new DNA and a new lease on life is like being born again. In fact, the nurses at the hospital call your transplant day your new birthday. They say that you should appreciate the little things in life and it is both true and a cliché. Sitting on my back deck watching the sun rise and listening to the birds chirping is more satisfying that just about anything in the world these days. I’ve also allowed myself the permission once again to reimagine that by mid-summer I can again experience the sound of golf shoes crunching on gravel, of clubs clicking against each other with a bag on my back, and to listen for the magical soft sound the ball makes when it falls into the hole and then rattles around. I'm dreaming of hearing and experiencing sounds that I previously wouldn't haven given a second thought to. I can't wait to hear the snap and crackle of Velcro when I unfasten my golf glove again for the first time. I also hope to one day return to links golf and listen to its distinctive sounds: the inevitable wind blowing through the long fescue in the dunes, the cawing of seagulls floating overhead, the flag fighting to stay upright in a stiff breeze and the sound of distant waves.

In the end, the lessons from my near-death experience aren’t that complicated.  Live the golden rule. Do unto others as you would have them do unto you. Be nice to people. Give and you shall receive. Watch It’s a Wonderful Life and it’s all there; friends and family are far more important than power or money.

Being back home has been a liberating experience especially as my doctor lifts some restrictions. I have begun to ease back into normal routines like showering without permission, cooking, reading the newspaper without needing to wear gloves, and staring idly into the fireplace for hours on end. The temptation to hit a few balls here and there is also quite compelling. As I mentioned in a previous post I still have a PICC line protruding from my arm so that I can give and receive blood easily. PICC lines are not conducive to physical activity, including golf. Compared to tennis or running, though, golf isn’t that physically taxing and I don’t see how it could interfere with my treatment. They told me no contact sports when I was discharged, and golf isn’t a contact sport. How harmful can it be to hit a few chip shots in the backyard?

Moron.

I ended up having to go to the emergency room one sun-splashed Sunday morning in the late fall after I developed a blood clot in the same arm that my PICC line is in. I’m not saying there is a correlation between hitting balls and the blood clot. In fact, I’m going to exercise my Fifth Amendment right against self-incrimination because technically there is no proof that I actually hit balls. The blood clot could have developed for other reasons. And besides, the medical literature offers conflicting research on the impacts of the golf swing, peripherally inserted central catheters and blood clots. Most studies don’t prove a correlation, at least when the golfer is just hitting wedges. If I had snuck in a couple of drives, well that may be a different story and potentially could have caused some damage.

In any event, the penalty for (allegedly) golfing with a PICC line is a self-administered needle to the stomach every day with an anticlotting drug. The penalty doesn’t seem to fit the innocent nature of the crime. A two-shot penalty would have been sufficient, but 120 days (and counting) of shots to the abdomen seems a bit much for such a small infraction of the rules.

“The wife” says I like to complain and I probably do. Although I count my blessings every day, after half a year at home you do start to go stir crazy. While I didn’t have to wear an ankle bracelet like Bernie Madoff or Dominique Strauss-Kahn did during their house arrests, the injustice of the situation has begun to weigh on me mentally the more time progresses.

To add insult to injury I have to follow a restricted diet (called Neutropenic) because my body can’t ward off infection yet. Among the foods in the bad category are fast foods, including In-N-Out Burger, Jimmy Johns and Jersey Mike’s. A sub sandwich, or “cold cuts,” as the doctors describe them with a menacing tone, could kill me because the meats sit out all day and grow bacteria on them. They warn you off eating an Italian Hoagie as if your finger were on the pin of a hand grenade. Kill joys.  I also can’t have sushi. Blueberries, raspberries, and strawberries are to be avoided like kryptonite. But the indignities get far worse. The greatest indignity of all is that I can’t eat unpasteurized cheese. This includes blue cheese, brie, and Gorgonzola. The ultimate horror is that I can’t eat fresh Pecorino Romano or Permagiano-Reggiano. I get the sense that transplants are easier for people of Anglo-Saxon descent; telling someone of Italian heritage they can’t eat fresh grated cheese is the ultimate indignity. At least I suffer in good company; my Jewish brethren also suffer because having a bagel with lox is also forbidden. 

