Author: Ken Goetz

The First Cardiac Catheterization

Posted on by Ken Goetz

Some medical discoveries fade as they settle into history. Others glow brightly. Here’s a little quiz for you. The poliomyelitis virus was a nasty crippler and killer that terrorized the world until the mid-1950s. Which of the following won the Nobel Prize for their work on the polio virus?

  1. John Enders
  2. Jonas Salk
  3. Thomas Weller
  4. Frederick Robbins

Most of you probably think that’s way too easy. Well, let’s see how you did. If you answered 1, 3, and 4, you’re an undisputed champion. Congratulations! You nailed it! Enders, Weller, and Robbins won the Nobel Prize in Physiology or Medicine in 1954, winning that prestigious award for developing a method to culture the polio virus in human tissues, the vital discovery that enabled production of enough virus to develop a vaccine.

I mention this bit of history not to disparage Salk, who never won a Nobel Prize but later was the first to develop a successful vaccine against polio, and thus became justifiably famous after standing on the shoulders of the above three. Albert Sabin was another vaccine developer. A few years after Salk’s contribution, Sabin came up with an effective oral vaccine.

Now let’s shift our attention to the heart with another quiz, one likely to stump most of you. Which of the following won the Nobel Prize for their work on cardiac catheterization in 1956, the time when such catheterizations were beginning to take off?

  1. André. Cournand
  2. Samuel Pepys
  3. Dickinson Richards
  4. Werner Forssmann

Okay, I rigged this one, making the same three choices correct. Yep, 1, 3, and 4 ring the correct bell. Oh, raise your hand if you smiled when you saw Samuel Pepys.

Until the 20th century, the human heart understandably was an organ doctors stayed away from. So when a man’s beating heart finally was invaded by a catheter, an event documented by x-rays, the news flew around the world.

That first catheterization wasn’t performed, as you might expect, in a major academic institution. It was done nearly a century ago in a small hospital some 30 miles from Berlin by an unsupervised 25-year-old German doctor. His name was Werner Forssmann, and the heart he catheterized was his own.

Forssmann was a surgical resident in 1929, when he calmly anesthetized the inner side of his left elbow, sliced through his skin with a scalpel, and inserted a catheter into the arm vein he had exposed. After pushing most of the catheter’s two-foot length into his body, Forssmann walked the long distance from the surgery suite to the x-ray department and even climbed a stairway with blood dripping as the catheter dangled from his arm. At last he stood in front of a fluoroscopy screen and viewed his insides through a mirror held by an obliging nurse. He could see plainly the end of the catheter twitching within his right atrium. He took x-ray films of his chest and arm to document his achievement.

 

From Forssmann: Die Sondierung des rechten Herzens, 1929

Sorry, this a copy of a copy and it doesn’t show up very well. but perhaps you can at least see the dark thin line (the catheter) going up from the arm to the upper part of the chest before it turns down toward the heart.

His intent, the young German doctor wrote later that year, had been to devise a better way to administer drugs directly into the heart during certain emergencies, the prevailing method at the time being to jam a long needle through the patient’s chest wall and blindly inject substances directly into the heart, a method more likely to kill than cure.

“While sliding the catheter in I had a feeling almost of soft warmth on my vein wall,” he wrote, and when the catheter entered his chest, “an especially intense warmth behind the clavicle [collarbone].” He also noted a dry cough, presumably triggered when the catheter’s movement irritated nerves in his chest.

Other than these sensations during the episode, the young doctor reported, “I felt nothing.” Even afterward he felt nothing detrimental, “aside from a slight inflammation at the site of the venesection, which probably resulted from faulty sterilization during my self-operation.” His method, he added with justifiable youthful pride, “opens up countless vistas of new possibilities.”

Surely the young Forssmann never imagined the extraordinary advances that ultimately followed his brave solo venture with a catheter. Nor did he foresee the troubles soon to strike him, the jabs and insults whipped up by his daring experiment, woes that followed him through much of his life.

The story will continue.

First Book Winner

Posted on by Ken Goetz

Our first book winner has emerged. T.D. lives in the Kansas City area and has chosen to receive the novel. The Colors of Medicine is heading her way.

My next post will describe the early history of cardiac catheterization, focusing on how it all began, a human interest story that surprises many. That should be up in another day or two.

