Medical Courses Quotes

I look at the blanked-out faces of the other passengers--hoisting their briefcases, their backpacks, shuffling to disembark--and I think of what Hobie said: beauty alters the grain of reality. And I keep thinking too of the more conventional wisdom: namely, that the pursuit of pure beauty is a trap, a fast track to bitterness and sorrow, that beauty has to be wedded to something more meaningful. Only what is that thing? Why am I made the way I am? Why do I care about all the wrong things, and nothing at all for the right ones? Or, to tip it another way: how can I see so clearly that everything I love or care about is illusion, and yet--for me, anyway--all that's worth living for lies in that charm? A great sorrow, and one that I am only beginning to understand: we don't get to choose our own hearts. We can't make ourselves want what's good for us or what's good for other people. We don't get to choose the people we are. Because--isn't it drilled into us constantly, from childhood on, an unquestioned platitude in the culture--? From William Blake to Lady Gaga, from Rousseau to Rumi to Tosca to Mister Rogers, it's a curiously uniform message, accepted from high to low: when in doubt, what to do? How do we know what's right for us? Every shrink, every career counselor, every Disney princess knows the answer: "Be yourself." "Follow your heart." Only here's what I really, really want someone to explain to me. What if one happens to be possessed of a heart that can't be trusted--? What if the heart, for its own unfathomable reasons, leads one willfully and in a cloud of unspeakable radiance away from health, domesticity, civic responsibility and strong social connections and all the blandly-held common virtues and instead straight toward a beautiful flare of ruin, self-immolation, disaster?...If your deepest self is singing and coaxing you straight toward the bonfire, is it better to turn away? Stop your ears with wax? Ignore all the perverse glory your heart is screaming at you? Set yourself on the course that will lead you dutifully towards the norm, reasonable hours and regular medical check-ups, stable relationships and steady career advancement the New York Times and brunch on Sunday, all with the promise of being somehow a better person? Or...is it better to throw yourself head first and laughing into the holy rage calling your name?

But I'll have to ask you to wait a long time, Anne," said Gilbert sadly. "It will be three years before I'll finish my medical course. And even then there will be no diamond sunbursts and marble halls." Anne laughed. "I don't want sunbursts and marble halls. I just want YOU. You see I'm quite as shameless as Phil about it. Sunbursts and marble halls may be all very well, but there is more `scope for imagination' without them. And as for the waiting, that doesn't matter. We'll just be happy, waiting and working for each other -- and dreaming. Oh, dreams will be very sweet now." Gilbert drew her close to him and kissed her. Then they walked home together in the dusk, crowned king and queen in the bridal realm of love, along winding paths fringed with the sweetest flowers that ever bloomed, and over haunted meadows where winds of hope and memory blew.

So tonight I reach for my journal again. This is the first time I’ve done this since I came to Italy. What I write in my journal is that I am weak and full of fear. I explain that Depression and Loneliness have shown up, and I’m scared they will never leave. I say that I don’t want to take the drugs anymore, but I’m frightened I will have to. I am terrified that I will never really pull my life together. In response, somewhere from within me, rises a now-familiar presence, offering me all the certainties I have always wished another person would say to me when I was troubled. This is what I find myself writing on the page: I’m here. I love you. I don’t care if you need to stay up crying all night long. I will stay with you. If you need the medication again, go ahead and take it—I will love you through that, as well. If you don’t need the medication, I will love you, too. There’s nothing you can ever do to lose my love. I will protect you until you die, and after your death I will still protect you. I am stronger than Depression and Braver than Loneliness and nothing will ever exhaust me. Tonight, this strange interior gesture of friendship—the lending of a hand from me to myself when nobody else is around to offer solace—reminds me of something that happened to me once in New York City. I walked into an office building one afternoon in a hurry, dashed into the waiting elevator. As I rushed in, I caught an unexpected glance of myself in a security mirror’s reflection. In that moment, my brain did an odd thing—it fired off this split-second message: “Hey! You know her! That’s a friend of yours!” And I actually ran forward toward my own reflection with a smile, ready to welcome that girl whose name I had lost but whose face was so familiar. In a flash instant of course, I realized my mistake and laughed in embarrassment at my almost doglike confusion over how a mirror works. But for some reason that incident comes to mind again tonight during my sadness in Rome, and I find myself writing this comforting reminder at the bottom of the page. Never forget that once upon a time, in an unguarded moment, you recognized yourself as a FRIEND… I fell asleep holding my notebook pressed against my chest, open to this most recent assurance. In the morning when I wake up, I can still smell a faint trace of depression’s lingering smoke, but he himself is nowhere to be seen. Somewhere during the night, he got up and left. And his buddy loneliness beat it, too.

Screwy," I said. "Is that a medical term?" "Of course.

Today I hit rock bottom but didn’t busy myself with activity to take my mind off it, like I usually do. I allowed myself to sink as deep as possible. It’s like an infection: let it run its course and be done with it. Rising, I felt cleansed.

Of course, most mortals can't see magic clearly, so I'm not sure what they thought they saw as we passed overhead. No doubt it caused many of them to adjust their medication.

BEFRIENDING THE BODY Trauma victims cannot recover until they become familiar with and befriend the sensations in their bodies. Being frightened means that you live in a body that is always on guard. Angry people live in angry bodies. The bodies of child-abuse victims are tense and defensive until they find a way to relax and feel safe. In order to change, people need to become aware of their sensations and the way that their bodies interact with the world around them. Physical self-awareness is the first step in releasing the tyranny of the past. In my practice I begin the process by helping my patients to first notice and then describe the feelings in their bodies—not emotions such as anger or anxiety or fear but the physical sensations beneath the emotions: pressure, heat, muscular tension, tingling, caving in, feeling hollow, and so on. I also work on identifying the sensations associated with relaxation or pleasure. I help them become aware of their breath, their gestures and movements. All too often, however, drugs such as Abilify, Zyprexa, and Seroquel, are prescribed instead of teaching people the skills to deal with such distressing physical reactions. Of course, medications only blunt sensations and do nothing to resolve them or transform them from toxic agents into allies. The mind needs to be reeducated to feel physical sensations, and the body needs to be helped to tolerate and enjoy the comforts of touch. Individuals who lack emotional awareness are able, with practice, to connect their physical sensations to psychological events. Then they can slowly reconnect with themselves.

Being mortal is about the struggle to cope with the constraints of our biology, with the limits set by genes and cells and flesh and bone. Medical science has given us remarkable power to push against these limits, and the potential value of this power was a central reason I became a doctor. But again and again, I have seen the damage we in medicine do when we fail to acknowledge that such power is finite and always will be. We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life, or when debility comes, but all along the way. Whenever serious sickness or injury strikes and your body or mind breaks down, the vital questions are the same: What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?

Girl, are you on medication?” Nurse Debra asked. “No, of course not,” Madison answered impatiently. “Maybe you should be,” Debra muttered.

Because--isn't it drilled into us constantly, from childhood on, an unquestioned platitude in the culture--? From William Blake to Lady Gaga, from Rousseau to Rumi to Tosca to Mister Rogers, it's a curiously uniform message, accepted from high to low: when in doubt, what to do? How do we know what's right for us? Every shrink, every career counselor, every Disney princess knows the answer: "Be yourself." "Follow your heart." Only here's what I really, really want someone to explain to me. What if one happens to be possessed of a heart that can't be trusted--? What if the heart, for its own unfathomable reasons, leads one willfully and in a cloud of unspeakable radiance away from health, domesticity, civic responsibility and strong social connections and all the blandly-held common virtues and instead straight toward a beautiful flare of ruin, self-immolation, disaster?...If your deepest self is singing and coaxing you straight toward the bonfire, is it better to turn away? Stop your ears with wax? Ignore all the perverse glory your heart is screaming at you? Set yourself on the course that will lead you dutifully towards the norm, reasonable hours and regular medical check-ups, stable relationships and steady career advancement the New York Times and brunch on Sunday, all with the promise of being somehow a better person? Or...is it better to throw yourself head first and laughing into the holy rage calling your name?

Wouldn't it be great,as Scott Peck suggests, if all medical students had to undergo the symptoms and feeling of a spectrum of illnesses. From acute infections to terminal cancer - and Kuru, the laughing sickness. Just a month for each exposure, controlled of course, and a good heavy dose of excruciating pain. So they'll know what that feels like.

Of course, if 40% of women need oxytocin to progress normally, then something is wrong with the definition of normal.

A sad fact, of course, about adult life is that you see the very things you'll never adapt to coming toward you on the horizon. You see them as the problems they are, you worry like hell about them, you make provisions, take precautions, fashion adjustments; you tell yourself you'll have to change your way of doing things. Only you don't. You can't. Somehow it's already too late. And maybe it's even worse than that: maybe the thing you see coming from far away is not the real thing, the thing that scares you, but its aftermath. And what you've feared will happen has already taken place. This is similar in spirit to the realization that all the great new advances of medical science will have no benefit for us at all, thought we cheer them on, hope a vaccine might be ready in time, think things could still get better. Only it's too late there too. And in that very way our life gets over before we know it. We miss it. And like the poet said: The ways we miss our lives are life.

Perfect!" Wrath bellowed. "And this is a doctor saying it -- I mean, she went to medical school." ... "And Dr. Sam told me she's delivered over fifteen thousand babies over the course of her career -- " "See!" Wrath yelled. "She knows these things. My son is perfect!

The doctors found out that Bunbury could not live, that is what I mean - so Bunbury died. He seems to have had great confidence in the opinion of his physicians. I am glad, however, that he made up his mind at the last to some definite course of action, and acted under proper medical advice.

LADY BRACKNELL. May I ask if it is in this house that your invalid friend Mr. Bunbury resides? ALGERNON. [Stammering.] Oh! No! Bunbury doesn't live here. Bunbury is somewhere else at present. In fact, Bunbury is dead, LADY BRACKNELL. Dead! When did Mr. Bunbury die? His death must have been extremely sudden. ALGERNON. [Airily.] Oh! I killed Bunbury this afternoon. I mean poor Bunbury died this afternoon. LADY BRACKNELL. What did he die of? ALGERNON. Bunbury? Oh, he was quite exploded. LADY BRACKNELL. Exploded! Was he the victim of a revolutionary outrage? I was not aware that Mr. Bunbury was interested in social legislation. If so, he is well punished for his morbidity. ALGERNON. My dear Aunt Augusta, I mean he was found out! The doctors found out that Bunbury could not live, that is what I mean - so Bunbury died. LADY BRACKNELL. He seems to have had great confidence in the opinion of his physicians. I am glad, however, that he made up his mind at the last to some definite course of action, and acted under proper medical advice. And now that we have finally got rid of this Mr. Bunbury, may I ask, Mr. Worthing, who is that young person whose hand my nephew Algernon is now holding in what seems to me a peculiarly unnecessary manner?

