Saturday, November 5, 2011

Breakthrough in treatment of heart disease

Medical breakthrough for heart repair
latestmedicaltechnology.net

In a medical breakthrough a man’s heart was saved through the use of a breakthrough medical technology. The man, John Christy, is the first person in the United States to undergo this procedure. The new procedure utilizes stem cells in helping repair the arteries all throughout a person’s body.
Christy was suffering from coronary artery disease at a very advanced stage. What was done to him was to insert his own specific stem cells into his body during a CABG surgery. The stem cells are used to grow new blood vessels in the heart. This is a revolutionary procedure that can save millions of lives when it is further developed and become widely available.


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Taking Your Blood Pressure Drugs at Bedtime May Cut Heart Risk

Blood Pressure Drugs at Bedtime May Cut Heart Risk

Study Suggests Benefits to Taking Blood Pressure Drugs Before Going to Sleep

By Kathleen Doheny
WebMD Health News
Reviewed by Laura J. Martin, MD

Oct. 27, 2011 — Taking at least one blood pressure medicine at bedtime cuts the risk of heart problems, according to new research.

The study also shows that participants taking at least one blood pressure pill at bedtime had lower blood pressure while asleep.

Earlier studies have suggested that bedtime dosing of at least one blood pressure medication may help control blood pressure. But the new study is believed to be the first to look at whether the timing makes a difference in terms of heart attacks, strokes, and death.

Ramon C. Hermida, PhD, director of the bioengineering and chronobiology labs at the University of Vigo in Spain, studied 661 people with both high blood pressure and chronic kidney disease.

“Taking blood-pressure-lowering medication at bedtime, compared to [taking] all medication upon awakening, not only improved blood pressure control, but significantly reduced the risk of cardiovascular events,” Hermida says in a news release.

The research appears in the Journal of the American Society of Nephrology.

Timing of Blood Pressure Medicines

Hermida’s team asked half of the men and women to take all their blood pressure medicine when they got up in the morning. On average, each person took two medicines. Many took more than three.

The researchers asked the other half to take at least one of their blood pressure medicines at bedtime.

They measured blood pressure by using 48-hour ambulatory monitoring at the start of the study — not just a single daytime measurement used in most earlier studies. They also measured blood pressure three months after any treatment changes or, at the least, every year.

The researchers followed the men and women for about five and a half years. They looked to see which heart problems developed. They tracked death from any cause and from heart disease or stroke.They also tracked heart attack, angina, heart failure, and other problems.

More than half of those with chronic kidney disease also have high blood pressure, according to the National Kidney Foundation. High blood pressure increases the risk of the kidney disease worsening. Overall, one in three U.S. adults has high blood pressure, according to the researchers.

Bedtime Dosing of Blood Pressure Medicine

Those who took at least one blood pressure medicine at bedtime had lower nighttime blood pressure while asleep. They were also more likely to have overall good control of their blood pressure.

The bedtime group was one-third as likely to have heart and blood vessel problems such as heart attack, stroke, or heart failure, the researchers found.

Improved overnight blood pressure with bedtime dosing had a real benefit. Each 5-point drop in sleep-time blood pressure was linked with a 14% reduction in risk for heart attack, stroke, or heart failure.

“Cardiovascular event rates in patients with hypertension can be reduced by more than 50% with a zero-cost strategy of administering blood pressure-lowering medications at bedtime rather than in the morning,” Hermida says in a news release.


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Thursday, November 3, 2011

How does cancer know its cancer? The answer leads to a new approach to treatment.

