Memoirs of a Surgeon. "Charles"

With scalpel in hand, I made a swift but deliberate incision down the midline of Charles’s abdomen.   I was soon to determine his fate.  Will it be like that of his younger brother’s, who lived only six months after he learned of his un-removable stomach cancer?  Or, will Charles be more fortunate?   I feared the worst.  All his preliminary tests hinted at an advanced form of stomach cancer.

My fears were soon confirmed.  After entering his abdominal cavity, my  hands encountered a nasty, grapefruit-sized firm tumor that had involved most of his stomach.  I don’t recall the swear- word I muttered to myself at the grizzly discovery.  Knowing my repertoire of swear-words, it probably was related to what I see my dog-loving neighbors carry around in blue plastic bags during their morning doggy walks.

Upon further exploration, I discovered more bad news.  My findings reminded me why the German word for cancer is  'Krebs'.  The literal translation is that of a crab.  Not unlike one, this cancer had literally extended its tenacious claws into Charles’ internal organs.  His spleen, liver and pancreas were firmly in the grasp of this monster.

It is decision time.  As surgeons, we face such decisions on a regular basis.  It is usually a point of no return during an operation.   Should I just quit, close and admit defeat?  If I do, I will just fuel the old wife’s tale and common misconception that “when the air hits the cancer  the patients will soon  die”.  In reality, air has nothing to do with it  A  person dying under such circumstances is the result of the hopeless and terminal nature of the disease.   If I quit and just close him up, what will I tell Charles and his wife who is anxiously waiting in the waiting-room?  I was never very comfortable with telling my patients about the finality of their terminal illness.  This discomfort incentivized  me to try harder.

Like most  surgeons, I hate to admit defeat.   Surgeons in general  are a very competitive , like athletes.  We hate to lose.  Besides,  it’s like a feather in your hat if you’re able to remove a monstrous tumor such as this one without killing the patient in the process.   It's like bragging rights, if you will, amongst your colleagues.  This bastard of a tumor was not going to defeat me.  Not today.

Once again and with more determination, I grabbed the enormous cancer in the palm of my right hand.   Oh, good.  It is mobile.  Despite its deadly invading claws, it moved when I attempted to rock it from side to side.  Such a finding usually indicates a potentially resectable  tumor. 

Not so fast buddy, I whispered to myself.  What good  will it do to remove the tumor if the patient dies in the process?  Advanced tumors of this type are like parasites.  They invade a person’s blood vessels making its removal a “bloody mess”.  Fortunately the vital points of attachments were expendable organs, such as the spleen and tail portion of the pancreas.  With experienced hands, a surgeon can remove these organs along with the cancer without too many resulting post-operative consequences.  Many people a year, lose their spleens in auto accidents and are not too adversely affected.

This would prove to be Charles’ lucky day. After removing his spleen and tail portion of his pancreas, I was able to carefully “peel off” the remaining portion of the tumor from its attachments to the liver and retroperitoneum, or back of the abdominal cavity.  One by one, I pried the greedy  tentacles of this monstrous cancer from Charles’ vital organs.  He lost about two units of blood in the process, which we quickly replaced with banked blood.

Triumphantly, I dropped the entire specimen, containing his  cancerous stomach, spleen and part of the pancreas, into a sterile fourteen inch basin.  I felt a bit like a wrestler, about to slam the limp body of his opponent onto the canvas waiting for the three-count.  Take that you bastard, I muttered to myself after  undeservingly  dignifying this ugly cancer with human qualities.  I felt proud about what I had accomplished .

  

The crater I left behind was “dry”, meaning that there was not much bleeding from the site of the surgical trauma.  Despite the enormity of the  operation I had just completed, I knew that unseen, microscopic bits and pieces of the cancer remained.  I had merely de-bulked his advanced cancer.     I had done enough.   I will rely on postoperative  chemotherapy to do the clean-up,  as is often done in these circumstances.  At least I had lessened the tumor burden that  Charles and the chemo would have to contend with.