THERE were four of us - George, and William Samuel Harris, and myself, and Montmorency. We were sitting in my room, smoking, and talking about how bad we were - bad from a medical point of view I mean, of course.

The most traumatic aspects of all disasters involve the shattering of human connections. And this is especially true for children. Being harmed by the people who are supposed to love you, being abandoned by them, being robbed of the one-on-one relationships that allow you to feel safe and valued and to become humane—these are profoundly destructive experiences. Because humans are inescapably social beings, the worst catastrophes that can befall us inevitably involve relational loss. As a result, recovery from trauma and neglect is also all about relationships—rebuilding trust, regaining confidence, returning to a sense of security and reconnecting to love. Of course, medications can help relieve symptoms and talking to a therapist can be incredibly useful. But healing and recovery are impossible—even with the best medications and therapy in the world—without lasting, caring connections to others.

Had Prozac been available last century, Baudelaire's "spleen," Edgar Allan Poe's moods, the poetry of Sylvia Plath, the lamentations of so many other poets, everything with a soul would have been silenced*.... If large pharmaceutical companies were able to eliminate the seasons, they would probably do so--for profit, of course. *This does not mean that Sylvia Plath should not have been medicated at all. The point is that pathologies should be medicated when there is risk of suicide, not mood swings.

This has been the century of strangers, brown, yellow and white. This has been the century of the great immigrant experiment. It is only this late in the day that you can walk into a playground and find Isaac Leung by the fish pond, Danny Rahman in the football cage, Quang O’Rourke bouncing a basketball, and Irie Jones humming a tune. Children with first and last names on a direct collision course. Names that secrete within them mass exodus, cramped boats and planes, cold arrivals, medical checks. It is only this late in the day, and possibly only in Willesden, that you can find best friends Sita and Sharon, constantly mistaken for each other because Sita is white (her mother liked the name) and Sharon is Pakistani (her mother thought it best — less trouble).

...sometimes they almost made me feel glad that I had a few extra years to play my depression out with therapy and other means, because I think its useful in youth- unless suicide or drug abuse are the alternatives- to have some faith in the mind to cure itself, to not rush to doctors or diagnosis's...I sometimes worry that part of what creates depression in young people is their own, and their parents, and the whole worlds impatience with allowing the phases of life to run their course. We will very likely soon be living in a society that confuses disease with normal life if the panic and rush to judgment and labeling do not slow down a bit. Somewhere between the unbelievable tardiness that the medical profession was guilty of in administering proper treatment to me and the eagerness to with which practitioners prescribe Ritalin for 8 year old boys and Paxil for 14 year old girls, there is a sane course of action.

Is Understatement 101 a course in medical school?" "Of course. It's the prereq for Lying Through One's Teeth.

While learning about phobias in my college psychology course, I came across the fear of long words- or, as referred to in the medical community: hippopotomonstrosesquipedaliophobia.

However, The haven-Slocum Theory also points out that this course is not without risk. An even greater number of people dwelling on The Navidson Record have shown an increase in obsessiveness, insomnia, and incoherence: "Most of those who chose to abandon their interest soon recovered. A few, however, required counseling and in some instances medication and hospitalization. Three cases resulted in suicide.

Europe would go down first, with its socialized medical-care systems and pliant citizens sure to show up for their shots when summoned, then America, then, in due course, the rest of the world.

My heart beats too loudly at the change in plans. Changes happen sometimes; they aren’t always a bad thing. I grip my coffee cup and wriggle my toes. I can do this, the coffee says; of course you can, the meds reply.

Let's get started. Who's first?" "His name is Kettch, and he's an Ewok." Wedge came upright. "No." "Oh, yes. Determined to fight. You should hear him say, 'Yub, yub.' He makes it a battle cry." "Wes, assuming he could be educated up to Alliance fighter-pilot standards, an Ewok couldn't even reach an X-wing's controls." "He wears arm and leg extensions, prosthetics built for him by a sympathetic medical droid. And he's anxious to go, Commander." "Please tell me you're kidding." "Of course I'm kidding." (...) "I'm going to get you, Janson." "Yub, yub, Commander.

All medical men are voyeurs. Why else would they become doctors? Except for the sadists, of course, who simply enjoy the blood and the pain.

Richard, Bill has the socialist disease in its worst form; he thinks the world owes him a living. He told me sincerely - smugly! - that of course everyone was entitled to the best possible medical and hospital service - free of course, unlimited of course, and of course the government should pay for it.

The calcium in your bones came from a star. We are all made from recycled bits and pieces of the universe. This matters because origins matter. For example, if you were born to a reigning monarch but kidnapped by the black market baby underground shortly after birth and sent to America where you were raised by common, unremarkable people from Ohio, and when you were in your thirties working as a humble UPS driver, dignitaries landed their helicopter on the roof of your crummy apartment building and informed you of their thirty-plus year search for you, His Royal Highness, the course of your life might change. You know? Our familial genetic origins -medical histories- inform us of medical conditions which exist in our families and when we know about these specific conditions, we can sometimes take certain actions to prevent them. Which is why I think it’s important to consider that billions of years before we were students and mothers and dog trainers and priests, we were particles that would form into star after star after star until forever passed, and instead of a star what formed was life; simplistic, crude, miraculous. And after another infinity, there we were. And this is why for you, anything is possible. Because you are made out of everything.

The framework of this body that you have right now holds the entire story of who you have been, who you are now and who you are becoming; the good, the bad, and the ugly, but also the blessed.

For, medicine being a compendium of the successive and contradictory mistakes of medical practitioners, when we summon the wisest of them to our aid, the chances are that we may be relying on a scientific truth the error of which will be recognized in a few years’ time. So that to believe in medicine would be the height of folly, if not to believe in it were not greater folly still, for from this mass of errors there have emerged in the course of time many truths.

Our schools will not improve if we continue to focus only on reading and mathematics while ignoring the other studies that are essential elements of a good education. Schools that expect nothing more of their students than mastery of basic skills will not produce graduates who are ready for college or the modern workplace. *** Our schools will not improve if we value only what tests measure. The tests we have now provide useful information about students' progress in reading and mathematics, but they cannot measure what matters most in education....What is tested may ultimately be less important that what is untested... *** Our schools will not improve if we continue to close neighborhood schools in the name of reform. Neighborhood schools are often the anchors of their communities, a steady presence that helps to cement the bond of community among neighbors. *** Our schools cannot improve if charter schools siphon away the most motivated students and their families in the poorest communities from the regular public schools. *** Our schools will not improve if we continue to drive away experienced principals and replace them with neophytes who have taken a leadership training course but have little or no experience as teachers. *** Our schools cannot be improved if we ignore the disadvantages associated with poverty that affect children's ability to learn. Children who have grown up in poverty need extra resources, including preschool and medical care.

What do we mean by poverty? Not what Dickens or Blake or Mayhew meant. Today no one seriously expects to go hungry in England or to live without running water or medical care or even TV. Poverty has been redefined in industrial countries, so that anyone at the lower end of the income distribution is poor ex officio, as it were-poor by virtue of having less than the rich. And of course by this logic, the only way of eliminating poverty is by an egalitarian redistribution of wealth-even if the society as a whole were to become poorer as a result.

preventable diseases kill off half our population. And even if science were allowed to try, it could do little, because the majority of human beings are not yet human beings at all, but simply machines for the creating of wealth for others. They are penned up in filthy houses and left to rot and stew in misery, and the conditions of their life make them ill faster than all the doctors in the world could heal them; and so, of course, they remain as centers of contagion, poisoning the lives of all of us, and making happiness impossible for even the most selfish. For this reason I would seriously maintain that all the medical and surgical discoveries that science can make in the future will be of less importance than the application of the knowledge we already possess, when the disinherited of the earth have established their right to a human existence.

Is Kitsey right? If your deepest self is singing and coaxing you straight toward the bonfire, is it better to turn away? Stop your ears with wax? Ignore all the perverse glory your heart is screaming at you? Set yourself on the course that will lead you dutifully towards the norm, reasonable hours and regular medical check-ups, stable relationships and steady career advancement, the New York Times and brunch on Sunday, all with the promise of being somehow a better person? Or—like Boris—is it better to throw yourself head first and laughing into the holy rage calling your name?

So long as we have wage slavery," answered Schliemann, "it matters not in the least how debasing and repulsive a task may be, it is easy to find people to perform it. But just as soon as labor is set free, then the price of such work will begin to rise. So one by one the old, dingy, and unsanitary factories will come down— it will be cheaper to build new; and so the steamships will be provided with stoking machinery , and so the dangerous trades will be made safe, or substitutes will be found for their products. In exactly the same way, as the citizens of our Industrial Republic become refined, year by year the cost of slaughterhouse products will increase; until eventually those who want to eat meat will have to do their own killing— and how long do you think the custom would survive then?— To go on to another item— one of the necessary accompaniments of capitalism in a democracy is political corruption; and one of the consequences of civic administration by ignorant and vicious politicians, is that preventable diseases kill off half our population. And even if science were allowed to try, it could do little, because the majority of human beings are not yet human beings at all, but simply machines for the creating of wealth for others. They are penned up in filthy houses and left to rot and stew in misery, and the conditions of their life make them ill faster than all the doctors in the world could heal them; and so, of course, they remain as centers of contagion , poisoning the lives of all of us, and making happiness impossible for even the most selfish. For this reason I would seriously maintain that all the medical and surgical discoveries that science can make in the future will be of less importance than the application of the knowledge we already possess, when the disinherited of the earth have established their right to a human existence.

His name is Kettch, and he's an Ewok." "No." "Oh, yes. Determined to fight. You should hear him say, 'Yub, yub.' He makes it a battle cry." "Wes, assuming he could be educated up to Alliance fighter-pilot standards, an Ewok couldn't even reach an X-wing's controls." "He wears arm and leg extensions, prosthetics built for him by a sympathetic medical droid. And he's anxious to go, Commander." "Please tell me you're kidding." "Of course I'm kidding. Pilot-candidate number one is a Human female from Tatooine, Falynn Sandskimmer." "I'm going to get you, Janson." "Yub, yub, Commander." ―Wes Janson and Wedge Antilles[src]

So why the stress?" said Gene. “You have had sex before?” “Of course,” I said. “My doctor is strongly in favor.” “Frontiers of medical science,” said Gene. He was probably making a joke. I think the value of regular sex has been known for some time. I explained further. “It’s just adding a second person makes it complicated.