Book Giveaway

Posted on by Ken Goetz

As a new blogger who has posted items for only a few months, I much appreciate the complimentary feedback I’ve received so far. I’m especially gratified by reports that some of you are going back and rereading everything I’ve written on this site. Such interest will keep me writing.

Admittedly, readership here is still modest. From the limited information I have, several hundred of you might log onto this site on any given day, yet far fewer have signed up to receive email notification when I add something new.

Because writers love readers, the more the better, and because I’d like all of you to know immediately when I post a new item, I’ve decided to resort to bribery to spread the word. For the next several months, those readers signed up to receive email notifications will be eligible to win a book autographed by one of my favorite authors.

Here’s how it will work: at the end and middle of each month, starting in a few days at the end of January, I’ll have an independent body draw a lucky winner from the pool of those who have provided their emails. I’ll then notify the winner and offer the choice of either a memoir or a novel. The chosen book will be snuggled into a plain brown envelope and entrusted to the postman for prompt delivery. In an effort to keep the voltage of suspense high, I won’t divulge the author’s name, but I’ll provide one flimsy clue, one so obscure that even members of His Majesty’s Secret Service would scratch their heads in bafflement. The clue? The author’s initials are KG.

INSIDER’S TIP: This is a drawing with a high probability of winning, at least initially, because the number of email registrants is quite low at the moment. Thus the odds of collecting a free book are a zillion times better than winning the lottery. So enter your email address on the right. And good luck!

A new post will be coming soon.   

Washington’s Swamp

Posted on by Ken Goetz

The latest Congressional approval rating I’ve seen, from December, reveals that 15% of our citizens approve of the work of our Washington legislators. Fifteen percent? That high? Was the poll over-weighted with lobbyists, lawmakers’ relatives, and residents in mental institutions?

Who isn’t aware that our proud career politicians, when they’re not squabbling with each other, run amok in other ways? They rarely appear on the House or Senate floors. They prod their staffs to produce thousands and thousands of pages of obfuscating prose that nobody (except trial lawyers) reads. Our politicos kowtow to lobbyists and blow smoke rings at those who elected them. And their obsession? Reelection! The longer they stay in office, the worse they become.

One of Donald Trump’s campaign promises was to drain Washington’s swamp. After he was elected, he faced daily crossfire from our major media, nearly all of whom seemed obsessed with ridding themselves, and us, of him. Trump was an easy target, given his bloated ego, mercurial mood swings, the tendency to contradict himself, and his outrageous tweets. Yet, in his spare time, he somehow managed to make certain changes in our domestic economy and in our foreign policy that I, among others, favored.

And now, with Trump at his lowest, and soon to be gone, the Washington swamp deepens. For proof look no further than the Covid Relief Bill, which sounds pleasant enough and suggests our vigilant lawmakers, their eyes fixed on our sinking economy, their hearts in tune with those squeezed by the pandemic, responded with relief for those in need. Balderdash! Let’s examine what really happened. As always, when money began accumulating in this appropriation bill, our herd of legislators stumbled over each other to slip their pet projects into the pot. But, as our economy continued to deflate, certain Congressional bosses, having no real interest in the carnage, stubbornly delayed passage to allow even more personal pork to be packed into one gargantuan sow.

This monstrosity, recently signed by the defeated Trump, should cause every citizen to retch. Imagine the worst giveaway ever, and discover you’ve pathetically undershot reality. Much of the massive loot will drain out of this country. Some $1.5 BILLION will go to places like Sudan, Ukraine, Nepal, Burma, and Cambodia (those dollars certainly will take a good whack at our Covid crisis!). This new law even awards “not less than $10 million” to be shipped to Pakistan for the study of gender issues? (Go figure!)

It gets worse. Greenbacks spill everywhere from this fat glob (5,593‑pages!). Hundreds of millions of dollars are to be shipped to other countries like Nicaragua, Vietnam, Peru, and Ecuador, to Egypt for its military, to Sri Lanka for boat repair, to Palestinian for economic aid.  The beat goes on. Our politicos casually allocated some $40 million for the Kennedy Center, a venue popular with the Washington elite, and convenient for their attendance. And you, Mr. and Mrs. Citizen? If you’re not too rich, you’ll get your 600 bucks.

Even some of those who ground this political sausage were unable to endure its stink. Have you seen these gripes from opposite ends of the political spectrum?