At my stage in this nightmare leukemia journey there is no sense of a permanent peace. Although my prognosis to date has been good, unfortunately, the disease can come back, so there is always a small voice in the back of my mind that I can't silence. For now, I have to block all that negativity out because we’re gearing up to go to the Masters. I hope I have enough stamina to walk the grounds a few hours a day. After going so long without exercise I am in a weakened state, although I am looking forward to cautiously walking up and down the steep hills and breaking a sweat for the first time in almost a year.

Friday, March 15, 2019

My New Augusta National Quest - Post 5 - "House Arrest"

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 Is there better therapy in the world than visiting Augusta with the shrubs in bloom?

I was discharged with a decent short-term prognosis just after Labor Day. The drill for the foreseeable future was to remain at home in an environment that is as sterile as possible, with no visitors. Because of the chemotherapy and transplant my immune system was still non-existent. I survived by taking 20 or so pills a day, having a home nurse come twice a week, and visiting the doctor at the hospital once a week. I was sent home with a peripherally inserted central catheter (PICC line) in my right arm so that I could get IV medication and so that the nurse didn’t have to prick my hand or find a new vein every time she needed blood.

A PICC line is one of the unnoted miracles of modern medicine. It allows patients who would otherwise be hospital-bound to go home and get their medication there. Among its disadvantages is that it inhibits you from swinging a golf club, not that I had much energy to do so anyway. Transplants take a long time to work and one of their primary drawbacks is that you have extreme fatigue almost all the time because your body has to convert over from your own DNA to that of your donor. The body has roughly 37 trillion cells, so that takes a lot of energy. One of my doctors said that if I committed a crime the police could convict my brother based on DNA evidence, because post-transplant his DNA is my DNA. The other voodoo aspect of the transplant is that my blood type will change from A positive to B positive once it is complete.

Despite the restrictions, it is obviously far better to be home than in a hospital. In addition to my visit to intensive care there were other low points of my stay. “The wife” and I agreed that one was when we were sitting in the hospital room on a murky afternoon watching reruns of the New $10,000 Pyramid on TV. Daytime TV is a vast wasteland and this felt like a nadir if there ever was one. The other low point was when my white blood cell counts began to rise. By design, some of the chemotherapy you are given obliterates your white blood cells and brings their count down to zero or near zero. This is a good thing because these were the bad cells that caused the leukemia. Your body eventually re-generates new white blood cells and I was given a drug called Neupogen, which helps stimulate their growth.

Bone marrow is created primarily in the big bones of your lower back and in your thighs. Once the Neupogen starts to kick in and your white blood cells start to grow again it brings on pain with such an intensity that you can't function. Did you ever hit yourself in the ankle or shin with a wedge when you were walking off a green or coming out of a bunker? Intensely painful, right? The pain of your bone marrow generating white blood cells anew is like that pain times one thousand, and it is one that doesn’t last a minute, but hours. The onset of the pain caused me to curl up in bed and sob, the pain of such intensity that I would have preferred death during those moments.

Enter the miracle pain drugs: opioids. Prior to my cancer, the strongest medicine I would ever take was Advil. I am not a pill popper and my philosophy is that it is better to tough it out, that most pains were transient, and the side effects of most medications usually don’t outweigh the benefits. Not so in this instance. I started with a morphine pump, another miracle of modern medicine. To kill the pain I was given a bag of morphine (an opioid narcotic) attached via an IV tube to a release button that controlled its flow. When you experience pain, you simply push the button and the morphine goes directly into your bloodstream through the IV. As Martha Stewart says, “it’s a good thing,” and the fact that the pain goes away immediately is far better than any craft project or fancy cupcake icing design she ever did.

Opioids can be bad and can be addictive. We all know that now, and it’s easy to judge people who become addicted to them. All I can say is that in my hour of greatest need when taking my next breath was a struggle, they provide needed relief and helped me get through to see the next sunrise.