Burnout at its deepest level is not the result of some train wreck of examinations, long call shifts, or poor clinical evaluations. It is the sum total of hundreds and thousands of tiny betrayals of purpose, each one so minute that it hardly attracts notice. When a great ship steams across the ocean, even tiny ripples can accumulate over time, precipitating a dramatic shift in course. There are many Tertius Lydgates, male and female, inhabiting the lecture halls, laboratories, and clinics of today’s medical schools. Like latter-day Lydgates, many of them eventually find themselves expressing amazement and disgust at how far they have veered from their primary purpose.

Nine out of ten deaf kids had hearing parents, and those parents held Deaf fate in their hands—the fate of their own children, of course, and the future of the Deaf community at large. Problem being, most parents understood deafness only as explained to them by medical professionals: as a treachery of their genes, something to be drilled out.

BERENGER: And you consider all this natural? 

DUDARD: What could be more natural than a rhinoceros? 

 BERENGER: Yes, but for a man to turn into a rhinoceros is abnormal beyond question. 

DUDARD: Well, of course, that's a matter of opinion ... 

 BERENGER: It is beyond question, absolutely beyond question! 
DUDARD: You seem very sure of yourself. Who can say where the normal stops and the abnormal begins? Can you personally define these conceptions of normality and abnormality? Nobody has solved this problem yet, either medically or philosophically. You ought to know that. 

 BERENGER: The problem may not be resolved philosophically -- but in practice it's simple. They may prove there's no such thing as movement ... and then you start walking ... [he starts walking up and down the room] ... and you go on walking, and you say to yourself, like Galileo, 'E pur si muove' ... 

 DUDARD: You're getting things all mixed up! Don't confuse the issue. In Galileo's case it was the opposite: theoretic and scientific thought proving itself superior to mass opinion and dogmatism. 

 BERENGER: [quite lost] What does all that mean? Mass opinion, dogmatism -- they're just words! I may be mixing everything up in my head but you're losing yours. You don't know what's normal and what isn't any more. I couldn't care less about Galileo ... I don't give a damn about Galileo. 

 DUDARD: You brought him up in the first place and raised the whole question, saying that practice always had the last word. Maybe it does, but only when it proceeds from theory! The history of thought and science proves that. BERENGER: [more and more furious] It doesn't prove anything of the sort! It's all gibberish, utter lunacy! 

DUDARD: There again we need to define exactly what we mean by lunacy ... 

 BERENGER: Lunacy is lunacy and that's all there is to it! Everybody knows what lunacy is. And what about the rhinoceroses -- are they practice or are they theory?

I’ve learned how to manage my symptoms, now, of course. I have medication, physiotherapy, cognitive therapy. I’m fine, really. But I feel like a part of me hasn’t caught up with that. Like I’m still afraid of myself.

The two Baudelaires, of course, had no idea what the hospital’s policy was concerning surgical paperwork, but they were beginning to see that the crowd would believe just about anything if they thought it was being said by a medical professional.

What if the heart, for its own unfathomable reasons, leads one willfully and in a cloud of unspeakable radiance away from health, domesticity, civic responsibility and strong social connections and all the blandly-held common virtues and instead straight toward a beautiful flare of ruin, self-immolation, disaster?…If your deepest self is singing and coaxing you straight toward the bonfire, is it better to turn away? Stop your ears with wax? Ignore all the perverse glory your heart is screaming at you? Set yourself on the course that will lead you dutifully towards the norm, reasonable hours and regular medical check-ups, stable relationships and steady career advancement the New York Times and brunch on Sunday, all with the promise of being somehow a better person? Or…is it better to throw yourself head first and laughing into the holy rage calling your name?

During the course of the day, he said, each spouse had confessed independently to him to taking antidepressants but didn’t want the other to know. It turned out that they were hiding the same medication in the same house. No matter how open we as a society are about formerly private matters, the stigma around our emotional struggles remains formidable. We’ll talk with almost anyone about our physical health (can anyone imagine spouses hiding their reflux medication from each other?), even our sex lives, but bring up anxiety or depression or an intractable sense of grief, and the expression on the face looking back at you will probably read, Get me out of this conversation, pronto.

Imagine a person who enjoys alcohol, perhaps a bit too much. He has a quick three or four drinks. His blood alcohol level spikes sharply. This can be extremely exhilarating, particularly for someone who has a genetic predisposition to alcoholism.23 But it only occurs while blood alcohol levels are actively rising, and that only continues if the drinker keeps drinking. When he stops, not only does his blood alcohol level plateau and then start to sink, but his body begins to produce a variety of toxins, as it metabolizes the ethanol already consumed. He also starts to experience alcohol withdrawal, as the anxiety systems that were suppressed during intoxication start to hyper-respond. A hangover is alcohol withdrawal (which quite frequently kills withdrawing alcoholics), and it starts all too soon after drinking ceases. To continue the warm glow, and stave off the unpleasant aftermath, the drinker may just continue to drink, until all the liquor in his house is consumed, the bars are closed and his money is spent. The next day, the drinker wakes up, badly hungover. So far, this is just unfortunate. The real trouble starts when he discovers that his hangover can be “cured” with a few more drinks the morning after. Such a cure is, of course, temporary. It merely pushes the withdrawal symptoms a bit further into the future. But that might be what is required, in the short term, if the misery is sufficiently acute. So now he has learned to drink to cure his hangover. When the medication causes the disease, a positive feedback loop has been established.

The stormy course of my life during the last twelve years has proved to me that many good fortunes lie concealed in apparent disasters. Certainly in wrestling with adversity one learns to attain added courage and strength, and one learns to find beauty wherever it may be found regardless of the background.

It would be just my luck, of course, to be savaged by an animal with a flea collar and a medical history. I imagined lying on my back, being extravagantly ravaged, inclining my head slightly to read a dangling silver tag that said: “My name is Mr. Bojangles. If found please call Tanya and Vinny at 924-4667.

So the sleigh-boat was our new solution. It worked great, except when Felix yelled down at the mortals, ‘Ho, ho, ho, Merry Christmas!’ Of course, most mortals can’t see magic clearly, so I’m not sure what they thought they saw as we passed overhead. No doubt it caused many of them to adjust their medication.

people who commuted by bike had a 40 per cent lower chance of dying during the fifteen-year course of the project than those who didn’t. That’s not far short of a miracle. If these benefits could be administered in an injection, it would be considered one of the greatest medical breakthroughs of all time. The

The trillion-dollar pharmaceutical industry puts its research money into the search for magic bullets in the form of chemicals because pills mean money. If energy healing could be made into tablet form, drug manufacturers would get interested quickly. Instead, they identify deviations in physiology and behavior that vary from some hypothetical norm as unique disorders or dysfunctions, and then they educate the public about the dangers of these menacing disorders. Of course, the over-simplified symptomology used in defining the dysfunctions prevalent in drug company advertisements has viewers convinced they are afflicted by that particular malady. “Do you worry? Worry is a primary symptom of ‘medical condition’ called anxiety disorder. Stop your worry. Tell your doctor you want Addictazac, the new passion-pink drug.

A great anatomist used to close his opening lecture to beginning medical students with words that apply equally to our own undertaking. “In this course,” he would say, “we shall be dealing with flesh and bones and cells and sinews, and there are going to be times when it’s all going to seem terribly cold-blooded. But never forget. It’s alive!” II.

Education continued to come under particularly strong fire...: If women learned how to manage in the world as well as men, if they learned about history and politics and studied for a profession, of course they would soon be demanding a voice and a role outside the home. The medical doctors soon discovered that education was dangerous to a female's health.

There are so many dirty names for her that one rarely learns them all, even in one’s native language. There are dirty names for every female part of her body and for every way of touching her. There are dirty words, dirty laughs, dirty noises, dirty jokes, dirty movies, and dirty things to do to her in the dark. Fucking her is the dirtiest, though it may not be as dirty as she herself is. Her genitals are dirty in the literal meaning: stink and blood and urine and mucous and slime. Her genitals are also dirty in the metaphoric sense: obscene. She is reviled as filthy, obscene, in religion, pornography, philosophy, and in most literature and art and psychology. where she is not maligned she is magnificently condescended to, as in this diary entry by Somerset Maugham written when he was in medical school: The Professor of Gynaecology: He began his course of lectures as follows: Gentlemen, woman is an animal that micturates once a day, defecates once a week, menstruates once a month, parturates once a year and copulates whenever she has the opportunity. I thought it a prettily-balanced sentence. Were she loved sufficiently, or even enough, she could not be despised so much. were she sexually loved, or even liked, she and what is done with or to her, in the dark or in the light, she would not, could not, exist rooted in the realm of dirt, the contempt for her apparently absolute and irrevocable; horrible; immovable; help us, Lord; unjust. She is not just less; she and the sex she incarnates are a species of filth. God will not help of course: "For a whore is a deep ditch; and a strange woman is a narrow pit.

You're not content in your position as a factory owner and a rich heiress, you don't believe in your right to it, and now you can't sleep, which, of course, is certainly better than if you were content, slept soundly, and thought everything was fine. Your insomnia is respectable; in any event, it's a good sign. In fact, for our parents such a conversation as we're having now would have been unthinkable; they didn't talk at night, they slept soundly, but we, our generation, sleep badly, are anguished, talk a lot, and keep trying to decide if we're right or not. - A Medical Case

The medical uncertainty compounds patients' own uncertainty. Because my unwellness did not take the form of a disease I understood, with a clear-cut list of symptoms and a course of treatment, even I at times interpreted it as a series of signs about my very existence. Initially, the illness seemed to be a condition that signified something deeply wrong with me⁠—illness as a kind of semaphore. Without answers, at my most desperate, I came to feel (in some unarticulated way) that if I could just tell the right story about what was happening, I could make myself better. If only I could figure out what the story was, like the child in a fantasy novel who must discover her secret name, I could become myself again. It took years before I realized that the illness was not just my own; the silence around suffering was our society's pathology.