“Members of Congress have not read this bill. It’s over 5000 pages, arrived at 2pm today, and we are told to expect a vote on it in 2 hours. This isn’t governance. It’s hostage‑taking.” (Tweet of Representative Alexandria Ocasio‑Cortez, Democrat of New York)

“It’s ABSURD to have a $2.5 trillion spending bill negotiated in secret and then—hours later—demand an up‑or‑down vote on a bill nobody has had time to read.” (Tweet of Senator Ted Cruz, Republican of Texas)

The total cost of this hideous statute is pegged at $2.3 trillion dollars, with about 1.4 trillion destined for other government expenses. The digits are small, but they represent trillions. For many individuals, including me, millions, billions, and trillions of dollars are so gigantic that they blur in the mind. To better appreciate their immensities, it helps to look at dollars as if they were units of time. Here’s a comparison I picked up years ago. One million seconds pass in about 11.5 days. One billion seconds last almost 32 years. And one trillion seconds? Well, that interval stretches to over 30,000 years.

 

Must we continue to allow our wastrels in Washington to burn our wealth? Would these pork-barrel Machiavellians modify their behavior if strict term limits were imposed, thus clipping their cushy time in office? I think so. There is at least one organization (U.S. Term Limits) working toward establishing Congressional term limits by amending the U.S. Constitution. I recently skimmed through that organization’s website and signed its petition with enthusiasm. Perhaps you will consider doing the same.

Berlin and the Brandenburg Gate: Conclusion

Posted on by Ken Goetz

Note: If you’re new to this blog, or if you don’t remember details of my first experience at the Brandenburg Gate recounted in an earlier post, you may want to go back and read part one of this story before reading what follows.

 

My last trip to Berlin came nearly four decades after I first entered the city. I was living in Munich in 1993, keeping busy as a visiting professor in the Klinikum Innenstadt of the University of Munich, my support coming from the Alexander von Humboldt Foundation. One day I received an invitation to attend, along with other Humboldtians, a meeting in Berlin hosted by the Foundation. I accepted immediately.

As I had during my very first trip to the city, I traveled by train, this time with passport. My speedy express flashed out of Munich and clicked along the rails at a fine pace until we had covered roughly half the distance to Berlin. Then, without warning, the train slowed abruptly and slogged along at what I judged to be about thirty miles an hour. “Was ist los?” I asked a conductor. He explained that we had just entered the former East German sector and tracks there had not been properly maintained, so it was unsafe to travel faster, this being some two years after Germany had been reunited.

When we finally rolled into Berlin, I studied the place to see how it looked after the Wall had come down. (That monster had been pounded into clumps, fragments, and souvenirs some three years earlier; and only widely scattered segments remained.) Not surprisingly, I was able to spot places where it had been, obvious lines where Eastern dullness collided with Western vibrancy.

We Humboldtians were provided rooms in a Hilton located in what until recently had been East Berlin. At the welcoming reception on our first evening I reached for a tidbit just as another arm did. That arm pulled back as I retracted mine, and I found myself facing a slightly taller fellow with thick dark hair. We introduced ourselves. He was Russian, a physicist on a temporary Humboldt professorship in Augsburg. We chatted a minute, in English. He spoke quietly, his sentences considerate. I pegged him to be a thoughtful man.

I ran into the same fellow on another evening as our group boarded a bus taking us to browse in a museum. We took adjacent seats and made small talk as the bus moved out. I didn’t know that part of the city and had no idea where we were, being totally lost until the Brandenburg Gate popped up directly ahead of us and set me straight.

The unexpected sighting reminded my of the first time I’d seen the famous gate, and that memory prompted me to tell the Russian what I had experienced. I explained how years earlier I had stood before that massive structure, looking eastward and observing darkness and drabness, wondering about the people who lived there. His face took on an odd look as I talked, but he said nothing. I feared I had offended him. He remained quiet as our bus stopped some minutes later, and even as we entered the museum.

Shortly after we began investigating artifacts displayed, my Russian companion motioned me to a quiet corner and explained his silence. He had been surprised by my story, he told me, and now he would surprise me. He explained that he too had often come to this city. His wife was a ballerina who frequently performed in East Berlin, and he usually accompanied her. What struck him about my story, he said, was that he had done essentially the reverse. He too had stared toward the Brandenburg Gate during late hours, standing outside his hotel in darkness and looking westward, gazing at the brightness beyond, trying to imagine what was happening in that glittering scene.

