I am sure that he´s been called that before. Mehmet Oz, I mean. Still, to me he is the Wizard of Oz and so I will call him that. This is how the Wizard of Oz is described in the classic book:

“So Oz brought a pair of tinsmith’s shears and cut a small, square hole in the left side of the Tin Woodman’s breast. Then, going to a chest of drawers, he took out a pretty heart, made entirely of silk and stuffed with sawdust.”

“Isn’t it a beauty?” he asked.

L Frank Baum
The Wizard of Oz

And it perfectly suits my friend, Mehmet Oz, who one recent morning became a Wizard to me when I saw him perform two open heart surgery operations in a row. This was the closest thing to its art form I had ever seen!

Mehmet is American, of Turkish Origin. He may be Turkish, but when he speaks he sounds like a full-fledged New Yorker. If you do a google search you will be amazed at all the material and sites on the net about him. He is both a great surgeon and a very well known “popularizer” of medicine.

Recently, I was in NYC with my family. One warm afternoon we went for brunch with Mehmet Oz´s family. After we were all seated in a nouveau Mexican restaurant on Park Ave South, my curiosity piqued, I began asking a few questions about that which he had dedicated much of his life to, heart surgery. My interest was met with an invitation. “How would you like to come to Columbia Presbyterian Hospital tomorrow and see me perform open heart surgery?” Mehmet´s overture caught me by suprise.

Given my family history, the offer hit an exposed, but generally well-guarded nerve. I come from a family in which my grandfather, my father and my uncle died in their 40s and 50s of heart attacks. Being in my 40s and consciously working to avoid a similar fate, I was propelled into a temporary stasis. My brain basically split in two. On the left side, my interest in attending the procedure was overwhelming. On the right, I was simply terrified. In the confines of a moment, as it usually happens with me, excitement eradicated fear. “Sure, I would love to go.” “9 am,” he said, and left it at that.

We went on to talk about renewable energy and a conference he had just attended on the subject at the Aspen Institute. Yet, a subject change to windmills and solar panels just didn’t cut it. I could not stop thinking about my crazy acceptance… about hearts, about life and death.

On the morning of the scheduled procedures, I got off to a late start. My internal conflict had not yet been resolved. I fluctuated wildly between some very basic human emotions. Excitement, fear. Fear, excitement. Fear. Taxi, West Side Highway, 170th St and Ft Washington. Excitement. Fear. It was 9:10 when I got there.

Mehmet had already gone from his office down to the operating room. His secretary was expecting me. She told me to scrub up and go down from the 7th floor to the 4th floor, dressed as a surgeon myself. She gave me a pass and pointed me to the hospital personnel elevator. To patients walking around the hospital I was suddenly transformed into a doctor. I immediately felt their gaze of respect. I felt like an impostor.

When I made it to the fourth floor where all the operating rooms were, a nurse greeted me and led me to Mehmet. Dressed in scrub, with a mask, on I hardly recognized him. There were 8 additional people surrounding the still body that lay on the operating table. Nurses, surgeons, heart and lung machine operators, anesthesiologists. This entrance into a situation I had never been exposed to before shocked me. I was reminded of my first flying lesson when the instructor had me stall the plane in mid-air to see if I would be able to put up with the rest of the course. I almost threw up. But I did become a pilot. That day in the hospital was a similar experience. An much like flying that plane, I was not about to fail in my endeavor to witness the event that was to take place before me. However, I had assumed that I would observe the operation from a safe distance, through a glass window. But the reality of it was quite different.

As I approached Mehmet he said, “If you were a resident you would be fired by now, but as you are my friend you can come over and see what we´re doing.” He then pointed to a stool that allowed me to stand virtually on top of the patient. My face not more than 2 ft away from the abnormally still, open heart.

What was to come next defies description. I realize it must be normal to doctors, but to me it was anything but. The patient was covered in green fabric with only the heart area exposed. I was immediately aware that while the doctors and nurses could not see the patient´s head from where they were, it was practically in between my legs.