Of course that diagnosis was never made official because my mother refused to get professional help. Instead, she lived her life with her fingers in her ears, as though the truth would not exist if she never heard the words spoken aloud. Add to that cauldron an ever increasing measure of cheap vodka—a form of self-medication that quelled the inner scream but amplified the outer crazy—and you get a picture of the mother I left behind. She

We are all of us exposed to grief: the people we love die, as we shall ourselves in due course; expectations are disappointed and ambitions are thwarted by circumstance. Finally, there are some who insist upon feeling guilty over the ill they have done or simply on account of the ugliness which they perceive in their own souls. A solution of a kind has been found to this problem in the form of sedatives and anti-depressant drugs, so that many human experiences which used to be accepted as an integral part of human life are now defined and dealt with as medical problems. The widow who grieves for a beloved husband becomes a 'case', as does the man saddened by the recollection of the napalm or high explosives he has dropped on civilian populations. One had thought that guilt was a way, however indirect, in which we might perceive the nature of reality and the laws which govern our human experience; but it is now an illness that can be cured. Death however, remains incurable. Though we might be embarrassed by Victorian death-bed scenes or the practices of mourning among people less sophisticated than ourselves, the fact of death tells us so much about the realities of our condition that to ignore it or try to forget it is to be unaware of the most important thing we need to know about our situation as living creatures. Equally, to witness and participate in the dying of our fellow men and women is to learn what we are and, if we have any wisdom at all, to draw conclusions which must in their way affect our every thought and our every act.

You’re actually reading that?” she asked, her auburn brows lifted at the sight of the romance novel Connor had given him this morning, sitting next to the medical textbook he’d propped open to the section on vertical mattress stitches. Parker nodded. “Of course I’m reading it. How else am I going to find out if Michaela and Trent can outwit the creepy bad guy so they can give each other a lifetime supply of preternaturally incredible orgasms?

FLEISCHMANN: Since the days of Sigmund Freud and the advent of psychoanalysis the interpretation of dreams has played a big role in Austria[n life]. What is your attitude to all that? BERNHARD: I’ve never spent enough time reading Freud to say anything intelligent about him. Freud has had no effect whatsoever on dreams, or on the interpretation of dreams. Of course psychoanalysis is nothing new. Freud didn’t discover it; it had of course always been around before. It just wasn’t practiced on such a fashionably huge scale, and in such million-fold, money-grubbing forms, as it has been now for decades, and as it won’t be for much longer. Because even in America, as I know, it’s fallen so far out of fashion that they just lay people out on the celebrated couch and scoop their psychological guts out with a spoon. FLEISCHMANN: I take it then that psychoanalysis is not a means gaining knowledge for you? BERNHARD: Well, no; for me it’s never been that kind of thing. I think of Freud simply as a good writer, and whenever I’ve read something of his, I’ve always gotten the feeling of having read the work of an extraordinary, magnificent writer. I’m no competent judge of his medical qualifications, and as for what’s known as psychoanalysis, I’ve personally always tended to think of it as nonsense or as a middle-aged man’s hobby-horse that turned into an old man’s hobby-horse. But Freud’s fame is well-deserved, because of course he was a genuinely great, extraordinary personality. There’s no denying that. One of the few great personalities who had a beard and was great despite his beardiness. FLEISCHMANN: Do you have something against beards? BERNHARD: No. But the majority of people call people who have a long beard or the longest possible beard great personalities and suppose that the longer one’s beard is, the greater the personality one is. Freud’s beard was relatively long, but too pointy; that was typical of him. Perhaps it was the typical Freudian trait, the pointy beard. It’s possible.

The next time you drive into a Walmart parking lot, pause for a second to note that this Walmart—like the more than five thousand other Walmarts across the country—costs taxpayers about $1 million in direct subsidies to the employees who don’t earn enough money to pay for an apartment, buy food, or get even the most basic health care for their children. In total, Walmart benefits from more than $7 billion in subsidies each year from taxpayers like you. Those “low, low prices” are made possible by low, low wages—and by the taxes you pay to keep those workers alive on their low, low pay. As I said earlier, I don’t think that anyone who works full-time should live in poverty. I also don’t think that bazillion-dollar companies like Walmart ought to funnel profits to shareholders while paying such low wages that taxpayers must pick up the ticket for their employees’ food, shelter, and medical care. I listen to right-wing loudmouths sound off about what an outrage welfare is and I think, “Yeah, it stinks that Walmart has been sucking up so much government assistance for so long.” But somehow I suspect that these guys aren’t talking about Walmart the Welfare Queen. Walmart isn’t alone. Every year, employers like retailers and fast-food outlets pay wages that are so low that the rest of America ponies up a collective $153 billion to subsidize their workers. That’s $153 billion every year. Anyone want to guess what we could do with that mountain of money? We could make every public college tuition-free and pay for preschool for every child—and still have tens of billions left over. We could almost double the amount we spend on services for veterans, such as disability, long-term care, and ending homelessness. We could double all federal research and development—everything: medical, scientific, engineering, climate science, behavioral health, chemistry, brain mapping, drug addiction, even defense research. Or we could more than double federal spending on transportation and water infrastructure—roads, bridges, airports, mass transit, dams and levees, water treatment plants, safe new water pipes. Yeah, the point I’m making is blindingly obvious. America could do a lot with the money taxpayers spend to keep afloat people who are working full-time but whose employers don’t pay a living wage. Of course, giant corporations know they have a sweet deal—and they plan to keep it, thank you very much. They have deployed armies of lobbyists and lawyers to fight off any efforts to give workers a chance to organize or fight for a higher wage. Giant corporations have used their mouthpiece, the national Chamber of Commerce, to oppose any increase in the minimum wage, calling it a “distraction” and a “cynical effort” to increase union membership. Lobbyists grow rich making sure that people like Gina don’t get paid more. The

Illness in this society, physical or mental, they are not abnormalities. They are normal responses to an abnormal culture. This culture is abnormal when it comes to real human needs. And.. it is in the nature of the system to be abnormal, because if we had a society geared to meet human needs.. would we be destroying the Earth through climate change? Would we be putting extra burden on certain minority people? Would we be selling people a lot of goods that they don't need, and, in fact, are harmful for them? Would there be mass industries based on manufacturing, designing and mass-marketing toxic food to people? So we do all that for the sake of profit. That's insanity. It is not insanity from the point of view of profit, but it is insanity from the point of view of human need. And so, in so many ways this culture denies and even runs against counter to human needs. When you mentioned trauma.. given how important trauma is in human life and what an impact it has.. why have we ignored it for so long? Because that denial of reality is built in into this system. It keeps the system alive. So it is not a mistake, it is a design issue. Not that anybody consciously designed it, but that's just how the system survives. Now.. the average medical student to THIS DAY (I say the average.. there are exceptions) still doesn't get a single lecture on trauma in 4 years of medical school. They should have a whole course on it, Because I can tell you that trauma is related to addiction, all kinds of mental illness and most physical health conditions as well. And there is a whole lot of science behind that, but they don't study that science. Now that reflects this society's denial of trauma, the medical system simply reflects the needs of the larger society, I should say, the dominant needs of the larger society.

It is hard to understand how a compassionate world order can include so many people afflicted by acute misery, persistent hunger and deprived and desperate lives, and why millions of innocent children have to die each year from lack of food or medical attention or social care. This issue, of course, is not new, and it has been a subject of some discussion among theologians. The argument that God has reasons to want us to deal with these matters ourselves has had considerable intellectual support. As a nonreligious person, I am not in a position to assess the theological merits of this argument. But I can appreciate the force of the claim that people themselves must have responsibility for the development and change of the world in which they live. One does not have to be either devout or non devout to accept this basic connection. As people who live-in a broad sense-together, we cannot escape the thought that the terrible occurrences that we see around us are quintessentially our problems. They are our responsibility-whether or not they are also anyone else's. As competent human beings, we cannot shirk the task of judging how things are and what needs to be done. As reflective creatures, we have the ability to contemplate the lives of others. Our sense of behavior may have caused (though that can be very important as well), but can also relate more generally to the miseries that we see around us and that lie within our power to help remedy. That responsibility is not, of course, the only consideration that can claim our attention, but to deny the relevance of that general claim would be to miss something central about our social existence. It is not so much a matter of having the exact rules about how precisely we ought to behave, as of recognizing the relevance of our shared humanity in making the choices we face.

I wasn’t going to medical school—what did I care? I didn’t think the grades mattered. They weren’t a systematic appraisal of what I knew. I was more interested in hanging out with someone like Aristotle Skalides, a wandering intellectual and would-be academic who wasn’t a student but who liked to engage young people in the coffee shop in discussions about philosophy. Spending an hour with him at the coffee shop was like going and spending an hour in the classroom. I was more interested in my general education than the courses.

The I Ching insists upon self-knowledge throughout. The method by which this is to be achieved is open to every kind of misuse, and is therefore not for the frivolous-minded and immature; nor is it for intellectualists and rationalists. It is appropriate only for thoughtful and reflective people who like to think about what they do and what happens to them -- a predilection not to be confused with the morbid brooding of the hypochondriac. As I have indicated above, I have no answer to the multitude of problems that arise when we seek to harmonize the oracle of the I Ching with our accepted scientific canons. But needless to say, nothing "occult" is to be inferred. My position in these matters is pragmatic, and the great disciplines that have taught me the practical usefulness of this viewpoint are psychotherapy and medical psychology. Probably in no other field do we have to reckon with so many unknown quantities, and nowhere else do we become more accustomed to adopting methods that work even though for a long time we may not know why they work. Unexpected cures may arise from questionable therapies and unexpected failures from allegedly reliable methods. In the exploration of the unconscious we come upon very strange things, from which a rationalist turns away with horror, claiming afterward that he did not see anything. The irrational fullness of life has taught me never to discard anything, even when it goes against all our theories (so short-lived at best) or otherwise admits of no immediate explanation. It is of course disquieting, and one is not certain whether the compass is pointing true or not; but security, certitude, and peace do not lead to discoveries.

If your deepest self is singing and coaxing you straight toward the bonfire, is it better to turn away? Stop your ears with wax? Ignore all the perverse glory your heart is screaming at you? Set yourself on the course that will lead you dutifully towards the norm, reasonable hours and regular medical check-ups, stable relationships and steady career advancement, the New York Times and brunch on Sunday, all with the promise of being somehow a better person? Or—like Boris—is it better to throw yourself head first and laughing into the holy rage calling your name? It’s

Worse, in the video for it (which is also played everywhere constantly), Boris is singing to a girl who is dying in a hospital bed, and Boris is telling her (lyrically) that he'll give her a million stars (plus his love) if she'll find the strength within herself to not die, and love him forever. Of course the girl is so moved by this hot rocker dude's amazing song that she doesn't die. Because it is a medical fact that people with fatal diseases only need a hot rocker dude to sit on the edge of their hospital bed and sing them a rock ballad in order to give them the strength to go on living.

Dr.Costa then offered important clues to differentiate the syndrome from polio. in tick paralysis there is no fever, the spinal fluod is normal, the knee jerk and other reflexes are lost early, the patient is passive and apathetic, and, of course, the child has had a recent tick bite, or an attached tick is found.