The weight of his story struck me, and I sensed a bond forming between us, we having observed opposite sides of the same bitter coin. I think he felt much the same. Our conversation was short. We soon split up and went our separate ways through the exhibits. It was nearly an hour later when he approached me again, looking restless. He had seen enough for tonight, he said. Rather than waiting for our bus, he was going to walk back to our hotel. Would I care to join him? I hesitated, knowing I’d get totally lost after venturing beyond the Brandenburg Gate. I didn’t want to chance that. He assured me he knew the way from there on, so we walked into the night, American and Russian, toward the Brandenburg Gate.

 

 

I don’t remember precisely how it happened, or what prompted us to pause as we neared the famed gate. But I shall never forget that electric moment when we looked each other in the eye, straightened our shoulders, and marched arm in arm and in perfect cadence through the Brandenburg Gate, I realizing, as surely he did too, that our experiences had been markedly different, not because of our inclinations or abilities, but because of the governments under which we lived.

After passing through the gate and untangling our arms, we continued our way to the Hilton, guided by the confident Russian. We said goodnight, not goodbye, for we thought we would see each other on the city tour scheduled for the next morning, the final event of our meeting. But that didn’t happen. I bailed out.

After breakfast on the final day I stepped outside into amazingly bright and crisp air and saw our tour bus had already arrived. It stood waiting at the curb. At that instant I realized it was not for me, that I had no interest in seating myself inside that vehicle. What I really wanted to do was to put more miles on my shoes before heading back to Munich on a mid-afternoon train. So, with that decided, I proceeded along the now familiar path to the Brandenburg Gate and walked quickly through it and beyond, convinced I’d made the right choice.

I was well warmed up by the time I spotted the damaged spire of the Kaiser Wilhelm Memorial Church, a handy marker confirming I was nearing the Kurfürstendamm, the target I was shooting for. I had enjoyed countless walks along that famous street, admiring its spiffy shops and restaurants, always taking time to examine other features of interest. Now I was eager for an encore.

Soon I was breezing along that iconic street, seeing signs of its accelerating rejuvenation, checking out additions I hadn’t seen before. I hadn’t gone very far, only a kilometer or two, when I happened to turn my attention to the traffic and, as chance would have it, spotted the very bus I’d seen outside the Hilton. I paid close attention as it passed by and saw clearly, in a window near the front, the face of my Russian companion, his forehead touching glass as he stared at the famous boulevard. It was, I thought, a fitting final glance of the man who had become a friend, for he seemed to be fully enjoying his view of the glittering scene.

 

Christmas and Beyond

Posted on by Ken Goetz

Christmas is rushing in and arriving tomorrow, the Covid-19 Christmas of 2020, that strange mutant promising to be different from any Christmas we’ve ever known. Tomorrow’s odd offshoot will be marked by smaller family gatherings, or none at all, by folks humming familiar carols rather than singing them (their closed mouths hidden behind masks, their shoulders properly distanced). It will be a day in which whopping numbers of friends and relatives greet each other not in person but from afar, their smiles conveyed by  Zoom, or FaceTime, or other fancy apps. But for you, reader of my blog, no matter how or where you spend your Christmas, I wish you a merry day.

Looking at the week ahead, I plan to write about a long-ago trip a friend and I took to Portugal. After our adventures there, we rode a train to Madrid, the city which provided high times and a troublesome secret I’ve shielded for all these years. I’ll reveal that embarrassment in a following episode, confessing at long last my roguish behavior while in the Spanish capital.

Housekeeping note: If you haven’t provided your email address here, please consider doing it now. I put mine in a few weeks ago, and it worked perfectly. I was notified immediately of my last few blogs as soon as they were posted.

Taking on South American Arrow Poison

Posted on by Ken Goetz

This piece is a bit different from others I’ve written here. I wrote this one years ago and published it in the Kansas City Star. I dug out a clipping of it today, retyped it with minimal changes (it originally was written with a typewriter), and here it is, an old story revived. I hope it holds your interest.

Medical researcher takes 2 ½ times the lethal dose of South American arrow poison – and survives. That might have been the gist of a newspaper headline years ago, if the press had been notified of a dramatic medical experiment that received little attention at the time.

Consider this background. A purified preparation of the arrow poison, curare, became available for medical use in the 1940s, and small doses of the purified preparation (d-tubocurarine) proved to be extremely useful during surgical operations, because the drug caused muscular relaxation and eased the work of surgeons.

