McLaughlin design mini-folio

L. M C LAUGHLIN • a mini-folio of design works

MARCH 2022

Hello . . .

Hello, I’m Linda McLaughlin, print designer . . .

Here are some samples of my work.

Eventually, I will write a more extensive intro!

Cover photo: Persimmonesque, Linda McLaughlin

Contents

MINI FOLIO 2021

Medicine Magazines. . . . . . . . . . . . . . . . . . . . . 2 Galas galore; other event promo . . . . . . . . . . 4 Music Presenters. . . . . . . . . . . . . . . . . . 6–7 Books. . . . . . . . . . . . . . . . . . . . . . . . 8 Wine Marketing. . . . . . . . . . . . . . . . . . . 9 References. . . . . . . . . . . . . . . . . . . . . 10

lindesign@sonic.net | Linda McLaughlin

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M EDICINE MEDICINE

magazines magazinesClick images to view online C OV I D - 1 9

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LESSONS LEARNED: MEDICINE ON THE FRONTLINES LESSONS LEARNED: SERVICE ON THE FRONTLINES

Misty Zelk, MD

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uring my previous career as a physician serving in the United States Armed Forces, I participated in two significant deployments that helped shape my medical practice and philosophy to this day. The Iraq War and Hurricane Katrina both resulted in significant levels of injuries and fatalities, not to mention widespread destruction and psychological aftereffects.

The lessons learned from those two experiences were manifold and useful today as we healthcare professionals deal with the Coronavirus outbreak. The first is that consequential medical advances are often made in stressful, wartime environments for one simple reason: as a medical professional, you have to do your best using the manpower and materials available. Necessity is the mother of invention, and when supplies and equipment are in short supply, you must make do. The sophisticated equipment, robust infrastructure, and testing protocols we tend to take for granted in peacetime are in fact often unavailable luxuries during a crisis.

The second lesson is that, in order to do your job to the best of your ability, you must learn to deal with your emotions as conflict rages and fatalities rise. Upon arriving in Iraq in 2004, I fully admit to having been initially overwhelmed by anxiety and panic in my first exposure to armed conflict.

As explosions and gunfire raged not far away, physicians and nurses treated our brave soldiers who had lost organs, limbs, and, too often, their lives. The sights and sounds of medical peers conducting themselves

Medical Care in Wartime Psychological Impacts of Protests Field Report: 2019 Kinkade Fire Harm Reduction: Opioid Use Harm Reduction: Vaping

Army National Guard veteran Dr. Misty Zelk serves as medical director for Healdsburg Physician Group and is on the editorial board of Sonoma Medicine.

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in Wartime in an unflappable manner under such circumstances were both unforgettable and highly instructive.

Thirdly, effective communication using common terminology and employing alternative information strategies is key to success in a crisis. When we deployed to New Orleans in the wake of Hurricane Katrina, the Federal Emergency Management Agency (FEMA) and other non-governmental organizations (NGOs) serving in the region were

their respective branches, to overcome large-scale emergencies. Post-Katrina we learned that all groups that might be called to serve need to train together: FEMA, the military, and the host of NGOs that come into service to provide supplies, aid, and other vital support functions.

Today as we are faced with the ravages of COVID-19, the availability of social media and the alternative information sources it offers provides

Keep your head down and treat only the patient in front of you at the moment.

Keep your focus. all employing different descriptors and “lingo,” leading to confusion and miscommunication. Worse still was that there was no “unity of command” among these various non-military groups and the local and state governments: no one was in charge. Having done no preparation whatsoever, local leadership resorted to pointing the finger at Washington, which acts as the third and final line of defense in such crises. While interested readers are welcome to look up the term, Katrina was what military personnel refer to as “FUBAR.” A fou rt h lesson in t he wa ke of Katrina changed the way the various branches of the U.S. military train for such events, as well as the ways in which they interact with civilian peer groups. Prior to this massive hurricane, the various branches trained very effectively, yet individually within

a powerful combination. Earlier this year I was made aware of a group of ER physicians, hospitalists, and intensivists who had formed an informal information-sharing network on Facebook to address coronavirus. In contrast to “official” guidance from CDC and WHO that has proven confusing and at times contradictory, this group allows peers to share real-world information from the start of presentation through different treatment phases. The ranks of this group have since greatly expanded to include epidemiologists and other medical professionals with meaningful data.

The socio-political elements of this pandemic are profoundly disturbing.

According to a report issued by its own government, the People’s Republic of China (PRC) purchased 2 billion surgical masks and 25 million pieces

COVID-19

IN THE EYE OF THE STORM

Providing Medical Care

of protective clothing from worldwide sources in January 2020. It was during this period that the PRC also rejected repeated offers from the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) to send experts to assist with testing and treatment. Bear in mind that the PRC itself already manufactured fully half of the world’s annual mask supply, even before placing its extraordinary order. Government and investigative authorities have since confirmed that at least a month expired before the Chinese disclosed the deadly nature of the virus to the rest of the world. Countless lives were unnecessarily lost as a result.

I

could go on, but the point to our healthcare community is to try to block out such troubling considerations for now. Political leaders and policymakers will deal with it at the appropriate time. We must instead stay focused on our mission. Whether on the traditional battlefield, or instead in the current COVID “battlefield” hospital environment, physicians, nurses, and allied medical support personnel have one job: to preserve life. It is on that focal point and no other that we must direct our full attention.

When the caseload becomes emotionally overwhelming, take a brief moment to step away and re-charge, and retain the lessons of medical care on the battlefield. Remember your training. Keep your head down and treat only the patient in front of you at the moment.

Keep your focus. Do your job to the best of your ability, as you always have.

And feel free to adopt the unofficial Marine Corps motto, “Improvise, Adapt, Overcome.” It serves as an invaluable touchstone in your practice at home, in a crisis here or abroad, and throughout all the myriad obstacles life invariably throws in our path.

Email: mzelk@yahoo.com Ed. note: Dr. Zelk retired from military service in 2019 with the rank of Colonel after serving 23 years with both the Army National Guard and the Air National Guard.

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Hospitals, health centers adjust to a new reality The impact on small and solo practices Interview with Dr. Sundari Mase 1918 Spanish Flu in Sonoma County

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Local Hospitals, Community Health Centers Adjust to COVID-19 Reality Dan Peterson, Donna Waldman, James Schuessler and Karen Milman, MD and it’s been tough to see the impact on our community, every decision we’ve made has aligned with our not-for-profit mission and values, and we are proud to care for all our patients here in Sonoma County.

Donna Waldman, Executive Director, Jewish Community Free Clinic

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u ring t he f irst week of the viral outbreak, which fell in the second week of March 2020, we were understandably very busy at the Jewish Community Free Clinic (JCFC) in Santa Rosa. The overflow of patients made it difficult for us to initiate and enforce necessary safety precautions, in part because our facility is staffed by all-volunteer caregivers, with a new round of physicians and nurses arriving with every shift rotation.

By the third week of March we realized that the wise move would be to close down the clinic for a week, so that uniform safety, security, and hygiene protocols could be enacted. During this time we also took pains to inform and educate our clients and the public at large about the new policies and procedures under way at JCFC. At the end of March we were back to full staffing, and had “pivoted” largely to telemedicine and over-the-phone medical consultations SONOMA MEDICINE

to ensure safety for both our caregivers and the patient population that takes advantage of our free services. At this writing we are seeing all of our patients either via video conferencing or speaking to them by phone.

Because the underserved are a large portion of our client base, and because this demographic contains a large percentage of low-wage workers serving in home-based, outreach, or long-term care facilities, free tuberculosis testing is in high demand at our clinic. Where we previously conducted in-clinic skin tests for this purpose, because of COVID19 we switched to referrals for off-site blood tests, instead.

And we continue to fill prescriptions for our clients, albeit under social distancing protocols. Our office is fortunate in that we have an open-air, gated atrium near the entrance. When a patient arrives to pick up a prescription, we take advantage of the atrium to dispense the meds and provide any explanations regarding their use. There is a waiting area outside the gate that allows each patient to come forward, one at a time, to receive their prescription.

Patient safety as well as the safety of our staff is our highest priority: fully 90 percent of our all-volunteer physician and RN caregiver contingent is over 65, and thus at higher risk from the virus.

Every day of the week we meet or coordinate with other health centers

across the county, so that all affected parties can receive up-to-date information, provide referrals, and in general continue our important collective mission. JCFC Medical Director Josh Weil, who has served us for over a decade, has been tireless in acting as our liaison with area hospitals and in helping the entire community better understand the social determinants of health. The stellar effort underlying this comprehensive education outreach is the reason why so many of us rightfully believe that when a healthcare emergency strikes, Sonoma County is the best and safest place one could possibly be.

James Schuessler, CEO, Healdsburg District Hospital

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hile I am somewhat new to S o n o m a C o u n t y, i t took no time at all for me to be impressed by the healthcare professionals not just here at Healdsburg District Hospital (HDH), but across the entire North Bay region. This is a most impressive medical community, with very high quality clinical professionals exhibiting a positive approach and outlook amid what has been a great challenge in the onset of COVID-19.

This includes county public health director Dr. Sundari Mase, who has SUMMER 2020

Selected spreads, Summer 2020

RDS & COMEDY NIGHT AWA

GALA 2019

Dan Peterson, CEO, Sutter Santa Rosa Regional Hospital

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dju st i ng ou r faci l it y t o respond to COVID-19 has been an incredibly costly and difficult endeavor that will significantly impact us for years to come.

Our entire integrated network acted quickly to adapt our “normal” operations and prepare for a surge of patients in response to this pandemic. While we have not yet seen a surge in patients, we remain ready to care for patients should a surge arise.

I n p r e p a r a t i o n , w e s c a l e d d o w n n o nemergency patient care, limited surgeries, and shifted thousands of patients from in-person office visits to telemedicine visits. These decisions were made in alignment with local, state, and federal guidelines to support slowing the spread of the virus, and with the safety of our patients, employees, and clinicians as our top priority. Understandably, these changes have impacted patient volumes across the board.

Our inpatient levels significantly decreased in March and April and began to rebound in May and early June. Our emergency department census continues to climb. In March, our emergency department saw approximately 60 percent of its normal intake, and roughly 70 percent in April. We attribute this dip to those who are fearful of coming in because they think they will contract COVID19. This is especially concerning because we are seeing patients who are prolonging timely care.

Their condition has worsened, and now they’ve done lasting harm and require advanced treatment and care.

We are currently taking a phased, safety-first approach to gradually broaden our clinical services where local guidance and public health orders allow us to do so. As of early June, we were not running at the same level of efficiency as before, which impacts our census and ultimately, our business. For example, many of our patients coming in for outpatient services are met in the parking lot instead of in the waiting room; we allow for greater time between patient visits; and we use extra cleaning measures—all of which add time to each appointment.

We continue to focus on long-term planning and responsibly managing our day-to-day operations so we can best serve the community for years to come. While the impact of COVID-19 is unfortunate,

“A celebration with & for our medical community” SCMA presentation platform; Dr. Nancy Doyle, John Gnam and Dr. Roger Pitzen; Naomi Fuchs, David Ebright and Daniel Rabkin; SCMA Executive Director Wendy Young.

Al Malasig and Dorine Leong (CAP); Dr. Patricia May accepts Sonoma Medicine plaque from Dr. Rajesh Ranadive and presents him with the presidential gavel; Corrina and Dr. Nikola Lozanov, N. Jay Farris and Dr. Robert Schulman.

Santa Rosa Golf & Country Club was the setting for the Sonoma County Medical Association’s 35th annual Awards Gala. More than 140 attendees and guests gathered on Friday, Jan. 24, 2020, to honor and celebrate achievements of their medical colleagues in 2019.

Prior to dinner and the award presentations, attendees enjoyed a reception and silent auction to support the Health Careers Scholarship program. Auction items donated by SCMA members, business partners, and supporters raised funds for local students pursuing careers in medical fields.

SCMA President Dr. Patricia May passed the gavel to incoming 2020 President Dr. Rajesh Ranadive, who welcomed guests and presented the awards. Winning auction bids were announced by SCMA Executive Director Wendy Young,

aNDrea rubiNsteiN, MD

and comedian Bobby Tessel concluded the evening with a light-hearted presentation to acknowledge National Belly Laugh Day.

Health Careers Scholarship Program

Thank You, Silent Auction Contributors

Breast and General Surgeons / Sutter Medical Group of the Redwoods; California Medical Association; Christopher Creek Winery; Cooperative of American Physicians; Jeff Sugarman, MD; John Gnam and Jackie Senter, MD; Practice & Liability Consultants; Santa Rosa Golf & Country Club; Sheela Hodes and Tammra Borrall / Compass; Stanley Jacobs, MD and Eric Culbertson, MD / Aesthetic Plastic Surgery; Stillwater Spirits; Traditional Medicinals; Vintners Resort / Vi La Vita Spa

Box left, clockwise fom top left: Awards are presented to Dr. Tabitha Washington (for Dr. Andrea Rubinstein), Dr. Shelleen Denno, Mary Szecsey, N. Jay Farris, Dr. Mary L. Williams and Dr. Peter Sybert.

Above: Drs. Richard Powers and Shelleen Denno, center left, with Dr. Denno’s family and Gala attendees.

2019 AWARD eeS

Mary szecsey

OUTSTANDING CONTRIBUTION TO LOCAL MEDICINE

RECOGNITION OF ACHIEVEMENT

In recognition of her efforts to reduce opioid risk for patients with chronic pain through her clinical practice at Kaiser Santa Rosa and for teaching and speaking across California for the past 12 years.

To honor her exceptional 25-year commitment as CEO of West County Health Centers, service on the Redwood Community Health Coalition Board, Sonoma County Health Action Council, and the California Primary Care Association.

sheLLeeN DeNNo, MD

Mary L. WiLLiaMs, MD

OUTSTANDING SERVICE TO THE COMMUNITY

ARTICLE OF THE YEAR

In recognition of her tireless contribution to hospital services and for helping transform West County’s only acute facility into a resource that provides care to critically patients requiring extended hospitalization.

In appreciation of her article, “Climate Change, Public Health and ‘Green’ Medicine,” which appeared in the fall/winter 2019-2020 issue of Sonoma Medicine magazine.

Peter sybert, MD

N. Jay Farris

OUTSTANDING CONTRIBUTION TO SCMA

PRACTICE MANAGER OF THE YEAR

With gratitude for his many years of service on the Board of Directors and leadership in repositioning SCMA as a stronger, growing and more representative organization.

In acknowledgement of his quest for continuous development of innovative, technical methodology as a tool for good and efficient support of the West County Integrative Medicine practice.

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Comedian Bobby Tessel entertains guests.

PHOTOS BY WILL BUCQUOY

Drs. Rajesh and Rajina Ranadive, with their daughter, Riya, and St. Joseph Health team.

Drs. David Vidaurri, left, and Tabitha Washington (center) with their Kaiser Permanente team guests.

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Sonoma Medicine has been the flagship publication of the Sonoma County Medical Association for many decades. Published quarterly, its articles are medically themed and written by physicians and other medical professionals in Sonoma County.

I have provided design and layout since 2010.

OUT OF THE OFFICE

The Great Apple Stomp 2018 Anna Aaronson

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t was a dazzlingly sunny afternoon in Graton on Sunday, Aug. 12, for the twenty-second annual “Great Apple Stomp,” hosted by Drs. Allan and Laura Bernstein.

As I arrived at the Bernstein residence around 12:30 p.m., the festivities were unfolding in the spacious backyard, a sprawling lawn skirted by orchards and varied flora.

I spoke with Mary Anne Westerfield, a veteran Stomp attendee; she has made the annual trek from San Rafael to Graton for eight years. She ushered me toward the orchards, tucked away adjacent to the yard. I filled my blue plastic bucket with Gravensteins.

“Gravensteins are not commercially popular,” Dr. Catherine Foster, another apple enthusiast, remarked as Mary Anne and I re-joined the party.

“But they’re great for juice and apple sauce.”

Foster shares Dr. Bernstein’s passion for produce: “My kids never got a meal without apples,” she said brightly.

After apple picking in the blistering sun, I was ready for a spell in the shade. I sat down with Dr.

Dick Kirk of Glen Ellen, a psychiatrist, as he reclined in a wooden lawn chair.

Dr. Kirk, who has been attending the Stomp for around six to eight years, met Dr. Bernstein through their mutual membership in the California Rare Food Growers’ Association. Dr. Kirk grows “hundreds of types of apples, plums, stone fruits, apricots, pluots . . . all the hybrids.”

The conversation took a contemplative turn, from fruit, to phenomenology, to self- and community empowerment.

“Curiosity is the antidote for criticism. That’s my mantra,” Dr. Kirk told me, cradling containers of freshly pressed juice in his arms.

Physicians, artists, chefs—only Stomp attendees themselves were more eclectic and colorful than the host of vegetation on the Bernstein premises.

From how to properly poach a fish, to the chemical ramifications of fat saturation, food connoisseur and chemist/chef Roger Gaffner regaled partygoers with facts as we chowed down on homemade blackberry pie.

“Use vodka to make a flaky pie crust,” chef Roger advised, as I tore through my pastry.