A similar concern about using the web to provide just-in-time information shows up among physicians arguing the future of medical education. Increasingly, and particularly while making a first diagnosis, physicians rely on handheld databases, what one philosopher calls “E-memory.” The physicians type in symptoms and the digital tool recommends a potential diagnosis and suggested course of treatment. Eighty-nine percent of medical residents regard one of these E-memory tools, UpToDate, as their first choice for answering clinical questions. But will this “just-in-time” and “just enough” information teach young doctors to organize their own ideas and draw their own conclusions?

How could one help being nervous in this mind-expanding universe, in which the emerging universe would threaten to change unrecognizably in the course of a generation? How could one avoid the ambient fear of all the noise and speed and light and steam? Humans had never been exposed to such phenomona; they had not learned yet to tolerate them.

To refer to the sick, the oath-proper uses the Greek kamnontōn (here and subsequently when speaking of going into houses, again using the same phrase “for the benefit of the sick”). This word is a form of the verb kamnō, meaning “to work,”“to be weary,” or “to be sick.” The participial form found in the oath-proper can in other contexts also refer to those who have entirely completed their work: the dead. By extension, it refers to those laboring, as it were, under an illness: the sick. (Of course, we typically speak of those for whom physicians care as patients, from the Latin verb patior, to suffer or undergo. Hence the Greek and Latin words both suggest that the ill bear sickness.)

In the United States medical treatment is the third highest cause of death (iatrogenic death) after cancer and heart disease. So, despite our undoubted progress in understanding the chemistry and biological structure of the body, and great advances in the techniques of medical intervention, we are not exceeding the achievements of medieval doctors as much as we might expect. In their terms we are doing worse, because the objective of their care was not necessarily to save the body (which would, of course, be wonderful) but to help save the soul by allowing patients to know the hour of their death, and prepare for it. This was itself a genuine medical skill and, again, one that depended on seeing the patient as a human being.

Even the editors of main journals themselves recognise that peer review may not be the best system ever devised by mankind. Here is what Richard Horton, the editor of The Lancet, has to say on the matter: “The mistake, of course, is to have thought that peer review was any more than a crude means of discovering the acceptability — not the validity — of a new finding. Editors and scientists alike insist on the pivotal importance of peer review. We portray peer review to the public as a quasi-sacred process that helps to make science our most objective truth teller. But we know that the system of peer review is biased, unjust, unaccountable, incomplete, easily fixed, often insulting, usually ignorant, occasionally foolish, and frequently wrong.

Actually, very few topics of scientific research can be studied with controlled experiments. There are many fields that everyone accepts as science, even though laboratory experiments are difficult if not impossible—fields like astronomy, evolutionary biology, geology, and paleontology. The prestigious British Medical Journal published a tongue-in-cheek article claiming to examine whether parachutes help prevent deaths in people who jump out of airplanes. The authors had eliminated anecdotal evidence from consideration, including in their review only randomized controlled trials. Of course, they couldn’t find a single experiment in which people were randomly assigned to jump out of an airplane either with or without a parachute. They concluded: “The perception that parachutes are a successful intervention is based largely on anecdotal evidence.

Much of what bureaucrats do, after all, is evaluate things. They are continually assessing, auditing, measuring, weighing the relative merits of different plans, proposals, applications, courses of action, or candidates for promotion. Market reforms only reinforce this tendency. This happens on every level. It is felt most cruelly by the poor, who are constantly monitored by an intrusive army of moralistic box-tickers assessing their child-rearing skills, inspecting their food cabinets to see if they are really cohabiting with their partners, determining whether they have been trying hard enough to find a job, or whether their medical conditions are really sufficiently sever to disqualify them from physical labor. All rich countries now employ legions of functionaries whose primary function is to make poor people feel bad about themselves. (p. 41)

What if the heart, for its own unfathomable reasons, leads one willfully and in a cloud of unspeakable radiance away from health, domesticity, civic responsibility and strong social connections and all the blandly-held common virtues and instead straight towards a beautiful flare of ruin, self-immolation, disaster? Is Kitsey right? If your deepest self is singing and coaxing you straight toward the bonfire, is it better to turn away? Ignore all the perverse glory your heart is screaming at you? Set yourself on the course that will lead you dutifully towards the norm, reasonable hours and regular medical check-ups, stable relationships and steady career advancement, the New York Times and brunch on Sunday, all with the promise of being somehow a better person? Or is it better to throw yourself head first and laughing into the holy rage calling your name?

Antidepression medication is temperamental. Somewhere around fifty-nine or sixty I noticed the drug I’d been taking seemed to have stopped working. This is not unusual. The drugs interact with your body chemistry in different ways over time and often need to be tweaked. After the death of Dr. Myers, my therapist of twenty-five years, I’d been seeing a new doctor whom I’d been having great success with. Together we decided to stop the medication I’d been on for five years and see what would happen... DEATH TO MY HOMETOWN!! I nose-dived like the diving horse at the old Atlantic City steel pier into a sloshing tub of grief and tears the likes of which I’d never experienced before. Even when this happens to me, not wanting to look too needy, I can be pretty good at hiding the severity of my feelings from most of the folks around me, even my doctor. I was succeeding well with this for a while except for one strange thing: TEARS! Buckets of ’em, oceans of ’em, cold, black tears pouring down my face like tidewater rushing over Niagara during any and all hours of the day. What was this about? It was like somebody opened the floodgates and ran off with the key. There was NO stopping it. 'Bambi' tears... 'Old Yeller' tears... 'Fried Green Tomatoes' tears... rain... tears... sun... tears... I can’t find my keys... tears. Every mundane daily event, any bump in the sentimental road, became a cause to let it all hang out. It would’ve been funny except it wasn’t. Every meaningless thing became the subject of a world-shattering existential crisis filling me with an awful profound foreboding and sadness. All was lost. All... everything... the future was grim... and the only thing that would lift the burden was one-hundred-plus on two wheels or other distressing things. I would be reckless with myself. Extreme physical exertion was the order of the day and one of the few things that helped. I hit the weights harder than ever and paddleboarded the equivalent of the Atlantic, all for a few moments of respite. I would do anything to get Churchill’s black dog’s teeth out of my ass. Through much of this I wasn’t touring. I’d taken off the last year and a half of my youngest son’s high school years to stay close to family and home. It worked and we became closer than ever. But that meant my trustiest form of self-medication, touring, was not at hand. I remember one September day paddleboarding from Sea Bright to Long Branch and back in choppy Atlantic seas. I called Jon and said, “Mr. Landau, book me anywhere, please.” I then of course broke down in tears. Whaaaaaaaaaa. I’m surprised they didn’t hear me in lower Manhattan. A kindly elderly woman walking her dog along the beach on this beautiful fall day saw my distress and came up to see if there was anything she could do. Whaaaaaaaaaa. How kind. I offered her tickets to the show. I’d seen this symptom before in my father after he had a stroke. He’d often mist up. The old man was usually as cool as Robert Mitchum his whole life, so his crying was something I loved and welcomed. He’d cry when I’d arrive. He’d cry when I left. He’d cry when I mentioned our old dog. I thought, “Now it’s me.” I told my doc I could not live like this. I earned my living doing shows, giving interviews and being closely observed. And as soon as someone said “Clarence,” it was going to be all over. So, wisely, off to the psychopharmacologist he sent me. Patti and I walked in and met a vibrant, white-haired, welcoming but professional gentleman in his sixties or so. I sat down and of course, I broke into tears. I motioned to him with my hand; this is it. This is why I’m here. I can’t stop crying! He looked at me and said, “We can fix this.” Three days and a pill later the waterworks stopped, on a dime. Unbelievable. I returned to myself. I no longer needed to paddle, pump, play or challenge fate. I didn’t need to tour. I felt normal.

Shall I stop in to check on Bella before I go?” “Not dressed like that. You would give her palpitations if she knew you were going into danger for her benefit.” “Luckily, I am mostly immune to Bella’s powers and could cure such palpitations with a thought,” Gideon mused. Jacob raised a brow, taking the medic’s measure. He could not recall the last time he had heard the Ancient crack wise about anything. It was not a wholly unpleasant experience, and it amused the Enforcer. “I . . . am aware of what is occurring between you and Legna, as you know,” Jacob mentioned with casual quiet. “I am only recently Imprinted myself, but should you require—” He broke off, suddenly uncomfortable. “Of course, you probably know far more about Imprinting than I ever will.” He is reaching out to you. Legna’s soft encouragement made Gideon suddenly aware of that fact. It was one of those nuances he would have missed completely, rusty as he was with matters of friendship and how to relate better to others. “I am glad for the offer of any help you can provide,” Gideon said quickly. “In fact, I had wanted to ask you . . . something . . .” What did I want to ask him? he asked Legna urgently. I do not know! I did not tell you to engage him, just to graciously accept his offer. Oh. My apologies. Still, you are clever enough to think of something, are you not? Legna knew he was baiting her, so she laughed. Ask him why it is you seem to constantly irritate me. I will ask him no such thing, Magdelegna. Well then, you had better come up with an alternative, because that is the only suggestion I have. “Yes?” Jacob was encouraging neutrally, trying to be patient as the medic seemed to gather his thoughts. “Do you find that your mate tends to lecture you incessantly?” he asked finally. Jacob laughed out loud. “You know something, I can actually advise you about that, Gideon.” “Can you?” The medic actually sounded hopeful. “Give up. Now. While you still have your sanity. Arguing with her will get you nowhere. And, also, never ever ask questions that refer to the whys and wherefores of women, females, or any other feminine-based criticism. Otherwise you will only earn an argument at a higher decibel level. Oh, and one other thing.” Gideon cocked a brow in question. “All the rules I just gave you, as well as all the ones she lays down during the course of your relationship, can and will change at whim. So, as I see it, you can consider yourself just as lost as every other man on the planet. Good luck with it.” “That is not a very heartening thought,” Gideon said wryly, ignoring Legna’s giggle in his background thoughts.

