After years of observation there can be no question that Mr. Trump is, at heart, a dictator – whether that be in business or politics. He is a bully of a certain type, a willing destroyer of anyone who disagrees with him. He is a pathological liar. He is power hungry and self-centered – a classic psychopathic narcissist. He is emotionally weak and unable to face criticism. He is often irrational and responds without thinking in a destructive knee-jerk manner to any criticism. He is a billionaire who is disconnected from the rest of us by extreme wealth. He has no empathy or compassion for his fellow Americans, often mocking and verbally abusing various individuals (imagined competitors, critics, soldiers, the disabled, immigrants, the poor, etc) with abandon. He has made a habit of using and abusing women; age has not mellowed his viewpoints about the roles of women with whom he is associated or how they should serve (or service) him. He is full of self-importance and false bravado, is fearful of anyone who is more capable, is not well educated (or simply failed to learn), is undiplomatic, is disrespectful to Americans and foreigners as well as foreign dignitaries, is socially inept, is high strung, and lacks analytical objective thinking skills. In short he is not a leader and never will be. He’s a rich incompetent man who has been put in charge. He has the classic personality make-up of a Napoleon, Mussolini, or Hitler – individuals who pretended to lead by misleading and threatening anyone who disagreed, steam-rolling the entire populace in order to satisfy the need for the worship and undying attention they craved. If Americans and world leaders won’t worship Trump, like those other dictators he’ll find a way to force it through any tactic as we’ve witnessed. He is the sort of head of state who would think nothing of plunging the entire world into chaos simply to make the point that he is the greatest. He is a true narcissistic psychopath.
The people who put him there and continue to support him are contributing to an ongoing cult of personality. Wikipedia: “A cult of personality, or cult of the leader, arises when a country’s regime – or more rarely an individual – uses the techniques of mass media, propaganda, the big lie, spectacle, the arts, patriotism, and government-organized demonstrations and rallies to create an idealized, heroic, and worshipful image of a leader, often through unquestioning flattery and praise.” If ever there was a definition of Trump and what he is doing, this is it.
This sort of personality can do a lot of damage in short order, whether that be as a CEO of a business, a politician, or a President. Once empowered they become drunk on the adulation and demand more and more of it. They are not leaders in the usual sense, as in an individual who can engender a following due to intelligent and compassionate support of those who work with them, amplifying their effectiveness by eliciting the best from the people around them. Rather, they lead through the elimination of dissent and creating an environment of fear, an environment of “us against them.” And “them,” of course, is anyone who doesn’t blindly follow them.
I have a lot of friends who are Republicans who defend this man. But only Republicans – no one else. They are his sycophants, his fawning worshipers. Their arguments are: 1. Well, he’s better than Obama! (Better how? Name something.) 2. At least he’s not a Democrat. (We are all Americans first, aren’t we? We pledge allegiance to our country, not to our Party, but that’s another entire discussion. Republicans have not cornered the market on being good Americans. Being a “good American” demands questioning of political “leaders” at all times and holding them accountable, not blind worship and looking the other way.) 3. God put him there because he’s a Christian. (No, Christian voters put him there because he’s a Republican who supports Christians who give him (and them) power. More on that below.)
That’s as good as it gets. I have yet to hear a rational explanation from any Trump supporter that explains why this maniac should be the President leading a country that is supposed to have the ideals of an advanced civilization. Not once has anyone replied to my questions that the man is rational, capable of problem-solving, diplomatic, highly educated in world cultures, socially savvy, wise, respectful, or particularly considerate of the American people. For those who support him because he “is” Christian, the man is the antithesis of what it means to be “Christian.” He simply is not, and there is no valid reason to describe him as such. Every day of his life he violates nearly all of the teachings of Christ, not to mention the teachings of Mohammed, Buddha, and every other important leader of any supportable religious movement; he also violates the philosophical ideas of Aristotle, Socrates, Epictetus, Aquinas, Nietzsche, Kant, Habermas, Nussbaum and other advanced thinkers of the past and present on how human beings should behave ethically and morally. One does not even need a religious framework or belief system to see plainly and clearly that Donald Trump is what most sensible people would call a “bad person.”