Then it was my turn to have a go at the apple press, so I walked to join the crop of children chucking apples into the massive wooden contraption. I watched

as the Gravensteins were pulverized: big, green orbs transformed into a nondescript mush. I turned the press, watching with satisfaction as the mush gave way to a river of amber juice. And it was some of the tastiest juice I’ve ever had.

From apple sauce, to chutney, to prime rib, the juice gleaned from the day’s event plays a role in many culinary delights and traditions. The apple’s greatest delight, however, is the ritualized union of individuals from all corners of the North Bay and beyond, in the glorious heat of an August day.

MEDICAL ARTS

The

Email: anna.aaronson@gmail.com

PHOTOGRAPHY of

DR. MISTY ZELK

P

hotography has always been a passion for me. It started with classes in junior high, and I never stopped. I’m drawn to the challenge of doing wildlife. It doesn’t take patience when you are so fascinated by the animals that you just enjoy watching them.

The 2016 Yellowstone trip was an “old-school” adventure complete with tent camping. My youngest daughter was approaching high school, and I wanted to get in one big road trip before school started.

Since I engage in a profession that is largely cerebral, I love doing something with my hands where the end result can be seen. My goal is to shoot well enough that I don’t need Photoshop. I also hang several pictures in my exam rooms. They are frequently a conversation starter for new patients, and many have said the photos put them at ease.

Dr. Allan Bernstein feeds the apple press.

Clockwise from upper left: Morning Glory Pool; Elk in Profile; Old Faithful Blows; Bear on the Run; Big Daddy Bison.

Says Dr. Zelk: “Watching that black bear cover a mile and eat a buffalo it had felled the day before was a once-in-a-lifetime experience.”

See more of Dr. Zelk’s travel photos, including the entire Yellowstone gallery, at https://photographybymz.shutterfly.com/pictures.

Clockwise from upper left: The View at Inspiration Point; Lower Falls Cascades Down; Exelsior Runoff. Below: Grand Prismatic Pool with Reflections.

Email: mzelk@yahoo.com

Anna Aaronson works at North Bay Neuroscience in Sebastopol.

Dr. Bernstein, host of the event, entertains guests while feeding Gravenstein apples into the apple press.

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Aerial photograph of Coffey Park, showing blocks of devastation.

Page A-1, Lead Photograph, Oct. 11, 2017.

John Burgess photograph, Press Democrat.

Touched by the Dragon’s Tongue Ted Hard, MD “Flames stream from its mouth; and sparks of fire leap out. Out of its nostrils goeth smoke as if from a boiling pot or caldron.

Its breath kindleth coals and a flame goeth out of its mouth . . .”

(Description of a dragon, the Devil’s beast, from Job 41: 19-21)

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Certain dates of historiCal importance often install themselves in our collective memory. Usually these are times of unexpected, catastrophic events with tragic consequences. Most of us remember where we were during the September 11, 2001, Twin Tower attacks. Likewise, older individuals recall exactly when they heard President Kennedy was assassinated on November 22, 1963. Before that, a few aging survivors still remember the “Day of Infamy” at Pearl Harbor, December 7, 1941. As physicians, we often recall

patients we have lost, better than our successes. Perhaps nature has hard wired the human brain this way, as a protective mechanism for ancient man. Pain, fear, and loss have a special spot in our minds.

In the distant past, the memory of a close, dangerous encounter (and future avoidance) may have been better for survival than the recall of a triumphant hunt.

Dr. Hard is an emergency physician at Petaluma Valley Hospital.

SONOMA MEDICINE

Dr. Zelk is board certified in internal medicine and pediatrics. She practices in Healdsburg.

Dr. Bernstein’s annual Apple Stomp yields a bumper crop of Gravensteins for the enjoyment of friends, neighbors, family, and out-of-town visitors.

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FALL 2018

And thus the morning of October 9, 2017 would be indelibly seared in my mind.

On Sunday, the day before, I had driven 130 miles to Santa Cruz to retrieve a backpack I had lost coming off a flight from Alaska. After posting a number of texts in the Delta Airlines “Lost and Found,” I received an unexpected call from an Italian man who had found my backpack at the airport. He wondered if I wanted to pick it up. Why he waited three weeks to call is unclear. Still, I asked no questions and drove to Santa Cruz. Inside the backpack was a disk of wildlife photographs I didn’t want to lose. I returned to Santa Rosa in the early afternoon, driving Route 1 along the Pacific Coast Highway, past Pigeon Point and Pescadero, then north to Half Moon Bay. The temperature was a comfortable 65, winds 8 mph, with a partially overcast sky. Although the ocean seemed restless, it was a pleasant October day.1 Upon returning to Santa Rosa, we went out to eat with friends that evening, then retired early, hoping to start the week with a good rest. Nothing would prepare us for the night to come.

At 1:30 in the morning the telephone rang. My good friend and retired physician Bob Scheibel called. He had woken to the sound of transformer explosions and found a fire working its way along the Foothills ridge. He thought he needed to leave. I got up and looked outside. There was no smell of smoke and no obvious sight of fire. I thanked Bob for his call and offered him a place to stay. At the time, I remember the wind seemed particularly fierce. Inside, a gust had blown a cup off a table. I walked through the house and closed all the windows. “What’s going on?” my wife asked. “Fire up in the Foothills — Bob may come down for a while.” Feeling safe and secure, and sure there was no pending danger to our Fountaingrove home, I made a potentially fatal mistake. I turned off the light and went back to bed. ii

Ca lifor n i a ns a re u sed to ca la mity. We have earthquakes from time to time. (Remember Napa, August 24, 2014, magnitude 6.0; and Loma Prieta, 1989, magnitude 6.9. By comparison, the “Great Quake” of San Francisco, 1906, was rated as magnitude 7.8).

Wildfires also char the landscape. The Oakland Hills fires of October 1991 SONOMA MEDICINE

killed 25 people, destroyed 2,800 homes, and remains in our distant memory.

Likewise, the Valley fire in Lake County on September 12, 2015, which killed four people and destroyed 1,955 structures, came close. 2 I drove through Middletown last year and noted the scattered signs of fire: charred trees, hillsides of burned brush; but the town seemed in the process of rebuilding, and the home sites that burned were mostly cleared.

When we moved to Rocky Point in Fountaingrove in 2007, a wildfire was the furthest thing from our minds. I recall looking over the Santa Rosa Valley one lovely October morning, remarking to a neighbor that we were truly blessed.

We were living in an area described by Luther Burbank as “the chosen spot of all this earth, as far as nature is concerned.”3 From my perspective the location seemed incredibly safe. No worry about f ire or f loods, hurricanes, or tornados. The open space across from our home had few trees and the brush was frequently cleared. The only thing we might be concerned about was an earthquake. In preparation, I kept a large “earthquake” box filled with flashlights, water, blankets and supplies, just in case we lost power for a couple of days. My neighbor reminded me of an old joke: “If you don’t have earthquake insurance, just set your house on fire.” The concept seemed amusing at the time. Not so now.

Missing from our hindsight was the Hanley fire of September 1964. This fire followed a remarkably similar path to the Tubbs fire, starting in Calistoga, fanned by wind, working its way west a long Ma rk West Spr ings Road to Santa Rosa. Due to some heroic work by firefighters the old Community Hospital was saved, just as f lames reached the hospital grounds. The Hanley fire was apparently started by a deer hunter in Calistoga who carelessly dropped a burning cigarette. No one was killed.

The flames scorched an area of 53,000 acres and destroyed 84 homes.4 At Rocky Point, cardiac thoracic anesthesiologist Dr. James Finn was a friend and neighbor of mine. Jim had a Bay tree in his backyard, which still retained burn scars from the f ire of 1964. 5 Perhaps this should have been a warning. Cal Fire has posted fire danger zones over the years, and the Fountain-

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SONOMA COUNTY MEDICAL ASSOCIATION

grove area of Santa Rosa remained a high risk zone marked in red on fire maps.6 Over the past two decades, builders, contractors, and buyers rarely considered the warning. The area was too beautiful, the views too scenic to pass up. The Fountaingrove Homeowners Association was even given an award for its meticulous clearing of brush and debris. Over time, builders erected a series of remarkable luxury homes along its ridges. The danger of wildfires seemed incredibly remote and homeowners were willing to take the chance. But Coffey Park? Coffey Park is in a highdensity, flat area containing 1,000 homes in western Santa Rosa across six lanes of open freeway. There is no way Coffey Pa rk could have been a da ngerous wildfire zone.

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Tennis Wick explains innovations to Sonoma County’s permit-generating process, newly streamlined to assist rebuilding by fire-loss residents.

Twelve other panelists representing legal, insurance, financing and construction also responded to attendees’ questions.

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ver 170 Santa Rosa residents, medical personnel, and employees of medical-technology firm Medtronic gathered on Jan. 17 to gain valuable guidance on the post-fire rebuilding and recovery process at SCMA’s FireRecovery Resource Panel and Dinner.

Held at Medtronic’s Cardiovascular office complex, this community-outreach event featured experts making presentations and answering questions about the broad spectrum of recovery issues, including construction, financial, legal, real state,

government, insurance, and debris clean-up.

CMA acted as a co-sponsor of the event, and CMA chief executive officer Dustin Corcoran told Sonoma Medicine that he had toured Santa Rosa’s fire-damaged areas earlier in the day. “The experience was jarring, and the destruction is almost unimaginable,” he said. “SCMA’s community-outreach event is providing a great resource to the local medical community, and CMA stands ready to continue providing long-term help in any way we can.”

Medtronic’s senior director for regula-

tory Affairs, Declan Dineen, was on hand for the informational meeting and Q & A session. He and his family lost their home, in Santa Rosa’s Hidden Valley neighborhood, in the firestorm. Dineen remarked on the value of the informational event as he, his family, and so many of his fellow Medtronic employees begin the rebuilding and recovery process.

SCMA’s co-sponsors for the event included CMA, Medtronic, and Exchange Bank. SCMA executive director Wendy Young acted as emcee for the event.

STRUCTURAL ENGINEER: Josh Wallace Project Manager, MKM & Associates 707-578-8185, Ext. 126 josh@mkmassociates.com

CERTIFIED TAX ADVISOR: Gerarde (Jerry) Moret Pisenti & Brinker LLP 707-577-1518 www.pbllp.com

ARCHITECT: Jaime Stich Jaime.stich@gmail.com

LEGAL: David Berry, Esq. Abbey, Weitzenberg, Warren & Emery 707-542-5050 dberry@abbeylaw.com

REAL ESTATE: Sudha Schlesinger Realtor, Pacific Union 707-889-7779 sudha@sschlesinger.com

DEBRIS CLEANUP & EROSION CONTROL: John Bly Executive Vice President Northern California Engineering Contractors Ass’n.

707-546-5500 | john@nceca.org

CITY OF SANTA ROSA: Chris Rogers Vice-Mayor crogers@srcity.org

BUILDING CONTRACTOR: Gregory Beal Thrive Construction Group gregory@thriveconstruction.group 707-827-3388

CITY OF SANTA ROSA: Gabe Osburn Deputy Director; Permit Dept. gosburn@srcity.org

INSURANCE: Rich Stark Personal Lines Mgr., George Peterson Insurance 707-525-2720 rstark@gpins.com

Linda McLaughlin | 707-303-6528

EVENT ORGANIZER: Wendy Young Executive Director Sonoma County Medical Association 707-525-4375 | exec@scma.org

&

Q A The following are abbreviated excerpts of some of the questions posed and answers provided during the workshop. Look for a complete and unedited transcript of the discussion at www.scma.org.

Q

A: It comes down to how you and your agent wrote your policy. The policy provides you with limits that you’re entitled to. Unless you can prove that there’s a miscalculation or an error on the agent’s part, for example, you told the company you had 2,000 square feet and they put 1,500 square feet on the form, you might have room for adjustment. The policy is the policy and unfortunately that’s what we’re forced to live with.

SONOMA MEDICINE

COUNTY OF SONOMA: Tennis Wick Manager, Permit and Resource Dept.

707-565-1900 www.PermitSonoma.org

PUBLIC ADJUSTER: Kyle Hensiek Vice President, GREENSPAN 800-453-6988 kyle@greenspan-ai.com

SONOMA MEDICINE

Favorite covers: (View full issues online at Sonoma Medicine archives,)

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HO P R FE ICR OE VREERCYO VDEI RNYN W E RO R&K SW RKSHOP

FINANCIAL: Kevin Smart VP/Residential Mortgage Mgr.,Exchange Bank 707-541-1252 | Dept 707-541-1490 Kevin.Smart@exchangebank.com

: Our insurance company has agreed to pay us the limit on our policy, but it still isn’t enough. Is it possible to recover more than our policy limits? Do we have any recourse?

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Panelist Contact Information

Fire Recovery Workshop & Dinner

iii

There is a sharp knock on our door. It is two in the morning. The knock repeats loudly. “Hold on!” I’m sure Bob is coming down from the Foothills for a place to stay. But the man at the door is not my friend. It is a neighbor from across the street. “Fire coming!” he yells. “You’ve got to evacuate. Now!” I grab a few belongings: my cell phone, a laptop, a battery pack. When I look outside there is a faint glow along Fountaingrove ridge. I am in my pajamas.

I realize I have time to dress. This is no big deal. I go back into the house. My wife grabs a few things. We have a cat and dog.

The dog seemed eager to go. The cat did not agree. When we finally found the cat, he defiantly hissed and refused to come.

My wife threw a blanket over his head and stuffed him into a dog crate. Outside, we made a quick decision to take both cars.

(Similar decisions proved deadly on two occasions). If the fire came we didn’t want to lose a vehicle. We planned to meet in the CVS parking lot. We soon became separated. The cars fleeing down Brush Creek were bumper-to-bumper. I ended up getting stuck in traffic and fell further behind. Cell phones were still working and we were able to communicate every few minutes to be sure everything was all right.

Bob Scheibel made a number of calls that night, warning friends a fire was coming. He remains one of our

FALL 2018

Q

: My adjuster has not been very communicative, and has not answered emails. Is email as good as snail-mail, or do you need to use hard copies to get answers?

A

: It is important for you to memorialize your conversations/ contact attempts in writing and keep a record for your files. You may have to contact the agent’s superior for assistance. If that doesn’t work, contact the Department of Insurance (DOI) which has been very good about following up on these complaints. (continued)

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Pediatrics and Adolescent Medicine

Pediatrics and Adolescent Medicine

Curtis Chan, MD, MPH, Anda Kuo, MD, and Tomás J. Aragón, MD, DrPH

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PUBLIC HEALTH DEPARTMENTS, non-profit hospitals, and

off our efforts with a big park event to introduce our patients and staff. We designed a day of free activities and a healthy lunch.

Staff and patients alike participated in ranger-led activities, such as Art in the Park, physical activities including zumba, yoga and youth soccer provided by the City of San Rafael, and demonstrations by community organizations including Wildcare, One Tam and the Marin County Free Library. We estimated that we would have 30–100 participants. We were thrilled to have to send repeatedly for more lunch food when our numbers topped 500. That activity reinforced our impression that there was a real interest in an opportunity to be outdoors.

As we worked to build on that initial excitement to develop a sustainable, ongoing program, we encountered more challenges. We have four clinic sites and a large and geographically dispersed population. So, while patients expressed interest in attending free physical activity groups, finding the times, activities and locations that could work for more than a small group of patients was difficult. We decided to focus on finding a variety of affordable activities in the community and provide a “prescription” for our patients to attend the one that best fit their schedule and interests. We found that, while the intent seemed to be there, there were other barriers that prevented patients from following through—most often cited were time, competing obligations, lack of familiarity with the location, discomfort with exploring a hike or joining a group on their own.

In fits and starts, we’ve landed on a format that seems to work for at least a subset of our patients—MCC in the Parks.

Our staff organizes periodic outings to local parks. We found that providing transportation and having our clinic staff attend the outings has been critical for patient participation, in many cases more because they know someone familiar will be with them as they explore something new, than because of an actual lack of access to a car. On these outings, we try to offer something for everyone—we model simple, affordable outdoor activities: flying a kite, tossing a frisbee, creating a hopscotch pattern with chalk, or going on a scavenger hunt to explore the nature around

park offerings and free programs provided by the parks and by other community part

governmental agencies conduct periodic “community assessments” to understand the health conditions of their patients and communities; which direct further planning and policy development. Healthcare providers are important informants to these “assessment” processes, because they care for many patients across communities likely to “represent the broad interests of the community,” and they understand the various healthcare systems.

Two important “community health assessments” conducted throughout the country are: • Community Health Needs Assessments (CHNA). By the Patient Protection and Affordable Care Act (ACA), tax-exempt hospitals are required to conduct a community health needs assessment (CHNA) every three years.

• Maternal & Child Health, Needs Assessment. The Title V (of the Social Security Act of 1935) Maternal and Child Health Service Block Grant requires that all states complete a comprehensive needs assessment every five years.

The 2014 Needs Assessment process identified 15 major health problems affecting mothers, children, and adolescents, along with annual data to measure outcomes. Stakeholders have further categorized these programs into four health impact areas (“Root Causes”): Social inequities that disproportionately impact the health of mothers and children:

1. Black maternal and infant health. Racism in its different forms (e.g., structural, institutionalized, personally mediated, internalized) cause worse outcomes for black women and infants, including maternal hypertension and obesity; and preterm birth and infant mortality.