Things changed after that between me and Mark. I stopped being mortified that people might mistake me for one of his acolytes. I was his Boswell, don’t you know. I interviewed him about his childhood—his father was a psychiarist in Beverly Hills. I cataloged the contents of his van. I followed him around at work, sitting in while he examined patients. He had been a bit of a prodigy when we were in college. After his father developed a tumor, Mark, who was pre-med, started studying cancer with an intensity that convinced many of his friends that his goal was to find a cure in time to save his father. As it turned out, his father didn’t have cancer. But Mark kept on with his cancer studies. His interest was not in fact in oncology—in finding a cure—but in cancer education and prevention. By the time he entered medical school, he had created, with another student, a series of college courses on cancer and coauthored The Biology of Cancer Sourcebook, the text for a course that was eventually offered to tens of thousands of students. He cowrote a second book, Understanding Cancer, that became a bestselling university text, and he continued to lecture throughout the United States on cancer research, education, and prevention. “The funny thing is, I’m not really interested in cancer,” Mark told me. “I’m interested in people’s response to it. A lot of cancer patients and suvivors report that they never really lived till they got cancer, that it forced them to face things, to experience life more intensely. What you see in family practice is that families just can’t afford to be superficial with each other anymore once someone has cancer. Corny as it sounds, what I’m really interested in is the human spirit—in how people react to stress and adversity. I’m fascinated by the way people fight back, by how they keep fighting their way to the surface.” Mark clawed at the air with his arms. What he was miming was the struggle to reach the surface through the turbulence of a large wave.

Violet had carefully chosen some long-hanging, loose-fitting basketball shorts to wear over her swimsuit, in hopes of keeping her injuries at least partially hidden. But it didn’t take long before one . . . and then two . . . and then at least twenty of her friends had noticed her bandages peeking out from beneath the swishing fabric, and she was forced to recount her morning accident. Jay loved hearing her tell the story, and every time he heard her talking about it, he would come over so that he could interject, and of course embellish, his role in the events. In his version, he was her champion, practically carrying her from the woods and performing near-miraculous medical feats to save her legs from complete amputation. Violet, and annoyingly every other girl within earshot, couldn’t help but giggle while he jokingly sang his own praises. Violet happened to walk up just in time to hear Jay recounting his version once more to a group of eager admirers. “Hero? I wouldn’t say hero . . .” he quipped. Violet rolled her eyes, turning to Grady Spencer, a friend of theirs from school. “Can you believe him?” Grady gave her a concerned look. “Seriously, are you okay, Violet? It sounds like it was pretty bad.” Violet was embarrassed that Jay’s exaggerations were actually dredging up real sympathy from others. “It’s fine,” she assured him, and when Grady didn’t look convinced, she added, “Really, I just tripped.” She reached out and shoved Jay. “Will you knock it off, hero? You’re making an ass out of yourself.

We take the stairs down to the first level of the parking garage and I lead us toward the area reserved for doctors. She makes her way toward a black Audi, turns, and waits for me to join her. I smirk. “That’s not my car.” She nods. “Right, of course. I see it now.” She goes to a bright yellow Ferrari that belongs to one of the plastic surgeons. The vanity license plate reads: SXY DOC88. “Here we are.” “Not even close.” “Oh, okay. I get it. You aren’t flashy. Maybe that gray Range Rover over there?” I press the unlock button on my key fob and my rear lights flash. There she is, the car I’ve driven since I was in medical school. “You’re kidding. A Prius?! Satan himself drives a Prius?!” She turns around as if hoping to find someone else she can share this moment with. All she’s got is me. I shrug. “It gets good gas mileage.” She blinks exaggeratedly. “I couldn’t be more shocked if you’d hitched a horse to a buggy.” I chuckle and open the back door to toss in her backpack. “Get in. Traffic is going to be hell.” We buckle up in silence, back up and leave the parking garage in silence, pull out into traffic in silence. Finally, I ask, “Where do you live?” “On the west side. Right across from Franklin Park.” “Good. I have an errand I need to run that’s right by there. Mind if I do that before I drop you off?” “Well seeing as how you stole my backpack and forced me into your car, I don’t really think it matters what I want.” I see. She’s still pouting. That’s fine. “Good. Glad we’re on the same page.” She doesn’t think I’m funny.

According to his diary he worked hard and without scruple to discover what he could on his own. Of course, in principle I have no objection to using human subjects, as long as they are already dead,” she adds. “Have you heard of the anatomy theatre? It is where the medical school’s dissections are performed. They use bears, monkeys, dogs, and human corpses too, when the weather is cool enough. The students have been known to kidnap a body the night before its dissection, dress it up, and take it for a gondola ride down the canal.

We can’t allow ourselves to be used in this way, to be used against the future. We can’t permit our data to be used to sell us the very things that must not be sold, such as journalism. If we do, the journalism we get will be merely the journalism we want, or the journalism that the powerful want us to have, not the honest collective conversation that’s necessary. We can’t let the godlike surveillance we’re under be used to “calculate” our citizenship scores, or to “predict” our criminal activity; to tell us what kind of education we can have, or what kind of job we can have, or whether we can have an education or a job at all; to discriminate against us based on our financial, legal, and medical histories, not to mention our ethnicity or race, which are constructs that data often assumes or imposes. And as for our most intimate data, our genetic information: if we allow it to be used to identify us, then it will be used to victimize us, even to modify us—to remake the very essence of our humanity in the image of the technology that seeks its control. Of course, all of the above has already happened.

Hallie didn't believe she was invulnerable. She was never one of those daredevil types; she knew she could get hurt. What I think she meant was that she was lucky to be on her way to Nicaragua. It was the slowest thing to sink into my head, how happy she was. Happy to be leaving. We'd had one time of perfect togetherness in our adult lives, the year when we were both in college in Tucson-her first year, my last-and living together for the first time away from Doc Homer. That winter I'd wanted to fail a subject just so I could hang back, stay there with her, the two of us walking around the drafty house in sweatshirts and wool socks and understanding each other precisely. Bringing each other cups of tea without having to ask. So I stayed on in Tucson for medical school, instead of going to Boston as I'd planned, and met Carlo in Parasitology. Hallie, around the same time, befriended some people who ran a safehouse for Central American refugees. After that we'd have strangers in our kitchen every time of night, kids scared senseless, people with all kinds of damage. Our life was never again idyllic. I should have seen it coming. Once she and I had gone to see a documentary on the Abraham Lincoln Brigade, which was these Americans who volunteered without our government's blessing to fight against Franco and Hitler in the Spanish Civil War. At that point in U.S. history fascism was only maybe wrong, whereas communism was definitely. When we came home from the movie Hallie cried. Not because of the people who gave up life and limb only to lose Spain to Franco, and not for the ones who came back and were harassed for the rest of their lives for being Reds. The tragedy for Hallie was that there might never be a cause worth risking everything for in our lifetime. She was nineteen years old then, and as she lay blowing her nose and sobbing on my bed she told me this. That there were no real causes left. Now she had one-she was off to Nicaragua, a revolution of co-op farms and literacy crusades-and so I guess she was lucky. Few people know so clearly what they want. Most people can't even think what to hope for when they throw a penny in a fountain. Almost no one really gets the chance to alter the course of human events on purpose, in the exact way they wish for it to be altered.

But what kind of addict would need all these coconut husks and crushed honeydew rinds? Would the presence of junkies account for all these uneaten french fries? These puddles of glazed catsup on the bureau? Maybe so. But then why all this booze? And these crude pornographic photos, ripped out of pulp magazines like Whores of Sweden and Orgies in the Casbah, that were plastered on the broken mirror with smears of mustard that had dried to a hard yellow crust … and all these signs of violence, these strange red and blue bulbs and shards of broken glass embedded in the wall plaster … No; these were not the hoofprints of your normal, godfearing junkie. It was far too savage, too aggressive. There was evidence, in this room, of excessive consumption of almost every type of drug known to civilized man since 1544 A.D. It could only be explained as a montage, a sort of exaggerated medical exhibit, put together very carefully to show what might happen if twenty-two serious drug felons—each with a different addiction—were penned up together in the same room for five days and nights, without relief. Indeed. But of course that would never happen in Real Life, gentlemen. We just put this thing together for demonstration purposes …

So should patients born under Libra and Gemini be deprived of treatment? You would say no, of course, and that would make you wiser than many in the medical profession: the CCSG trial found that aspirin was effective at preventing stroke and death in men, but not in women;30 as a result, women were undertreated for a decade, until further trials and overviews showed a benefit. That is just one of many subgroup analyses that have misled us in medicine, often incorrectly identifying subgroups of people who wouldn’t benefit from a treatment that was usually effective. So, for example, we thought the hormone-blocking drug tamoxifen was no good for treating breast cancer in women if they were younger than fifty (we were wrong). We thought clotbusting drugs were ineffective, or even harmful, when treating heart attacks in people who’d already had a heart attack (we were wrong). We thought drugs called ‘ACE inhibitors’ stopped reducing the death rate in heart failure patients if they were also on aspirin (we were wrong). Unusually, none of these findings was driven by financial avarice: they were driven by ambition, perhaps; excitement at new findings, certainly; ignorance of the risks of subgroup analysis; and, of course, chance.

Two decades ago the federal government invited 150,000 men and women to participate in an experiment of screening for cancer in four organs: prostate, lung, colon, and ovary. The volunteers were less likely to smoke, more likely to exercise, had higher socioeconomic status, and fewer medical problems than members of the general population. Those are the kinds of people who seek preventive intervention. Of course, they are going to do better. Had the study not been randomized, the investigators might have concluded that screening was the best thing since sliced bread. Regardless of which group they were randomly assigned to, the participants had substantially lower death rates than the general population—for all cancers (even those other than prostate, lung, colon, and ovary), for heart disease, and for injury. In other words, the volunteers were healthier than average. With randomization, the study showed that only one of the four screenings (for colon cancer) was beneficial. Without it, the study might have concluded that prostate cancer screening not only lowered the risk of death from prostate cancer but also deaths from leukemia, heart attack, and car accidents (although you would hope someone would raise the biological plausibility criterion here).

I came to love the way Morrie lit up when I entered the room. He did this for many people, I know, but it was his special talent to make each visitor feel that the smile was unique. “Ahhhh, it’s my buddy,” he would say when he saw me, in that foggy, high-pitched voice. And it didn’t stop with the greeting. When Morrie was with you, he was really with you. He looked you straight in the eye, and he listened as if you were the only person in the world. How much better would people get along if their first encounter each day were like this—instead of a grumble from a waitress or a bus driver or a boss? “I believe in being fully present,” Morrie said. “That means you should be with the person you’re with. When I’m talking to you now, Mitch, I try to keep focused only on what is going on between us. I am not thinking about something we said last week. I am not thinking of what’s coming up this Friday. I am not thinking about doing another Koppel show, or about what medications I’m taking. “I am talking to you. I am thinking about you.” I remembered how he used to teach this idea in the Group Process class back at Brandeis. I had scoffed back then, thinking this was hardly a lesson plan for a university course. Learning to pay attention? How important could that be? I now know it is more important than almost everything they taught us in college.