So why do many Americans support him? Why do Evangelicals blindly support him? Well, many Americans ARE Evangelicals, and they don’t think objectively about the hypocrisy of their position; they don’t question authority when it represents itself as Christian. The orthodox have been taught from birth (or later due to a religious transformation) to accept as fact everything that is spoken from the pulpit or bible study or Sunday School. Blind acceptance is, in fact, a requirement for the Evangelical to follow Christ and be saved. They must go to him “as a little child,” not questioning the elders and their dogma. How do I know this? I know because when I was ten I was forced to attend a Pentecostal fundamentalist church for a decade. I read the Bible all the way through three times, memorized entire books of the New Testament for Bible Quiz competition, and attended the affiliated Christian University from which I have my degree – a major in Biology, a minor in Chemistry, and a required concentration in Christian Theology. Blindly following Trump is the same as blindly following Jesus for Evangelicals. I know this from the inside. Evangelicalism – and any other Orthodox religion that demands absolute fealty – uses the same tactics that all cults use to dispel dissent and force members to stay in line. And as Evangelicals are prone to cultist behavior, then of course they are easy to recruit to other cult-like organizations such as the Republican Party, now ruined by this influx of “believers.” Evangelicals will support a bad person for President if that bad person also happens to be in either cult. It’s an easy leap from blindly worshiping Jesus to blindly worshiping Trump – Trump as the savior of America. The best way to make him even more powerful would be to crucify him – which begs the question as to whether or not it is safe to impeach (a virtual crucifixion) him without risking the overthrow of the government. It’s a slippery slope from fascist President to fascist dictator, especially with a Congress and Supreme Court filled with his lackeys.
And this is why there should be an absolute strict separation of religion and government. Violation of this basic requirement for a successful democracy obviously leads to the problems we are having now.
I have no political affiliation anymore. I’m a person first and foremost – a human being. This is my primary connection to all of the rest of the people on the planet. We are the same at this level. I’m classified as an American – the country of my birth – of European ancestry. I know what it means to be an American, and it’s not what the Republican Party has reduced it to. I’m an Iowan, whatever that’s supposed to mean; it’s the region I’m from and it shaped me in certain ways. I’m Caucasian. I know what it means to be white in America. I’m Midwestern. I know what it means to me to be Midwestern and I know what it means to Americans who are not from the Midwest; I know that I’m not necessarily the person they imagine I am, as I’m also a citizen of the world; I know there are other ways of being and existing. I’m a product of the broad American culture and that’s what makes me an American. That’s how it’s defined, whether we are immigrants, naturalized citizens, or native-born. My neighbors are Americans too, in spite of the differences in how we experience what it means to be American. Yet the only one of the categories I mention above in which I (we) exist that is firm, solid footing is “human being.” This is the category that matters. The rest is constantly in flux, being defined, re-defined, and argued about. I think some of us Americans have forgotten that we should look after each other – and all of the citizens of the world – first as human beings.
I was “born” a Republican into a Republican family. I gradually eliminated my association with the Party as I got older and became increasingly troubled by the ideologies expressed by the Party leadership. I was troubled by the position that some of us are better Americans than others, a position that was really about race, gender, and immigration status. I was troubled – as a physician – by the attitudes toward women’s health and particularly with the troubling concept that women should both be restricted from ready access to birth control and be compelled to have babies whether or not they can manage them or whether or not it is medically dangerous. Pregnancy is a private medical condition that should be covered by HIPPA (absolute confidentiality) like the rest of medicine. I was troubled by attitudes toward my American friends and colleagues who were “not white” or considered “foreigners” from a certain white American perspective. I was troubled by the attitude toward the poor and the urge to pull the rug out from under all the social programs that keep people safely off the streets whether that be programs for affordable housing, Medicare, Social Security, Medicaid, Disability, Pensions, etc., I was troubled by the inability to compromise, I was troubled by the rabid cult-like dedication to the NRA and the concept of unrestricted gun ownership as well as the highly inappropriate influence the NRA lobby has on Congress. I was immensely troubled by the anti-education stance taken by certain Republicans and the lack of support for students and teachers and the dumbing down of public education as a whole. I continue to be horrified at America’s never-ending saber rattling and spending on war and death, and on and on. In years past I always voted selectively for the individuals I thought were the most competent regardless of Party affiliation. Registered as a Democrat now, I still vote for the individual, not the Party. My allegiance is, after all, to the concept of a more true America, not blind dedication to a political group.
America is a place of contradictions. It is good and it is bad. It depends upon who and where you are as to how you see and experience it. It can be beautiful and hideous all at once. Learning its history is a troubling journey, as its history is one of both amazing progress and terrible behavior. A lot of people have died in the United States and the rest of the the world because of what we’ve done. A lot have also been saved. It’s all a paradox. Our struggles affect the entire planet.
This is not a country that can survive with the sort of president we have now. No country is. Nor is it a country that can withstand the problem of fealty to Party rather than fealty to the concept of America as a sort of Utopia that we are working – however painfully – toward; a utopia that everyone is entitled to – not just those lucky enough to be born within the confines of its borders. We are citizens of the world, not just this country.