TED is a great site. The site says TED Ideas Worth Spreading. This video is a great example. It is titled How Does Cancer Know It Cancer? It looks at the cure of Cancer in a new light.

http://www.ted.com/talks/jay_bradner_open_source_cancer_research.html

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Vampire like bacteria may become antibiotic

Vampire-like Predatory Bacteria Could Become A Living Antibiotic
| 80beats | Discover Magazine blogs.discovermagazine.com | by Douglas Main





The bacterium Micavibrio aeruginosavorus (yellow), leeching
on a Pseudomonas aeruginosa bacterium (purple).
What’s the news: If bacteria had blood, the predatory microbe Micavibrio aeruginosavorus would essentially be a vampire: it subsists by hunting down other bugs, attaching to them, and sucking their life out. For the first time, researchers have sequenced the genome of this strange microorganism, which was first identified decades ago in sewage water. The sequence will help better understand the unique bacterium, which has potential to be used as a “living antibiotic” due to its ability to attack drug-resistant biofilms and its apparent fondness for dining on pathogens.
Anatomy of a Vampire:
The bacterium has an interesting multi-stage life history. During its migratory phase it sprouts a single flagellum and goes hunting for prey. Once it find a delectable morsel of bacterium, it attacks and irreversibly attaches to the surface, and sucks out all of the good stuff: carbohydrates, amino acids, proteins, DNA, etc.
Sated, the cell divides in two via binary fission, and the now-depleted host is left for dead.
Hungry for Pathogens:
M. aeruginosavorus cannot be grown by itself; it must be cultured along with another bacteria to feed upon. A 2006 study found that it only grew upon three bacterial species, all of which can cause pneumonia-like disease in humans. A more recent study showed that it can prey upon a wider variety of microbes, most of them potentially pathogenic, like E. coli.
These studies also found that M. aeruginosavorus has a knack for disrupting biofilms, the dense collection of bacteria that cause harmful plagues on teeth and medical implants alike, and can be up to 1,000 more resistant to antibiotics than free-swimming bugs.
The bacteria can also swim through viscous fluids like mucous and kills Pseudomonas aeruginosa, the bacterium that can colonize lungs of cystic fibrosis patients and form a glue-like film.
These qualities have caught the eye of researchers who think it could be used as a living antibiotic to treat biofilms and various types of drug-resistant bacteria, which are a growing problem in medicine. Sequencing the organism’s genome is an important step in understanding its biochemistry and how it preys on other microbes.
Clues From the Vampire Code:
The new study found that each phase of life involves the use (or expression) of different sets of genes. The migratory/hunting phase involves many segments that code for flagellum formation and genes involved in quorum sensing. The attachment phase involves a wide variety of secreted chemicals and enzymes that facilitate the flow of materials from the host.
Micavibrio aeruginosavorus possesses no genes for amino acid transporters, a rather rare trait only seen in a few other bacterial species that depend heavily upon their host to help them shuttle these vital protein building-blocks. This absence helps explain the bacterium’s dependence on a narrow range of prey, from which it directly steals amino acids. Although it remains unclear exactly how the microbe attaches to and infiltrates other cells.
The Future Holds:
The range of microbes upon which Micavibrio aeruginosavorus can survive is expanding; after being kept in laboratory conditions for years it has apparently evolved a more diverse diet. If this expansion continues, that could be a real problem for its use as an antibiotic; it could begin to eat beneficial gut bacteria, for example.
Researchers claim it is harmless to friendly gut microbes, but it hasn’t been tested on all the varieties of bacteria present in humans.
Several important steps must be taken before testing in people, like learning more about what traits makes another bacteria tasty to Micavibrio aeruginosavorus. Researchers speculate the bacterium may need to be genetically altered in order to go after specific pathogens, or to reduce the risk of it causing unforeseen complications.
Reference: Zhang Wang, Daniel E Kadouri, Martin Wu. Genomic insights into an obligate epibiotic bacterial predator: Micavibrio aeruginosavorus ARL-13. BMC Genomics, 2011; 12 (1): 453 DOI: 10.1186/1471-2164-12-453
Image credit: University of Virginia
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November 2nd, 2011 2:07 PM Tags: antibiotic resistance, antibiotics, bacteria, genome sequence, genomics, Pseudomonas aeruginosa
by Douglas Main in Environment, Health & Medicine, Living World, Top Posts | 7 comments | RSS feed | Trackback >



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Wednesday, November 2, 2011

A potential new bio marker for heart attack

From online WSJ

Cardiac biomarker: A protein that regulates heart-muscle contractions may help to diagnose heart attacks in the 60% to 70% of patients admitted to the hospital with undetermined chest pain, according to a U.S.-led study in the Journal of Molecular and Cellular Cardiology. Cardiac biomarkers are proteins released into the bloodstream that signal a heart attack has occurred and its severity. The most widely used biomarker, cardiac troponin-I, takes up to six hours to be detected, and elevated levels also can indicate severe infections and other conditions.