2. Inadequate and unaffordable housing disproportionately affect the health of low-income families.

Toxic Stress and inequitable resources during early childhood cause a life course of health disparities: 3. Preterm Births. Babies were more likely to be born preterm or with low-birth weight among women with specific risk factors— poverty/Medi-Cal insured, Latina, Black, working, smoking, and obese.

4. Infant formula and breastfeeding. By two months old, 77% of infants of low-income families are fed infant formula, instead of exclusively breastfed as recommended.

5. Early childhood obesity. Nutrition and physical activity inequities are causing overweight (13%) and obesity (18%) among young children of low-income families in San Francisco.

6. Childhood dental decay. 34% of SFUSD kindergarteners have experienced dental caries.

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7. Child Abuse. 5.5% of SF children have experienced substantiated abuse or neglect.

8. Stress of special healthcare needs. Parents of children with special healthcare needs have increased stress because of health concerns, fragmented services, and lack of support.

9. Physical inactivity. Half of Latino (51%) and Black (48%) SFUSD 5th graders failed the Fitnessgram standards for aerobic capacity, twice the rates of White (26%) and Asians (23%).

Psychosocial health during preconception and perinatal periods: 10. Adolescent depression & suicidality. 26% of high school students (SFUSD) are feeling sad or hopeless.

11. Preconception and prenatal drug abuse. Women abusing drugs have poor health and social outcomes for themselves, but also poor pregnancy, birth, and infant outcomes.

12. Intimate partner violence during pregnancy. One in 10 women with Medi-Cal in SF experience intimate partner violence during pregnancy.

13. Perinatal depression. One in six mothers with Medi-Cal in SF suffer from postpartum depression, three times higher than those with private insurance (18.2% vs. 5.5%).

Equitable access to healthcare for young women: 14. Primary care utilization for young women. In San Francisco and other counties, women with Medi-Cal are significantly less likely to have regulary primary care and reproductive care compared to women with private insurance.

15. Prenatal care access. 30% of pregnant women with Medi-Cal missed first-trimester prenatal care, six times higher than those with private insurance (30% vs. 5%).

— SFDPH 5 Year Action Plan 2016–2020

— Dr. Paula Braveman, 2009

This approach is particularly relevant to understanding and addressing health disparities, because social and physical contextual factors underlie socioeconomic and racial/ethnic disparities in health.”

Thus, the four health impact areas are linked together through a life course approach and other inter-generational models of understanding health inequities. Dr. Braveman provides a model and examples of how health professionals can not only provide “medical care” and educate on “personal behavior” in their daily job, but they can utilize their experience and knowledge to inform the policies that shape “living and working conditions” in the San Francisco Bay Area; and the overall “economic and social opportunities.”

In San Francisco, communities have emphasized “toxic stress” as the intermediary mechanism between “living and working conditions” and inequitable access to “opportunities and resources.”

–1– Social inequities that impact the health of mothers and children;

The San Francisco Department of Public Health emphasizes a life course approach to assessing community health status and public health practice. Dr. Paula Braveman summarizes this as “how early-life experiences can shape health across an entire lifetime and potentially across generations; it systematically directs attention to the role of context, including social and physical context along with biological factors, over time.

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Efficiency

Quality

Social and Institutional Determinants of Childhood Health in SF

Equity

Social Environment General Socioeconomic Conditions Economy, wealth distribution, racism

As health leaders are increasingly understanding their communities’ health problems and their root causes, health organizations and medical professional organizations in the San Francisco Bay Area have become committed to improving the social determinants of children’s health. Health providers have valuable perspectives on the living and working conditions that cause toxic stress and impact health.

Medical practice and public health are both based upon science and data, which are essential for advancing health equity and social progress. In the following issues, SFDPH will describe various approaches to addressing the social determinants of children’s health.

Developing partnerships with the medical society can significantly advance these approaches, including: primary prevention, legislative and institutional policy development, and collective action. Finding solutions for the 15 health problems will require access to healthcare, quality healthcare, and strong collaborations to address the social determinants of health.

Disease during childhood and life course

Inequitable Access to resources and services

Biological, Brain Development – mental health, adaptive behaviors –

Toxic Stress

–3– Psychosocial health during preconception and perinatal periods; –4– Equitable access to healthcare for young women.

Disease Treatment Preventive Services

Access & Utilization

Built Environment Neighborhoods, roads, parks, workplaces, schools, homes

Education, employment, housing, community cohesion, social network

Model developed in collaboration with community representatives from Coleman Advocates for Children & Youth, UCSF in 2015.

Social Determinants of Children’s Health

Mechanism: Root Causes of Children’s Health Inequities

Root Causes of Children’s Health Inequities:

–2– Toxic stress & inequitable resources during early childhood;

He alt hca re

— John Muir

with a breeze coming off the Bay. We watch as an older sister uses a giant wand to blow bubbles and her siblings and a handful of other small children laugh and run in circles trying to catch them. One of our colleagues is walking with some of the adults and more adventurous older children in our group. There are school-age children kicking around a soccer ball. When the walkers return, we gather together, sharing a healthy snack.

These are pretty typical activities for a day at the park. But they feel momentous and important as a physician getting to step out of the medical office setting and share these experiences with our patients.

Inspired by the Park Prescription movement that is starting to happen across the country, our clinics started working several years ago with the Marin County parks, the San Rafael city parks and Marin County Health and Human Services to develop a program to promote physical activity and time outdoors in our local parks.

The primary team from our clinic involved in developing the program includes a family practice physician, a pediatrician and a health educator. When we first started to envision a Park Rx program, we immediately thought of the several visits a day spent trying to support families of overweight children and our adult patients with diabetes and hypertension trying to adopt healthy lifestyle changes. The parks and their programming represented a resource to offer patients who are faced with a lack of affordable physical activity opportunities in the community.

We were excited about the promising documented health benefits that were seen by our colleagues at the Marin City Health and Wellness Center, who worked with the Marin County Parks and Health and Human Services staff to develop structured physical activity classes in the park next to their clinic site.

They were able to document improvements in blood pressure and Body Mass Index as well as subjective reports of actually feeling better from the patients who participated in the program after a two-month pilot.

With financial support from the county parks, we kicked

behaviors. Despite the additional burden of toxic stress in a very expensive city, low-income and under-represented communities have less access and fewer choices, including those for education, child and youth development, recreation, housing, and healthcare services.

Whereas much of the 200+ year history of the United States was fueled by colonialism, capitalism, and racism, the living and working conditions in San Francisco can also be shaped locally toward health equity. Our city’s “built environment” and “social environment” have been influenced by the cultural and social conditions that we’ve created. As described by our model with community partners below, equitable distribution of economic and educational opportunity across race and class is the major determinant of children’s health.

IMPROVING PUBLIC HEALTH EQUITY FOR CHILDREN AND FAMILIES

Tracey Hessel, MD

Everybody needs beauty as well as bread, places to play in and pray in, where nature may heal and give strength to body and soul.

Det Soc erm ial inan ts

PRESCRIBING NATURE

It’s a beautiful day, sunny

Poor Living and Working Conditions — SFDPH Model developed from survey and focus groups conducted by 2014 Community Needs Assessment

Curtis Chan, MD, MPH, is Medical Director of Maternal, Child & Adolescent Health and Deputy Health Officer, San Francisco Department of Public Health. Anda Kuo, MD, is Professor of Pediatrics at UCSF and practices at the Children’s Health Center at Zuckerberg San Francisco General Hospital. Tomás J. Aragón, MD, DrPH, is Health Officer, City & County of San Francisco and Director, Population Health Division, SFDPH.

Skyrocketing income inequality and costs-of-living exacerbate the living and work condition inequities that cause toxic stress and many health disparities affecting young women, children, and families. Toxic stress affects biological disease processes directly, fractures mental health, and increases likelihood of harmful WWW.SFMMS.ORG

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Selected spreads, November 2018

San Francisco Marin Medicine, the journal of the San Francisco Marin Medical Society, adheres to more of an academic style. I provided production, including refinement of quantitative graphic information, for several issues in 2018.

SPECIAL SECTION

election

election

2018

SFMMS CANDIDATE for CMA PRESIDENT-ELECT peter N. bretan, jr., md, facs

16

kenneth S. blumenfeld, md, faans

from burdensome factors such as MOC, inefficient EMR, and unsustainable office overheads. I have a direct interest in this issue as the field of urology several years ago had one of the highest burnout rates, approaching 65%. Now after much effort addressing the roots of burnout, the rate has decreased by 20%. The American Board of Urology, in response to the AUA and CUA, has eliminated MOC, and replaced it with a CME program named Life Long Learning. This new program has been much better received by our membership, and I am proud to have been part of changing this process that is so vital to our specialty.

I served for 28 years in the USPHS Reserves, attaining the naval rank of Captain (O-6). I was deployed for the care of Cuban refugees in 1980, and to those displaced from Hurricane Katrina in 2005, leading the rebuilding of hospital medical staffs in New Orleans afterwards. Thus I have a deep understanding of the need for a concerted Public Health response to disasters.

While my career has given me in-depth medical knowledge, with rich and varied leadership experiences, the accomplishment I cherish the most is being the Founder and CEO of LifePlant International. LifePlant is a charitable organization that furnishes life-saving transplants in developing countries, for which I was recognized by the AMA with the Benjamin Rush Award for Citizenship and Community Service.

My greatest motivation is in service to give back to society for my good fortune. I grew up as a child farm laborer, and I know what it is to be without adequate healthcare. Because of this I will fight for all physicians to be adequately represented, trained and heard too, so that they are adequately compensated for care of their patients. Universal coverage is an important goal of both the CMA and AMA, and must be sustainable for all physicians and their patients to succeed. With my broad and in-depth leadership experiences, I can help CMA accomplish this aim in a time where a rapid understanding of complex issues is necessary. That is why I am running to be your next CMA President.

I am very proud and grateful to have been endorsed by the SFMMS for this position. I humbly ask for your vote and support to lead our CMA as President-Elect this upcoming year.

—Peter N. Bretan, Jr., MD, FACS

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SAN FRANCISCO MARIN MEDICINE OCTOBER 2018

Every position or office I’ve held in organized medicine has been a call to service. My decision to run for President-Elect is no different. It comes from requests and encouragement of those around me combined with a sincere desire to represent and lead our CMA. Being president of an organization like CMA requires dedication, determination, and sacrifice. It has to be a labor of love. Ideally being the President of CMA should not be a goal or aspiration but rather a position you are chosen to fill for the good of the organization.

For my qualifications I would refer you to the Declaration of Candidacy below. Notwithstanding the credentials of my fellow candidates, I would distinguish myself as being most prepared to perform the duties and responsibilities of the President of CMA. Doctors, and their patients, need advocacy and representation. Regulatory burden, physician burnout, narrow networks, workforce shortages, drug costs, healthcare disparity, inadequate GME funding, encroachment of scope of practice, attacks on medical staff autonomy, and attempts to repeal MICRA are just some of the issues we will be facing.

Many of our challenges are brought upon us by others. Consider Prop 46, the governor’s attempt to supplant Prop 56 funds, SB 562, and AB 3087 to name a few. Other challenges and opportunities we champion based on emerging policy and politics.

We will be working with a new administration and the prospect of universal access. We will be asked how to control the costs of healthcare. We will be stewarding a ballot measure on sugar-sweetened beverages. There will be continued debate on opioid abuse and gun violence. We will be working to enhance physician wellness. As always, efforts will be made to increase the number of medical school and residency positions in California. Diversity in our organization, leadership and workforce will remain a priority. Lastly, we must address how to provide care to the mentally ill and underserved.

Campaigning for President-Elect, I have listened more than I have spoken. I hear your concerns and struggles. I want to assure you that your issues will be my issues. Our CMA, not the CNA or SEIU, is and must remain, the premier medical organization in California, the go to on healthcare policy, and the mouthpiece for patient advocacy.

Candidate Statement

THE SFMMS but we decided to try a contest anyway. The guidelines were simple: In 350 words or so, respond to this question:

Anthracyclines

DECLARATION OF CANDIDACY

published in an upcoming issue of our journal, San Francisco Marin

Kenneth S. Blumenfeld, MD, is a board certified neurosurgeon practicing in San Jose, California. He was in solo practice from 1992 to 2016. Since 2016 he has been with the Palo Alto Foundation Medical Group as a full-time neurosurgeon and Tier 1 administrator. Dr. Blumenfeld has worked at, as well as served on the medical executive committees of multiple hospitals north and south of the Golden Gate. He is a past Chief of Staff at Good Samaritan Hospital in San Jose and an UCSF Adjunct Clinical Professor. He is currently a member of the medical staffs of Regional Medical Center of San Jose, El Camino Hospital of Los Gatos and Mountain View, O’Connor Hospital of San Jose, and Dominican Hospital of Santa Cruz. He has helped build and establish several Level II Trauma Centers as well as Comprehensive Stroke Centers. Dr. Blumenfeld obtained his medical degree from the Johns Hopkins School of Medicine in 1986 and completed his neurosurgical residency at the University of Pennsylvania in 1992. He obtained his board certification in 1995 and remains a diplomat and Fellow of the American Association of Neurological Surgery.

Dr. Blumenfeld has a long history of service in organized medicine, having joined the Santa Clara County Medical Association and California Medical Association in 1993. Within SCCMA he has served as a delegate for both the SSGPF and his district.

He has been a VP of External Affairs, SACPAC Chair, and is currently the President. His activities within CMA have included being Vice Chair and Chair of the Council on Legislation. He has been a CALPAC board member and currently serves as a Trustee from District VII. Dr. Blumenfeld is a member of numerous specialty societies including the California Association of Neurological Surgery (CANS), American Association of Neurological Surgery, Western Neurosurgery Society, and Council of State Neurological Societies.

OCTOBER 2018 SAN FRANCISCO MARIN MEDICINE Cardiovascular Effec t

Example Doxorubicin

Medicine. The top winner will receive a cash prize to be determined.

Please use anonymous re-naming for any patients and others as judged necessary. Publication can be anonymous if requested and appropriate.”

This offer was sent out to as many medical student, resident, and fellow lists as we could access. The response was heartening, as you can see for yourself in the 21 entries published here.

Judging for the winner(s) will be done by SFMMS leaders and announced later, but really that is not as important to us as the quality and diversity of responses. So, take a look and see how these brief responses to our question make you feel about the future of medicine here. We expect you’ll be glad to read these.

Esp. of chest

Myocardial dysfunction, valvular degeneration, acute pericarditis, constrictive pericarditis

Her2 inhibitors

Trastuzumab or Herceptin

High rate of cardiomyopathy esp. in combination with anthracyclines

VEGF inhibitors

Bevacizumab or Avastin

Systolic and diastolic hypertension

Small molecule (tyrosine kinase) inhibitors

-ib drugs such as sunitinib, imatinib, dasatibib, nilotinib, etc.

• Vascular events (TIA, PAD, MI), often in patients with atherosclerotic risk factors • Hypertension • Pulmonary hypertension • Cardiovascular dysfunction • Arrhythmias (atrial fibrillation)

Immunomodulatory drugs

Thalidomide, lenalidomide

Venous thromboembolic disease, myocardial infarction, stroke, hypertension

Immunotherapy

Checkpoint inhibitors

Case reports of autoimmune myocarditis; still uncertain CV safety profile

Rajni Rao, MD

Preoperative assessment for cancer surgery, including weighing of risks and benefits of coronary interventions and dual antiplatelet therapy vs. pursuing cancer treatment Management of postoperative complications including atrial fibrillation, acute coronary syndrome, hypertension

A Model Clinical Ethics Consultation Service — and Beyond

Assessment of risk prior to potentially cardio-toxic chemotherapy Careful echocardiographic evaluation of possible LV dysfunction

over their heads. It was the quickly decisive, high-tech, commonsense field of cardiology that attracted me to medicine. I later realized that these presumptions were myopic and that these two fields are importantly linked for me and most importantly, for many of our patients.

My view of medicine changed when my father, who had lived with Crohn’s disease almost his entire adult life, began having recurrent small bowel obstructions refractory infusions of adalimumab and necessitating urgent surgery. The surgeon had opened the abdomen and found invasive small bowel cancer. Chemotherapy, IR procedures, and 14 hospitalizations and nine months later, he succumbed. Along the way, we had gotten to know an entire team of people, with names, emails, cell phones. Nurses who called us to check-in before we had to call them. Doctors who contacted us as soon as they heard a result.

Appointments made for us. Chaplains, social workers, massage therapists, counselors, group sessions, symptom-management specialists. People to help us park, obtain a wheelchair, home nursing, etc. A team-based style of care not often seen in other types of medical practices. Information given, considered, and shared decisions to be made by patient and physician. I couldn’t quite grasp what made my father want to battle the disease so determinedly against any reasonable odds and with so much suffering. But I later began to notice similar characteristics in

Table 1. Common cardiovascular considerations of cancer therapies Treatment

Example

Anthracyclines

Doxorubicin

Dose-dependent cardiomyopathy

Radiation

Esp. of chest

Myocardial dysfunction, valvular degeneration, acute pericarditis, constrictive pericarditis

Her2 inhibitors

20

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Trastuzumab or Herceptin

Cardiovascular Effect

High rate of cardiomyopathy esp. in combination with anthracyclines

VEGF inhibitors

Bevacizumab or Avastin

Systolic and diastolic hypertension

Small molecule (tyrosine kinase) inhibitors

-ib drugs such as sunitinib, imatinib, dasatibib, nilotinib, etc.