We can respectfully disagree on government policy issues and still make progress, but all parts of our government have to work for that to happen, and a real concern for the average person has to exist. Sometimes our government does terrible things due to the fault or failure of Congress, the President, or the Supreme Court. Whether it be slavery, McCarthyism, the Viet Nam War, the unnecessarily long and violent path to Civil Rights, the terrible treatment of Native Americans, or gender equality – the failure to do the right thing over the centuries has done a lot of damage. The responsibility for it falls on both the government we’ve elected or appointed AND the voters who put them there. We are all at fault if we look the other way when our government is harming its own citizens or citizens around the world.
If we want a better country, we have to be better people. We have to do the right things.
The United States cannot be “led” by an incompetent President, Party not withstanding. Nor can Congress support or fail to support the President on the basis of Party politics rather than policy and character. Performance matters; so does competence. So does ethics. The aim of the Republican led Senate to gut the impeachment process is more than just a travesty – it’s an effort to gut the balances of power of the various branches. Taken to the obvious end-point, its a full-out assault on the ideological basis of the American Republic.
What this looks like from my viewpoint sixty years into my life as an American, is an attempted overthrow of the government by the Republican Party – a power grab to control the people, the government, and religion in America. To do this Republicans need a dictator, not a President, and thus the undying support. Why? Because Presidents have to be elected, and that is their weakness. Dictators take power and then have to be overthrown by the will and courage of the people, and that is the dictator’s strength. People who are afraid do not stand up and say no. Over half of us actually believe in an American government that can work on behalf of all our people – not just the white ones. We outnumber the Republicans wishing to overthrow the democracy. Yet at the moment they appear to be winning by cheating and abusing power at the highest levels. Trump is, at the end of the day, his own sort of domestic terrorist. His bully pulpit is Twitter, and from there he terrifies and tortures and attempts to ruin the lives of his critics and everyone caught in the crossfire. He is not a President. He’s a giant poorly behaved two year old.
America has faced many crossroads, some of which could have been the end of the country. In the past we’ve managed to pull through, albeit severely scarred by the process. Will we pull through this time? I don’t know. This is the first time that Congress or the Cabinet has failed (so far) in its duty to control an out-of-control President. I know the damage is already great and is getting worse by the minute, and we are already dragging along a lot of baggage from our difficult past. How much can we bear before we collapse? As a physician I normally advise any patient I see who is suffering from the accumulation of life’s traumas to go into therapy and face their demons. This is what Americans need to do – face the way we’ve each contributed to the difficulties we are having now as a society and take responsibility. This has to start at the grass-roots level and extend to the highest level, ending with the President of the United States. We should demand he step down. The Senate should impeach him for gross incompetence, among other things. If he won’t step down or they won’t impeach and remove him, then the Cabinet should invoke Article 23 and remove him from office. But then what? We still have the problem of a Congress full of Trump toadies who enabled this fiasco – the fox is guarding the hen-house. What are we to do? They all have to be thrown out.
The young people of America need to register to vote and be heard. If you want the old “white” way to go away and see a new sophisticated America with a return to political diplomacy and a government that respects the people, you’re going to have to both vote it into existence and actively seek office yourselves for altruistic reasons – to do good in the world. Indeed we need change in America.
America has sometimes been “good.” It has sometimes been very bad, as it is right now. Only once was it almost great, and that was the time Americans pulled together and saved the world from Hitler. I say “almost” because we too committed atrocities in the heat of war – Japanese internment camps here at home, nuclear bombs on Japan. We are not innocent in all of this, we Americans who stand by and watch and don’t say anything.
The next dictator to destroy the world could come from our own midst. We would be wise to remember that if we ever want to be great again. Perhaps that dictator is already here.
Trump has to go and Republicans (and others) who support(ed) him have to take ownership for what they’ve done to our country. It’s time to stop pretending that this is only about Party Politics. All of our lives are at stake now. Do NOT forget the past! Terrible things have happened and they can happen again. Do the right thing now. Stand up and say “No, not in America.” This is not a place for dictators. It is not a place where hope should be lost and ethics forgotten. Americans, BE Americans and wield your power! Speak up and out! March in the streets! Send letters! Vote! Don’t just sit there – do what you have to do to protect our common hope for the future of America and the World.
This is an old post from 2016 that has particular pertinence today considering the upcoming impeachment hearings and the commitment of Mitch McConnell and the rest to politicize the event and violate the Constitution by admitting to – and agreeing to – not being impartial. This is where we are today. This is exactly what one could expect.
The election is over, but I want to talk about the process and the resulting aftermath.
The roster of Republican’s vying for the position of leader of the free world was the worst display of incompetent misfits ever gathered into one place. What I saw was personality disorders, pathological lying, lack of intelligence, lack of analytical ability, refusal to acknowledge facts, religious zealotry, magical thinking, and….I don’t know….bombast. Throw in a lack of empathy for others and a desire to neutralize and dis-empower anyone who disagreed with them, and the entire picture was so surreal it seemed impossible.