I started to feel sorry for him. The patient was a man in his 50s. He looked dead to me. He was as pale as I had ever seen anyone who still had breath in his body. His heart was not beating, nor were his lungs contracting. He was connected to a heart and lung machine that did all this work for him. Given that I walked in 15 minutes late to the 90 minute aortic valve replacement procedure, I did not see how this patient´s heart had come to a stop. It seemed to me as though Mehmet was operating on a dead person. His body was cut wide open, his bones broken to accommodate the surgery. How on earth was Mehmet and his team going to put 53 year old, gray hair Humpty Dumpty together again?

Now, it´s not that I am unfamiliar with medicine. One of the companies that I started, Medicorp Sciences, enabled me to spend 3 years working with immunologists. But the world of biotech immunodiagnostics has very little to do with live people, with denuded organs, with real hearts. Columbia Presbyterian…the whole situation..was something else. I was in front of a male in his 50s whose aortic valve, the traffic police of the heart, was failing. Interestingly, because of this it had to do much more work to achieve the same results as a healthy heart, causing it to become greatly enlarged. Mehmet explained to me that surprisingly, enlarged “tough” hearts are very dangerous and heart attacks on them tend to be fatal. He also explained that it was harder to restart an enlarged heart. The restart was supposed to happen in the next half hour.

I believe it was then, while Mehmet was explaining to me the high likliehood of fatality when an enlarged heart undergoes an attack, that I started to faint. Until then my family´s ghost had not been mentioned – HEART ATTACK; but when those magic words were uttered, my blood pressure collapsed. What I do remember was, that as this started happening, I panicked. All I could think was that I would fall forward, on top of the patient and the millions of stitches around his heart, the myriad connections to the heart and lung machine, the sonogram probe, the anesthesia catheters, would all be in disarray, and I would kill him. It was this thought that prevented me from actually fainting. New doctors have to swear that they will not harm patients. In this case I felt the hypocratic oath applied to fake doctors as well. I was of enough mind to say something like, “I am going to rest,” and moved back and sat on the floor somewhere. I was advised to put my head between my legs, as that was supposed to lift my blood pressure from its hurricane lows. It worked. A few minutes afterwards I started to feel the blood flow through my veins again. I went back to the operating table.

The following 90 minutes were not as difficult. Human beings have an amazing capacity to adapt to a wide array of situations in a relatively short timeframe. What was debilitating the first 10 minutes, became less so the second 10 minutes and even less so the second hour. And horror gave way to enormous intellectual interest for my unusual surroundings and the deftly performed functions of the professionals around me. Mehmet was truly inspirational. Not only was he rebuilding Humpty Dumpty with tremendous precision and speed but he was also extremely helpful at explaining to me all that was going on around me.

This is what I understood. Some people have defective heart valves. Heart valves manage the flow of blood through the heart. When these valves leak the heart works imperfectly having to pump much more blood to achieve sub par results. After years of doing this, hearts build up like body builder arms. If these enlarged hearts fail they have a very hard time restarting, leading to massive heart attacks. What Mehmet and his very able team do is open the chest of the patient, inject an anticoagulant so the blood does not clot during the operation, get to the heart, connect the heart to a heart and lung machine, disconnect the heart from the rest of the circulatory system so it stops pumping, open up the heart, cut the defective biological valve, replace this defective valve for a man made valve (that looks as simple as a faucet stopper but has taken decades to develop), install the artificial valve with tremendous skill and tens of stitches, sew the heart back together, restart the heart, restore the ability to coagulate, close the chest. All this while the patient is under total anesthesia, unable to feel anything, unaware of what is going on around him.

After we were done with our first patient Mehmet asked me to put surgical gloves on and handed me the malfunctioning real valve for me to see. He pointed out to me how calcified it was; and it did indeed look very calcified. Upon closer examination it seemed as if the cartilage had grown a bone. As useful as bones are, they do seem a bit out of place inside a heart. Mehmet also said something about the human soul residing in the place where the valve belonged. Being more European than American I felt as uncomfortable mixing religion and medicine as I do when I hear Bush mixing religion and politics so I said nothing.