It turns out that one of the reasons Secretariat was such a successful horse was that his heart was abnormally large. During the depths of my hospital troubles I was saved emotionally not by a doctor, intern, fellow, nurse practitioner, physician’s assistant or registered nurse, but by a nurse’s aide. Alana was her name, an angel from Trinidad. Her job was to take vital signs in the middle of the night, to change sheets and to perform other support functions for the broader medical team. Aside from getting world-class treatment, a big part of fighting through this disease is emotional. Keeping a positive attitude, which is easy to preach, is far more difficult to put into practice when you’re attached to IVs around the clock and it's two in the morning and you're lying awake in the dark. Alana understood that staying connected to reality and not losing sight of what you are fighting for are supremely important. She has the most positive attitude of anyone in the City of Brotherly Love, and it was infectious. Simple things like calling me "sweetie" or telling me I looked great when I knew I was a mess made a big difference. Before I was taken to intensive care she sat next to my bed and held my hand, offering positive encouragement and her prayers.

The University of Pennsylvania Hospital has a rich heritage. It was the first medical school in the country, founded in 1765 by Benjamin Franklin. It has countless PhD’s, distinguished professors and medical prize winners. In my book, Alana is the Secretariat of the University of Pennsylvania Hospital, and one of the most tremendous human beings I ever met. May god bless her loving soul.

My last visit to the doctor brought very good news. She said the “the wife” and I could go to the Masters, with some limitations. I can’t fly. Technically I can, but since my immune system remains weak I’d have to wear a respirator and wipe down the area around me on the flying germ factory airplane. Boarding a plane dressed like a fireman and behaving like Felix Unger aren’t my cup of tea, so we’re happily going to make the long drive. We’re going to take it slow on the way there and the way back, doing a tour of Southern cities so as to not stress ourselves out trying to drive too much in one day.

Friday, March 01, 2019

My New Augusta National Quest - Post 4 - "Lucky"

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Despite my current dietary limitations, I am longing to eat one of these

I responded well to the first and second rounds of chemo and the next step toward getting the disease in remission was to find a donor for a bone marrow transplant. Even though the chemotherapy completely wipes out the source of the problem, which is rogue white blood cells, given that I had the FLT-3 mutation, the incidence of recurrence is unfortunately high, and replacing the body’s bone marrow is the preferred course of action. The reason the doctors want to replace the bone marrow is because that is how the body generates blood cells, and the theory is to cut off the problem at its source. In what my doctor rightly describes as voodoo medicine, treatment has advanced to the point where they can give you a shot that tells your body to replace your own bone marrow with that of your donors. How it works is beyond description for a lay person. Lending money and buying stocks is God’s work? Not exactly. This voodoo medicine is God’s work.

For some people finding a donor is a stressful ordeal. The best case is to have the donor be a family member. For those that can't find a blood relative donor, they try via a pool of donors. The donor base statistically favors those of Western European descent. As one of Italian-Irish lineage the transplant specialist felt I would have a good chance of finding a match. Those in other ethnic groups apparently haven’t built up a huge base of donors so it is more of a challenge and potentially life threatening. It turns out that I didn't need to go to the donor pool because I was very lucky: my younger brother was a perfect match as a donor. The transplant team looks to match ten different criteria and the closer you can get to all of them, the better the chances that the transplant will be successful. My bro was 10 out of 10, which is better than birding the 12th hole at Augusta National!

My actual transplant was thankfully a non-event, even anti-climactic. I got an injection and a bag of the life-saving marrow and that was it, the entire procedure completed in less than two hours. Mental note: Osso busso is off the menu from now on.

Transplant complete, now the fight against the disease shifted to the mental. Although the transplant itself was relatively non-invasive, I had to remain in isolation for between 20 and 30 days. Isolation, as in restricted to your hospital room, which has been completely sterilized and scrubbed down. Anyone entering my room had to put on a gown and gloves to keep the environment germ free because my immune system didn’t exist. An infection or virus could kill me. You also have to take an impressive list of medications day and night, and take fluids through IV, including blood transfusions as needed. In the long list of complaints a leukemia patient can have, having to just sit around in a locked hospital room ranks relatively low, although it requires the patience of a saint, something I’m not naturally suited for. The one small act that saved my sanity is that the doctors allow you out of the room, but not off the floor, for a brief time after 10pm and before 6am when the activity level in the hallways has decreased.