The “God” they invoked to support their viewpoints was nothing, of course, but an extension of their own narcissism, a smaller and even more horrible version of themselves, created specifically by them to be a mirror of their own ideology or that of the Evangelicals to whom they were pandering.
How is it possible that such incompetent people can run for the highest office in the land and expect to be taken seriously? Has America really fallen so low that the lowest common denominator necessary to be considered to run the country is that one can breathe and stand upright and rile up the ignorant masses? In all seriousness, this current political situation is so akin to the rise of the Nazis it is impossible to ignore.
Americans who value freedom and the responsibilities of citizenship have to stand against what the Republicans and radicalized Christians are trying to do to our country.
Our government seems completely corrupt. Our politicians are not in office to represent the welfare of American citizens or the United States. They are there for two things: power and money, and as career politicians they can get it. The system is self-supporting for those willing to sell their souls to it, and there are plenty who are unethical enough to go for the gold. They tap into the emotional insanity of the religious right to get the votes they want and sacrifice any commitment to fairness and intelligent secular thinking in the process.
Candidates for legislative positions, regardless of Party or whether they be State or Federal, should meet strict criteria to be considered for such work. How is it possible that one must have a minimum of eleven years of training and pass multiple examinations and licensure certifications – repeatedly – to be considered for the right to practice Medicine, but a representative or Senator must only be a citizen of a certain age to “rule” the citizens of a State or the entire country? How is it possible that a hair-dresser, plumber, electrician, and carpenter requires more training, testing, and certification than a legislator? How is it that applying for a job of almost any sort requires a minimum of education, technical skills, intelligence, and commitment to do the work – except for sitting in Congress or a State legislature – or even the Presidency?
Shouldn’t a congressman have, at a minimum, a basic four year liberal arts college degree? Shouldn’t a congressman have to pass a certifying examination to determine if they have an adequate base of knowledge in world history, government, geography, anthropology, sociology, world religions, physics, biology, math, chemistry, and law before even putting themselves up for consideration? Shouldn’t a congressman or legislator have basic analytical thinking skills? Shouldn’t they have the ability to reason based upon facts? Shouldn’t they be able to demonstrate good character, as in honesty and integrity? Shouldn’t the President?
Shouldn’t a congressman or legislator or President be required to take the MMPI and MBMD personality and psychological profiles to make certain they are not a complete nut-job before taking on the task of ruling the people? Why are we not demanding stringent performance criteria be applied to those who purport to be “qualified” to rule the people and determine the course of the United States of America?
Just look at those who are always in the news, running off their mouths about everything from the Constitution to culture to immigration to how to understand scientific thought. Sarah Palin and her equally foolish daughter Bristol, ego-maniacal bully Donald Trump, the liar Carly Fiorina, the skin-head Anne Coulter, the religious zealot and hypocrite Mike Huckabee, the vicious war-mongering TV personalities on FOX News, the law-breaker Apostolic Christian hypocrite Kim Davis, the anti-education moron Scott Walker, the homophobes Rick Santorum and Pat Robertson, the wet noodle silver-spoon-in-the-mouth spineless Jeb Bush, the throw-the-baby-out-with-the-bathwater Ted Cruz…shall I go on? Even Ben Carson, a pediatric neurosurgeon, one of the most educated people in the world, has a complete inability to be analytical when it comes to the junction of his religious beliefs and science – in short he’s a complete idiot even if he’s a savant when it comes to neurosurgery.
The only solution to this problem is to demand a basic education requirement and the successful completion of a thorough written examination, and the successful completion of psychological and personality examinations with a normal result before one can be considered for candidacy for high office. Then remove all the perks associated with serving in high office, and I mean ALL of them, to eliminate the personal gain associated with political office. Limit the time one can perform the job: a single term of three years for a Congress Representative, a single term of six years for a Senator, and a single term of six years for President. No repeats, no re-elections. Same for State positions and Governors. All of these jobs are “public service” jobs, not career jobs. Salaries should be just enough to cover living expenses, and all benefits should be terminated as soon as they leave office. No forever pensions, no forever health insurance, no special travel perks, no follow-up jobs as lobbyists. In and out, that should be the rule. That is the only way to get people who are interested in responsible and ethical public service who are there for the right reasons. It’s also the only way for the country to re-establish the concept of equality under the law for all citizens and to eliminate the stranglehold the wealthy have on the average person. The regular citizen has to be represented by intelligent, educated, honest, people dedicated to the concept of freedom and fairness. As it stands now, America has become a country with a government that cares only about itself, run by wealthy ideologues and religious zealots. The process of running for office has become a freak show, a circus event.