Experiments on rats and human blood samples found that cardiac myosin binding protein-C (cMyBP-C), a large protein that plays a key role in stabilizing the heart, is a potentially faster, more precise cardiac biomarker than troponin-I, researchers said. Initial experiments showed significantly higher levels of cMyBP-C in rats with induced heart attack compared with control animals.

Further experiments found greater concentrations of cMyBP-C than cardiac troponin-I in blood samples from 16 heart attack patients compared with 11 healthy controls. Laboratory tests showed cMyBP-C is released quickly and can be detected up to 12 hours following a heart attack.

Caveat: It isn’t known if cMyBP-C is released from ischemic, dying or injured cells, or a combination of the three. The research was carried out in rats and a small number of blood samples from humans.


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Breakthroughs in Mobile Technology for Medicine - WSJ.com

Breakthroughs in Mobile Technology for Medicine - WSJ.com
online.wsj.com
By STEPHANIE SIMON

Eric Topol felt a twinge of nostalgia when he stopped carrying around his trusty stethoscope.

It didn’t last long.

Dr. Topol, a cardiologist in San Diego, carries with him instead a portable ultrasound device roughly the size of a cellphone. When he puts it to a patient’s chest, the device allows him to peer directly into the heart. The patient looks, too; together, they check out the muscle, the valves, the rhythm, the blood flow.

“Why would I listen to ‘lub dub’ when I can see everything?” Dr. Topol says.

The $8,000 device—called the Vscan, made by GE Healthcare, a unit of General Electric Co.—is just one entry in the booming field of mobile-health technology. In an era where many medical schools hand out iPods along with dissection kits, Dr. Topol, the chief academic officer for Scripps Health, a San Diego-based nonprofit health-care network, says smartphone apps, wireless sensors and other innovative tools hold “transformative potential.”

He and other physicians say the technology can not only improve diagnoses and treatment, but also revolutionize how doctors and patients think about health care. Mobile tools allow physicians to monitor vital signs, note changes in activity levels and verify that medications have been taken, without ever seeing a patient face to face.

That means fewer office visits—and fewer hospitalizations, since even very ill patients can be monitored from afar. For their part, patients can monitor their health in real time, gaining access to an unprecedented amount of data that will allow them to “take charge of their own health care,” Dr. Topol says.

Kelly Morris, a mother in Union Grove, Ala., sees the potential most clearly in a red plastic tag she clips to her daughter’s shirt each morning. One side of the tag reads: “In Case of Emergency.” The other instructs responders to text a unique PIN to the number 51020. Anyone who does so will receive a text offering detailed instructions for 13-year-old Michaela’s care. They’ll learn, for instance, that her particular form of epilepsy does not respond well to the most common seizure drugs and that certain medications make her manic.

“These are things I would like an emergency team to know,” Ms. Morris says. “It gives me the ability to say what I want to say, even if I’m not there.”

Another feature of the $10-a-year service allows trained medics, who are given special access codes, to pull up a preprogrammed list of the patient’s emergency contacts. The medic can swiftly notify them all—by automated text, email or phone call—that the patient is being taken to a specific hospital.

The technology, called “invisible bracelet,” was developed by Docvia LLC of Tulsa, Okla. In addition to the red plastic tags, the company sells key fobs and stickers that can be attached to ID cards and that carry the same instructions about texting a PIN in case of emergency.

Eyes on the Road

Emergency responders are also on the front line of another innovation: a wireless ambulance-monitoring system developed by GlobalMedia Group LLC, a developer of telemedicine hardware and software based in Scottsdale, Ariz.