Claude Bernard, the great 19th century physiologist, had shown that curare causes paralysis by blocking nerve impulses just as they reach voluntary muscles at a site called the neuromuscular junction. That’s how the poison kills. It paralyzes the muscles of respiration and produces asphyxia. But no one knew whether curare had anesthetic effects on the brain.

Curare almost always was given along with a general anesthetic, but on rare instances it had been used as the sole agent during operations on infants and children. Did they feel pain? Nobody knew. They may have suffered needless pain during their operations.

Some scientific reports indicated that the drug did reduce or even abolish the electrical activity of brain cells in experimental animals, and one investigator believed his results with dogs demonstrated that curare caused complete unconsciousness or amnesia, but his conclusions were widely criticized.

A group of anesthesiologists in Salt Lake City decided to do what was needed, an experiment on a trained medical observer given large doses of curare. One of the group, Dr. Scott M. Smith, 34, volunteered to be the guinea pig.

The experimental plan was simple. When the paralysis from curare became so severe that it prevented Dr. Smith from talking, he would indicate affirmative answers by contracting whatever muscles he could still move. When paralysis was complete, he would make mental notes of his experiences. The team would keep him alive with artificial ventilation.

The experiment was performed one January afternoon at the University of Utah Medical Center in 1946. Electrodes were placed on Dr. Smith’s scalp and arms to record his brain waves and electrocardiogram. His initial blood pressure was 130/70; pulse 92; respiratory rate 16.

A catheter was placed into one of his arm veins, and an infusion of saline began flowing into his blood stream. Curare was injected through the catheter.

Dr. Smith reported feeling “a bit of a glow.” His jaw muscles weakened. He found it “hard to talk.” Swallowing was difficult. Keeping his eyes open was an effort. His legs felt weak.

Seven minutes after he began receiving the drug, he requested oxygen by face mask. “Can hardly bring teeth together,” he said. One hundred units of curare had been given.

Moments later he lost his ability to speak, though he could make sluggish movements of his hands and head. He signaled that he was clear mentally and that he could hear distinctly. Artificial respiration was started when his breathing weakened.

After receiving one hundred and fifty units of curare: blood pressure, 130/70; pulse, 106; respiration now maintained artificially.

Thirteen minutes into the experiment, strain as he might Dr. Smith no longer could move his head or open his eyes. He answered questions by wrinkling his forehead. Yes, he could see clearly when his eyelids were elevated manually by another member of the team.

He could barely move his limbs, yet he indicated he wanted the experiment to continue. Questions restated in the negative or double negative were answered correctly by appropriately wrinkling or not wrinkling his forehead.

A pin was jabbed into his skin. Yes, he felt the pain. Two hundred units of curare had been given.

Nineteen minutes into the experiment: blood pressure, 130/70; pulse, 100. Paralysis of his diaphragm and chest wall made him totally dependent upon artificial respiration. Secretions accumulated in his throat. These were removed with a suction tube. Wrinkling of his forehead grew weaker.

Dr. Smith indicated that he wanted the next 100 unites of curare rapidly, as planned. The drug was given; 300 units had been administered.

Slowly, inexorably, the curare sapped Dr. Smith’s remaining strength. His voluntary movement now consisted of a slight twitch of his left eyebrow. When his eyelids were manually elevated, he would report later, he saw double images. Paralysis of his eye muscles prevented him from aligning his eyes, thus causing the double vision. He perceived objects clearly when they were placed in his line of gaze.

Did he want an additional 100 units of curare? His left eyebrow twitched the answer. Yes.

His communication with the rest of the team was limited to an almost imperceptible movement of the inside portion of his left eyebrow. He indicated that he was perfectly conscious. He wanted an additional 100 units of curare. This final dose was given rapidly.

For the next 11 minutes, Dr Smith was unable to communicate with the rest of the experimental team. He was totally paralyzed, his life completely in the hands of the experienced team surrounding him.

He could not talk. He could not breathe. He could not open his eyes. He could not signal any discomfort or any need. Yet, as he was later to relate he was “clear as a bell” during this entire time. Blood pressure, 130/84; pulse, 120.

A co-worker removed Dr. Smith’s face mask and slipped a breathing tube into his throat, through his voice box and into his windpipe. This was a check of the subject’s perception of internal pain. The procedure caused less pain than anticipated, he later related, probably because of his extreme muscular relaxation. Several breaths of air were forced in and out of his lungs before the tube was withdrawn and artificial respiration was resumed through the face mask.