Bringing this man back to life was a two stage process. First, the heart then the lungs. These two vital organs were “reborn” in two very different manners. The heart started beating slowly. A heart beating, one imagines, is some kind of jerky movement. In reality, is a much slower and awing process. The heart inflates and deflates while moving sideways. The lungs however, are a whole different thing. They appear and disappear, changing tremendously in size as they do. While I was mesmerized seeing the heart and lung machine being disconnected step by step, first the heart and then the lungs, Mehmet surprise me with the following comment on the lungs. He picked up the lungs as they were breathing and asked me “Do you see these black stains here?” “Yes, I responded, looking at these ugly marks that made the lungs appear as if they had fallen on a dirty floor and were stained. I instantly assumed that the man had been a smoker. But as it turns out, I was wrong. The patient was not a smoker. What Mehmet explained to me is that anyone who lives in a large polluted city like New York has those stains and that people who live in the countryside do not. Sufficed to say, I was taken aback by at the severe repercussions of environmental preference.

After Humpty Dumpty was magically put together again, real heart beating, valve working and making a funny noise (it seems that the patient will have to get used to it because he will hear that noise for the rest of his life) I felt prepared for anything. What could be worse than witnessing open heart surgery? Well, I got my answer rather quickly. Witnessing the next operation, a triple bypass, was worse.

By osmosis I had learned that bypasses are done by taking veins away from other parts of a patient’s body and grafting them around the blocked arteries near the heart. But hearing and seeing are two very different things. While the other patient had his chest open while covered with cloth; the bypass patient, an Indian man also in his 50s, was having two operations simultaneously. Two Japanese surgeons, colleagues of Mehmet, operated around the heart while another American surgeon operated on the leg. He was not really covered. The sight of a fellow man having simultaneous surgery, exposed leg and heart, was extremely challenging. This time I managed to keep myself together and made it through the procedure.

The second operation turned out to be less predictable than the first. When the Indian patient was opened they discovered that there was a hole between his ventricles that was not supposed to be there. One of the surgeons proceeded to explain that this surgery was not supposed to involve the use of the heart and lung machine. But given the congenital defect that had to be corrected, the patient needed to put on the machine. So this time I had the opportunity to see what I had not seen during the previous surgery. I watched first hand, a temporary suspension of life…the heart and lungs being brought to a halt and replaced by a synthetic machine. If it hadn’t been that I had already seen that the reverse process actually worked, I would have been petrified. But this time I trusted the Wizard of Oz and his team. I simply watched the heart stop beating and the lungs stop breathing. And because Columbia Presbyterian has all these machines that not only show measurements on screens as pilots do, but replicate the sounds of the heart as the heart beats, I was able to see both the heart stop and most impressively, ceased hearing that comforting beating sound. No sounds have been added to the artificial heart, nor have any efforts been made into making this machine resemble anything close to a heart. So to the untrained eye, when a heart is stopped for surgery it simply looks like the person just died. But he hasn´t died. As soon as the heart was still, the two Japanese surgeons worked deftly, both to correct the hole and graft the veins from the leg and chest around the clogged arteries of the heart, performing the three bypasses. Seeing their hands work with such accuracy and agility was extremely assuring. They could sew the finest of stitch in the closest proximity to the other. There was a Frankesteinian element to the whole thing, particularly as more and more grafts were applied around the heart. These surgeons made it all look like a maki in which different things looked as if they were made to be together. After an hour of work the Indian patient was sewn back and his bypassed heart was working.

Between watching this phenomoenon and listening to one of the surgeons so clearly explain to me what they were doing, I failed to notice that Mehmet had left the room.

When I got to his office I was in for yet another emotional twist in the complicated world of medical science. Mehmet was still in his scrubs, but he was no longer the life saving surgeon performing his delicate art on the operating table. He had transformed into a disseminator of knowledge. “I dont want to sell fifty thousand copies this time, he was saying, “I did that with my last book and as much as I learned in the process, I want to get a million out there.”

Still under the spell of this Wizard of Oz, I looked around his office and took note of the many articles he had been in, the many magazine covers he had graced. Not only was Mehmet a master surgeon, I suddenly realized that he was also an amazing educator and popularizer of medicine itself. The old cliche, “prevention is the best medicine” holds true here. And what better way to prevent then trough the promotion and popularization of its benefits?

And it appears as though he was right about the million copies. This afternoon I went to Borders bookstore with my kids, and there it was.. Mehmet´s book, You: The Owner´s Manual…right next to Harry Potter!