The TransportAV system, which costs about $30,000, uses a small video camera, digital stethoscope and microphone mounted on a stretcher to transmit live images of the patient to the treatment team waiting in the hospital emergency room. Paramedics and nurses in the ambulance can send close-up images of wounds, real-time video of the patient’s response to various treatments, and audio of heartbeats and respiration.

Such monitoring isn’t all that crucial for short ambulance rides. But specialized facilities like Cincinnati Children’s Hospital Medical Center often pick up patients in other states, four or five hours away. Hamilton Schwartz, an ER physician at Cincinnati Children’s, says the system lets him see the patient for himself, instead of having to rely on an ambulance nurse to describe symptoms by cellphone. Dr. Schwartz can then order treatments en route, brief the ER team or prepare a surgical suite for the ambulance’s arrival.

Dr. Schwartz has been using the system on a trial basis for several months and says his “gut feeling is that it’s great.” He has launched a formal study to determine whether doctors who use this technology order different treatments from those who simply hear the patient’s symptoms described.

IPhone Diagnostics

When the patient is in the hospital and the physician is on the road, a different type of long-distance monitoring is needed. The Mobile MIM system, approved last month by the Food and Drug Administration, lets doctors use their iPhones to view images from sophisticated hospital tests such as MRIs and CT scans. Developed by MIM Software Inc., of Cleveland, the program reproduces the scans with enough clarity and fidelity that physicians can make diagnoses via smartphone.

Yuko D’Ambrosia, a Denver obstetrician, uses an iPhone for another purpose—keeping track of her patients’ labor.

Nurses on the labor and delivery floor routinely use sensors to monitor the fetal heart rate and the mother’s contraction patterns and oxygen levels. In days past, Dr. D’Ambrosia would call the hospital every hour or two to ask a nurse to describe the data being spit out by the sensors.

“Everyone uses different terminology,” she says. “I would have to spend a few minutes trying to tease out what that heartbeat looks like.” If she wasn’t satisfied with the nurse’s description, she’d drive to the hospital to look at the graphs and charts in person.

Now, however, Dr. D’Ambrosia uses an application called AirStrip OB to pull up that information on her iPhone. With a couple of taps, she can view, in real-time, all the data from the sensors strapped to her patient’s belly. If she spots danger signs, she can order a Caesarian section by phone, so the patient will be prepped and ready for surgery by the time she gets to the hospital.

Hundreds of hospitals nationwide use the system, developed by Airstrip Technologies of San Antonio, Texas.

The California Hospital Medical Center in Los Angeles has adopted a more elaborate patient monitoring system, EverOn, for critically ill patients.

The system consists of a sensor-studded mat that is placed under a patient’s mattress. Nurses program the device to alert them if any of the patient’s vital signs drop to a level that they deem worrisome for that individual.

If that happens, the EverOn wirelessly transmits an alarm that goes off at the main nursing station on the floor, in the patient’s room, and on nurses’ smartphones or pagers.

“We’ve had a lot of saves on close calls,” says Jamie Terrence, the hospital’s director of risk management. “The nurse gets in there before we have to call code blue for cardiac arrest.”

The mat, made by EarlySense Ltd. of Dedham, Mass., can also be set to send nurses reminders at predetermined intervals, so they don’t forget, for instance, to turn a patient regularly to prevent bed sores. Installing the system throughout a typical 30-bed hospital unit costs about $230,000, with annual maintenance costs of about $50,000.

Other monitoring devices abound.

Sotera Wireless Inc. in San Diego is developing a wristband sensor that tracks vital signs—including blood pressure, cardiac rhythm, even activity level—and sends wireless alerts to the doctor at the first sign of trouble.

AT&T Inc. is developing “smart slippers” with pressure sensors to detect any changes in the wearer’s gait that may signal a health issue or increased risk of falling. If such changes are detected, a transmitter is supposed to notify the patient’s doctor.