On May 1st, I was leading a normal life; four months later I was a vampire: locked in a room 23 1/2 hours a day, consuming blood and coming out for only 30 minutes in the middle of the night. Not that I’m complaining, because the efforts by the medical team are astonishing and I’m above ground with much to be grateful for.

With nothing but free time I got to watch the PGA championship from beginning to end, just as I did in May with the Players Championship. I watched every single shot of the tournament and the Golf Channel’s coverage before and after the rounds. To state the obvious, your choices of entertainment laying in a hospital gurney are limited and it was nice to imagine being out in the sunshine, walking on lush fairways with the wind blowing, rather than smelling cleaning solvents, eating hospital food and watching my hair fall out.

Since the golf bug bit me decades ago I have always been obsessed with the game. To me it's not a recreational activity I pursue in my leisure time, but instead it is a way of life. I love the beauty and serenity of being out in nature chasing around a little white ball. I love the camaraderie, the friendships, the etiquette, the challenge, and the self-knowledge you get from embracing golf. Laying in my hospital bed for extended periods of time breathing recycled air really made me lust to get out in nature again. Honestly, just being able to take a walk in the park or to feel the sun beating down on me would be enough. Golf would be a huge bonus.

Being cooped up for such a long time gave me a lot of time to think. And time to dream. Part of the way I managed to get through the first part of this ordeal was to dream about getting out on a golf course once again. I’m still hopeful that I can get to the point where I can make the trek to Augusta next month to watch the Masters. I have to remain patient and take it one day at a time and to remember that I have a lot to be grateful for.

I would remain in isolation in the same room for twenty straight days, although I was lucky because I was on the short end of the range. I’m not sure I could have endured another 10 days. I used to think that the greatest words in the English language were, “Mr. Sabino, you’re on the tee,” while in a special place like Cypress Point or Royal Dornoch. What a fool I was. The greatest words in any language are “Mr. Sabino, you’re discharged.” Finally, I was free to go home and was able to walk out of the hospital without assistance.

And I was one step closer to getting back to Augusta and to playing the game again.

Friday, February 15, 2019

My New Augusta National Quest - Post 3 - "Nadir"

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Hope springs eternal, and I'm hopeful to see this in person in April

Entering the alien world of cancer treatments was an eye-opening experience at all levels. I have been a long-time reader of the works of Atul Gawande, an Oxford and Stanford educated surgeon and Harvard Medical School professor who writes for the New Yorker. He espouses the importance of following a defined protocol and of a seemingly trivial thing: using checklists. He espouses it for the same reason Sully Sullenberger and Jeff Skiles immediately went to their emergency checklist after hitting a flock of birds after taking off from LaGuardia Airport. Because they work.

Maybe Bryson DeChambeau is on to something with his scientific and methodical approach to the game. He is continually rising on the money list with his checklist approach to golf.

One of the reasons I had great care around the clock is that everyone was reading from the same playbook and religiously followed their procedures and checklists. Even if each individual practitioner is of the highest caliber, the system is only as good as its weakest link. The way they all worked together on an integrated basis and handed off seamlessly from shift-to-shift is because they follow their protocol. This was an eye-opening lesson for me.

Although I was in a fog, during those first few hospital days I noticed that the doctors kept saying that I would hit “nadir” on about day 14 of treatment. I wasn’t exactly sure what nadir meant since this isn't the kind of word we typically use in Jersey. My closest prior association with the word Nadir is the activist Ralph. I ended up getting a master class in the meaning of nadir during my initial hospital stay. In retrospect, the reason that use such a fancy term is so they don’t scare the hell out of you. Nadir means hitting rock bottom. Everyone at the hospital works really hard to keep the environment upbeat. Using phrases like “rock bottom” or “crashing” don’t fit the construct.