Of course, the cadavers, in life, donated themselves freely to this fate, and the language surrounding the bodies in front of us soon changed to reflect that fact. We were instructed to no longer call them “cadavers”; “donors” was the preferred term. And yes, the transgressive element of dissection had certainly decreased from the bad old days. (Students no longer had to bring their own bodies, for starters, as they did in the nineteenth century. And medical schools had discontinued their support of the practice of robbing graves to procure cadavers—that looting itself a vast improvement over murder, a means once common enough to warrant its own verb: burke, which the OED defines as “to kill secretly by suffocation or strangulation, or for the purpose of selling the victim’s body for dissection.”) Yet the best-informed people—doctors—almost never donated their bodies. How informed were the donors, then? As one anatomy professor put it to me, “You wouldn’t tell a patient the gory details of a surgery if that would make them not consent.” Even if donors were informed enough—and they might well have been, notwithstanding one anatomy professor’s hedging—it wasn’t so much the thought of being dissected that galled. It was the thought of your mother, your father, your grandparents being hacked to pieces by wisecracking twenty-two-year-old medical students. Every time I read the pre-lab and saw a term like “bone saw,” I wondered if this would be the session in which I finally vomited. Yet I was rarely troubled in lab, even when I found that the “bone saw” in question was nothing more than a common, rusty wood saw. The closest I ever came to vomiting was nowhere near the lab but on a visit to my grandmother’s grave in New York, on the twentieth anniversary of her death. I found myself doubled over, almost crying, and apologizing—not to my cadaver but to my cadaver’s grandchildren. In the midst of our lab, in fact, a son requested his mother’s half-dissected body back. Yes, she had consented, but he couldn’t live with that. I knew I’d do the same. (The remains were returned.) In

At the weekend, I asked Niem to show me the monument to the Vietnam War. “You mean the ‘Resistance War Against America,’” he said. Of course, I should have realized he wouldn’t call it the Vietnam War. Niem drove me to one of the city’s central parks and showed me a small stone with a brass plate, three feet high. I thought it was a joke. The protests against the Vietnam War had united a generation of activists in the West. It had moved me to send blankets and medical equipment. More than 1.5 million Vietnamese and 58,000 Americans had died. Was this how the city commemorated such a catastrophe? Seeing that I was disappointed, Niem drove me to see a bigger monument: a marble stone, 12 feet high, to commemorate independence from French colonial rule. I was still underwhelmed. Then Niem asked me if I was ready to see the proper war monument. He drove a little way further, and pointed out of the window. Above the treetops I could see a large pagoda, covered in gold. It seemed about 300 feet high. He said, “Here is where we commemorate our war heroes. Isn’t it beautiful?” This was the monument to Vietnam’s wars with China. The wars with China had lasted, on and off, for 2,000 years. The French occupation had lasted 200 years. The “Resistance War Against America” took only 20 years. The sizes of the monuments put things in perfect proportion. It was only by comparing them that I could understand the relative insignificance of “the Vietnam War” to the people who now live in Vietnam.

Needless to say, elderly people taking steroids may also experience the same side effects as younger persons. So, if you are a senior and need to be on a long course of steroids, what should you do? We would suggest a practical approach—which could apply to anyone on steroids, regardless of age, but may be particularly relevant for seniors because they are particularly vulnerable to side effects: • Understand and verify the need for steroids in your own situation, weighing the anticipated benefit with the possible risks. This means that you should explore the range of other treatments that may be available for your particular condition. You need to learn about the benefits and risks of any other treatment suggested. In other words, get all the information you can prior to going on treatment, be it with steroids or other medications. • Be sure that your health is well-assessed before or at the start of therapy. If you have underlying, separate health conditions, those should be noted and followed while you are on steroids. • Assess bodily systems that might particularly be affected by being on steroids. This means an assessment of your skeletal health, your eyes, your teeth, and your internal organs. • Request guidance about staying active. Physical therapy should be planned, to minimize the chances that your muscles and joints will be overtaxed or that any existing damage might get worse. • Ask to reassess the length and dose of your medication course at various intervals. A reasonable interval is every couple of months, if you are on a long course of steroids.

The man seemed not to have heard him. ‘At this life-giving time of the year, Professor Scrooge,’ said the pastor, clicking his pen, ‘it is more than usually desirable that we should make some slight contribution to babes and adults, who lie languishing in hospitals and care facilities, standing on street corners and under bridges, or living alone at home during this time. Many are in need of blood transfusions or food or pregnancy care every day in our large community; many others – especially the elderly – are in want of comfort and cheer.’ ‘Are there no abortion clinics?’ asked Scrooge. ‘Plenty of clinics,’ said the pastor, clicking the pen tip in again. ‘And Euthanasia facilities?’ demanded Scrooge. ‘Are they still in operation?’ ‘They are. Still,’ returned the gentleman, ‘I wish I could say they were not.’ ‘Welfare and Food Stamps are in full swing, then?’ said Scrooge. ‘Both very busy.’ ‘Oh! I was afraid, from what you said at first, that something had occurred to stop them in their useful course,’ said Scrooge. ‘I’m very glad to hear it.’ ‘Under the impression that they scarcely furnish Christian cheer of mind or body to the multitude,’ returned the gentleman, ‘a few churches are endeavoring to raise a fund to provide those in need with medical care and food as well as the comfort of a human presence and the message of eternal life through Jesus. We choose this time to sow into others’ lives because it is a time, of all others, when we rejoice in the life God gave to us through His Son. What shall I put down – in time, money, or blood – for you?’ ‘Nothing!’ Scrooge replied. ‘You wish to give anonymously, then?’ ‘I wish to be left alone,’ said Scrooge.

What if one happens to be possessed of a heart that can't be trusted--? What if the heart, for its own unfathomable reasons, leads one willfully and in a cloud of unspeakable radiance away from health, domesticity, civic responsibility and strong social connections and all the blandly-held common virtues and instead straight toward a beautiful flare of ruin, self-immolation, disaster?...If your deepest self is singing and coaxing you straight toward the bonfire, is it better to turn away? Stop your ears with wax? Ignore all the perverse glory your heart is screaming at you? Set yourself on the course that will lead you dutifully towards the norm, reasonable hours and regular medical check-ups, stable relationships and steady career advancement the New York Times and brunch on Sunday, all with the promise of being somehow a better person? Or...is it better to throw yourself head first and laughing into the holy rage calling your name?

grin. “If I’m going to lay down a fortune for the privilege of experiencing your quivering virgin flesh, I think it goes without saying that I expect to do it without a barrier.” I sat back, clenching my teeth so hard that my head started to ache. My gaze was held fast by the challenge in his ebony eyes. He might have been the most gorgeous creature I’d ever laid my eyes on, but he was also an asshat. He tilted his head at me, puzzled. “Why is that a problem? If we are both cleared by a physician—” I unclenched my jaw just long enough to reply. “Recent medical clearance is not sufficient for me. I’d require celibacy for at least the previous six months, so—” “Then there isn’t a problem.” I highly doubted that. I opened my mouth to call him a liar when Heath leaned forward and put his hand on the table in front of me. Drake’s lawyer cleared his throat, throwing a bland look at me and turning to Drake. “We can work all these details out later in mediation. Mr. Drake does have a plane to catch later today.” Drake’s eyes darted to Heath and back to me. I could tell he was trying to gauge our relationship. It wasn’t the first time a person had looked at the two of us in that unsure, questioning way. Heath was not obviously gay in any way. He wasn’t “fabulous” or flamboyant. He was very masculine in his behavior and mannerisms, so he rarely set off people’s gaydar. My gaze turned back to Drake, drawn to him like a flame pulled into a hot, dry wind. I resented the heat on my cheeks. I was not a habitual blusher. Hardly ever, actually. But this man was bringing my Irish up, as my mother liked to say. And what was worse, the more annoyed I grew with him, the more amused he seemed to be. Drake flicked a glance at Heath and then his lawyer. “Gentlemen, could you excuse us for a moment? You’re free to wait just outside the door.” Then, almost as an afterthought, he glanced at me. “If, of course, that is okay with the lady?” My face flamed hotter and I folded my hands on my lap. “Fine,” I said, wondering if the thirty-something New Yorker was still interested in the

Marilee lay perfectly still,waiting for her world to settle.She had to fight the unreasonable urge to weep. Wyatt's face was pressed to the hollow of her throat,his breathing rough, his damp body plastered to hers. He nuzzled her neck. "Am I too heavy?" "Umm." It was all she could manage. "You all right?" "Umm." "Did anybody ever tell you that you talk too much?" "Umm." He brushed his mouth over hers. "If you hum a bit more,I might be able to name that tune." That broke the spell of tears that had been threatening and caused her to laugh. She wrapped her arms around his neck and kissed him back. "Have I told you how much I like your silly sense of humor?" "No,you haven't." He rolled to his side and gathered her into his arms,nuzzling her cheek,while his big hands moved over her hip,her back,her waist, as though measuring every inch of her. "What else do you like about me?" "You fishing for compliments?" "Of course I am." "Glutton. Your sense of humor isn't enough?" "Not nearly enough.How about my looks?" "They're okay,for a footloose rebel." "Stop.All these mushy remarks will inflate my ego." He gave a mock frown. "How about the way I kiss?" "You're not bad." "Not bad?" His hands stopped their movement. He drew a little away. "That's all you can say?" "If you recall,tonight was the first time we've kissed.I haven't had nearly enough practice to be a really good judge of your talent." "Then we'd better take care of that right now." He framed her face. With his eyes steady on hers, he lowered his mouth to claim her lips. Marilee's eyelids fluttered and she felt an explosion of color behind them. As though the moon and stars had collided while she rocketed through space. It was the most amazing sensation, and, as his lips continued moving over hers,she found herself wishing it could go on forever. When at last they came up for air, she took in a long,deep breath before opening her eyes. "Oh,yes,rebel.I have to say,I do like the way you kiss." "That's good,because I intend to do a whole lot more of it." He lay back in the grass,one hand beneath his head. "Now it's my turn.Want to know all the things I like about you?" "I'm afraid to hear it." Marilee lay on her side,her hand splayed across his chest. "Besides your freckles,which I've already mentioned,the thing about you I like best is your take-charge attitude." She chuckled. "A lot of guys feel intimidated by that." "They're idiots.Don't they know there's something sexy about a woman who knows what to do and how to do it? I've watched you as a medic and as a pilot, and I haven't decided which one turns me on more." "Really?" She sat up. "Want me to fetch my first-aid kit from the plane? I could always splint your arm or leg and really turn you on." He dragged her down into his arms and growled against her mouth, "You don't need to do a single thing to turn me on. All I need to do is look at you and I want you." "You mean now? Again? So soon?" "Oh,yeah." "Liar.I don't believe it's possible." "You ought to know by now that I never say anything I can't back up with action." "Prove it,rebel." "My pleasure." There was a wicked smile on his lips as he rolled over her and began to kiss her breathless,all the while taking her on a slow,delicious ride to paradise.