• Vascular events (TIA, PAD, MI), often in patients with atherosclerotic risk factors • Hypertension • Pulmonary hypertension • Cardiovascular dysfunction • Arrhythmias (atrial fibrillation)

Immunomodulatory drugs

Thalidomide, lenalidomide

Venous thromboembolic disease, myocardial infarction, stroke, hypertension

Immunotherapy

Checkpoint inhibitors

Case reports of autoimmune myocarditis; still uncertain CV safety profile

SAN FRANCISCO MARIN MEDICINE JULY/AUGUST 2018

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Familiarize oneself and stay current on updates on oncology treatments and cardio-oncology trials

my patients referred to me by oncologists — they were often well-informed, driven, savvy consumers of their healthcare, who needed something from me so that they then could then move on to the real business of the day: fighting cancer. They needed facilitation of their care, not more roadblocks on a road that is already riddled with roadblocks. However, what is cardiooncology? Is it not just the practice of cardiology in patients who happen to have cancer?

Perhaps. But even before getting into checkpoint-inhibitor mediated myocarditis and trastuzumab cardiomyopathy (Table 1), perhaps the primary role of the cardio-oncologist (Table 2) is philosophical, to mainly facilitate, to ferry patients from point A to point B, whether that be a pre-op evaluation or chemotherapy or surgery, or even just getting them through some minor hypertension, and all along the way working with our oncology colleagues as a polyglot learning their ever-changing language of drug combinations that will inform our understanding of cardiotoxicities.

We began our carcinoid heart disease center at UCSF by problem-solving with oncologists, who are the ultimate barristas, trying to craft the perfect personalized solution for a given patient with a rare neuroendocrine tumor. We began to learn best practices, employ n-of-1 trials in our patients, and when evidence not in supply, craft a solution individually. This sometimes means careful timing of double heart valve surgery prior to liver debulking treatment, and other times meant designing a palliative transcatheter pulmonic valve replacement hybrid procedure in those too frail for surgery. It may mean the most inelegant treatment of hypertension, with multiple short acting drugs in low doses all on sliding scales, for patients with disabling paraneoplastic dysautonomia. After we rolled out our Epic EHR, we soon started receiving the MyChart messages from our patients with breast cancer within minutes of them completing their screening echocardiograms on trastuzumab — “could you please tell me my ejection fraction?” It doesn’t take long for patients to realize that so much hinges upon that number, and any delay we have in answering their email leaves them hanging,

not knowing if the life-altering medication would have to be halted for cardiotoxicity. From these patients, we have learned another cardio-oncology prerogative: be creative, responsive, flexible, and available, because to quote Sid Mukherjee again, “All cancers are alike but they are alike in a unique way.”

Cardio-oncology, or oncocardiology as it is also called, represents the intersection of the two fields and the cardiovascular care of cancer patients because of unrelated coexisting disease states or to manage the cardiovascular effects of cancer treatment. It is a growing field because CV disease and risk factors are common and there is an explosion of new targeted cancer treatments that have or may have CV side effects (Table 1).

What we can adopt, whether or not we choose to formally practice cardio-oncology, is a version of the patient-centered care our oncology colleagues provide. They have developed teams with various expertise to help patients and their familyies navigate the complexities of cancer treatments, multiple appointments, cost, and emotional and social issues. They have learned how to make themselves available to patients and how to take a well-informed patient and put him or her in the driver’s seat. And this is what our cancer patients should rightly expect from all their physicians.

Where We’ve Been:

The Program has provided close to 2,000 consults since its inception. PMHV currently serves hospitals in San Francisco, the North Bay, Peninsula, and the East Bay — including CPMC, Novato Community Hospital, Sutter Santa Rosa Regional Hospital, Sutter Lakeside Hospital, Mills Peninsula Hospital, Eden Medical Center, and Sutter Delta Hospital.

With the growth of the Program, the pace of consultations

Dr. Rajni K. Rao is Associate Professor of Medicine at UCSF, and is a cardiologist with special interests in non-invasive cardiology. Rao received her undergraduate degree from Harvard University and her medical degree from UCSF. She completed her internship at the Massachusetts General Hospital and returned to UCSF for her internal medicine residency and cardiology fellowship. She served as chief cardiology fellow and completed advanced training in echocardiography at UCSF. She has received numerous awards including two recognizing her as a distinguished educator.

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Who We Are: The Program in Medicine and Human Values (PMHV) at California Pacific Medical Center (CPMC) was founded in 2003. One of the authors of this article, Dr. William Andereck, longtime chair of CPMC’s Ethics Committee, conceived of the Program as a response to the threats posed by an increasingly technical, complex, and costly healthcare system to the values and dignity of individual patients. After a generous grant from a private donor, Dr. Andereck recruited his former mentor Dr. Albert Jonsen, a founder in the field of bioethics, to assist in forming a program of clinical consultation, education, policy, and research for the staff and patients of CPMC. While still based at CPMC, the Program has now expanded and provides Ethics Consultation services to Sutter Health’s healthcare team members, patients and their families, throughout a number of Bay Area hospitals. Our role is to assist in making decisions for the very complex patient situations in the setting of a medical tragedy and crisis. Additionally, we offer education and training in how to work through ethically challenging patient cases, as well as conducting research and promoting scholarship.

Collaboration with oncology and primary care, IR, surgery, radiation oncology; enhanced communication for shared decision-making Establish a patient-centered practice with excellent communication, considering the use of traditional office visits or electronic communication, video or telehealth visits, physicians and allied health professionals

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Program Programin inMedicine Medicineand and Human HumanValues Values Yearly YearlyEthics EthicsConsultations Consultations 1985-2017 1985-2017

500 500

has been exponentially increasing and in 2017, we provided service in 411 consults, the highest for the Program so far. This represents an outstanding accomplishment for PMHV, and it showcases the recognition that Sutter Health places in our services to patients and clinicians.

What We Do:

Although anyone involved in a patient’s care (healthcare provider, patient, etc.) can request an ethics consultation, most consultation requests continue to come from physicians (most frequently by the attending physician), and this number has been steadily growing. In 2017, over 60% of our consults were called by doctors in need of assistance in making tough choices for their patients and their families. Social workers and case managers also consistently request ethics consults.

Most of the ethical issues consulted on by PMHV center around patients who, due to their illness, have lost their ability to make their own medical decisions. The challenges of decision making often involves family members in conflict with each other about who best represents the patient’s wishes.

We often assist surrogate decision makers struggling with the harsh realities of their loved one’s hospitalization by working closely with physicians and family members to ensure that the medical decisions made are in the best interest of the patients we serve. The Program sees a significant share of patients who not only have no healthcare decision makers, but we can find no one who can represent their interests. In these cases of unrepresented patients, the hospital policy is utilized to adopt an inter-disciplinary process for decision-making. Another Request Breakdown 2017 60.36% MD 19.52% Social Work/Case Management 9.91% PA, NP, ANP, etc.

5.11% RN 4.00% Administration/Management 0.70% Patient/Family 0.40% Other

400 400 300 300 200 200 100 100 00 1985 1985

1990 1990

1995 1995

2000 2000

2005 2005

2010 2010

2015 2015

Year Year

12

21

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Primary Diagnosis Group

Primary Ethical Issue 100

Guillermo Palchik, PhD, and William S. Andereck, MD, FACP

Management of treatment-related hypertension, cardiomyopathy, vascular events Assistance with management of polypharmacy and side effects of multiple cardiac and other drugs

# # Consults Consults

― Siddhartha Mukherjee, The Emperor of All Maladies: A Biography of Cancer ― William Grossman, speaking about the importance of acting quickly in acute myocardial infarction

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SAN FRANCISCO MARIN MEDICINE SEPTEMBER 2018

INTEGRATING ETHICS WITHIN A HEALTHCARE SYSTEM

Ongoing cardiovascular management of baseline CV conditions for a cancer patient

What can a cardiologist offer to combat the “Emperor of All Maladies”?

I’ll be quite honest. I had started my medical training at the other MGH (Massachusetts General Hospital) on the oncology ward, caring for people submitting themselves to the cruelty of bone marrow transplant sometimes with what seemed like an ineluctable ambition for living based on slim or even nonexistent odds, subjecting their bodies to all forms of pain. With this limited view, I regarded oncology as a sad field, presided over by a special strain of physicians — big-hearted people with infinite kindness, dark circles under the eyes and faintly glowing halos

Ravi Akshay, PGY-1 Resident, UCSF

Andrew Ikhyum Kim, MD, MPhil, UCSF Resident, Internal Medicine/Primary Care

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Dose-dependent cardiomyopathy

Radiation

Table 2. Suggested responsibilities of a cardio-oncologist

Cardio-oncology:

“Minutes are myocardium; seconds are sarcomeres.”

“Es que no tengo papeles,” responded the worried appearing woman to my questions. Maria was an undocumented immigrant admitted to labor and delivery who had expressed her concerns about being hospitalized because of her immigration status. I tried in so many ways to break through her concerns but to little avail.

My attending, Dr. C, however, knew exactly what to do. She walked up to Maria and sat down at her eye level. She paused to allow for silence and looked directly in her eyes and said, “No le preocupe que no tenga papeles”—Don’t worry about your immigration status. In that moment, the entire room let out a sigh of relief.

I struggled to understand the magic that transpired in that room. Dr. C’s questions were not any different from other providers’. And yet, her patients accepted her as more than their provider and formed a connection that seemed beyond my grasp.

But when I saw her interaction with Maria, I started to understand. It was not one single thing, but it was not a cluster of unrelated acts either. It was a combination of actions born out of genuine empathy. It was the cultural competency to speak Spanish. It was the act of sitting with her patient. It was her silent acknowledgement of the patient’s fears, and the confident reassurance that followed. It was the brief moment of looking in Maria’s eyes and seeing her, completely and thoroughly. To see and be seen, to reach this ultimate form of mutual understanding that broke through the barriers of race, culture and language; this is what I had observed that was so special.

Empathy, respect, cultural competence, patient-centered care. We often discuss these ideals, but too often we do not teach how to incorporate them into our care. And perhaps it cannot be taught. Perhaps it must be shown. This is what Maria taught me.

I aspire to not just listen to my patients, but hear them. I aspire to not just spend time with my patients, but share a moment. I aspire to not just express empathy, but to feel it.

Healthcare Ethics

What’s New in Cardiology

“ . . . The story of cancer . . . is the story of patients who struggle and survive, moving from one embankment of illness to another. Resilience, inventiveness, and survivorship — qualities often ascribed to great physicians — are reflected qualities, emanating first from those who struggle with illness and only then mirrored by those who treat them. If the history of medicine is told through the stories of doctors, it is because their contributions stand in place of the more substantive heroism of their patients.”

Yegua Streetpeople

During my sub-internship, we cared for a retired street performer and songwriter with end stage renal disease, who also happened to have rare nephrocutaneous manifestations. Amidst her multifaceted identities, the identity of “fascinating case report of Kyrle’s disease” began to overshadow the others. One evening she confessed to me her exhaustion after a cavalcade of four teams of three learners came by on physical exam rounds to look at her skin findings. They entered, caked their hands with antiseptic gel, donned unwelcoming blue nitrile gloves, undressed her gown, and shone penlights over her body, as if she were a specimen. Admittedly, I was guilty of this academic voyeurism and fascination too.

On a rotation where we had immense physical pressures, the threat of burnout arose not from the hours, but rather from the realization that I also felt guilty of dehumanizing our patients.

Before starting the rotation, I had printed out this reminder on my desk: “We must not see any person as an abstraction. Instead, we must see in every person a universe with its own secrets, with its own treasures, with its own sources of anguish, and with some measure of triumph.” And already, I found myself reducing patients to abstractions.

Here, the solution rested in music. That night on 30-hour call, I found our patient’s old recordings from her performing days, sat with her for hours, and listened to her music. A blush and chuckle washed over the uremic frost on her face as she shared interpretations of her lyrics, “That one I wrote when I fell in love with a circus boy while hitchhiking in Mississippi.”

She passed away one week later when I was again on call.

Our team sat with her partner and we listened to her albums in remembrance of her. For us learners, these resuscitating experiences—such as the humanizing capacity of music—helps to fight burnout, more so than any physical respite could. The pager’s cry pulled me away into a sleepless night. And I walked off reassured: Our patient was no longer identified by the obscure eponym of Kyrle, but by her own chosen pseudonym, Yegua Streetpeople.

“Of all the patients you have encountered thus far, which one has been the most memorable and/or had the most impact on you and why? Winners will be

—Kenneth S. Blumenfeld, MD, FAANS

Table 1. Common cardiovascular considerations of cancer therapies

WWW.SFMMS.ORG Treatment

MEDICAL TRAINEE WRITING CONTEST

Writing quality is of course largely subjective,

Representation, education, and advocacy are what CMA must do and what I am about. Let me represent you as the next President-Elect of our great CMA. I will not disappoint. I ask for your vote.

Thank you.

# Cases

I’m Peter Bretan, a laparoscopic urologic and kidney transplant surgeon. I work in Marin, Sonoma and Santa Cruz counties. My main hospital serves Kaiser, the Palo Alto Medical Foundation and the County Alliance Medi-Cal with a large under- and uninsured population. Thus my practice is as inclusive as possible, and interacts with all modes of practice.

In CMA I’ve been a past Trustee, President’s Forum Chair, current District X AMA Delegate, and CMA Small and Solo Group Practice Forum Delegate. I’ve served as President of my component medical society three separate times, and also bring extensive leadership experience in medicine outside of the CMA. I’ve previously directed Transplant Programs at the Cleveland Clinic Foundation, UCLA and St. Joseph’s in Santa Rosa, and was an Associate Professor at UCSF. I continue to teach students as an immunology lecturer at UC Berkeley. My academic accomplishments include over 200 scientific publications, two medical patents, and service as a current reviewer for five medical journals. I completed a PhD curriculum in basic science that provides a solid foundation in medical science that can help our profession in healthcare policy-making.

As a professor at Touro Medical School in Clinical Urology, I have taught a healthcare policy class for the past 15 years. This course for students and practicing physicians has been important for our profession in California to educate legislators—not only about what it takes for doctors to save lives, but that all lives are precious, not just to the families they are part of, but to society as a whole. That is why I continue to teach a healthcare policy course, as it is important to our profession especially in these times of great change.

Today we need this type of cooperation, as we are faced with a complex and rapidly changing environment that threatens the foundation of all medicine, especially the doctor-patient relationship. We need a strong partnership with not just our current legislative allies, but to expand this base with a similar course offered statewide.

I am the Western Section Healthcare Representative for the American Urological Association (AUA). As the current President of the California Urological Association (CUA), I have tackled important medical practice issues such as physician burnout

2018

SFMMS CANDIDATE for CMA PRESIDENT-ELECT

Candidate Statement

WWW.SFMMS.ORG

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2015 2016 2017

40 20 0

Other

Non-Beneficial Treatments

Difficult Patients

Unrepresented Patients

Surrogate Decision Making

Respiratory System Nervous System/Mental Disorders Circulatory System Hepatobilioary System & Pancreas Kidney & Urinary Tract Digestive System Infectious and Parasitic DDs Skin Blood & Immunological Disorders Alcohol/Drug Use Multiple Significant Trauma Injuries, Poison, & Toxic Effect of Drugs Musculoskeletal System Newborn & Other Neonates Ear, Nose, Mouth, & Throat Other

0%

important theme we often come across involves patients and their family members requesting treatments, most often at the end of life, that physicians consider to be medically ineffective.

As such, we are often involved in cases that deal with withdrawing or withholding medically non-beneficial treatments.

These cases are among the most difficult for everyone, as they constitute the realization that the medical team has no more medical options to offer the patient, even in the face of family struggles to accept the reality and finality of the medical illness.

Where We Are Going:

Ethics Consultation Service: PMHV strives to continue to provide a robust standardized service to patients, families, and providers at Sutter Health. We continue to analyze our consultation data to identify trends and patterns for triggers for ethics consultation and involving the service earlier rather than later.

As medical technologies become more advanced, the care of our patients becomes more complex with dilemmas arising every step of the way in terms of the appropriateness of interventions in the setting of life-altering illness.

Sutter-Wide Education: We are increasing our presence Sutter-wide through targeted education for providers in areas where knowledge and skill gaps have been identified. We are using innovative platforms to deliver this education, e.g.

Annual Summer Workshop, noon conferences for medical residents and fellows, regular WebEx sessions on commonly encountered dilemmas, and invited presentations for different departments and hospital services. Ethical Times, our quarterly newsletter, reaches over 1,200 subscribers and provides the community with an overview of the latest issues in the field of bioethics.