But how does one get those in control of the government to pass a bill requiring term limits and a minimal educational requirement for themselves, let alone a personality/psychological inventory? The fox is guarding the hen-house. They will never do it. They have too much power and money to lose. The only way is through an uprising of the people, and I don’t see that happening unless the people get fed up enough to start a civil war.
Wait a minute – you mean Japan? No, not exactly. I mean it’s possible to have a beautiful Moss Garden in Iowa simply by locating the correct micro-environment. Like the Japanese, we have many opportunities to take advantage of microclimates in our own yards and gardens if we just stop a minute and look around! With a little ingenuity one can make almost any sort of garden in Iowa.
I first saw pictures of Moss gardens in exotic books about Japanese gardening, and although I had on occasion stumbled across logs and soil dripping with moss while hunting Morels in the Spring in the Iowa woods and found big patches of moss growing in the oddest places in town, it just never occurred to me to make the effort to cultivate moss.
Yet I had a very annoying little garden spot on the north side of the house, a narrow little space between the sidewalk and some cut limestone and pebbles against the house that was constantly filling up with moss. In fact, I had to fight the moss off! It would grow up over the stems of the Begonias and Impatience I planted there, stunting the poor things. The space always annoyed me, as nothing I did there ever seemed quite right, and the space was sort of an afterthought, the last thing I attended to every year.
So, one day I was in St. Louis and decided to visit the Missouri Botanical Gardens. What a treat! The place is stunning, and any reader who has the opportunity and any interest at all in gardening should go! Water Gardens, conservatories, annuals, exotics, the unusual, garden sculptures, massive Asian style gardens, herbariums, and on and on! Just a stunning place. And there I stumbled upon a Moss Garden hidden on a peninsula under a copse of little trees overlooking the big pond in the massive Japanese Gardens. It was quiet with a stone path leading into a little stone hut where one could sit and admire the carpet-like appearance of the moss, with little red crab apples scattered across it, while ducks and Canada Geese landed on the pond. Each person who came in became instantly quiet, as if they were in a sanctuary of sorts. It was really not just beautiful, but a beautiful thing to experience.

A view of the Moss Garden overlooking the pond in the massive Japanese Gardens at the Missouri Botanic Gardens in St. Louis. It is covered by a copse of flowering crab apple trees, allowing in dappled light. Nearby is a stone hut where one can sit and meditate. It’s a stunning view.
So home I went determined to make a moss garden if it was the last thing I ever did. My space for it is not exactly private, located on a public sidewalk, but it’s a very quiet street and a very quiet sidewalk, so it didn’t matter. I turned the soil and raked out the moss that already existed, putting it in a pile. Sticks, leaves, and plant residue was removed and the surface smoothed. The moss was replaced in a patchwork with wide open spaces inbetween. Several missions around town and in the woods located patches here and there of two other varieties of moss which were harvested and brought back to be pressed into the soil in various spaces, adding to the patchwork of color and pattern, as each variety was a little different from the next. Then a trip to the woods for other types, and finally even to an abandoned house or two where I found some really unusual mosses growing on old boards, shingles, and even curtains. (The roofs had caved in, allowing in rain and just enough light to create an optimal moss environment.) If the moss was adherent to a twig or sliver of wood, I just brought the whole thing. Eventually I obtained at least six different varieties of moss, all of which I pressed into the soil.

A freshly planted Moss Garden using patches of Moss harvested in town, in the woods, and from abandoned buildings in the area.
Then it was a matter of watering regularly to keep it moist, though Iowa is a pretty wet place and most of the time I had to do nothing. Moss likes a bit of sunlight, not total shade, and this spot had a short period of direct sunlight in the morning and late afternoon, dappled shade for part of the day, and total shade for part of the day, just about perfect. Plus, it was relatively cool compared to other areas around the house. The biggest problem was the squirrels who, for some reason, seemed to want to know what was under each piece of moss, turning them over repeatedly until I wanted to catch each one of them and give it a good thrashing. Eventually they became mostly bored of their tiresome game, but they still poke around in there almost every day doing some sort of devilment, the little monsters. The other problem was simply keeping grass clippings and what not off of the surface. In order to thrive, the moss has to get air and light, so it has to be kept free of detritus. So from early Spring until late Fall I attend to this task with a little bowl and a hand held brush with soft bristles, going out every couple of weeks and cleaning it off. In the Fall I just let winter take over; the leaves cover it or they don’t, I don’t care. By March 1st, though, I uncover it to find bright green happy moss already expanding on the cold ground. It grows a lot during long periods of cold as long as it’s not January and twenty below. The snow on top of it keeps it warm enough to continue to spread under the snow. Moss is tough. In the summer it can dry out completely and appear to be dead, only to revive itself with late Fall rains. Aside from the occasional sweeping, it’s not difficult to manage. It gets so thick weeds can hardly get through it.