There was just one remaining surgical dilemma I was faced with.  I had just finished removing Charles’ entire stomach. How will he be able to eat?   I was faced with the open end of his esophagus and that of his small intestine, staring me in the face.  I would have to “make “a new stomach for him. Fortunately for me and my patient, my pioneering surgical predecessors  have devised  just such an operation many years ago.   I had performed the “Hunt-Lawrence” gastric reservoir on numerous occasions during my training and early surgical career.  It is a tour-de-force of an operation, requiring skill, knowledge of anatomy and is  fraught with risks and complications.   My patient Charles became the beneficiary of my familiarity with this procedure.  I had wondered since, what a less experienced surgeon would have done under similar circumstances.     

Much to my delight, Charles recovered quickly.  He was a perfect patient.  He remained on a liquid and semi-solid diet for a brief time after surgery.  He also endured a brutal 6 month course of chemotherapy, administered by the oncologist who referred Charles to me. 

Twenty years and many Christmas fruit baskets later, Charles is golfing his way into geezer-hood.  He is now about 66 years old and his last check up revealed no signs of a returning cancer.  Charles had  been cured.

 I retired from surgery at the age of 65, three years ago.  For my retirement party, I invited several colleagues, nurses and others that had a great influence upon my professional life.  Among many patients that had a lasting impression on my surgical career, I invited only one.  It was Charles.

Charles recently asked me whether I had other patients who survived as long as he has after such an advanced cancer operation.  Not to my knowledge, I told him, although some came close. He is my crowning glory, my hole in one, my Tour-de-France victory, my super bowl ring.  I had pitched a "perfect game"  The eight years of schooling after high school, the five years of surgical training and 35 years of grueling night call  was all worth it.

Memoirs of a Surgeon--"was it all worth it"?

During a 35 year career, a surgeon lives through many experiences that impacts on his character, emotional state, beliefs  and values.  So it is not surprising, that during my own career as a general surgeon, I have witnessed the unfolding of life from the womb to the tomb.  This included encounters with people from all walks of life.  In particular, I have witnessed  behavior not befitting the dignity of human kind to the utmost reaches of morality, kindness and love.  I choose to remember the latter kinds of interactions I have had the good fortune of being part of during my career. 

As doctors, we are privileged to be part of people's  most private life experiences.  Whether it is the joy of placing a newborn baby on the belly of a tearful  mother, or the deepest sorrow of a parent following the tragic news about the death of a child, one cannot help but be moved and forever changed.

 I have never become accustomed or comfortable about delivering bad news.  Unfortunately, I have chosen a profession  that by its very nature causes injury before the healing nature of the craft can be appreciated.   Whether it is treating a trauma patient, or excising a cancerous tumor, surgeons inflict pain and injury, before they reap the fruits of their labor and earn the gratitude and trust of their patients.

 One of my favorite utterances has always been: "A chance to cut is a chance to cure"  much to the chagrin and rebuke of my medical colleagues who merely "push pills" and never actually cure a disease, as is the case with diabetes or high blood pressure.  When I remove an inflamed appendix, the patient has forever been cured of appendicitis. Unfortunately as surgeons, we have to live with the consequences of our actions.  I have never had a patient who liked me a day or two after a hemorrhoidectomy  when going to the bathroom can only be compared to passing a broken bottle with the wide end first.  Fortunately, there are also positive experiences which more than make up for the negative ones.   It's hard to find a more grateful patient than one who has lost two hundred pounds as a result of your efforts, and is now able to live life the way it was intended, unencumbered by morbid obesity.

 I was fortunate during my career in surgery to be involved in the types of surgical procedures that resulted in making patients feel better and live longer lives.  As a result, among the greeting cards during the holiday season  and throughout the year, I was privileged to receive gifts and letters of thanks from patients who were eager to share their gratitude for what I have done for them.  I keep a folder filled with such letters.  When I am disheartened or depressed about the medical profession, I pull out this folder and read through a few of these faded cards and letters that have accumulated there during the past 35 years.