Clinical Neuroethics: Many of our consultations have to do with psychiatric and neurological components of the patient’s illness. Therefore, the Program created the Clinical Neuroethics Initiative (CNI), the first endeavor to address issues related to these patients and apply an ethical spotlight to the dilemmas physicians face in the real world of patient care. The objective of CNI is to improve quality care for neurological patients by developing practical solutions and best practices for physicians dealing with the ethical issues that arise when caring for neurologically compromised patients. Even though neuroethics departments and services are becoming increasingly more WWW.SFMMS.ORG

5%

10%

15%

20%

25%

prevalent at academic institutions, and components are being added to the curriculum in law and medical schools, there is currently no other program than ours designed specifically to embed neuroethicists across neurological specialties and work closely with neurological program directors to identify the ethical issues they face in caring for their individual patient populations. This work is now being made possible through a generous grant from the Hearst Foundation.

Organizational Ethics: Many ethical problems in healthcare derive not merely from the perplexing questions facing patients, families, and doctors, but also from the structural features and barriers presented by institutions and their policies.

In the past, we have conducted employee survey polls about ethical culture and behaviors in their hospitals, and provided information on how the institution can best address organizational ethics issues. We continue to recognize these issues and develop solutions to best address them. A recent project of the Program has been recognizing and addressing moral distress of nurses. The Program has also developed major policies on how to address decision-making for unrepresented patients as well as how to respond to requests for non-beneficial treatments that have now been adopted by multiple institutions across Sutter Health.

The Program in Medicine and Human Values continues its upward trajectory in providing ethics consultations and education throughout Sutter Health and beyond, while our professional presentations and contributions to the literature increasingly bring national and international recognition.

Internally, we are developing in-depth assessment tools to better measure our activities, and creating new ways to disseminate what we are learning more widely.

Gil Palchik, PhD, is the Sutter Health Program in Medicine and Human Values’ specialist in neuroethics. Dr. Palchik received both his MSc and PhD in neuroscience from Georgetown University, where he focused on cellular and molecular neuroscience.

William S. Andereck, MD, FACP has practiced internal medicine in San Francisco since 1979. He is program director and senior scholar at the Sutter Health Program in Medicine and Human Values and a former editor of this journal.

JUNE, 2018

SAN FRANCISCO MARIN MEDICINE

13

Table 2. Suggested responsibilities of a cardio-oncologist Ongoing cardiovascular management of baseline CV conditions for a cancer patient Preoperative assessment for cancer surgery, including weighing of risks and benefits of coronary interventions and dual antiplatelet therapy vs. pursuing cancer treatment Management of postoperative complications including atrial fibrillation, acute coronary syndrome, hypertension Assessment of risk prior to potentially cardio-toxic chemotherapy Careful echocardiographic evaluation of possible LV dysfunction Management of treatment-related hypertension, cardiomyopathy, vascular events Assistance with management of polypharmacy and side effects of multiple cardiac and other drugs Collaboration with oncology and primary care, IR, surgery, radiation oncology; enhanced communication for shared decision-making Establish a patient-centered practice with excellent communication, considering the use of traditional office visits or electronic communication, video or telehealth visits, physicians and allied health professionals Familiarize oneself and stay current on updates on oncology treatments and cardio-oncology trials

Murder

These 2017 issues of San Mateo County Physician represent a more illustrative editorial style.

Production included extensive copy-editing.

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MEDICINE SONOMA COUNTY MEDICAL

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galas

33rd Annual

SCMA Board of Directors Invites You and A Guest

A S S O C I AT I O N

Michael Magnotti, MD

to the

In appreciation of his article, “‘Low T’ and Testosterone Therapy,” which appeared in the fall 2017 issue of Sonoma Medicine, the Sonoma County Medical Association presents Michael Magnotti, MD with the award for Article of the Year.

Outstanding Contribution

Lisa Ward, MD

Kris Hartigan, RN

In recognition of her leadership in improving health care delivery standards for safe prescribing of opioids at Santa Rosa Community Health and across the larger community, the Sonoma County Medical Association presents Lisa Ward, MD with this award for Outstanding Contribution to Sonoma County Medicine.

In recognition of her dedicated supervision of staff and support of radiation and medical oncologists at St. Joseph Health Medical Group’s clinics, and an exceptional 45-year career in oncology nursing, the Sonoma County Medical Association presents Kris Hartigan, RN with this award for Practice Manager of the Year.

Steve Osborn

Allan Hill, MD

THURSDAY, DECEMBER 7, 2017 | 6:00

In recognition of his quarter century as managing editor for the award-winning Sonoma Medicine magazine, and for guiding and inspiring high standards of excellence in SCMA communications, the Sonoma County Medical Association presents Steve Osborn with this award for Recognition of Achievement.

Acknowledging his service and highly-valued contributions as a volunteer physician working in cooperation with Operation Access to deliver outpatient surgical services to those in need, the Sonoma County Medical Association presents Allan Hill, MD with the award for Outstanding Contribution to the Community.

“Celebrating exemplary service to the community through medicine.”

Clinton Lane, MD In appreciation of his exemplary level of leadership and commitment to SCMA through service on the Board of Directors and as a CMA delegate, while maintaining a challenging and diverse primary care practice, the Sonoma County Medical Association presents Clinton Lane, MD with the award for Outstanding Contribution to SCMA.

P.M.

Please join your colleagues in honoring the achievements of Allan Hill, MD Outstanding Contribution to the Community

Lisa Ward, MD Outstanding Contribution to Local Medicine

Clinton Lane, MD Outstanding Contribution to SCMA

Steve Osborn Recognition of Achievement

Kris Hartigan, RN Practice Manager of the Year

To Be Announced Article of the Year

4

#SonomaStrong

Medical Heroes of the Firestorm

With deep gratitude for unprecedented service to patients and community throughout the October 2017 firestorm, the Sonoma County Medical Association honors all Sonoma County physicians with this special Recognition of Service.

SCMA 2017 Awards Gala Program

5

SCMA 2017 Awards Gala Program

Social hour begins at 6:00, followed by dinner, the awards presentation, and more!

MENU

Salad; Entrée — Duet: Sea bass and short ribs OR Vegetarian: Roasted King Trumpet mushrooms; Dessert and coffee.

Tickets for SCMA members and guests: $75 • Nonmembers: $125 each.

1868 2018

RSVP and purchase tickets: contact Rachel at 525-4375 or rachel@scma.org.

Send checks to SCMA, 2312 Bethards Drive #6, Santa Rosa, CA 95405.

— PLEASE RSVP BY MONDAY, DEC. 4 — (indicate dinner choice at RSVP)

Thank you!

Anniversary Celebration &

SPONSORED BY

Sutter Medical Group of the Redwoods

®

35TH ANNUAL

Galas galore.

Sonoma County Medical Association (two styles), San Francisco Marin Medical Society (logo), and San Francisco Dental Society (program “A celebration with & for our medical community” cover and history layout spreads).

Click images to view event programs online.

2019

awards & comedy night

“A celebration with & for our medical community”

SATURDAY, OCTOBER 5, 2019

FRIDAY, JANUARY 24, 2020

OLYMPIC CLUB LAKESIDE

SANTA ROSA GOLF & COUNTRY CLUB, SANTA ROSA

Joh n's Mark s

Celebrating the Past, the Present, and Welcoming the Future

Program printing sponsored by Dr. Dennis Shinbori & Family

A Few Memories . . .

Historical Notes

TIMELINE

1891

TIMELINE

SAN FRANCISCO 1869 It was 1869 when our predecessors met to form the first dental society in California, the San Francisco Dental Society. California had only been part of the country for 25 years and a state for only 19 years.

San Francisco had grown from 250 residents in 1846 to 34,000 after the Gold Rush of 1849 and to almost 150,000 after the Comstock Lode discoveries in 1859.

Some of these dentists could have lived in one of those marvelous redwood Victorian houses that were sprouting up. This same year, 1869, the transcontinental railroad linked both coasts, erasing much of our isolation. These dentists must have been accustomed to rapid change in their environment and in their profession.

Few dental schools existed at that time, with none on the west coast. Licensing boards were forming but were not well enforced. Some of the dentists may have still been trained under apprenticeship. It wasn’t easy to get around SF at that time, except by foot. Most of the city’s population lived and worked in the northeast section of the city, as did most of the dentists. They frequently had their office on the ground floor and lived upstairs in the same building. Sometimes there was an assistant who helped clean and boil instruments. At lunchtime, he might have gone to one of the many nearby bars, where they served free food as long as you were having a drink. He enjoyed hearing music on the streets, where musicians made the streets their concert hall. I hope the music compensated for the constant odor of all those four-horse-team coaches or the noisy steam coaches.

Top left: 100th Anniversary issue of SFDS Newsletter, 1969. Top right: Poster Contest winner, 1982.

Above left: Past SFDS Presidents, 1988. Above right: Staff Apprecation Night, 1991. Right: Past Presidents meet at the Olympic Club, 1992.

Below: SFDS Board of Directors, 1990.

In their practices, what techniques and

1832

1893 —

Amalgam introduced in U.S.

1838

John Lewis patents dental drill

1839

1st dental magazine debuts, the American Journal of Dental Science

1896 —

G. V. Black advocates scientific cavity preparation 1st conviction in California for practicing dentistry without a license Pacific Coast Dentist magazine debuts College of Physicians and Surgeons (later UOP Dugoni School of Dentistry) founded 1st X-rays of teeth (C. Edmund Kells)

1897

American Dental Association and Southern Dental Association merge to become National Dental Association (renamed ADA in 1922)

1st dental college opens (Baltimore, chartered in 1839)

1900

Federation Dentaire International founded American Society of Orthodontists organized

1841

1st dental practice law enacted (Alabama)

1902

1844

1st use of nitrous oxide in dentistry (Horace Wells)

1848

1st printed dental supply catalog on record, Murphey’s Dental Catalogue

Edgar Randolph Parker, later renamed Dr. Painless Parker and dubbed a “menace to the dignity of the profession” by the ADA, arrives in San Francisco

— 1840

— 1849

1st dental society formed, the American Society of Dental Surgeons

1854

All-porcelain dentures patented American Dental Association founded

1867

1st self-cleaning spittoon introduced (Whitcomb Fountain Spittoon)

1868

George F. Green invents electric dental engine

1869

San Francisco Dental Society formed

1870

California Dental Association organized

1873

John B. Beers introduces gold shell crowns

—

Alfred C. Fones trains assistants to perform prophylactic procedures (beginning of dental hygienists)

1906

San Francisco earthquake

1907

William H. Taggart develops method of casting gold inlays using disappearing wax pattern

1912

National Dental Association reorganizes, adopting tripartite membership concept

California gold rush begins California 31st state admitted to U.S.

1859

1880

1905

Thomas Fletcher introduces cements and other dental filling materials C. M. Richmond patents porcelain tooth soldered to gold backing

1913

National Dental Association Scientific Foundation and Research Commission established Official Bulletin, predecessor to the Journal of the American Dental Association

1915

World Dental Congress, San Francisco

1918

1st dental hygiene curriculum in California (UCSF School of Dentistry)

1920

American College of Dentists founded

1925

Flexible materials for taking impressions begin to replace plaster

1881

University of California, San Francisco, School of Dentistry founded

1934

ADA 1st publishes Accepted Dental Remedies

1885

W. G. A. Bonwill suggests geometric and mechanical laws of articulation

1938

Mail-order dentures declared illegal

1945

1st water fluoridation

—

Act governing practice of dentistry enacted in California

1947

Oral & Maxillofacial Surgery accepted as a dental specialty

—

Southern California Odontological Society formed (reorganized to become Southern California Dental Association in 1898)

1888 —

—

Charles H. Land patents porcelain inlays Edward H. Angle devises system for classifying malocclusions

Prosthodontics accepted as a dental specialty

—

Pedodontics (now Pediatric Dentistry) accepted as a dental specialty

—

Orthodontics (now Orthodontics and Dentofacial Orthopedics) accepted as a dental specialty

Continued on p. 20

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SAN FRANCISCO DENTAL SOCIETY

ANNIVERSARY GALA

SAN FRANCISCO DENTAL SOCIETY

ANNIVERSARY GALA

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SAN FRANCISCO DENTAL SOCIETY

Linda McLaughlin | 707-303-6528

Historical equipment were available? Let’s look at what they had—and what was on the horizon: • Did they have adjustable, reclining chairs? No, but the dental manufacturer SS White had invented a standalone, attachable headrest for any chair.

The first pump-type hydraulic dental chair soon came in 1877.

Notes • Or maybe he saw Mark Twain, a frequent visitor, or John Muir, taking a break from his 6-year intensive study of Yosemite.

• He could have strolled by the new Palace Hotel or by our first banks, the Bank of CA and Wells Fargo, or our second mint at 5th and Mission being constructed.

• Did they have high-speed, air-driven handpieces? No, they only had hand drills to supplement their hand instruments. In 1871 Morrison patented the first commercially manufactured foot-controlled dental engine, and Green the first electric dental engine.

By 1873, our dentists were appreciating the invention of the cable car by a Scottish immigrant, Andrew Hallidie.

After earlier streetcars driven by steam or horses, San Francisco became the first city in the world to introduce cable cars into its traffic system.

• Did they have local anesthesia? No, but ether, chloroform, and nitrous oxide could be used.

I’m confident that our dentist predecessors were forward-looking, like most dentists. They treated their patients the best they could with the science, technology, and materials available, just like we do. But humankind always wants to make progress and improvements.

Dentists were already turning their attention from mostly extractions of teeth to saving teeth and preventing disease.

Tube toothpaste would not be available for about 20 years, but dentists made dentifrice for their patients in powder or liquid form in porcelain jars or bottles.

They designed instruments for scaling to treat and prevent periodontal disease.

• What materials did they have?

Although silver amalgam was being introduced, the best restorative material was the cohesive annealed gold foil method introduced by Arthur in 1855. Barnum developed the rubber dam, held in place by small weights around the tooth or with a wide band holding it around the head. (And isn’t that still the best method for isolation and cleanliness?) The molding process for vulcanite dentures began in 1864.

Some gold dentures were being made, both with porcelain teeth.

• After work, what did these dentists do for fun or recreation? For a nickel, he could ride a street car to the beach or take a ferry ride to Oakland. On the way to the beach, he could see the new Golden Gate Park being constructed and later view the seals at our first Cliff House.

• If he strolled around the city, maybe he saw our self-proclaimed emperor, Emperor Norton, also strolling around, eccentric, but beloved by our citizens.

ANNIVERSARY GALA

Because of that transcontinental railroad, not only goods, but knowledge reached these SF dentists faster.

In Missouri, a Union Army veteran dentist named Greene Vardiman Black was back in his office developing the fundamentals for tooth preparations and for improvements in our foot engines and our instruments. This development would soon lead our local dentists into the twentieth century.

TIMELINE

—

Public Health Dentistry accepted as a dental specialty

1948

SFDS first publishes the monthly Newsletter

—

Periodontics accepted as a dental specialty

—

National Institute of Dental Research established

1949

Oral Pathology accepted as a dental specialty

1954

1st large scale dental benefit plan in the U.S.

1955

California Dental Association Service (CDS, later renamed Delta Dental) incorporated

1957

1st clinically successful air-driven high-speed handpiece (S.S. White Co.)

1958

1st belt-driven high-speed angle handpiece (Page-Chayes)

1960

Stannous fluoride added to toothpaste

1963

Endodontics accepted as a dental specialty

mid ’6os 1967 1973 —

Sealants introduced

Michael Buonocore introduces composite resin SFDS Newsletter becomes The Mercury California Dental Association (northern) and Southern California Dental Association merge

1974

Denti-Cal created

1976

First SFDS Annual Children’s Poster Contest

1980

Per-Ingvar Branemark introduces concept of osseointegration in U.S.

— 1985

CDA creates The Dentists Insurance Company Direct digital radiography introduced First female SFDS President elected: Dr. Donna Hurowitz

1994

SFDS purchases a building at 2143 Lombard Street

—

Top left: Mayor Frank Gordon proclaims June 14 as SFDS Day, 1995. Top right: Sealant clinic, 1997. Above left: ADA Sessions booth, 1997. Above right: SFDS mortgage burning celebration, 1999. Right: GM meeting, 2000.

Below: CDA HOD, 2007.

CAD/CAM introduced in dentistry

1990 1993

1995

. . . and a Few More

SFDS building dedicated Mayor Frank Jordan declares June 14, 1995, as San Francisco Dental Society Day

1997

1st complete clear aligner system created (Invisalign)

2001

SFDS The Mercury becomes The Bridge

2019

ADA FDI World Congress in San Francisco San Francisco Dental Society Celebrates 150 years with Gala on October 5, 2019

—by Donna B. Hurowitz, DDS SAN FRANCISCO DENTAL SOCIETY

ANNIVERSARY GALA

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SAN FRANCISCO DENTAL SOCIETY

ANNIVERSARY GALA

other promo

6.75 “ FRONT COVER

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Business Partner Program

BROCHURE OUTSIDE 7.0”

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Benefits at a Glance Benefit

Appreciation Mixer.

Brand recognition

rogram

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usiness

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onals

CIATION Exceptional physicians leading our community into better health

t 707-620-0808

?

6.75 “ INSIDE FRONT COVER

Endorsed Partner

Business Partner

Business Partner

Electronic communication announcing your partnership.

YES

YES

Your company name and logo displayed in all SCMA marketing and event materials throughout your membership term.

YES ongoing

YES ongoing

Electronic communication featuring your services and products.

YES 2x per year

YES 1x per year

Article or featured benefit spotlight in News Briefs e-newsletter.