As a final touch, one can add stones, boulders, statuary, and an occasional tuft of grass or single flowering plant to the patch of Moss for artistic interest. It’s a very simple but beautiful look that causes those strolling by to stop and ponder for a moment – a bit of Zen for just a moment before walking into the daily insanity of regular life.
1.This video was made after bringing my remaining Seraphim home from the pigeon show in December, 2011. I had put up a new set of breeding boxes, and the birds were quite excited by this turn of events. Most of the young adults in this film still have a few colored feathers which will soon be replaced with pure white. Four of these birds were sold, leaving eight for breeding.
http://www.youtube.com/watch?v=IMs_274tgJM
2.This video is a more close-up look at the same Seraphim as they happily show off in the loft. It’s a lot more fun to see them up close; their “faces” are very cute and neotinic (child-like) with their big eyes and short little beaks. They are such a blinding white that it’s hard for the camera to accommodate properly for color and light.
http://www.youtube.com/watch?v=adHDxfU7ja0
3.The following is a video of two baby Seraphim from two different sets of parents. Note the differences in markings. They both demonstrate the recessive red feathers seen as juveniles, and primarily in a pattern mostly on the wingshields and tails. This is typical of Seraphim young. They will molt to pure white as adults. At this age they do not demonstrate the more dramatic appearance seen in the adults—-they just look like clumsy little babies, because that’s what they are. They don’t know what they are doing!
http://www.youtube.com/watch?v=35ssm-JD6to&feature=related
4.Here is a Seraph cock doing a little courtship dance for a very pretty brown lacewing oriental frill hen. Males will show off to any hen, but this one simply was not interested and flew off and left him standing there.
One of the newest developments for minimally invasive operations in General Surgery is the application of robotic technology to routine abdominal and pelvic surgery. The DaVinci Surgical Robotic System developed by Intuitive Surgical is the leader in the field. This robotic system is exactly what it says – intuitive. It is a well designed system that is extremely easy for the surgeon to use and has many benefits for the surgeon and the patient.
The way it works is this: As usual, the patient is given a general anesthetic and prepped and draped in the typical manner. The abdomen is filled with carbon dioxide through a tiny nick in the skin through a specially designed safety needle. A 1.2 centimeter incision is made and a thin plastic cylinder called a trocar is gently pushed through the abdominal muscle and into the abdomen with an easy back-and-forth twist. A miniature camera lens is placed through the trocar and into the abdomen to look around, the image highly magnified on a TV screen hanging from the ceiling on a movable arm. Two, three, or four more trocars are placed through additional tiny incisions, the number depending upon the number of robotic arms needed for the operation at hand. A trocar is placed for a bedside assistant to use as well.
The robot is then rolled to the table and docked, each arm attached to a trocar and then loaded with the surgeon’s choice of instruments for the case.
The surgeon then leaves the table and and takes a seat at a nearby console from which he will perform the operation. He slides his seat up to the “cockpit,” places his forearms on a horizontal rest, places the thumb and third finger of each hand into the hand controls, places his feet in position to run four different foot pedals to adjust the camera and robot arms and energy sources for the operation, and places his face into a forehead console that contains a large screen where the camera image is magnified in 3-D.
Every movement the surgeon makes with the fingers of each hand is transmitted directly to the instruments locked in the arms of the robot. The movements are absolutely precise. The instruments are especially designed with “wrists” that make them work like tiny little hands inside the abdomen, making it possible for incredible rotation, extension, and flexion of the working end of the instrument; in fact, it acts almost exactly like the surgeons regular wrist and hand. The robot sensors indicate the exact center of the trocars at the level of the muscle in the abdominal wall so that all robotic arm movements use that point as the movement fulcrum; there is thus no tension of any sort placed on the entry point in the muscle. It is as if the surgeon climbed inside in miniature to do his work.
The surgeon can thus do the operation inside within a smaller space and without pushing and pulling on the abdominal wall muscle. The magnification is tremendous, and everyone in the room can see the operation in real time on various monitors hanging around the room as it is performed, making it easy to anticipate the surgeon’s needs. The assistant at the table helps by passing sutures and needed materials inside to the “hands” of the working instruments as requested by the surgeon, and assists with retraction, irrigation, and suction as needed. If a surgeon is teaching, he can “write” on one of the TV touch screens in the room with his finger-tip, showing the surgeon at the console, who can see the writing in his own viewfinder, exactly where to cut, sew, retract, or place an implant. The technology is so advanced, in fact, that one could sit at a console in the comfort of their living room here in Iowa and operate on a patient anywhere in the country!