I found myself in such a state of mind the other day.  I needed a picker upper. Maybe it's the holiday blahs or  SAD, [Seasonal Affective Disorder] from years of living in Cleveland, Ohio.  As I sorted through the dozens of letters, I ran across a letter, that I had read many times before.  Unlike most of the other letters, this one was extra special.  It was a letter of gratitude for something  "I didn't do" or "Couldn't do", which just reminded me of my fallibility and humility as a surgeon.  It is reflective of the imperfect nature of our surgical skills and the strength of the human spirit when everything else fails.   It is so touching that I am compelled to share it with others.   The amazing story of this wonderful human being, the wife of a physician, began months before she died.  To the best of my recollection, she suffered from a rare tumor involving most of her small intestines.  Her husband entrusted me with her care and on two previous occasions, I was fortunate enough to repair a high grade bowel obstruction by partial resections and bypasses of the obstructions, knowing all along that my best efforts will ultimately be unsuccessful in the long run because of the relentless growth of this nasty malignancy.  When I was confronted with yet another one of her high grade obstructions, I felt compelled to operate in an effort to relive her of the agony of the painful obstruction.  To my dismay and great disappointment, I was unable to relieve the obstruction.  Rarely during my surgical career did I find myself in such a predicament.  There was absolutely no possible way I could   relieve this patient's obstruction without causing  her immediate death.  Dejected and defeated, I had to confront this wonderful patient and her loving husband with the tragic news of my failure to help.  In my humble opinion, she was doomed to a painful death from a bowel obstruction and an indwelling plastic tube in her stomach for the remainder of her short life, merely to keep her from constant vomiting.  With a courage that I have never witnessed before, they accepted their fate.  I have purposefully omitted names and dates to protect their privacy in the letter that follows:

Dear Dr. Schreiber
                                                                          --------

"Now that it's all over, I would like to take this opportunity on behalf of my three sons, ----, ---- and --- and myself to thank you from the bottom of our hearts for all the help, care and kindness you showed to my dearest wife -----, during her recent illness.

She expired on the ---------- after 22 days of hospitalization for intestinal obstruction.  We decided not to have surgery and so we got Hospice involved and took the approach to just make her comfortable.  She suffered tremendously, she had gross tense ascites[fluid in the belly]; severe pain and was on continuous N-G Suction for all her 22 days.  Unfortunately, she was of clear mind+ knew everything that was happening.  I have seen many people die [as a physician] but I do believe that my wife was one of the bravest.

In spite of her being so ill, in so much pain+ respiratory difficulties, she welcomed all visitors and always found something to say to them which would comfort them. She was at total peace with her maker.

She reminded me many times not to forget to thank you for all you did for us.  She had the utmost faith in you + your demeanor, + your caring and compassionate ways will always be an inspiration to me.

I tell my big son -------- that if he ever becomes a doctor [he has become one since]he must be like Dr. Schreiber.

------- was very taken up by your kind, gentle way you listened to her; your efficiency and of course your sterling surgical skills.  When you told her nothing more could be done, it broke her heart, but she recovered and told me that she believed you implicitly and never doubted your judgment.  From then, she started trying to cope with the finality of her dying.

In her dying days her strength of character, her inner peace was an inspiration to all she touched and in our final prayer with our pastor, she prayed that God will make more 'Christian' doctors like you, Dr. Schreiber.

I miss my wife so very much-  It's a very sad life without her and obviously I have not adjusted.  Hopefully time will heal.

God bless you Dr. Schreiber and your staff.  You are one of a Kind.

Sincerely;

------------------- [M.D.]

Humility is not  generally attributed to surgeons.  I must admit to a touch of this character deficiency during the early years of my career before I realized my own shortcomings as well as that of my craft.  Practicing surgery in a society where 'dying is not an option' is not easy.  It becomes increasingly difficult to admit to defeat and inadequacy lest you expose yourself to  criticism from competitive colleagues, with much less morals and values.