YES 4x per year

YES 2x per year

Logo and link to your website in News Briefs e-newsletter.

YES 12 +_ x per year

YES 12 +_ x per year

Descriptive listing, logo and link to your website at scma.org.

YES 12 months per year

YES 12 months per year

Advertising space in annual Awards Gala program.

YES full page 1x per year (included in Rose Gold sponsorship)

YES 1/2-page 1x per year

Rose Gold sponsorship benefits for annual Awards Gala, including name and logo on event promo materials, signage and website presentations.

YES 1x per year

NO

Ad in SCMA Physician Directory.

YES full page

YES 1/2-page

SCMA member mailing labels upon request.

YES 2x per year

YES 1x per year

Invitation to attend and recognition at exclusive SCMA-sponsored events such as workshops, Practice Managers Forum (quarterly), Physician Appreciation Mixer (annual), and other social events.

YES all events and workshops

YES by invitation to selected events and workshops

Business Partner identification on all SCMA materials carrying your business logo.

YES ongoing

YES ongoing

Use of SCMA Business Partner seal in your marketing material.

YES 12 months per year

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SONOMA COUNTY MEDICAL ASSOCIATION

Exclusive referrals by SCMA staff.

YES 12 months per year

YES 12 months per year

707-525-4375 • www.scma.org Wendy Young, Executive Director • exec@scma.org • Direct 707-620-0808

Members, guests and partners gather at the 2019 SCMA Physician Appreciation Mixer.

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and personal needs of medical professionals

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SCMA partners provide business or personal services and products that are relevant to practicing physicians—it’s a mutually rewarding arrangement that gives partners visibility with additional business prospects, and SCMA physicians benefit from referrals and pricing from trusted service providers.

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Program Details

Opportunities

Engage!

Only a limited number of businesses are invited to participate in this exclusive program. As a mission-focused nonprofit organization, SCMA accepts only experienced and highly qualified partners who share our vision of service to community.

Two primary levels of partnership, Endorsed and Business, are available to qualified companies. SCMA will accept no more than two Partners providing like goods or services. An Exclusive Partner designation is also available for those wishing to be the sole provider of specific services.

All partnership levels are open continuously with an annual commitment from the time an application is approved. Some of the benefits are shown in the Partnership Benefits Table on page 3, although the immeasurable value of access and credibility cannot be fully illustrated.

ENDORSED PARTNER ($12,000 annual fee) Endorsed Partners receive the full range of annual benefits, including expanded advertising opportunities and a Rose Gold sponsorship for the Annual Awards Gala.

Additional access is available through hosting partner-sponsored events and the opportunity to address members at SCMA functions.

BUSINESS PARTNER ($7,000 annual fee) The Business Partner level offers a strong measure of ongoing visibility and marketing outreach with inclusion in SCMA publications and the website.

Business Partners may also attend SCMA functions and selected events.

Access

Brand Referrals Partnership recognition

Your services and products will be constantly in front of physicians and medical professionals in Sonoma County.

Partner logos are featured in all SCMA publications. Your marketing materials will be displayed in SCMA’s office and distributed in membership mailings.

Cover photo: SCMA member physician Dr. Brian Prystowsky listens to a young patient’s chest while she is held by her father during her 9-month wellness exam. (BETH SCHLANKER/The Press Democrat)

SCMA Executive Director Wendy Young

Exceptional physicians leading our community into better health

AND

MI ER

FULTON CROSSING GALLERY 1200 River Road, Fulton

T H E S O N O M A C O U N T Y M E D I C A L A S S O C I AT I O N

Invites you to a

SCMA/MLCMS members and spouse or guest: No charge Nonmembers: $40 per person RSVP to Rachel, 525-4375 or rachel@scma.org

You are invited to gather with your colleagues and share a toast with the physician leaders of SCMA and MLCMS. Come share a glass of vino and let us know how we can best support you and your practice.

SPONSORS

Mixer highlights

relaxed setting. Join us and visit with our president, Dr. Peter Bretan—this is his 4th term as president—and enjoy tasting some quality craft beers. For more information about Moylan's, visit www.moylans.com.

Enjoy outstanding wines and a delicious array of appetizers.

Presidents’ Wine Reception

Stroll through multiple rooms of gallery space, filled with an extraordinary variety of multi-media paintings, sculpture, furniture and crafts.

Visit individual studios and meet artists at work.

Discover many other surprises and treats for attendees !

WITH SPECI AL GUEST S:

Sunday, Sept. 24, 2017 • 4:30 – 8:00 p.m.

Hook & Ladder Winery

2134 Olivet Road, Santa Rosa, CA 95401 www.hookandladderwinery.com

Proceeds from wine sales will go to the SCMA/SCMA Alliance and Foundation Health Careers Scholarship Fund.

ENDORSED PARTNERS

Listen to live, genre-blurring, chill-out jazz

by Eki Shola.

Dr. David Barbe, AMA President

Dr. Ruth Haskins, CMA President

Dr. Peter Sybert, SCMA President

A M E R I C A N M E D I C A L A S S O C I AT I O N C A L I F O R N I A M E D I C A L A S S O C I AT I O N

EXCLUSIVE PARTNER

SONOMA COUNTY MEDICAL ASSOCIATION

BUSINESS PARTNERS

Co-Sponsored by:

Free to SCMA members Nonmembers $15.00 David Berry, Of Counsel

Sheela SheelaHodes Hodesand and Tammra TammraBorrall Borrall Serving physician families since 2006 Serving physician families since 2006 Serving physician families since 2006

707.547.3838 707.547.3838

back to toc

Mixers . . . from a Marin pub to Santa Rosa wine & art to presidential presentations.

Invites you to a

Fulton Crossing is an artisan center in Sonoma County, providing workshop and gallery space to local artists and craftsmen. With 23 studios and two warehouses, the center offers a treasure trove of creative work. www.fultoncrossing.com

MMS’s Beer & Burgers Reception is a great way to gather with your colleagues in a

With the help and generosity of our Business Partners, SCMA is able to expand the value of membership and service to community. And at the same time, introduce members to vetted partners.

Questions or need more information?

Please contact SCMA Executive Director Wendy Young at exec@scma.org or call Wendy directly at 707-620-0808.

Historic “Sonoma Co. Hospital” painting by Eugene Perrot, circa 1896

BREWERY AND RESTAURANT

MMS members and spouse or guest: No charge Nonmembers: $45 per person To RSVP, contact Rachel Pandolfi at 415-924-3891 or rachel@marinmedicalsociety.org.

SCMA Business Partners offer services to support both professional and personal needs. See examples to the left.

All suggestions and ideas are welcome; let’s discuss possibilities and come up with a unique package that benefits your business and our physicians! How can we best work together?

15 ROWLAND WAY, NOVATO

WEDNESDAY, AUGUST 26, 2015 • 6–8 P.M.

Business Partners provide:

Partner with us!

RECEPTION

MOYLAN’S

Physicians also require a variety of personal services— from financial and retirement planning to assistance financing and purchasing homes.

Personal development Travel

To become an SCMA Business Partner, please complete the application that accompanies this brochure.

Additional copies are also available on the SCMA website at www.scma.org. We ask you to provide a company overview, to describe your products and/or services, and to propose a benefit or pricing incentive that SCMA members would receive as a result of your partnership with SCMA.

cordially invite you to attend the nineteenth annual

www.moylan.com

Medical practitioners require experts in a multitude of business activities—consultants to manage operating and capital expenses, improve compliance procedures and malpractice insurance, review legal matters, develop staff resources and apply new business strategies.

Real estate transactions

Banking services

Wildfire recovery

physician appreciation Wednesday evening May 29, 2019 — 5:30–8 P.M.

Office improvements

Insurance

You will be associated with the oldest and largest physician community in Sonoma County, while supporting a vibrant and active local organization valued by physicians.

The medical association reaches most practicing physicians and their staffs throughout Sonoma, Mendocino and Lake counties. SCMA members are affiliated with large medical groups such as Kaiser Permanente, NCMA, St. Joseph Health, and Sutter Health as well as solo/small practice groups and various organizations.

MARIN MEDICAL SOCIETY’S

Home building

Auto purchases and leases

YOU AND YOUR SPOUSE OR GUEST ARE CORDIALLY INVITED TO ATTEND

THE

Architecture and interior design

Gym memberships

The Sonoma County Medical Association, a component of the California Medical Association, is a nonprofit, professional physician membership organization.

Established in 1858, its membership consists of doctors representing all medical specialties in Sonoma County.

SCMA collaborates closely with individual physicians, medical groups, governmental agencies and healthcare providers on initiatives and programs that address public health concerns. Acceptance as an SCMA Business Partner confers strong credibility with a broad audience of influential professionals.

Legal services

Financial planning

Who We Are

EXCLUSIVE PARTNER Call SCMA regarding details and pricing for a custom benefit package.

SCMA helps reduce greenhouse emissions with an e-car partially funded through Sonoma Clean Power’s DriveEV program. Shown are SCMA Executive Director Wendy Young and SCP Chief Executive Officer Geof Syphers.

Physicians are actively referred only to approved partners—by phone, website and SCMA publications.

Physicians need: Business administration

RSVP to Rachel at 707-525-4375 or rachel@scma.org Limited to 100 Guests.

Catered by: Estate Chardonnay, Pinot Noir, Cabernet Sauvignon

lindesign@sonic.net | Linda McLaughlin

5

MUSIC MEDICINE

presenters magazines Sonoma Bach 2012-13 Season brochure, posters, post cards and program covers.

sonoma Bach PRESENTS

2012–2013 SEASON OPENING GALA & BENEFIT CONCERT FEATURING

Live Oak Baroque Orchestra Elizabeth Blumenstock, director Christopher Fritzsche, countertenor

NOVEMBER 15, 2012 8:00 p.m.

PARADISE RIDGE WINERY SANTA ROSA, CALIFORNIA

Bach sonoma

2 0 12 – 2 0 1 3

2012 sonoma

sonoma

early music festival

Bach

SO N O M A

B AC H

Bach

52 8 B STR E E T PRESENTS

SA N TA R OSA CA 95401

2012–2013

SeasonalDelights

sonoma Bach

usica Transalpina

8 PM Saturday, April 28 holy FAmily ePiSCoPAl ChurCh, rohnert PArk

4 PM Sunday, April 29 St. Andrew PreSbyteriAn ChurCh, SonomA

Schein and Schütz

The 16-voice Circa 1600 choir, joined by organist Charles Rus, performs madrigals

by Johann Schein and motets by Heinrich Schütz, two longtime friends who worked in 17th century Leipzig and nearby Dresden.

8 PM Friday, May 4 St. VinCent de PAul CAtholiC ChurCh, PetAlumA

Baro ue

Charles rus, orGan

8 PM Saturday, May 5 holy FAmily ePiSCoPAl ChurCh, rohnert PArk

asterworks

Seattle organist Charles Rus journeys to Santa Rosa’s historic Church of the Incarnation to play music of Johann Sebastian Bach and other German Baroque masters on the church’s authentic Casavant pipe organ. A recital not to be missed!

4 PM Sunday, May 6 ChurCh oF the inCArnAtion, SAntA roSA

Magnifica !

sonoma BaCh Choir

The much-loved Sonoma Bach Choir teams up with the Whole Noyse brass ensemble and members of the Live Oak Baroque Orchestra to perform grand motets and other festive music by Michael Praetorius and Samuel Scheidt, two of Bach’s most important predecessors.

8 PM Saturday, May 12 holy FAmily ePiSCoPAl ChurCh, rohnert PArk

tiCkets: $ 10– $ 18 per ConCert festival passes: $ 36– $ 60 Purchase by phone: 877-914-BACH (2224) Purchase online: www.sonomabach.org Group rates available! presented By

presents

FOR A WINTER’S EVENING

with

LIVE OAK BAROQUE ORCHESTRA

SeasonalDelihts

hristmas

An Early Music

THE NATIVITY STORY IN SONG

The Christmas story, from the with . . .

Annunciation to the Gifts of Circa 1600, chamber choir the Magi, as told through the Robert Worth, director gorgeous vocal and instrumental music of Renaissance and David Parsons, organ Baroque composers.

MUSiC oF JoSqUin AnD ByRD

WItH

Circa 1600

SATURDAY,

chamber choir

JANUARY 5, 2013 8 PM

Robert Worth, director

e Bachs were an immense musical family, with composers on almost every branch of the family tree. The Sonoma Bach Choir, Circa 1600 and Live Oak Baroque Orchestra come together to perform glorious motets by Johann sebastian Bach and two of his many musical relatives: Johannes Bach and Johann christoph Bach. celebrate the arrival of summer with these festive concerts!

WiTh

sonoma Bach choir

UNITED CHURCH OF CHRIST 825 MIDDLEFIELD RD PETALUMA

AnD

Elizabeth Blumenstock

The “Winter” concerto from Vivaldi’s beloved “The Four Seasons” headlines

Josquin des Prez

William Byrd

The springtime Feast of Corpus Christi inspired the most famous mass of the Renaissance—the Missa Pange Lingua

by Josquin des Prez—and also a gorgeous set of Corpus Christi motets

by William Byrd.

Two more Vivaldi concertos round

predecessors, 17th-century English composer Christopher Simpson.

Come early for a BaChGrounder!

TICKETS $ 12 to $ 20

www.sonomabach.org

877-914-2224

Live oak Baroque orchestra

fridAy, MAy 31

out the show, along with a rarely performed gem by one of Vivaldi’s

circa 1600 Directed by RoBeRT WoRTh

Directed by eLizABeTh BLUMensTock

this orchestral tour de force.

St. Andrew PreSbyteriAn ChurCh, SonomA

15th century Flemish tapestry (detail)

Friday, November 30

8p.m.

Saturday Afternoon Club 430 10th Street, Santa Rosa

Saturday, December 1 8p.m.

United Church of Christ 825 Middlefield Road, Petaluma

Tickets $12 to $20

www.sonomabach.org or call 877-914-2224

Portrait of Antonio Vivaldi, 1723

Brave New Music 2013 to 2017; logo design, website design, all promotional materials, concert programs.

6

The CoRPUS ChRiSTi MASS

ELIZABETH BLUMENSTOCK, v i o l i n

4 PM Sunday, May 13

BachGrounders begin 45 minutes prior to each concert. These half-hour lecture-demonstrations focus on each concert’s music, instruments, interpretation and performance practice.

Bach PResenTs

2 0 12 – 2 0 1 3

From the Alps to the Danube, Austria has long been home to great music. Violinist Elizabeth Blumenstock leads the Live Oak Baroque Orchestra and the Monteverdi Consort vocal sextet in virtuoso music by 17th century composers who worked in Vienna and Salzburg, including Heinrich Biber, Georg Muffat, Johann Schmelzer and Antonio Bertali.

SeasonalDelihts

M U S I C O F V IVALD I

live oak Baroque orChestra

CirCa 1600 ChamBer Choir

sonoma

presents

Linda McLaughlin | 707-303-6528

Saturday, March 9 8 p.m.

United Church of Christ 825 Middlefield Road, Petaluma

Sunday, March 10 4 p.m.

St. Andrew Presbyterian Church 16290 Arnold Drive, Sonoma

Tickets $12 to $20

www.sonomabach.org or call 877-914-2224

8 p.M.

saturday Afternoon club 430 10th st, santa Rosa

SAturdAy, june 1

8 p.M. United church of christ 825 Middlefield Drive, Petaluma

TickeTs: $12 to $20 www.sonomabach.org 877-914-BACH (2224)

Russian River Chamber Music Twenty seasons of promo and programs for all concerts and events. Here are just a few. " . . . I wish you every success with your audacious, varied, wonderful series!"

100 Windsor River Rd. Windsor, CA 95492 707-838-1400

musicians in the world, heard in intimate venues in one of the most beautiful places on the planet—for free.”

this brochure is generously sponsored by

offers these concerts

laimed artists on a free-

me basis.River if you 100 Windsor Rd. can’t pay,

Windsor, CA 95492 ay, please be generous. . . your 707-838-1400

NEW this season: S alon S erieS

aring stance to take among

ation who continue to charge for

r support will augment generous

ion, the bulger family, and the city a “subscription donation” if you

attendee for all five concerts.

Our a nidea n i of v ae“Stimulus r s a r yPackage,” s e a sthese on soirée events feature RRCM’s Quartet-in 2 0 0 7 -music 2 0 0from 8 Germany Residence performing and Scandinavia in two delightfully casual venues, with complimentary fine Gary served M cLauGhLin , artistic Director wines, coffee, and delectables!

mise E

This season, we are delighted

PL

to be able to return to offering our Main Stage concerts on a free

welcome

admission, donations

basis. Our popular pre-concert

them at post-concert receptions will continue to

a n n i v e r senhance a r ythesmusical e a sofferings o n our extraordinary

2009-2010

anniversary season

musicians bring to the stage.

2 0 0 8 -and 2 0this 0 9 exciting news: rrcm will Carefully Crafting & educational program be initiating a newDelivering Effectively Gary M c LauGhLin, a rtistic Director that will put string instruments into the hands Your Message

2010-2011

Gary McLauGhLin, a rtistic Director tom barnett

mise EN

of kids and provide them with individual instruc-

707 322 0773

restaurant development & management

w w w. year. m o n sPlus, o n c we o mwill m u continue n i c a t i o nour s . c olong m tradition of

G ary M c L auGhLin , a rtistic D irector

917 college avenue suite 100 santa rosa ca 95404

PLACE

tion. We will also be presenting young people in performances of various kinds throughout the +415 297 8100 |

restaurant de

anniversary season

Nineteenth

talks with the artists and the chance to visit with

Windsor, CA 95492 707-838-1400

more than you can imagine.