And myriad smartphone applications promise to help patients do everything from monitoring their blood glucose to taking their pills on time.

So much information, so readily available, can have a downside. “We could create a whole culture of cyberchondriacs,” says Dr. Topol, the cardiologist in San Diego.

He acknowledges, too, that something will be lost when most face-to-face visits with physicians are replaced by wireless exchange of data. “We’re getting virtual touch, rather than actual touch,” he says.

But Dr. Topol says in his own practice, he’s found that many patients are more willing to make lifestyle changes that keep them healthy when they can monitor the consequences of their actions in real time. A doctor can talk “until he’s blue in the face,” he says, but it sometimes takes cold, hard data to motivate a patient.


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The eulogy of the great innovator

I know this seems a bit out of character but it is a great comment about the person greatly responsible for the growth of the Tech Savvy Patient

A Sister’s Eulogy for Steve Jobs

By MONA SIMPSON

Published: October 30, 2011
I grew up as an only child, with a single mother. Because we were poor and because I knew my father had emigrated from Syria, I imagined he looked like Omar Sharif. I hoped he would be rich and kind and would come into our lives (and our not yet furnished apartment) and help us. Later, after I’d met my father, I tried to believe he’d changed his number and left no forwarding address because he was an idealistic revolutionary, plotting a new world for the Arab people.

Even as a feminist, my whole life I’d been waiting for a man to love, who could love me. For decades, I’d thought that man would be my father. When I was 25, I met that man and he was my brother.

By then, I lived in New York, where I was trying to write my first novel. I had a job at a small magazine in an office the size of a closet, with three other aspiring writers. When one day a lawyer called me — me, the middle-class girl from California who hassled the boss to buy us health insurance — and said his client was rich and famous and was my long-lost brother, the young editors went wild. This was 1985 and we worked at a cutting-edge literary magazine, but I’d fallen into the plot of a Dickens novel and really, we all loved those best. The lawyer refused to tell me my brother’s name and my colleagues started a betting pool. The leading candidate: John Travolta. I secretly hoped for a literary descendant of Henry James — someone more talented than I, someone brilliant without even trying.

When I met Steve, he was a guy my age in jeans, Arab- or Jewish-looking and handsomer than Omar Sharif.

We took a long walk — something, it happened, that we both liked to do. I don’t remember much of what we said that first day, only that he felt like someone I’d pick to be a friend. He explained that he worked in computers.

I didn’t know much about computers. I still worked on a manual Olivetti typewriter.

I told Steve I’d recently considered my first purchase of a computer: something called the Cromemco.

Steve told me it was a good thing I’d waited. He said he was making something that was going to be insanely beautiful.

I want to tell you a few things I learned from Steve, during three distinct periods, over the 27 years I knew him. They’re not periods of years, but of states of being. His full life. His illness. His dying.

Steve worked at what he loved. He worked really hard. Every day.

That’s incredibly simple, but true.

He was the opposite of absent-minded.

He was never embarrassed about working hard, even if the results were failures. If someone as smart as Steve wasn’t ashamed to admit trying, maybe I didn’t have to be.

When he got kicked out of Apple, things were painful. He told me about a dinner at which 500 Silicon Valley leaders met the then-sitting president. Steve hadn’t been invited.

He was hurt but he still went to work at Next. Every single day.

Novelty was not Steve’s highest value. Beauty was.

For an innovator, Steve was remarkably loyal. If he loved a shirt, he’d order 10 or 100 of them. In the Palo Alto house, there are probably enough black cotton turtlenecks for everyone in this church.

He didn’t favor trends or gimmicks. He liked people his own age.

His philosophy of aesthetics reminds me of a quote that went something like this: “Fashion is what seems beautiful now but looks ugly later; art can be ugly at first but it becomes beautiful later.”

Steve always aspired to make beautiful later.

He was willing to be misunderstood.

Uninvited to the ball, he drove the third or fourth iteration of his same black sports car to Next, where he and his team were quietly inventing the platform on which Tim Berners-Lee would write the program for the World Wide Web.