The experiences of dealing with hopelessly ill  patients whose expectations you cannot fulfill, leave you wondering.  Was it all worth it?  After re-reading the letter above several times in the past years, I always come to the same conclusion.......YES IT WAS.

Memoirs of a Surgeon-- "Old Joe"

It's 3 O'clock in the morning.  I am "on call" for emergency general surgical cases.  I awaken to the irritating sounds of a beeper sitting on my night-stand, as it has  for the past  30 years of my career, controlling almost every aspect of my life.    When I call the number displayed on the digital read-out, it is the hospital operator's familiar voice, connecting me with an anxiously waiting "house physician" in the emergency department of the hospital.

 House physicians are fully  trained and American Board of Surgery-certified surgeons who generally do not have a private practice of their own. They choose instead to practice their surgical profession by taking "call" in local hospitals, earning a fair hourly wage for their efforts.  In the absence of surgical intern and resident  trainees that commonly assume this role in larger teaching hospitals, these physicians are entrusted by the hospital to respond to the urgent surgical needs of hospitalized patients and triage new patients in the emergency room needing surgical expertise.  In some ways, patients in non-teaching private hospitals obtain the benefits of "the system" because they can rely upon fully trained and often experienced professionals to attend to their urgent surgical needs.  In contrast, larger teaching hospitals, whose "on call" systems I am very familiar with, having been a resident myself and having been the director of surgical teaching programs for the better part of my career, often have inexperienced first or second year residents, serve as "first responders" to the surgical needs of the hospitalized patients.  The Achilles heel of the latter system is the quality of the hierarchical  chain of command and its inherent time requirements.  Precious minutes and hours may go by before the "attending surgeon" is notified of the ongoing surgical emergency.  Depending on the quality of the training staff,  the attending surgeon may choose to defer decision making to the in-house staff in deference to the learning experience inherent is such a decision.

I was the beneficiary of having a trusted "house physician" on call that particular night, whose skills and knowledge base I was fully familiar with, having reviewed his credential prior to hiring him for the job in my capacity as Director of Surgery.   He informed me of the presence in the emergency room of an 80 year old nursing home patient, Joe W.  The physician took it upon himself to do all the necessary preliminary tests, X-rays and physical assessments necessary for an elderly male patient who developed the sudden onset of severe abdominal pain, following his evening meal in the nursing home.  All this took place, while I was resting comfortably in my warm bed at home.  Now that he had made the correct diagnosis of an "acute abdomen" and even, anticipating the need for emergency surgery, had inserted a naso-gastric tube,  bladder catheter and ordered blood from the blood-bank as required by protocol, he decided to summon me from home.  He further informed me of the presence of "free air" on abdominal X-rays, the hallmark of a ruptured viscus (bowel), and his suspicions of a perforated ulcer in light of the sudden onset of pain in a patient who has been taking Ibuprofen on a regular basis for his chronic arthritis.

The need for emergency surgery was but a foregone conclusion.  I managed get out of the confines of my warm bed in the middle of winter, leaving behind my wife and children whose only awareness of Old Joe W. was a tired husband and father who chose to go to bed more fatigued than usual at 9 P.M. the following night.  They never even knew that I had been gone since 3 A.M. that morning.  Just another typical day in the life of a surgeon.

Upon arriving to the emergency room and conferring with the house physician,  I had agreed entirely with his assessment of the situation and commended him on his handling of the case, a gesture too often lacking by some of my learned surgical colleagues.  I proceeded to meet Joe's anxious family who sat patiently in the waiting room.  I informed them of the suspected diagnosis and the need for emergency surgery along with the dangers associated with such a serious operation in a man his age and associated multitude of medical problems.  "Do your best doc" was their response, "we trust you".  I never take such comments lightly.  I consider it a privilege to be entrusted with the lives of loved ones like Joe, who appeared to be the last remaining patriarch of this family.