“I felt that I would give anything to be able to take one deep breath,” he said following the experiment. “The period of a few seconds taken for the tracheal intubation seemed unusually long, and I was awfully glad when artificial respiration was resumed.” Sensations of “shortness of breath” and “choking” troubled him during the period of paralysis even though he received adequate oxygen.

Neostigmine, a drug which counteracts the effects of curare, was injected into Dr. Smith’s blood stream. Blood pressure, 130/100; pulse, 100. He still could not move a single muscle.

More neostigmine was injected. As the antidote began to take effect, the subject was able to move the inside portion of his left eyebrow. The last muscle to become paralyzed was the first to recover.

Communication was now reestablished. Dr. Smith signaled he could hear and see normally. He indicated he wanted more neostigmine. Droplets of moisture formed on his forehead. His eyes watered.

Fifty minutes into the experiment: blood pressure, 140/90; pulse, 80. Weak breathing movements appeared.

Moments later he could open his eyes with difficulty. More neostigmine was administered. His breathing movements became more prominent. Large quantities of secretions collected in his throat. These were aspirated periodically by one of his colleagues.

Dr. Smith’s forehead began wrinkling vigorously. By a long series of questions it was finally discovered that the accumulating secretions were most annoying to him. He desired more frequent aspiration of the secretions.

One hour had elapsed since the first dose of curare had been injected. In spite of the frequent aspirations, he continued to experience a “choking” sensation. Rivulets of sweat ran from his forehead.

Even the briefest moment of discontinuing artificial respiration was most uncomfortable to him. He signaled that it be continued without pause. He regained some voluntary control of his tongue, but he could not yet speak. More neostigmine was injected at his request.

One hour and fifteen minutes into the experiment. With great effort, he was able to say several words, weak and slurred, but understandable.

His speech gradually became clear. “I probably could get by without artificial respiration, but still want it.” He could open his eyes more easily. He preferred to keep them shut.

“Will be glad when I can swallow.” He was able to cough weakly. Blood pressure, 120/70; pulse, 88.

Artificial respiration was stopped one hour and 20 minutes after it had begun. The subject could swallow with difficulty.

His use of voluntary muscles gradually returned. Two hours and 25 minutes after the initial dose of curare, he was talking freely, describing his unusual experience. A short time later he sat on the edge of the bed, with assistance.

He later complained of feeling drowsy (for the first time) and reported feeling “uneasy.” He also was nauseated for a brief time.

He improved progressively over the next several hours, but some muscle weakness persisted throughout the evening.

Dr. Smith’s keen awareness through the entire experiment clearly indicated that curare did not depress the brain. In fact he believed that his hearing may have been more acute under curare. He distinctly heard remarks whispered some 20 feet away.

He and his co-workers published their findings in the journal Anesthesiology, advising that “curare not be used alone in surgical procedures but that it be employed only as an adjuvant with agents capable of relieving pain and obtunding consciousness. This suggestion holds not only for adults but also for children in whom a painful experience, even though not reportable to the physician, may constitute a serious psychic trauma.”

After this report was published, Dr. Smith received many requests for additional information concerning his experience while under influence of curare, among them being psychiatrists who wanted to psychoanalyze him, presumably to determine what sort of person would volunteer for such an experiment, or maybe to learn whether his experience had any residual effect on him. Apparently it did not. Dr. Smith went on to a distinguished career in anesthesiology.

One on One in Kuopio Addendum

Posted on by Ken Goetz

If you’ve read my previous post, the one in which I describe my energetic examination of a doctoral student in Kuopio, you know that story ended with a critical question unanswered, with a mystery unsolved. I have just received further intelligence pertaining to that story, as I describe below. However, if you haven’t read my previous post, and if you prefer to know the background of a mystery before putting a finger on its resolution, I suggest you check out the previous post (or even the one before that which begins the story), before you plunge into the clarifying depths below.

Martti, who lives in Kuopio, provided the new information.. Martti is a good friend of mine and the professor with whom I traveled by bus, on another occasion, to Leningrad, the notable trip I described in two earlier postings. Martti was present for all phases of my “One on One” story, and for good reason. He had served as the major professor of the student involved, and he was the man who appointed me to be his student’s opponent.