Since everything is highly magnified, blood loss is reduced to nearly zero. Every tiny little blood vessel is easily seen and coagulated before even a drop of blood can be lost. The instruments make it possible to sew with ease and get into places where one cannot normally work using regular laparoscopic instruments while operating at the bedside. Anatomical landmarks are easily located and sensitive structures avoided. As a result of all of these improvements, the patient awakens with even less discomfort than they would have with regular laproscopy (minimally invasive surgery). Their hospital stay is frequently shortened as well.
As for the surgeon, he/she can work while sitting comfortably and without stress and strain to the neck, back, and shoulders; they can see better and work efficiently. At the end of the case they are not sore and exhausted.
So with robotic surgery, everyone wins. The operation is performed with ease for the surgeon, the patient feels better and goes home earlier, there is less need for transfusion, return to work and regular life is facilitated, the surgical team can see and help more productively, and costs are reduced for the insurance carrier.
There is, as always, one downside. The technology is expensive and is a big investment for the medical center. Nonetheless, the overall process likely results in less cost in the overall system. Even newer technology coming down the pike will further enhance our ability to perform operations with even higher precision. It makes it a great time to be a surgeon, as this technological revolution is a fascinating challenge for us and is exactly the sort of development that gives us renewed interest, excitement, and pleasure in our work every day. For me, it has always been the process of finding and then learning and applying better methods in surgery and medicine that has kept me interested every day—-the constant challenge of it all from a professional and intellectual standpoint. Add in the improved experience and outcomes for my patients, and it makes for a really happy combination for all of us.
I’ve used the DaVinci robotic surgical system for a wide variety of cases, including Fundoplication for Reflux Disease, Gall Bladder removal, Colon and Rectal surgery for both cancer and benign colon diseases, Hernia Repairs, Bladder Suspensions for Poor Bladder Control, Hysterectomy and Ovarian procedures, Vaginal Suspension for Prolapse, Removal of Adhesions, Lymph Node Dissections for cancer, and others. The Urologists in our group are using it for Radical Prostatectomy for Prostate Cancer as well as major kidney operations and other procedures for the ureter and bladder. Other surgeons around the country are likewise applying robotics in their minimally invasive surgical cases, and like us, sometimes performing operations that we couldn’t do using minimally invasive techniques before!
Robotics is changing the world of surgery for the better in a myriad of ways. In my twenty year career I’ve gone from doing everything with a big incision and long hospital stays to space-age outpatient major surgery, and in some cases now even incision-less surgery! Who could have imagined such things??!! I’m reminded of my childhood in the 60’s watching “The Jetsons” cartoon and musing to myself how cool it would be if we actually HAD robots and magical artificial brains and invisible waves flying through the air that could make things around us move and do things and make our lives so much better. Well, it’s all arrived, that’s for sure, and nothing will ever be the same again. This career of mine has certainly been a fun, interesting, and yes – even magical – journey. 🙂
David D. Coster, M.D., FACS

James: Best in Show, AOV, High Standard (HS). Des Moines ISPA Fancy Pigeon Show, December 2011. James is the founding Seraph cock of one of my Seraphim lines.
[Note: I have moved all of my current Seraphim breeding/sales information to Coz Lofts at cozlofts.wordpress.com. Please enjoy the Pigeon Loft articles here, but for current news and opportunities for Seraphim go to the new dedicated Seraphim site.]
My birds did very well at the 2011 ISPA Fancy Pigeon Show in Des Moines in 2011, all scoring from 92 to 95 on a scale of 100, with three birds scoring “High Standard” at 95 and three others @ 94. This experience with my twelve show birds exceeded my expectations. I’ve kept back eight of those birds for breeding stock, including James, Best in Show Seraph cock. NoBand couldn’t compete since he had no band, but the judge scored him for me anyway and felt he was pushing a 96. He is the founder of another Seraphim line in my loft. SuperJock likewise will be staying put, along with his son, GiantHead, a spectacular young cock still too young to breed but already paired up with the best hen from 2011. This is my team for this year, and I am hoping for even more success. One of these days I would like to have the almost impossible to achieve Royal Standard in my loft!
In January all the birds will be set up for breeding. I can allow only a limited season due to space limitations, so if any of you fanciers out there want a pair of high quality birds this year, drop me a line and I’ll breed extra designer birds just for you out of a combination of these great blood lines. You can reach me at cozmd@aol.com.
A few months ago, I was given a gift – The Bonsai Handbook, by David Prescott. I have always been interested in the art of Bonsai, but never took enough interest to actually DO Bonsai. After reading the book, I decided it was about time I made an attempt.