As I retreat to the O.R. dressing room in preparation for surgery, I can't help but feel a sense of humility, pride and obligation for being privileged to be there on that cold winter night.  Would all of this, and the comfortable life I had enjoyed as a surgeon, have been possible without the perseverance  of my parents and my upbringing?  I owed it to Joe, and myself to do my very best in my efforts to save the life of this man in the twilight of his life.  How often do I hear my colleagues lament of the waste of time and money to save the elderly.  I tend to individualize my surgical decisions based on the circumstances.  Joe W., despite his advanced age and life in the nursing home, had a meaningful life.  He enjoyed visits from his family, and by all indications his family was genuinely  concerned for his well-being and recovery.  I reminisced about some painful decisions I faced with my own parents confined in a nursing home.  The answer was clear in my mind.  I will do my best to save Joe's life.

As I stood,  dressed in surgical scrubs, just a foot away from this fully draped, anesthetized  and prepped 80 year old man with and "acute abdomen", I noticed the O.R. clock.  It was 3:50 A.M.  "Incision", a verbal prompt to the nurses to document the start of surgery.  I notice my heart and mind racing, as is often the case when I start surgery.

I hold the scalpel, like the violin bow I used to hold as a child and young adult many times before.  Unlike the sound of music when I stroked the bow over the strings of my violin,  my first scalpel stroke across the skin was met with blood and the sight of yellow adipose tissue, the sight of which I am so accustomed to.  I look at the anesthesia monitor to check the oxygen saturation . My impression of the darker than usual blood, indicative of poor oxygenation, was not confirmed by a normal reading on the monitor.  Comforted by this finding, I proceeded to make my scalpel strokes more deliberate.   The "Linea Alba" , the white midline fascia we all posses, was encountered after just a few strokes, indicative of the emaciated state of 80 year old Joe because of  the absence of a thick yellow fatty layer, common in younger patients.  With the tip of my scalpel blade, I carefully incised the thin but fibrous Linea Alba.  A dark membrane appears.  Peritoneum, the holy grail of abdominal surgeons.  Above, exists the world as we know it.  Below, the mystery of a world few are privileged to know.  The peritoneum was bulging, indicative of the "free air" evident on the X-rays in the emergency room. This air, usually absent, emanated from the hole in his bowel, the source of which is soon to be found and patched, not unlike a hole in a car's inner-tube.   We hear the "swoosh"  of foul-smelling gas escaping from the incision I made in the membranous peritoneum.  Once I kept the exposed bowel out of harm's way, I proceed to enlarge the abdominal incision, just large enough to place a mechanical abdominal retractor, designed to keep the incision open, thus freeing the surgeons' hands to perform the more delicate work.

Once within the peritoneum I experience a feeling I often experience at this stage of an operation.  I feel the sense of irrational guilt, as if transgressing a place for which punishment awaits.  A place of taboos and the hidden confines of one's soul.  I'm sure my surgical colleagues in other specialties may take issue with my  interpretation of the location of one's soul.  I can't help but feel a sense of pride for the privilege I had been blessed with.

I soon find myself surrounded elbow-deep  by mal-odorous  loops of slippery bowel, well beyond the thickness  I would expect from normal bowel.  Peritonitis is a term signifying contamination of the peritoneal cavity by substances and infectious materials, not normally present.  Imagine placing an irritating substance into your eye and the resultant redness and inflammation that would ensue.  I'm sure common sense would call for immediate irrigation of the toxic substance.  In general surgery, there is a common saying;  "The secret to pollution is dilution".  Studies have confirmed that it takes many liters of sterile saline, to adequately irrigate and cleanse a contaminated peritoneal cavity.  Although impossible to completely re-sterilize the peritoneal cavity, antibiotics and the self-healing properties of the peritoneum can safely be relied upon to finish the job of cleansing.