100 Windsor River Rd. Windsor, CA 95492 707-838-1400

— NORTH BAY BOHEMIAN

Our Main Stage concerts this season feature three international ensembles from Shanghai, Paris, and Tel Aviv.

We continue our popular tradition of pre-concert talks with the performers (7:00 p.m.), and post-concert receptions 100 Windsor River Rd. at interesting venues around town.

ARCHITECTS, INC.

harrisonwoodfieldarch.com

having our Main Stage artists present programs in local schools, and awarding scholarships that enable kids to attend summer music camps. Stay

exp. date

ouR lAdy of guAdAlupe ChuRCh on

developing educational project!

Your support is essential to the success of this season, and to our bold new educational program.

Ticket Purchase Options

• Go to www.russianrivermusic.org and click on “Purchase Tickets.”

______________________________________________________

• Call Brown Paper Tickets at (800)838-3006.

at address on back panel . . .

• Call RRCM at (707)524-8700 and leave a message. Someone will return your call to confirm or take your order.

• Tickets will also be available at the door!

MAIN Healdsburg

1083 Vine Street 136 Healdsburg, California 95448

grants from the Wallis Foundation, Faye Smith, and the City of Healdsburg. To show your support

www.russianrivermusic.org

way of a donation, send your check to RRCM at 1083by Vine Street 136

Mar

707-524-8700

theCalifornia address on95448 the back panel of this brochure, or Healdsburg,

www.russianrivermusic.org visit the updated website for information about 707-524-8700 how to contribute: russianrivermusic.org.

. . . just a few of more than 100 ensembles who have graced our stages.

MAIN STAGE CONCERTS: Healdsburg Community Church 1100 University between March Avenue and Powell

MAINSTAGE CONCERTS: Healdsburg Community Church on University between March Avenue and Powell

www.russianrivermusic.org

RUSSIAN RIVER CHAMBER MUSIC

Shanghai Q uartet

OCTOBER

2

2009 Friday, 7:30 P.M.

oin us for our Healdsburg eighteenth season of Community Church concerts featuring local and world-class artists performing music with a shanghaiquartet.com distinctly Asian Youand are in the audience a Russian Musicof of Yi-Wen Jiang, Turina, Penderecki, and Schubert European emphasis

Cocktails and hors d’oeuvres Conversation around architecture and music

The house lights dim.

Performance by the Glendeven String Quartet Catered dinner with award-winning wines

A BENEFIT EVENT

River Chamber Music concert.

After a over 25 years ago, this stellar Since its formation in Shanghai

ensemble has collaborated with some of the world’s most and for the pure inspiration distinguished artistscarand regularly tours the major music hush,offour musicians walk on stage centers of Europe, North America, and Asia. masterful music-making!

rying their instruments—and through “The whole performance was superb.” the applause, anticipation soars: What will theyTickets deliver?

Another hush, and $20 the music begins.

The room is transformed.

You can’t odiac rio viv tring uartet believe that only four musicians are MAY FEBRUARY saturating 14 5 the space with such gorgeous sounds.

You watch their arms move, 2010 2010 bowsFriday, glide: the is MenFriday, 7:30 P.M. 7:30 P.Mchoreographer .

Healdsburg Healdsburg delssohn or Mozart. Their faces are Community Community Church Church intent on the music, on each other. Your fixed Music of Poulenc, Stravinsky, Debussy, Marcus Paus,senses Milhaud, andare Bartokfilled and your Musicattention of Dohnanyi, Uri Brener, and Beethoven Renowned for their unbridled energy, depth of expression and This brilliant young Israeli quartet has chalked up top prizes at on the unfolding drama of the music, unique approach to programming, this young clarinet-violinprestigious international competitions in Australia, France, the piano ensemble has been impressing audiences and critics Netherlands, Austria,who and the Czech Republic and received the individual beauty ofcoveted fourawards voices alike throughout the U.S., Europe, and Japan. in Germany and Israel as well. call and sing, weep and laugh—alone “ The Aviv Quartet is rapidly emerging as one of today’s fi nest “ A truly polished and awe-inspiring performance. ensembles.” and together, sometimeschamber a symphonic choir and sometimes in unison—all in a All programs and artists subject to change.

Doors open at 6:45. Pre-concert talks begin at 7:00. language everyone knows at heart.

In this moment, your life has a meaning it just doesn’t have in all of its everyday moments. For this hour or two, you immerse your intellect and your senses in a delicious retreat, allowing the eloquence of Brahms or the passion of Ravel to melt down your street consciousness and elevate you to another possibility.

Welcome to the experience of live chamber music.

Russian River Chamber Music exists to bring you this.

—NEW Y ORK T I MES

Z

T

Q

A S

avivquartet—sempremusica.com

zodiactrio.com

—NYC.COM

—THE GUARDIAN (London)

“ H OUSE , Uninterrupted”—as featured in California Homes magazine—is the design of architect Richard Keding (a student of Frank Lloyd Wright) and the home of Mike and Lorene Kuimelis. Come and share its open, flowing design and panoramic views with the architect, owners, and a few good friends of chamber music.

SUNDAY , MARCH 13, 2005 DONATION $200 PER PERSON EVENT INFORMATION 707 524 8700 WWW . RIVERMUSIC . ORG

Tickets $25

Romanza November 13

2009

The Glendeven String Quartet plays and discusses masterworks of the German Romantic tradition by Beethoven and Schubert.

Hear the poetry of literary masters contemporaneous with the composers.

Enjoy Viennese coffee, German chocolate cake, and choice Riesling and Gewürztraminer wines with a short primer on German and Alsatian wines by local wine expert, Michael Hirschberg.

Friday, 7:30 P.M. MISSION: to present Flying Goat Coffee 324 Centerlive Street chamber music Healdsburg of the highest quality in a variety of settings and formats to promote the appreciation of chamber music.

Glendeven String Q uartet

Nordic Echoes April 11

2010

SUNDAY, 4:00 P.M.

Costeaux French Bakery 417 Healdsburg Avenue Healdsburg

The music of Scandinavian composers Sibelius, Nielsen, and Grieg performed by the Glendeven String Quartet and paired with Scandia-inspired hors d’oeuvres and select wines.

Enjoy the casual elegance of an old world café and be prepared for some entertaining surprises.

MISSION: to present live chamber music of the highest quality in a variety of settings and formats to promote the appreciation of chamber music.

The house lights dim.

You are in the audience of a Russian River Chamber Music concert. After a hush, four musicians walk on stage carrying their instruments—and through the applause, anticipation soars: What will they deliver? Another hush, and the music begins.

The room is transformed. You can’t believe that only four musicians are saturating the space with such gorgeous sounds. You watch their arms move, bows glide: the choreographer is Mendelssohn or Mozart. Their faces are intent on the music, on each other. Your senses are filled and your attention fixed Gary McLaughlin, Artistic Director on the unfolding drama of the music, the individual beauty of four voices who call and sing, weep and laugh—alone and together, sometimes a symphonic choir and sometimes in unison—all in a language everyone knows at heart.

In this moment, your life has a meaning it just doesn’t have in all of its everyday moments. For this hour or two, you immerse your intellect and your senses in a delicious retreat, allowing the eloquence of Brahms or the passion of Ravel to melt down your street consciousness and elevate you to another possibility. pro f iexperience l e of Welcome to the live chamber music.

Russian River Chamber Music exists to bring you this.

Brentano String Quartet

February 2001, February 2004

Los Angeles Guitar Quartet

December 1999

Kitka Vocal Ensemble

w w w. r u s s i a n r i ve r m u s i c . o r g 707-524-8700

chamber music

October 1999

Music worthy of Davies Symphony Hall . . . it seemed unbelievable that we could enjoy that much talent at that price. —John Holt

April 2000, December 2002

russian river

The Lark Quartet, with Peter (“PDQ Bach”) Schickele

Shanghai String Quartet October 2000

—Terry Rusinow

My check is enclosed

heAldsbuRg CommuNity ChuRCh on

university between march Ave. & powell old Redwood highway just North of hembree ln.

Five-Concert Subscription $100 ($10 savings)

The Russian River Chamber Music Society’s concerts have done much to bring this vital art to a broad and general public.

They put great music where it belongs: in the community. —Charles Shere, The Press Democrat

______________________________________________________

______________________________________________________

tuned through our website for more news on this

Patrons’ contributions will augment generous

Single Tickets $25 / Youth 18 and under, $13

The Russian River Chamber Music Society brings first-class talent to Healdsburg. They contribute immeasurably to the artistic life of our community and deserve generous support for being such a treasure. —Bob Snyder

______________________________________________________

Salon S ERIES

This is music that is diverse, exciting, and fresh. The professional quality is a pleasure to the senses. And it’s in Healdsburg!

ouR lAdy of guAdAlupe ChuRCh on d Redwood highway just North of hembree ln. ______________________________________________________

Kudos to the Russian River Chamber Music Society for offering us the world’s great music played by brilliant international musicians.

The intimate and exquisite beauty of chamber music enriches our lives. —Barbara Medaille

______________________________________________________

707-524-8700

Single Tickets $20www.russianrivermusic.org / Youth 18 and under, $10

The Russian River Chamber Music Society brings first-class talent to Healdsburg. They contribute immeasurably to the artistic life of our community and deserve generous support for being such a treasure. —Bob Snyder

______________________________________________________

M AIN STAGE S ERIES

This is music that is diverse, exciting, and fresh. The professional quality is a pleasure to the senses. And it’s in Healdsburg!

usic.org

Kudos to the Russian River Chamber Music Society for offering us the world’s great music played by brilliant international musicians.

The intimate and exquisite beauty of chamber music enriches our lives. —Barbara Medaille

00

______________________________________________________

—Terry Rusinow

1083 vine street 136 healdsburg, california 95448

rnia 95448

______________________________________________________

The Russian River Chamber Music Society’s concerts have done much to bring this vital art to a broad and general public.

They put great music where it belongs: in the community. —Charles Shere, The Press Democrat

Tickets

t 136 008-2009 season supporter!

_________________

this brochure is generously sponsored by

“ . . . some of the best chamber music ever written performed by the best

bay boheMian sly—north sponsored by

G • I N T E R I O R S

this br

great chamber music . . .

this brochure is generously sponsored by

—Tim Munro, eighth blackbird (2009 Grammy-Award winners)

er chamber Music graciously all over the musical spectrum on for quality and taste."

oodfield

Swentyof Years

Chamber music is a conversation unlike any other

in the performing arts. The players in any given concert are few and their talents prodi-

Gary McLaughlin, Artistic Director

gious. Each player is indispensable. There is no conductor: each player contributes to the whole in a complex dialog of giveand-take. The result is magnificent music-making in which each voice is clearly heard as part of the musical offering.

Because it’s performed in smaller venues, chamber music offers an intimacy and immediacy rarely experienced with large ensembles in huge halls. Because the concerts are easier to produce and cost less than orchestral concerts, they are a particularly effective means of presenting classical music— both traditional and new—to a wide spectrum of audiences.

Miro String Quartet

October 2003, April 2006

Healdsburg’s not a small town anymore, and the Russian River Chamber Music series proves it.

— Diane Peterson The Press Democrat

Russian River Chamber Music began in May of 1992 when Gary and Linda McLaughlin produced the “Prelude to a Season” concert to determine if there was an audience for chamber music in the Healdsburg area.

There was. They enlisted a board of directors, and the premiere

Eroica Trio May 1998

Providing opportunities for children

to experience the joys of chamber music early in life is central to Russian River Chamber Music’s mission.

Each year, at least one of the visiting ensembles presents an educational program for young people in local schools as part of this outreach. Family concerts have been offered at various venues, and an ongoing emphasis on music education for adult listeners is encouraged with pre-concert interviews with musicians, radio interviews, and concert broadcasts.

The work of the Russian River Chamber Music Society is accomplished through the generous efforts of its volunteer board and part-time staff. Financial support comes from member contributions, season underwriting, concert sponsorships, grants, and ticket sales.

The success of the series

speaks for the timeless attraction of chamber music: its intimacy, beauty, diversity, and excitement. We urge you to attend our concerts and experience for yourself the pure inspiration of masterful music-making. We invite your much-needed financial support. And we thank you for your participation in the ongoing effort to bring the highest level of chamber music artistry to our community.

season was launched in the fall. Non-profit status was acquired the following year.

p r of i l e Cuarteto Latinoamericano

November 2004

At its primary concert venue—Healdsburg Community Church—as well as the Performing Arts Center in Windsor, RRCM has presented more than 60 instrumental and vocal ensembles of national and international renown, performing over 250 works of music from the 10th to the 21st centuries.

w w w . r u s s i a n r i v e rThe mseries u s has i cfeatured . o r gpost-concert receptions in various community locations so that audience members may meet and visit

7 0 7 - 5 2 4 - 8 7with0 the 0 performing artists.

What I love about Russian River Chamber Music is that even the “musically challenged” are welcomed to the warmth and intimacy of the venue and treated to great music in an accessible and personal way.

—Demaris Brinton

Music fr

om

O

Sonoma Paradiso Evolving from the “Imagine” benefit auctions, these annual free children’s concerts featured guides to the music, CDs, and art projects coordinated with f this World! ut o community organizations.

Rocks!

2010 sonoma paradiso

Community Concert

santa rosa symphony Richard Loheyde, conductor Marcy Smothers, emcee

tuesday, august 3, 2:00 p.m.

Preparation

sonoma county fairgrounds

activities for the

2007 Children’s Concert

santa rosa, california

The SANTA ROSA SYMPHONY Richard Loheyde, conductor Thursday, July 26, 2007 Wells Fargo Center for the Arts, Santa Rosa, California

back to toc

lindesign@sonic.net | Linda McLaughlin

7

Co 41

BOOKS

various

Introduction

1

When thou dost ask me blessing, I’ll kneel down And ask of thee forgiveness: so we’ll live, And pray, and sing, and tell old tales, and laugh At gilded butterflies, and hear poor rogues Talk of court news and we’ll talk with them too, – Who loses and who wins; who’s in, who’s out; – And take upon’s the mystery of things, As if we were God’s spies: and we’ll wear out, In a wall’d prison, packs and sects of great ones, That ebb and flow by th’moon.

—Shakespeare, King Lear, Act IV, scene III, p. 245

Aging and Neurocognition: Overview and Case History Gregg Richardson I’M GREGG RICHARDSON. I’m 66, a full-time clinical neuropsychologist at the Kaiser Oakland Medical Center, and cared for both my parents in my Berkeley home for roughly a decade, coordinating their medical care, home care and finances, until both died (peacefully) in their 80s.

After Mom came home from a skilled nursing facility following hip repair, I tried caring for her myself, but within two weeks had hired a weekday caregiver. You don’t realize how draining it is to add hours of caregiving to a full-time work schedule unless you’ve done it. You also come to appreciate why single working mothers (and others in similar positions) are over-stressed and under-appreciated.

My favorite joke of last year was about the older man who walks into a bar, goes up to an older woman on a bar stool and says, “Hey, beautiful! Do I come here often?” The older you are, the more likely you are to appreciate that joke, since we all get a little forgetful as we age.

In fact, lots of things happen to us with age, and memory is only one of the areas in which we can decline. My mother’s physician once sent her home with a list of the things that can happen as we age. The one I understood immediately was that you know you’re over 50 when an “all-nighter” means not getting up to pee. That’s most often because various parts of our lower urinary tracts become less reliable, and why

Prayers, songs, laughter, the telling of tales, all ripened by age, a passing-on of the wisdom learned in simply being alive. The great gift of aging, to pass on wisdom to those yet to age.

These stories were developed primarily from panels, starting in 2004, in which various helping professionals discussed aging with other professionals and lay people of different ages and cultures as part of continuing education. These panels were and continue to be sponsored by the International Institute for Humanistic Studies (www.humanstudies.com), a nonprofit organization dedicated to building bridges of communication among cultures through compassion, courage, hope, resilience, and tolerance. We hope that that these facts and stories become gifts of wisdom for you, as you too awaken to aging.

—Myrtle Heery Spring 2015

References Shakespeare, W. (2005). The tragedy of King Lear (J. L. Halio, Ed.), Cambridge, England: Cambridge University Press.

Varnedoe, K. (2006). Pictures of nothing. Princeton, NJ: Princeton University Press.

The Santa Rosa Reader

4

Crisis of Faith?

(196 pages)

(2008)

I

jessica flinders

’ve never begun an editorial in these pages with more misgiving. This won’t be a “feel good” piece. The profession I’ve served and loved for over 30 years has provided me livelihood, fulfillment and inspiration. With rare exception, my colleagues have been diligent and dedicated professionals, committed to caring for the patients we mutually serve. To my colleagues, I say it is still a pleasure and privilege to work with you all. But we work inside a lousy system.

In fact, it is no system at all. So if I seem critical, please understand that my complaint here is a lover’s quarrel.