Steve was like a girl in the amount of time he spent talking about love. Love was his supreme virtue, his god of gods. He tracked and worried about the romantic lives of the people working with him.

Whenever he saw a man he thought a woman might find dashing, he called out, “Hey are you single? Do you wanna come to dinner with my sister?”

I remember when he phoned the day he met Laurene. “There’s this beautiful woman and she’s really smart and she has this dog and I’m going to marry her.”

When Reed was born, he began gushing and never stopped. He was a physical dad, with each of his children. He fretted over Lisa’s boyfriends and Erin’s travel and skirt lengths and Eve’s safety around the horses she adored.

None of us who attended Reed’s graduation party will ever forget the scene of Reed and Steve slow dancing.

His abiding love for Laurene sustained him. He believed that love happened all the time, everywhere. In that most important way, Steve was never ironic, never cynical, never pessimistic. I try to learn from that, still.

Steve had been successful at a young age, and he felt that had isolated him. Most of the choices he made from the time I knew him were designed to dissolve the walls around him. A middle-class boy from Los Altos, he fell in love with a middle-class girl from New Jersey. It was important to both of them to raise Lisa, Reed, Erin and Eve as grounded, normal children. Their house didn’t intimidate with art or polish; in fact, for many of the first years I knew Steve and Lo together, dinner was served on the grass, and sometimes consisted of just one vegetable. Lots of that one vegetable. But one. Broccoli. In season. Simply prepared. With just the right, recently snipped, herb.

Even as a young millionaire, Steve always picked me up at the airport. He’d be standing there in his jeans.

When a family member called him at work, his secretary Linetta answered, “Your dad’s in a meeting. Would you like me to interrupt him?”

When Reed insisted on dressing up as a witch every Halloween, Steve, Laurene, Erin and Eve all went wiccan.

They once embarked on a kitchen remodel; it took years. They cooked on a hotplate in the garage. The Pixar building, under construction during the same period, finished in half the time. And that was it for the Palo Alto house. The bathrooms stayed old. But — and this was a crucial distinction — it had been a great house to start with; Steve saw to that.

This is not to say that he didn’t enjoy his success: he enjoyed his success a lot, just minus a few zeros. He told me how much he loved going to the Palo Alto bike store and gleefully realizing he could afford to buy the best bike there.

And he did.

Steve was humble. Steve liked to keep learning.

Once, he told me if he’d grown up differently, he might have become a mathematician. He spoke reverently about colleges and loved walking around the Stanford campus. In the last year of his life, he studied a book of paintings by Mark Rothko, an artist he hadn’t known about before, thinking of what could inspire people on the walls of a future Apple campus.

Steve cultivated whimsy. What other C.E.O. knows the history of English and Chinese tea roses and has a favorite David Austin rose?

He had surprises tucked in all his pockets. I’ll venture that Laurene will discover treats — songs he loved, a poem he cut out and put in a drawer — even after 20 years of an exceptionally close marriage. I spoke to him every other day or so, but when I opened The New York Times and saw a feature on the company’s patents, I was still surprised and delighted to see a sketch for a perfect staircase.

With his four children, with his wife, with all of us, Steve had a lot of fun.

He treasured happiness.

Then, Steve became ill and we watched his life compress into a smaller circle. Once, he’d loved walking through Paris. He’d discovered a small handmade soba shop in Kyoto. He downhill skied gracefully. He cross-country skied clumsily. No more.

Eventually, even ordinary pleasures, like a good peach, no longer appealed to him.

Yet, what amazed me, and what I learned from his illness, was how much was still left after so much had been taken away.

I remember my brother learning to walk again, with a chair. After his liver transplant, once a day he would get up on legs that seemed too thin to bear him, arms pitched to the chair back. He’d push that chair down the Memphis hospital corridor towards the nursing station and then he’d sit down on the chair, rest, turn around and walk back again. He counted his steps and, each day, pressed a little farther.

Laurene got down on her knees and looked into his eyes.