After dealing with the intense peritonitis I encountered in Joe, I proceeded to trace the source of the contamination to a typical place in the  first part of the duodenum, just beyond the outlet of the stomach.  The hole in the bowel was mushy, intensely inflamed and still spewing forth particles of food and golden bile.  In such circumstances, it is prudent to "do no further harm".  Instead of performing a risky bowel resection or permanent anti-ulcer operation, which may be appropriate in healthier younger patients, I chose to perform the quickest procedure I was taught to perform under similar circumstance. I stitched the hole closed and placed a patch of omentum  (a fatty anatomical membrane ), not unlike gluing a rubber patch on a hole in an inner-tube.

"Good morning Joe, I'm Dr. Schreiber.  You don't know me, but I am your surgeon and I operated upon you last night. How are you feeling?"  "Ah-Huh", came a faint response.  I chose to interpret the groan as:  "Hi Dr. Schreiber, thank you for saving my life".  After a bout of pneumonia and a urinary tract infection, Joe W. was ready to be transferred back to the dreary confines of his nursing home.  I couldn't help but wonder.  Did I do my 80 year old new friend Joe W. a favor by saving his life?  Will he enjoy the winter of his remaining life, surrounded by loving family and friends?

My question was answered, loud and clear.  Joe never said goodbye.

My Father, Righteousness and the American Flag

My mother, stricken and ravaged by a stroke, looked helplessly on as I stared at my father’s almost lifeless body just a few feet away on the nursing home bed. They shared a room together during the last ten years of their life. She, helpless and physically incapacitated, and he a mere shell of the man he once was, coexisted in the dreary setting of an American nursing home.  What has become of my loving mother and father, after their struggles for freedom and a better life in the country of their dreams?  I knew the end was near for both of them.

     I noticed that my father’s gown had slipped down, revealing his bony chest, sunken neck and wasted shoulders, once robust and well developed from years of pushing the wooden planes and saws he used during his years as a carpenter and cabinetmaker.  As I reached down to pull his gown up, I was struck by the faded remnants of a tattoo on his right shoulder.  As a child growing up, I remember seeing the same tattoo of an American flag on his sweaty and hairy shoulder while he toiled away in his cabinet shop during the late 1940’s and early 1950’s to earn a meager living for me and my mother.  He was always eager to tell me the meaning behind his tattoo, which he had proudly worn since 1928.

     “Oh Tata, the name we all affectionately called him , if I could only hear you  once more and tell me of the dreams you told me so many years ago and about your struggles to come to America”.  My mind raced with fading memories of those stories and the circumstances of our family’s survival during World War II in the former Yugoslavia. I realized that my life and very existence, as well as that of my children, was the direct result of this man, my dying father’s principled and righteous life, during the hellish years of that war, so long ago.  That flag represented his dream for a better life in a land that was free of persecution, hatred and prejudice, so prevalent during most of his life back home.

     We are descendents of the Donauschwaben, or Danube-Schwabians, German colonists who had been settled by the Hapsburg Monarchy some two centuries before in the area that lay between the Danube, Tisza, Drava, Sava and Morash Rivers in the former Yugoslavia, after the expulsion of the Turks who left an unpopulated wilderness and wasteland behind them. Many of the settlers never saw the fruits of their labors because of famine and plague that swept through their ranks. The pioneer spirit prevailed, however, and they not only re-established a civilization but in the span of 200 years made this area one of the most fruitful in Southeastern Europe. It was even referred to as the "Breadbasket of Europe".That was our home.


     During the Second World War Yugoslavia was occupied by the German Army and their allies.   As the German Army and their allies began to retreat in the face of the Russian invasion, a portion of the German speaking population evacuated along with them.  But about one half of the German population,  who had nothing whatsoever to do with the German occupation and who had lived in peace and friendship with their various Slavic neighbors for almost two centuries, were not prepared to abandon what for them was their homeland. They remained behind despite the inherent risks and atrocities that were to befall them at the hands of Tito’s communists and their Russian allies, solely because of their German heritage.  I, along with my father and mother, were among these unfortunate remaining ethnic Germans.