Medicine is a mess. We spend $2.2 trillion a year for health care in the United States, and it’s not as good as we thought. “Best health care in the world” now refers to isolated islands of medical excellence in a sea of mediocrity. By the best health metrics our outcomes rank 37th in the world. Among the 13 industrial economies of the world we rank last. We can transplant organs and keep people alive through the terminal stages of chronic illness, but we can’t immunize many of our children, guarantee adequate care to all our pregnant women, or provide basic care and preventive services for the estimated 45 million people in our population who are uninsured.

Not a pretty picture. Few want it this way, but the problem is complex, and it touches every level of values around which societies organize. Health care has been described by one bioethicist as “the largest social reform issue in the U.S. since the abolition of slavery.”

The author, taking the words of the late Edward M. Kennedy to the streets, Health Care Rally, Santa Rosa Courthouse Square, September 2009.

80

THERE IS A WILDERNESS

81

(106 pages)

in the middle of the heart.

It’s not just a tangle of underbrush, though it seems mostly that.

In places there is a fertility where a seed’s green arm can reach into the light, and in time unfurl a bright many-petaled corolla.

A rubble of rocks tell of a landslide from long ago and now bank a small lake of clear blue sky.

This geography has its own weather which is change itself and brings moisture in tear-like precipitation to the dry stony stubble.

And beyond the desert parts, if you keep going, you might discover a meadowed valley where the sweet smell of earth and flowers breeze through birdsong-laced air.

Though the heart can hardly be mapped, it’s had its cartographers, whose hard-won findings we search for in what we call art.

3

2

(84 pages) (174 pages) Ch. 4

Chapter Four: FOUR-LIMB STUDIES

CHAPTER 4 • FOUR-LIMB STUDIES

Ch. 4

I

DIFFERENT DOWNBEATS

n the first three chapters, we worked with the one-, two-, and three-limb studies respectively. Before launching into the study of four limbs I would like to review the “how to” process of the diagrams. The purpose of each diagram is to help the drummer focus on the flow of energy between specific limb combinations, with the goal of deconditioning pathways of reflexive, inappropriate responses, which can appear when energy is not flowing. This awareness of internal flow leads directly to a more melodic execution of musical ideas on the drum set. Below is an example (also shown on page 5) of a four-limb sequence in 2/4 time written in standard notation. Below that is the same sequence using an Inner Drumming diagram.

The final set starts with the left foot.

Continue by using different limbs as starting points. This will strengthen your ability to play phrases that begin on different parts of the kit.

The following diagrams start with the right hand.

INCORPORATING RHYTHMS The Inner Drumming diagrams allow for the insertion of any rhythm that you choose. The simple three-note rhythm below can be plugged into the four-limb sequence, RF-RH-LH-LF.

THE JOURNEY CONTINUES The remaining diagrams on the next two pages continue with another way of playing with all four limbs. By now you should be able to read the diagrams without the labels for each limb.

The next set starts with the left hand.

Below is the three-note rhythm in standard notation when it’s plugged into the four-limb sequence on the left. The accents show the beginning of each four-limb grouping.

MAP IT OUT SLOWLY To establish a new four limb sequence, start with one limb at a time and progress to all four. The following set of four diagrams all start with the right foot (circled dot) and add one limb at a time. As before, take your time and feel the movement of energy through the pathways. The point is to give yourself the opportunity to relax and establish an internal map of the different linear combinations. Speed and musical expression will then flow more freely in your playing.

FOUR-LIMB PENDULUM RUDIMENT

Now repeat that rhythm in the sequence without reading the notation. Make sure you stay true to both the rhythm and the sequence, and remember to count. This produces an interesting polyrhythmic effect, which could look complex when written in standard notation, but is easier to comprehend internally when using the diagrams. You will have success when the key rhythm is allowed to flow internally, and the linear movement from limb to limb becomes second nature. I also recommend improvising freely, in or out of time, with any rhythm that you choose.

When experimenting, play single hits on each limb at first and then explore multiple strokes.

The next diagram is a four-limb pendulum rudiment that’s created by alternating between the two diagrams above. Take your time and experiment by playing them with different pulses and rhythms.

Work slowly at first until the pendulum rudiment is internalized.

26

27

(88 pages) (click images for online sampler) nEw york, is a full-throttle experience.

lokoya & the neW york experIence

in Cabernet Sauvignon.

While in New York, enjoy dinner for four with famed

Did you notice it today? Passion and imagination led to the penning of music and

novelist Jay McInerney, author of Bright Lights, Big City at

ultimately to the crescendos of the collective artistry of musicians who have spent a life-

Mario Batali’s renowned Babbo Restaurant in New York City’s

time preparing for today’s performance. We will see it again today—just look around you.

Bright Lights, Big City, Bold Wine

West Village. Mr. McInerney, who also happens to be editor of House &

There is something fanciful about being here in the Grand Pavilion, isn’t there?—the

—MARCEL PROUST

likE

Robert Parker refers to these singular wines as a tour de force

that writes the future. It sets the course for passion.

Auction Lots

Welcome

• One 3L 2002 Lokoya Mount Veeder Cabernet Sauvignon • One 3L 2002 Lokoya Howell Mountain Cabernet Sauvignon • One 3L 2002 Lokoya Diamond Mountain Cabernet Sauvignon

lokoya,

I magInatIon powers everything new and all things worthwhile. It is the notion

Garden magazine, will sign two first-edition copies of his best seller. Next,

noonday sun playing across the stage in anticipation of the auction; the return visit of

Maximilian Riedel will host a lunch for four at Le Bernardin where he exhibits

the Russian National Orchestra; the vividly moving, inspired works of art that came to

the finer points of Riedel Sommeliers glassware using an array of artisan wines.

us from the halls of Russian orphanages and from children’s charities here in Sonoma

Enjoy the Sommeliers glassware at home with a set of four. The lot includes two

County. Stirring, indeed!

nights for two couples at luxurious accommodations in midtown Manhattan.

As sponsors and donors, we can unleash the same power of imagination to uplift

(4 Guests • 2 Nights • Airfare not included)

those who are least able to help themselves: children. Thank you for your generosity,

donoRs: Barbara Banke and Jess Jackson; Jay McInerney; Riedel Crystal

which empowered us to load this book with exotic adventures, rare experiences, and incredible collections of artistry in the form of wine and engineering marvels. It’s enough to conjure up childlike awe in all of us.

Remember to let your imagination run free. Enjoy yourself. Be playful. Be open and giving, remembering that 100% of today’s auction proceeds go directly to children’s charities. This is about imagination as a preview of life’s coming attractions. Consider yourself the writer and producer of that future—our children’s future—just an arm’s

a u c t i o n

reach away.

c a t a l o g

Peggy & Fred Furth

Barbara Banke & Jess Jackson

Imagine 2005 Event Chairs

2

Painting by Sergei Abdzyachimov, age 15 (detail)

3

Sher Music Co. . . . A few cover designs.

8

Linda McLaughlin | 707-303-6528

3

40

Painting by H. Boeshko(detail)

41

WINE

marketing

(crop mask available)

92

april 30, 2008

“Outstanding Value Producers” 2005 Chalk Hill Estate Bottled Chardonnay — 90 points —

2001 Chalk H ill Estate Vineyard Selection

“Refreshing, intense and vibrant, with a mix of spice, floral, fig and

pinot gris

apricot flavors that are rich, deep and complex.”

Chardonnay

of white peach, “ Nose apricot, jasmine, mineral and

barrel-fermented style emphasizing bold, ripe fruit and toasty oak. Steve Leveque oversees the winemaking; all of the grapes are estate-grown.

a subtle note of almond.

“It’s a fairly unique area, in the hillsides, not like valley floor viticultural,”

Round and luscious

says Leveque, who explains that it’s warmer than other pars of Sonoma,

with deep, concentrated flavors of honeydew

melon, red apple

has always been this winery’s

go-to wine, and over the years it has been made in rich and distinctive,

such as Russian River, and has a mix of volcanic and river bed soils.

Employing full Burgundian methods, Leveque aims to add more layers, nuance and texture to the wine. He’s also picking the fruit a little riper.

and

— James Laube

brown spice. The wine’s 1.4 percent residual sugar adds

richness to the texture without overt sweetness, much like a similarly priced grand cru Alsace version.

”

C H A L K H I L L E S TAT E V I N E YA R D S & W I N E R Y 10300 CHALK HILL ROAD, HEALDSBURG, CALIFORNIA 95448

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Chardonnay. A portion of the proceeds from the sale of each bottle will be added to the ongoing

nnay clones, studied for

efforts of the Furths’ personal goal of

blending—leading to

helping disadvantaged children.

han eleven

BLENDED FROM FOUR SPECIFIC vineyard blocks, the wine shows impressive

g s ea s o n

fruit richness and concentration. It was fer-

t with Sauvignon Blanc

mented and aged in small French oak barrels, adding texture and complexity to the bright fruit character. Aromas and flavors of exotic fruits— fig, green apple, pineapple, mango—then spices,

ng of Sauvignon Blanc

hazelnut, and caramel add to the crisp, fresh acidity

mentation,

making it an ideal food wine or engaging aperitif.

ve fermentation

Drink this wine with family, friends and food!

nd roundness

non Blanc

It’s meant to be enjoyed, not pondered—unless it is to cause joyful reflection and thanksgiving.

“ In the vineyard, it’s our calling to assist the land

PRODUCTION DETAILS

in making the wines for us; in the winery, careful

Blend 100% CHARDONNAY Appellation 100% RUSSIAN RIVER VALLEY Alcohol 14.2%

nurturing enhances the way the wines express the land. To taste the white wines of Chalk Hill Estate is to u nder st and t hat t hey c ould c ome fr om no oth e r p lac e.”

— Steven Leveque, Winemaker

y

forn i a 9 5 4 4 8 lk h i ll . c o m

C h a l k H i l l E s t at e ’ s Wo r l d - C l a s s Wh i t e s White Wines at Chalk Hill Since Chalk Hill Estate’s founding in 1972, proprietors Fred and Peggy Furth

tropical flavors; and the Estate’s coolest, north-facing slopes give Pinot Gris the long hangtime it needs to reach optimum ripeness.

have been committed to cultivating world-class white wines. These wines are

The Furths honor the rich legacy of Chalk Hill Estate with a commitment to stewardship of the land. Over

exclusively Estate grown, sourced from among the 60 vineyard blocks that lie

two-thirds of the property remains uncultivated, with vineyards that lie among and rise above beautiful for-

along our 350 planted hillside acres.

An exceptional variety of soils, aspects and slopes allows each wine to develop its finest character under the specific growing conditions it likes best— resulting in Chardonnay, Sauvignon Blanc and Pinot Gris wines of intensely aromatic, impeccably balanced varietal expression.

Diverse Terroir Defines a World-Class Appellation From dramatic hillsides to vineyard gardens, from dry creek beds to forests of native oak—the most prominent feature of Chalk Hill Estate is diversity. Long ago, seismic upheaval lifted the floor of the Russian River Valley to the hilltops, forming this diverse landscape and imparting it with incredibly varied soil profiles. In amazing proximity, soils here range from gravel and rock to clay

winemaking. Following pressing, our Chardonnay wines cold settle and then are gently transported to French oak barrels from renowned Burgundian cooper François Frères.

Steve carefully determines the percentage of new oak that will best enhance

ests and gardens. The high erosion potential of the steep hillside vineyards requires an integrated approach

each lot. Fermentation takes place with 100% native yeast, a rare practice

to management. Sustainable farming preserves the beauty and productivity of the site without disturbing

among Chardonnay producers that greatly improves wine quality. Complete

the surrounding ecosystem.

malolactic fermentation contributes roundness and depth. The wines age in

Crafting World-Class White Wines

plexity. This is a point where many producers leave wines on their own. By

barrel with their solids, while constant bâtonnage develops layers of com-

At Chalk Hill Estate, we believe that hands-on vineyard methods mean minimal intervention is necessary

contrast, and according to the Burgundian practice of élevage—literally the

later, during winemaking. For Chardonnay, we subscribe to a meticulous Burgundian philosophy—some-

raising of the wines, as one raises children—Steve closely monitors the wines’

thing many wineries claim but to which few actually commit. For our Graves-style Sauvignon Blanc, our

development during the 10 to 12 months of aging prior to bottling. Because we

winemaker Steve Leveque has been particularly influenced by Professor Denis Dubourdieu’s research at the

are committed to vineyard and winery practices that make fining and filtering

University of Bordeaux. Since coming on board in 2003, Steve has made significant improvements in every

unnecessary, we are one of the few producers who release 100% unfined and

step of our white wine production, from vineyard to winery.

unfiltered Chardonnay.

In the vineyard, we keep yields low, and regularly remove leaves as needed to permit penetration of light and

Sauvignon Blanc also cold settles before transport to a combination of new and

loam. In places, a distinctive layer of volcanic ash called tufa lies under the

air. While this is beneficial for all our white wine grapes, it’s crucial with Sauvignon Blanc, as optimum light

used French oak. With this variety, Steve prevents oxidation throughout wine-

topsoil, inspiring the name “Chalk Hill.” Unique climatic features also distin-

exposure reduces the presence of unattractive vegetal characters. We hand-harvest all our white wine grapes

making—from press right through to bottling. Oxidation negatively affects the

guish Chalk Hill from the neighboring appellations. Russian River Valley, to

into small containers, making multiple passes through the vineyards to ensure the grapes have reached full

delicate Sauvignon Blanc nuances Steve likes to emphasize with the clones he

the west, is cooler, while Alexander Valley, to the northeast, is warmer. Chalk

maturity. At the winery, we hand-sort every cluster, discarding clusters—and even single berries—that don’t

selects—passion fruit and grapefruit, rather than the wine’s more typical grassy

Hill’s unique position in the middle receives the best of both influences.

As early as 1870, winegrowers took advantage of these sites, and today we source our white wines from vineyards dedicated to Chardonnay, Sauvignon

reach our standards. Throughout direct-to-press, whole-cluster pressing, Steve samples the flavor and tex-

expression. In addition, the wine does not undergo malolactic fermentation, so

ture of the juice in order to determine when to stop. All our wines are vinified in separate lots throughout

that it may retain its bright varietal character. Bâtonnage enhances complex-

Chardonnay

Sorting Sauvignon Blanc

ity, and the wine’s development is closely monitored in Boutes and Sylvain French oak barrels. Sauvignon Blanc is bottled unfiltered.

Blanc, Semillon, Sauvignon Gris and Pinot Gris. For more than 30 years, we’ve studied this rich diversity of growing areas and replanted each wine variety in

With Pinot Gris, pressing is a delicate balancing act. Steve tastes the juice

the specific location it likes best. We optimize each element of wine growing—

every few minutes, carefully managing the lightest extraction of color from the

row vine orientation, sun exposure, rootstock, irrigation, spacing and trellis-

coppery-purple grape skins. After cold settling, Pinot Gris ferments in neutral

ing systems—for white wines of unmatched character and unique personality.

French oak barrels (four to five years old). As with Sauvignon Blanc, malolac-

We source Chardonnay from sites like our original Founder’s Block, where our

tic fermentation is prevented in order to retain brightest varietal expression.

oldest vines produce tiny, very concentrated berries; Sauvignon Blanc thrives

Aging in barrel on its lees allows Pinot Gris to become richer and more layered,

on the Estate’s gravelly hillsides and loamy clay enclaves, where some blocks

and regular bâtonnage further develops the wine’s complexity. After 10 to 12

contribute stone fruit and minerality while others impart aromatic perfume and

months of aging, the wine is bottled unfiltered. f

Pinot Gris

Join us for the Chairman’s Club Spring Gathering

“A Day in Provençe” Relax and enjoy a beautiful spring day at Chalk Hill Ridge Park, while feasting on a Provençal picnic prepared by Chef Didier. Sip wines especially selected for the occasion by Steve Léveque. date: Saturday, May 10, 2008 time: 12:00 noon–4:00 p.m. chairman’s club members $85 non-club members $100 RSVP to Diana Brown at 707.657.4845 or dbrown@chalkhill.com

by April 25, 2008

back to toc

lindesign@sonic.net | Linda McLaughlin

9

References SUSAN GUMUCIO

Communications Director Sonoma-Mendocino-Lake Medical Association, 2013–present susan@smlma.org 707-481-8995 STEVE OSBORN

Director of Communications Sonoma County Medical Association,1991–2013 Editor, Sonoma Medicine, Marin Medicine, 1991–2016 osborn53@sonic.net 707-527-8568 HOWARD DANIEL

Editor, Marin Medicine, 2015–2016; pen4rent.com howard@pen4rent.com 707-657-7674 CHUCK SHER

Owner/Publisher, Sher Music Co., shermusic.com shermuse@sonic.net 707-763-8134

“Spectacular work!”

—Steve Osborn

“For two years, I closely collaborated with Linda on the production of Marin Medicine magazine. Rarely have I had the pleasure of working with so versatile and talented a graphics/design professional.

—Howard Daniel

“You’re the best I’ve ever worked with! Thank you for everything.”

—Cynthia Melody, MNA Executive Director, 1991–2016 Sonoma County Medical Association Marin Medical Society Mendocino-Lake County Medical Society

10

Linda McLaughlin | 707-303-6528

| lindesign@sonic.net