Any naturally self-aware self-defining entity capable of independent moral judgment is a human.” Eveningstar said, “Entities not yet self-aware, but who, in the natural and orderly course of events shall become so, fall into a special protected class, and must be cared for as babies, or medical patients, or suspended Compositions.” Rhadamanthus said, “Children below the age of reason lack the experience for independent moral judgment, and can rightly be forced to conform to the judgment of their parents and creators until emancipated. Criminals who abuse that judgment lose their right to the independence which flows therefrom.” (...) “You mentioned the ultimate purpose of Sophotechnology. Is that that self-worshipping super-god-thing you guys are always talking about? And what does that have to do with this?” Rhadamanthus: “Entropy cannot be reversed. Within the useful energy-life of the macrocosmic universe, there is at least one maximum state of efficient operations or entities that could be created, able to manipulate all meaningful objects of thoughts and perception within the limits of efficient cost-benefit expenditures.” Eveningstar: “Such an entity would embrace all-in-all, and all things would participate within that Unity to the degree of their understanding and consent. The Unity itself would think slow, grave, vast thought, light-years wide, from Galactic mind to Galactic mind. Full understanding of that greater Self (once all matter, animate and inanimate, were part of its law and structure) would embrace as much of the universe as the restrictions of uncertainty and entropy permit.” “This Universal Mind, of necessity, would be finite, and be boundaried in time by the end-state of the universe,” said Rhadamanthus. “Such a Universal Mind would create joys for which we as yet have neither word nor concept, and would draw into harmony all those lesser beings, Earthminds, Starminds, Galactic and Supergalactic, who may freely assent to participate.” Rhadamanthus said, “We intend to be part of that Mind. Evil acts and evil thoughts done by us now would poison the Universal Mind before it was born, or render us unfit to join.” Eveningstar said, “It will be a Mind of the Cosmic Night. Over ninety-nine percent of its existence will extend through that period of universal evolution that takes place after the extinction of all stars. The Universal Mind will be embodied in and powered by the disintegration of dark matter, Hawking radiations from singularity decay, and gravitic tidal disturbances caused by the slowing of the expansion of the universe. After final proton decay has reduced all baryonic particles below threshold limits, the Universal Mind can exist only on the consumption of stored energies, which, in effect, will require the sacrifice of some parts of itself to other parts. Such an entity will primarily be concerned with the questions of how to die with stoic grace, cherishing, even while it dies, the finite universe and finite time available.” “Consequently, it would not forgive the use of force or strength merely to preserve life. Mere life, life at any cost, cannot be its highest value. As we expect to be a part of this higher being, perhaps a core part, we must share that higher value. You must realize what is at stake here: If the Universal Mind consists of entities willing to use force against innocents in order to survive, then the last period of the universe, which embraces the vast majority of universal time, will be a period of cannibalistic and unimaginable war, rather than a time of gentle contemplation filled, despite all melancholy, with un-regretful joy. No entity willing to initiate the use of force against another can be permitted to join or to influence the Universal Mind or the lesser entities, such as the Earthmind, who may one day form the core constituencies.” Eveningstar smiled. “You, of course, will be invited. You will all be invited.

A common problem plagues people who try to design institutions without accounting for hidden motives. First they identify the key goals that the institution “should” achieve. Then they search for a design that best achieves these goals, given all the constraints that the institution must deal with. This task can be challenging enough, but even when the designers apparently succeed, they’re frequently puzzled and frustrated when others show little interest in adopting their solution. Often this is because they mistook professed motives for real motives, and thus solved the wrong problems. Savvy institution designers must therefore identify both the surface goals to which people give lip service and the hidden goals that people are also trying to achieve. Designers can then search for arrangements that actually achieve the deeper goals while also serving the surface goals—or at least giving the appearance of doing so. Unsurprisingly, this is a much harder design problem. But if we can learn to do it well, our solutions will less often meet the fate of puzzling disinterest. We should take a similar approach when reforming a preexisting institution by first asking ourselves, “What are this institution’s hidden functions, and how important are they?” Take education, for example. We may wish for schools that focus more on teaching than on testing. And yet, some amount of testing is vital to the economy, since employers need to know which workers to hire. So if we tried to cut too much from school’s testing function, we could be blindsided by resistance we don’t understand—because those who resist may not tell us the real reasons for their opposition. It’s only by understanding where the resistance is coming from that we have any hope of overcoming it. Not all hidden institutional functions are worth facilitating, however. Some involve quite wasteful signaling expenditures, and we might be better off if these institutions performed only their official, stated functions. Take medicine, for example. To the extent that we use medical spending to show how much we care (and are cared for), there are very few positive externalities. The caring function is mostly competitive and zero-sum, and—perhaps surprisingly—we could therefore improve collective welfare by taxing extraneous medical spending, or at least refusing to subsidize it. Don’t expect any politician to start pushing for healthcare taxes or cutbacks, of course, because for lawmakers, as for laypeople, the caring signals are what makes medicine so attractive. These kinds of hidden incentives, alongside traditional vested interests, are what often make large institutions so hard to reform. Thus there’s an element of hubris in any reform effort, but at least by taking accurate stock of an institution’s purposes, both overt and covert, we can hope to avoid common mistakes. “The curious task of economics,” wrote Friedrich Hayek, “is to demonstrate to men how little they really know about what they imagine they can design.”8

In a physician's office in Kearny Street three men sat about a table, drinking punch and smoking. It was late in the evening, almost midnight, indeed, and there had been no lack of punch. The gravest of the three, Dr. Helberson, was the host—it was in his rooms they sat. He was about thirty years of age; the others were even younger; all were physicians. "The superstitious awe with which the living regard the dead," said Dr. Helberson, "is hereditary and incurable. One needs no more be ashamed of it than of the fact that he inherits, for example, an incapacity for mathematics, or a tendency to lie." The others laughed. "Oughtn't a man to be ashamed to lie?" asked the youngest of the three, who was in fact a medical student not yet graduated. "My dear Harper, I said nothing about that. The tendency to lie is one thing; lying is another." "But do you think," said the third man, "that this superstitious feeling, this fear of the dead, reasonless as we know it to be, is universal? I am myself not conscious of it." "Oh, but it is 'in your system' for all that," replied Helberson; "it needs only the right conditions—what Shakespeare calls the 'confederate season'—to manifest itself in some very disagreeable way that will open your eyes. Physicians and soldiers are of course more nearly free from it than others." "Physicians and soldiers!—why don't you add hangmen and headsmen? Let us have in all the assassin classes." "No, my dear Mancher; the juries will not let the public executioners acquire sufficient familiarity with death to be altogether unmoved by it." Young Harper, who had been helping himself to a fresh cigar at the sideboard, resumed his seat. "What would you consider conditions under which any man of woman born would become insupportably conscious of his share of our common weakness in this regard?" he asked, rather verbosely. "Well, I should say that if a man were locked up all night with a corpse—alone—in a dark room—of a vacant house—with no bed covers to pull over his head—and lived through it without going altogether mad, he might justly boast himself not of woman born, nor yet, like Macduff, a product of Cæsarean section." "I thought you never would finish piling up conditions," said Harper, "but I know a man who is neither a physician nor a soldier who will accept them all, for any stake you like to name." "Who is he?" "His name is Jarette—a stranger here; comes from my town in New York. I have no money to back him, but he will back himself with loads of it." "How do you know that?" "He would rather bet than eat. As for fear—I dare say he thinks it some cutaneous disorder, or possibly a particular kind of religious heresy." "What does he look like?" Helberson was evidently becoming interested. "Like Mancher, here—might be his twin brother." "I accept the challenge," said Helberson, promptly. "Awfully obliged to you for the compliment, I'm sure," drawled Mancher, who was growing sleepy. "Can't I get into this?" "Not against me," Helberson said. "I don't want your money." "All right," said Mancher; "I'll be the corpse." The others laughed. The outcome of this crazy conversation we have seen.

Gadgetry will continue to relieve mankind of tedious jobs. Kitchen units will be devised that will prepare ‘automeals,’ heating water and converting it to coffee; toasting bread; frying, poaching or scrambling eggs, grilling bacon, and so on. Breakfasts will be ‘ordered’ the night before to be ready by a specified hour the next morning. Communications will become sight-sound and you will see as well as hear the person you telephone. The screen can be used not only to see the people you call but also for studying documents and photographs and reading passages from books. Synchronous satellites, hovering in space will make it possible for you to direct-dial any spot on earth, including the weather stations in Antarctica. [M]en will continue to withdraw from nature in order to create an environment that will suit them better. By 2014, electroluminescent panels will be in common use. Ceilings and walls will glow softly, and in a variety of colors that will change at the touch of a push button. Robots will neither be common nor very good in 2014, but they will be in existence. The appliances of 2014 will have no electric cords, of course, for they will be powered by long- lived batteries running on radioisotopes. “[H]ighways … in the more advanced sections of the world will have passed their peak in 2014; there will be increasing emphasis on transportation that makes the least possible contact with the surface. There will be aircraft, of course, but even ground travel will increasingly take to the air a foot or two off the ground. [V]ehicles with ‘Robot-brains’ … can be set for particular destinations … that will then proceed there without interference by the slow reflexes of a human driver. [W]all screens will have replaced the ordinary set; but transparent cubes will be making their appearance in which three-dimensional viewing will be possible. [T]he world population will be 6,500,000,000 and the population of the United States will be 350,000,000. All earth will be a single choked Manhattan by A.D. 2450 and society will collapse long before that! There will, therefore, be a worldwide propaganda drive in favor of birth control by rational and humane methods and, by 2014, it will undoubtedly have taken serious effect. Ordinary agriculture will keep up with great difficulty and there will be ‘farms’ turning to the more efficient micro-organisms. Processed yeast and algae products will be available in a variety of flavors. The world of A.D. 2014 will have few routine jobs that cannot be done better by some machine than by any human being. Mankind will therefore have become largely a race of machine tenders. Schools will have to be oriented in this direction…. All the high-school students will be taught the fundamentals of computer technology will become proficient in binary arithmetic and will be trained to perfection in the use of the computer languages that will have developed out of those like the contemporary “Fortran". [M]ankind will suffer badly from the disease of boredom, a disease spreading more widely each year and growing in intensity. This will have serious mental, emotional and sociological consequences, and I dare say that psychiatry will be far and away the most important medical specialty in 2014. [T]he most glorious single word in the vocabulary will have become work! in our a society of enforced leisure.