     During the German occupation of Yugoslavia, my father and a group of his  close multi-ethnic neighbors and friends had fervently and steadfastly resisted recruiting efforts by the Germans, claiming pacifism as their reason and the cause  in which they believed. Their refusal to join the German army was met with harsh criticism and ridicule by their more zealous neighbors and supporters of the occupation and it's malevolent causes.  My father recalled being ostracized and shunned by some of his former alleged “friends and neighbors”. Life for them during the German occupation of Yugoslavia was one of social and economic isolation.  Once-loyal customers and friends suddenly became uninterested in using my father’s services as a cabinet-maker and carpenter.  Membership in local cultural clubs and social gatherings was met with excuses and regrets.  It was during those formidable years that my parents befriended and developed relationships with our Hungarian and Serbian neighbors of all religious persuasions that have remained true for many years to come. In hindsight, these relationships and acquaintances ultimately may have saved our life.
      As the Allies and Russian forces invaded the land, it was time for indiscriminate revenge against all ethnic Germans, somewhat akin to the internment camps established in the United States for ethnic Japanese American citizens following the bombing of Pearl Harbor.
 
     During the years that followed, approximately 250, 000 Danube Swabians perished in the concentration camps of Tito.  Furthermore, 100, 000 of our people from Rumania and Hungary were abducted to Russia and Rumania for forced labor, where many more perished.
 

 
     My father’s accounts of those years of genocide in the concentration camps was much more horrific and frightening. Those experiences had given him nightmares for many of his adult years.  He was kept confined in a stark environment with meager rations along with hundreds of other adult men.  There were daily executions by the camp guards.  It was the arbitrary and indiscriminate nature of these executions that was most frightening.  While some men, who were known sympathizers during the German occupation were deserving of their punishment, others like my father were not.


     As fate would have it, there arose a desperate need for skilled labor in post-war Yugoslavia by Tito's Communist government. They were eager to re-build the country's destroyed infrastructure, in particular electric power plants requiring the manufacture of detailed wooden templates from which new electric turbines were to be made.  This effort demanded the assembling of all available skilled draftsmen and craftsmen in the region.  Among these craftsmen, were good friends and  colleagues of my father who were very aware of my father's skills.  When recruited by the Communist government, these men professed their lack of specific wood-working expertise, but also admitted to knowing an individual, my father, who did possess these specialized skills.  Unfortunately, Julius and his family were interred in the nearby German concentration camp and thereby unavailable to assist in the re-building effort.
    Desperate for skilled workers with wood-working expertise,  the Communist authorities decided to closely scrutinize my father's whereabouts and activities during the German occupation of Yugoslavia.  With the sworn and documented testimonies of our Hungarian and Serbian friends ,  my father's proven innocence pacifism and loyalty towards his neighbors regardless of their ethnicity or religious beliefs during the German occupation,  our family was freed from the concentration camp.  During these interrogations and proceedings, my father's admiration for Americans (and their allies) as vividly demonstrated by the tattoo of the U.S. flag on his right shoulder, may have been the deciding factor in our survival as a family.
     Almost fifty years later, I stood motionless in the nursing home, as I watched my father's lifeless and wasted  body being placed on the gurney to be transported to the funeral home.  My dear mother, with tears in her eyes, sat still in her wheelchair as she observed the sad scene unfold in front of her.  I could not help but think what went through her mind at that time.  Did she choose to remember the happy days they spent together before the war?  Did she remember the near-death experiences in our old homeland during the war? Or, did she choose only to remember the life of freedom and joy of our past 40 years in our new country and the grandchildren, fathered by her only son whose life she saved and nurtured for all those years, and now standing beside her?  I will never know.  She too is now just a pleasant memory.
     As I recently stood in the cemetery, staring at the tombstone of my parents with my own son Richard and his wife Farm at my side,  I was overcome with emotion, as is often the case when I visit the grave-site.  Will my children every know the sacrifices of their parents and grandparents?  Will they ever appreciate the meaning of the freedoms they enjoy as Americans?  Will they inherit the humility and righteousness of their grandparents?  Will they know the right thing to do, like Tata and Omy when lives are at stake?  Oh well, I can only hope so.