Here is what Martti wrote after reading my One on One account. “It is exactly as you wrote it. It is an old tradition that doctoral candidate offers to the opponent a drink in the evening celebration ceremony which is always arranged in honor of opponent.” (I had forgotten that the dinner was in my honor.) Martti continued, “Knowing [name of doctoral student] for many years the drink offered was a quite regular one. I guess that you might have met a gastroenteritis virus, which has been around of Kuopio that time in summer. [Student’s name] has always told me that defending his thesis has been one of the most remarkable happenings in his life.”

So it does appears that I was struck by a sneaky virus at the worst possible time of my Kuopio sojourn as an opponent, a timing so precise that it interrupted my celebratory dinner, and, unavoidably I think, raised suspicions as to what had triggered that obnoxious illness and deprived me of a festive evening.

One on One in Kuopio

Posted on by Ken Goetz

After a refreshing night in my Kuopio hotel, I took on a hefty breakfast before getting down to the business I had come for. I opened the dissertation of the doctoral student I was to examine,  now being familiar with him as the young pilot who had ferried me from Helsinki the evening before. His thesis had been printed professionally; its bulk was roughly equal to a thick issue of Reader’s Digest, and its contents, I had discovered, were suitably encyclopedic.

I had read through his entire volume at least twice before, making marginal notes I might use as questions. Now, with the examination looming, I sharpened my approach. I began on page one and read each sentence carefully, perused each paragraph, and jotted detailed notes along the margins. After all, this was to be a significant public event with faculty, friends, and relatives of the candidate all in attendance. It would be a big deal, and I had agreed to do my part.

My attention to my duty waxed and waned during that weekend. I took breaks and strolled for hours through Kuopio’s streets on the Midsummer holiday. I enjoyed a lovely dinner in the home of my host professor and his wife, and I read a few chapters of a novel I had brought along. But I also completed my preparations. By Sunday evening I was soundly prepped, armed and ready, to perform my job as what the Finns call an opponent.

I knew the entire process would be noticeably formal, that the event required academic regalia. Since I had none, I borrowed cap, gown and hood from a good friend of mine, an academic pathologist. The outfit he provided came in a fine shade of Kelly green, the color denoting medical doctors, and it created a surprisingly majestic aura. After climbing into that costume, and evaluating my image in a full length mirror, I realized that never before had I looked so professorial, or so wise. I wasn’t surprised when the driver who took me to the auditorium called me “sir”.

The preliminaries went off without a hitch. At the appointed time, the candidate and I made our appearance, he stage left, I stage right, in the sizeable hall. I can’t say with certainty how many were in attendance, but I think a hundred or more filled the seats. The candidate and I were introduced to the audience by the chairman of the physiology department, the candidate gave his opening address, and then I was invited to begin my questioning.

We each were provided with a chair and small desk, along with tablet and pencil, and of course each of us had brought our marked copy of the all-important thesis. A number of experiments described therein had a flavor close to several performed in my own laboratory, and others described were sound as well. I don’t like being tethered to desk or lectern, so for much of the time I stood and wandered about the stage.

As I lobbed my questions to him, I took care to portray my positive impression of the work he had done, and I listened patiently to his answers, which at times were quite detailed. Nevertheless, in my role as his opponent, I thought it necessary to press him for further clarifications, thereby forcing him to put even finer points on his results. The audience remained attentive throughout.

And so we went, back and forth, and back and forth again, in English of course, not in the young man’s native tongue, for some ninety minutes. Long before the end, it was obvious to me, and I think to all present, that the candidate knew his stuff, that he deserved his doctorate. After I decided that enough had been covered, and in proper detail, I turned to face the audience.

I had been coached earlier on how to report, in Finnish, that the candidate had passed my examination, this to be done primarily so his grandmother and other older relatives, with no grasp of English, would know immediately of my decision. I had a hunch my joust with Finnish would not go well, for my practices had tangled my tongue. The Finnish language has more than the normal load of complexities, but when the time came I sputtered the multi-syllabic phrase with gusto (knowing the Finns never mumble as the Danes do), and then stepped over to congratulate the man I had grilled.

His grip shocked me. His hand could not have been colder had it been pulled from a snowbank, a clue that his performance on stage had been accompanied by substantial stress. We immediately were surrounded by a group of well-wishers, and after some moments I excused myself and returned to my hotel, thinking the entire affair had gone off smoothly. I had no basis for comparison, but signs suggested the afternoon had been successful, the only oddity being the temperature of the hand I shook.  I managed to catch a short nap before freshening up and making my way to a restaurant just across the street from my hotel, the site where a celebratory dinner was about to begin.