We have all heard about plate tectonics, the theory that explains how the crust of the earth is divided into moving parts that crash causing earthquakes along its edges. What this theory says is that the earth is made of seven large plates and many small plates that move in different directions in three different ways: they converge, diverge, or transform (as they crash). While this may be purely a coincidence, it appears to me that human beings, in their evolution, have also developed cultural tectonic plates. If we divided the world in “cultural tectonic plates” meaning groups of people linked by language, religion, politics, history or what we define as culture, we would also have seven major cultural plates and some smaller ones. These seven plates would be:
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I read in Bill Bryson´s book that our brains makes only 2% of our body mass but demands 20% of the energy we consume. And not only that. Since the brain manages how energy is distributed around our body, when there´s an energy shortage the brain makes sure that other organs suffer first. Not unlike elaborate computer chips, our brain seems to have tremendous energy requirements to function properly. If this is so, here is an idea for a new diet….think more and less of your food will become fat.

Two years ago I wrote an article called “Programming Human Beings during Vacations” in which I argued that the deciphering of the human genome was the very beginning of an arduous process in truly understanding genetics. I said that while some people feared that tinkering with genes was only a few years away, my belief is that we are probably still at least a century away from changing the genetic programs of living individuals with the first objective most likely being to reverse the program that makes us age. So while I had been aware for a while that we and all other animals and plants are genetically programmed to age and die, I had a wrong understanding of how this was the case, and Bill Bryson´s book clarified it. I knew that we are born with a fixed number of neurons and that we lose them as we go through our lives. But what I did not know is that there´s “not as much as a stray molecule” in a 90 year old person that was there when this person was 80. This means that a person of 90 is a complete new person from a person of 80, yet old. In other words, not only are we programmed to age but we are constantly “renewing” ourselves, as older people.
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Here´s another complicated post to write. On the last one I sounded “homoweird” and now here comes one in which I may sound racist. But here it goes anyway. It refers to Polynesians and Melanesians. And my statement is that Polynesians seem to be much more admirable people than Melanesians. As a warning I will say that my contact with both groups is the very limited experience of a bike riding tourist, still these are my observations from travelling around a week in Melanesia (New Caledonia) and over a week in Polynesia (Tahiti, Moorea, Bora Bora and Tikehau) and riding rented bikes: in short Polynesians appear to be a much more “advanced” culture than Melanesians. This is what I mean. In New Caledonia Melanesians make about half the population of the country, the rest being Europeans, mostly French, and some Asians, mostly Chinese. In Polynesia the blend of people in the islands seem to be about the same. About half of the people are Polynesians and the other half Europeans, including tourists, as there´s much more tourism in Polynesia than in Melanesia. But there the similarities end.
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Nature vs nurture. I tend to side with the Nurture side. In general, I believe that education and overall upbringing play a very important role in the personality and skills of most individuals. But in the case of at least a certain type of sexual orientation, given my experience over here in the South Pacific, I have my doubts. Here´s the observation.

Since we arrived in French Polynesia we had 11 dinners in 9 different restaurants. In all of the 9 restaurants waiters were either women or extremely effeminate men. Intrigued about this I asked around and was told that in this part of the world the only men who want to become waiters are the “mahu” or men raised as women. Other men do all sorts of jobs around the hotel, they are gardeners, they carry luggage, they are managers, they steer boats, but they are not waiters, which in Polynesia is considered a job for women only. And what are the mahu? Well they are men who, while dressing and looking as men, behave as women. They walk as women, have high pitched voices, they are men who seem to show you that there´s something radically different not only about men and women´s bodies but about gender behavior as well, and that you can have the body of a man and the behavior of a woman. Now what I find hard to believe is that these men are like this because they were “raised as women”. Is it nurture or is it nature? Are they raised as women or is it that from the time they are very little that´s what they want to be and they are raised accordingly? Aren´t the polynesians on to something that is better, namely accepting sexual orientation early on? Aren´t we in the West forcing would be Western mahus to be men as much as we used to force lefties to be right handed?

“Human beings are the only animals that can harm at a distance.” This is a phrase out of the book. I complement it with one of my own. Human beings are the only animals whose greatest possibility of harm comes from members of their own species. Even the most dangerous animals need not fear their kind. Lions don´t fear lions; sharks don´t fear sharks; yet, even having swam this morning among sting rays I know that if any other animal ever harms me (bacteria aside) it will be another human being.