Many of us have had the unfortunate experience of purchasing a Bonsai at some local store only to find little instruction on management with the predictable result of almost immediate death of the poor thing. How finicky can these silly things be, I wondered? I went to the Des Moines Botanical Center and spent a good deal of time studying their rather large collection of Bonsai and, based upon what I read there, and how they had them set up, I thought it must really not be that terribly difficult as long as one pays close attention to the process and tends the plant frequently.
The Bonsai Handbook confirmed my suspicions as I read through it at breakneck pace and discovered that, with a little modification to take into account the severity of Iowa winters, I could more than likely manage to create my own Bonsai. In fact, I knew just the little tree to consider – a small five-year-old Japanese Fern-Leaf Red Maple that had been struggling year after year under the heavy weight of Iowa’s wet winter snows; it was all gnarled and scrawny for its age, but tough as the dickens, and the trunk was about the right diameter.
So, I dug it up and found, to my delight, that this little tree has the most fantastically interesting clump of “nebari“, or large twisted roots at the base of the trunk; it’s these roots that make the trunk particularly interesting artistically, and also enhances the value of the Bonsai.

Fern-Leaf Japanese Red Maple—only about eight inches tall after four years due to struggles with winter snow.

The root structure after washing and removing the dirt from the roots and trimming the long roots away.
I made the decision to go with an oblong shaped pot six inches deep – deeper than is usually used for Bonsai, my reasoning being that the recommended lowest temperature for the Bonsai is 14 degrees F, a temperature significantly higher than the lows one might see here in Iowa of -20 on occasion. Deciduous Bonsai must have a cold winter dormant period, and the only place that will work for any Bonsai I create for outdoor dormancy is in the relative cover against the south side of the house where the pots can be kept warmer than the ambient air temperature. Extra soil will likely prevent root damage from too low temperatures, especially if the pots are heavily mulched for the winter. Furthermore, we often see temps as high as 100 degrees in the summer, a temp so high that even in the shade a poor little Bonsai is likely to need to be watered nearly constantly! I have to take all these factors into consideration when determining the best plan of action; I even used plastic pots instead of ceramic as ceramic usually cracks here with these weather extremes. I hope I’ve done the right things!
So, the next step was to place the tree into the pot before the roots had a chance to dry out. I put a two-inch layer of large stones in the bottom and filled the pot with a combination of garden topsoil and black loam from my garden, mixed with some vermiculite. This is not the usual formula, but again I had to take into account weather conditions here in Iowa, so wrong or right, that’s what I did. I then carefully placed the tree and trimmed the branches, carefully tamping the soil down around the roots and leaving the nebari beautifully exposed. Then I collected red lava stones, white marble stones, and patches of moss growing around my house here and there to finish off the top of the soil.
I then began the process of making it pretty, carefully dividing and poking the moss into the spaces between the nebari and around the base of the trunk, and then finally placing red lava rock on one side and white marble on the other. The tree has branches only on one side, and I decided to take advantage of that fact in the following way: the bright red leaves will be in striking contrast to the white stones underneath the branches, and the red lava stones on the opposite side will balance the red of the leaves hovering over the white stones. The branches will be wired to grow only in one direction to give the impression that the tree is blowing to one side, much like one sees with old trees that have dealt with a prevailing wind all of their lives.

The final soil covering of moss, lava rock, and white marble. The tree is slightly to one side to allow for the growth of branches to the right only.

A final artistic trim and wiring of some of the branches with copper wire, and the Bonsai is safely ensconced in the conservatory, away from squirrels!
The final step was to artistically trim a few more branches and carefully wire them with copper wire to begin the process of forcing them to grow in the correct direction. Finally, I brought the whole thing inside where it will be safe from varmints as it re-establishes its roots and begins leafing out for spring. I hope it works as well as I imagine!
For the second Bonsai I chose an old Daphne ‘Carol Mackie’, a variegated variety of the Daphne shrub. I have no idea how this will work – since it’s a shrub, and not a tree – but this shrub needed to be removed anyway and I decided to give it a try. It has some really interesting branches and an old, fat trunk with a big swath of dead wood in it extending way up into some of the branches. This dead wood effect, or “shari,” creates a very interesting effect visually. A “jin” is a sharp spike at the top of the main trunk, a characteristic that is particularly nice on pine Bonsai. At any rate, I went through the same process with the Daphne, and also carved out some of the dead wood to make it look like an ancient but miniature giant tree, and then wired the smaller branches extensively to create additional visual interest. If it works, this could be an incredibly beautiful specimen. Daphne bloom in the spring with pale pink, fantastic-smelling clusters of flowers. We’ll see what happens!

Here is the red maple a couple of weeks later, growing like mad. It is usually a very deep purple, but it has less light in the house where I put it for safe keeping. I will put it outside the first week of May.