A sizeable group had already arrived when I entered the restaurant. My successful doctoral candidate/pilot was standing near the entrance, greeting his guests. He had a cocktail in hand and offered it to me. How kind of him, I thought, to have a drink ready for me. I passed into the room reserved for our dinner, chatting with a number of guests and feeling relaxed and pleased that all had gone well. Gradually we seated ourselves, and I was about to begin the first course when my stomach alerted me that certain parts of my internal machinery were slipping out of whack. I tried to ignore the message and focus on the delicacy before me, but my symptoms revved up rapidly, sending the distinct message that trouble lay ahead, that I was about to make a mess of my plate, and probably more.

With little grace, I excused myself and tumbled out of the restaurant feeling terrible. I rushed across the street to my room, barely making the bathroom before the eruptions began. That night went on and on, a thoroughly unpleasant interval, with the bathroom as my refuge. During this miserable time, as I passed through the various modes of emptying myself, questions naturally arose. I began to wonder whether the doctoral candidate thought my treatment of him had been unfair, or maybe even a bit rough. The frost on his hand certainly suggested he had suffered an ordeal. After having provided me with a fine flight the night before, did he presume he deserved to be treated gently as a form of repayment? (That made little sense to me, because I thought he had performed very well under my questioning, that with my help he had shone brightly all afternoon.) Still, considering my sudden and unexpected distress, I couldn’t avoid wondering whether he had concocted a clever method of revenge. Why did he have that cocktail for me at the ready? And what else could conceivably have brought on my abrupt distress? Wasn’t all of this quite suspicious?

Now, decades later, those questions remain unanswered. Were my suspicions justified? Who knows? Maybe some mysterious virus just happened to slip into my digestive tract at an inopportune time and trigger my set of erroneous suppositions. So, in conclusion, I have no answer. But even now the question lingers. Did he, or didn’t he?

Flying above Fire

Posted on by Ken Goetz

When I landed in Helsinki, the middle leg of my previously-mentioned tour, I was met by the young pilot assigned to fly me to Kuopio. By odd circumstance that fellow was the very candidate I was to examine on the following Monday. Apparently those who arranged this scheme thought it would provide a pleasant avenue for us to become acquainted before we appeared together on a public stage (I’ll explain that later). I’d been assured the fellow was an accomplished pilot, so I settled myself comfortably in his single-engine aircraft, anticipating a pleasant flight, and having no inkling of the spectacle that lay ahead.

The day was June 19, 1987, an excellent time to arrive in Finland, for it was Midsummer Eve in that country, a special time I discovered, and one loaded with traditions. One colorful custom sends multitudes of folks hustling off to nearby lakes, almost all to gather timber and pile it into huge clumps. Then, just as daylight fades, to set all ablaze.

I knew none of this as I we taxied to our runway, I paying alert attention to the commercial jets lumbering tall around us. After receiving permission from the control tower, we accelerated with all the energy a single propeller can provide and gradually reached the speed necessary to ease us off the ground. Remembering those moments now, I’m sure everything had been carefully planned, for our airplane gained altitude just as light was fading.

Southern Finland, the part over which we flew, is awash with lakes, huge lakes, some of them snaking along for fifty miles and more. From our height we had superb views of those expansive stretches. Large areas of water gleamed like scattered puddles filled with rain. I quickly noticed other things were afoot along the waters’s edges. Sparks flared and rapidly grew into dots of fire along the shores. More and more fires appeared, all with orangish hues of burning timber. Fires exploded everywhere, hundreds of them marking the irregular intersections between land and water, and all of them sliding smoothly beneath us, their patterns changing constantly, each seemingly more incredible than the last.

We probably were some 1,500 to 2.000 feet above the earth for most of the flight, that height providing a broad view of the bonfires.  On and on we flew for a couple of hours, conversing over the drone of the engine, discussing what we were seeing below, and occasionally dipping down for closer observations, ever alert for new sightings.

Although I’ve flown in other small planes, none has gripped me like that singular flight into the dark. Night had taken over completely by the time we reached Kuopio. Bonfires still burned brightly along Lake Kallavesi as we landed, I realizing at that moment, as I suspect the pilot did too, that our next adventure together would play in a different key, for I would be the one with the wheel in my hands. I’ll unravel that story next time.