Interestingly, I learned that Tikehau is a case in point. Until 100 years ago cannibalism was practiced here. Cannibalism was an ancient practice in Polynesia only recently banned by Europeans. It seems that Polynesia had many kings, or a king per island or group of islands, and there´s over 100 islands in this vicinity. These kings, or A´ri as they were called when they wanted to rule another island, would first propose to the fellow king some kind of deal of submission. Now, more often than not, it turns out that the fellow king would not agree to it and he and his subjects would fight for their independence…and lose. And losing meant becoming the conquering king´s lunch! As crazy as this seems, somehow being here on such a tiny island, cannibalism makes a little more sense to me. When a population invaded an island and ate their people first, as disgusting as it sounds, they got fed. But secondly and most importantly, they eliminated a rival population from competing for the same basic resources…food and fresh water. Still, animals as far as I know, have not arrived at his “realization.”
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My wife and I are in the South Pacific. We are here without internet, without dvds and without TV. We are in a tiny island called Tikehau, a coral reef. We are not even in Tikehau proper, but in a smaller nearby island that has no cars and altogether around 80 people. So after we are done with the fish watching and canoeing, we both read. She reads 2000 page long Tolstoy´s War and Peace while I go for a more modest objective, Bill Bryson´s Short History of Nearly Everything, only 600 pages long. To me this is the reading equivalent of climbing the Aconcagua. I now do most of my reading in magazines and on the net and rarely tackle books that are not half as long as 600 pages!

Nevertheless, partly because of the lack of alternatives and mostly because I found this book fascinating, I did read. And I finished the whole book. And I strongly recommend it. I will not however review the book but write a series of random thoughts partly inspired by the book and partly by my own thinking over here in the South Pacific…


Monopolies in the South Pacific

Published by MartinVarsavsky.net in General with Comments Off on Monopolies in the South Pacific

I am in the South Pacific. I have been here for two weeks. I was in New Caledonia, now I am in French Polynesia. I also think this is the longest time I have been without internet, without using a computer, without writing e mails or surfing since 1994.

New Caledonia and Tahiti belong to France, they are French Territories, to use their terminology, Territoires de Autre Mer. And in many respects they are like France, their GDP per capita is like that of France, their cars are like those of France, their bread is fortunately like that of France, but there´s however one susbtantial difference that accounts for the fact that there´s practically no internet access here and that is that France is in the European Union and the European Union forced France Telecom to compete while in New Caledonia and Tahiti there´s no competition in telecoms, and it shows. Monopoly telecom services are incredibly poor. I should know. I built Viatel to fight monopolies and being here only makes me happier that I did so. In a monopoly world mobile phone services are pathetic. In New Caledonia there was no roaming for Vodafone and even after I acquired a local sim card I found that there was no GPRR service and that sms worked received mode only (my replies appeared as sent but never arrived at their destination). In Tahiti things were only slightly better. My Vodafone Blackberry worked, but only as a GSM phone, no e mail. I could send and receive hugely expensive sms. Surprisingly when I bought a local VINI (name of the local operator number here) phone number to try it out, I could again only receive and not send international sms. And as far as the internet goes, things are awful over here.

In the French territories you can fly modern planes, you can rent boats, helicopters, drive the

Here we are, in French Polynesia. As most travellers, we are equipped with travel guides. We seek a balanced view, so we carry two guides: one is in English, the Lonely Planet guide, and the other one is the famous Petit Futé guide, in French. Now, here´s the problem with these guides. They are too positive. They always give two thumbs up…for everything. An example: We are in Rangiroa, a coral island in the Tuomotu Archipelago. We are staying at the Ki Ora Village and this is what Petit Futé has to say about it: “The location is magnificent…you will be enchanted by its white sands…its luxury is uncomparable to anything you have ever seen.” Lonely Planet does not want to be outstaged. They counter by saying “If you are in search of luxury look no further than the Ki Ora Hotel.” Now this is what I think those guides should say… The Kia Ora is an understaffed, poorly designed, overpriced hotel in a nice location. At 600 euros per night their overwater bungalows are a dissapointment to say the least. Their furniture seems to come straight out of a Miami Beach motel foreclosure. In the United States you would not pay over $100 per night for a similar room.

And this is not just the case with this hotel and the islands in general…
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