“You can do this, Steve,” she said. His eyes widened. His lips pressed into each other.

He tried. He always, always tried, and always with love at the core of that effort. He was an intensely emotional man.

I realized during that terrifying time that Steve was not enduring the pain for himself. He set destinations: his son Reed’s graduation from high school, his daughter Erin’s trip to Kyoto, the launching of a boat he was building on which he planned to take his family around the world and where he hoped he and Laurene would someday retire.

Even ill, his taste, his discrimination and his judgment held. He went through 67 nurses before finding kindred spirits and then he completely trusted the three who stayed with him to the end. Tracy. Arturo. Elham.

One time when Steve had contracted a tenacious pneumonia his doctor forbid everything — even ice. We were in a standard I.C.U. unit. Steve, who generally disliked cutting in line or dropping his own name, confessed that this once, he’d like to be treated a little specially.

I told him: Steve, this is special treatment.

He leaned over to me, and said: “I want it to be a little more special.”

Intubated, when he couldn’t talk, he asked for a notepad. He sketched devices to hold an iPad in a hospital bed. He designed new fluid monitors and x-ray equipment. He redrew that not-quite-special-enough hospital unit. And every time his wife walked into the room, I watched his smile remake itself on his face.

For the really big, big things, you have to trust me, he wrote on his sketchpad. He looked up. You have to.

By that, he meant that we should disobey the doctors and give him a piece of ice.

None of us knows for certain how long we’ll be here. On Steve’s better days, even in the last year, he embarked upon projects and elicited promises from his friends at Apple to finish them. Some boat builders in the Netherlands have a gorgeous stainless steel hull ready to be covered with the finishing wood. His three daughters remain unmarried, his two youngest still girls, and he’d wanted to walk them down the aisle as he’d walked me the day of my wedding.

We all — in the end — die in medias res. In the middle of a story. Of many stories.

I suppose it’s not quite accurate to call the death of someone who lived with cancer for years unexpected, but Steve’s death was unexpected for us.

What I learned from my brother’s death was that character is essential: What he was, was how he died.

Tuesday morning, he called me to ask me to hurry up to Palo Alto. His tone was affectionate, dear, loving, but like someone whose luggage was already strapped onto the vehicle, who was already on the beginning of his journey, even as he was sorry, truly deeply sorry, to be leaving us.

He started his farewell and I stopped him. I said, “Wait. I’m coming. I’m in a taxi to the airport. I’ll be there.”

“I’m telling you now because I’m afraid you won’t make it on time, honey.”

When I arrived, he and his Laurene were joking together like partners who’d lived and worked together every day of their lives. He looked into his children’s eyes as if he couldn’t unlock his gaze.

Until about 2 in the afternoon, his wife could rouse him, to talk to his friends from Apple.

Then, after awhile, it was clear that he would no longer wake to us.

His breathing changed. It became severe, deliberate, purposeful. I could feel him counting his steps again, pushing farther than before.

This is what I learned: he was working at this, too. Death didn’t happen to Steve, he achieved it.

He told me, when he was saying goodbye and telling me he was sorry, so sorry we wouldn’t be able to be old together as we’d always planned, that he was going to a better place.

Dr. Fischer gave him a 50/50 chance of making it through the night.

He made it through the night, Laurene next to him on the bed sometimes jerked up when there was a longer pause between his breaths. She and I looked at each other, then he would heave a deep breath and begin again.

This had to be done. Even now, he had a stern, still handsome profile, the profile of an absolutist, a romantic. His breath indicated an arduous journey, some steep path, altitude.

He seemed to be climbing.

But with that will, that work ethic, that strength, there was also sweet Steve’s capacity for wonderment, the artist’s belief in the ideal, the still more beautiful later.

Steve’s final words, hours earlier, were monosyllables, repeated three times.

Before embarking, he’d looked at his sister Patty, then for a long time at his children, then at his life’s partner, Laurene, and then over their shoulders past them.

Steve’s final words were:

OH WOW. OH WOW. OH WOW.


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