I also learned during my trial by fire that it’s not the disease that necessarily kills you, sometimes it’s the treatment or side effects. My initial induction chemo included three different drugs and their side effects were far ranging. The evil nemesis that got me is a dastardly condition called mucositis. The chemicals poisons you are given are designed to wipe out a large part of your existing cells but they don’t perfectly discriminate and sometimes attack cells that you need to survive. I developed a severe case, with sores in my mouth and esophagus. As a consequence, I couldn’t drink or eat and eventually had a difficult time breathing because my tongue swelled. At one point I was a real-life patient at the center of a Thomas Eakins painting, encircled at close range by a cluster of white lab-coated Philadelphia doctors, which is not something anyone should ever aspire to.

Nadir for me was when they transferred me off the specialty oncology floor and into intensive case. If the hospital environment itself was an alien environment, the ICU is the real-world version of being in a Twilight Zone episode. It’s a high stress environment that is crowded, has bad light and acoustics, and poor air. There are a lot of monitors and nothing to eat.  Come to think of it, it’s a lot like traveling through Terminal A at Newark Airport.

Unlike a regular hospital floor, there is no idle chatter or banter among the practitioners.The doctors and nurses in ICU behave like Tiger does when holding the lead in a tournament. It’s game day and everyone has their game face on all the time. My doctors were baffled by my particular set of symptoms so they assembled a multi-disciplinary team to discuss my case. It was truly a surreal scene. Due to my condition I couldn’t speak, but I could see ten doctors assembled around my bed in a “U” formation and they spoke of me as if I weren’t there. The team included a pharmacist, my oncology team, and specialists from Infectious Disease, ENT, Allergy, Radiology, Neurology, Gastroenterology and Intensive Care. It seemed like every department was weighing in except the Obstetrics and Gynecology team, although I was in such a daze they could have been there too and I just missed them.

Even with all that firepower they couldn't figure out what precipitated my rapid demise. I will spare you the gory details, but the ICU doctors saved my life. I had to be intubated first through the nose (not for the faint of heart) and then when there were complications, through the mouth, and it was touch and go for a while. God bless everyone who helped save me and “the wife,” who literally stood by my bed for 72 straight hours. It's affirming to recount the story now, after the fact, with a good outcome, but I can assure you in the moment, when you have that many talented people trying to identify the problem and failing to come up with a definitive answer, it is terrifying.

As if I didn’t have enough problems with the cancer, one of the consequences of being in ICU for three days is that I came back to the oncology treatment floor a basket case. Since I couldn’t eat, they had to feed me something that looked like wallpaper paste intravenously (it’s called TPN). It turns out that TPN has a lot of sugar in it, so I developed diabetes. In addition to all the other IV medications and pills I was taking, I had to be pricked several times a day to have my blood sugar level checked and given an insulin shot in the stomach to correct any imbalances. I began May looking like a poorly aging version of Keith Hernandez. In a short period of time I was doing a pretty good impression of a fasting Mahatma Gandhi: mustache still intact, but bald and frail, my days spent largely in bed while occasionally shuffling around in a white sheet.

Ever the optimist, rather than viewing the debacle I went through as problematic, I felt lucky to be in the care of such experienced and determined people who excelled at what they do.

Since I spent the entire month of May in my room, which overlooked the University’s central quad, I got to watch the preparation for the graduation festivities and to dream of one day getting better and being able, first, just to go outdoors, and then, of being able to golf once again. Barring further complications, I’m still hopeful that things can come together and that “the wife” and I will make it to the Masters this year.

Post Script - For the physician readers among my followers, two weeks after the incident I got a visit from the Allergy doctor, a professor at Penn who was part of the bedside huddle. Frustrated by not being able to help, he wouldn't let my case go and went away and did research in the medical textbooks. After reviewing my blood work from the time he concluded that I had a rare condition called 'acquired angioedema' brought on by the leukemia, and he found a specialty medicine to treat me if the condition ever returns.

We live in a time of heightened animosity across many parts of our life these days, especially in the political arena. The cable news driven tribalism that is dividing us is troubling. It is easy to become cynical and have a lack of trust. This is a busy guy, he could have easily gone on to other things after my condition passed. He didn't, which is encouraging to say the least. He is just one small example of people who go above and beyond and shows there are plenty of good hearted, caring souls among us. Among other life lessons he reinforced, such as, persistence matters, he has helped reorient me to focus on the positive and not the negative, something that is increasingly difficult to do in the negative media environment we live in.