Medical Residency Quotes

Life's like a penis; When it's soft you can't beat it; When it's hard you get screwed. - The Fat Man, Medical Resident in The House of God

Considering I'm a struggling medical resident and you're a fucking millionaire, I'm getting the short end of the stick," I grumbled. "Don't insult me. I'm a billionaire.

Something as trivial as a little gift of candy to medical residents improves the speed and accuracy of their diagnoses. In general, positive emotion enables us to broaden our understanding of what confronts us. This

There are no emergency autopsies,” another resident pointed out to me. “Your patients never complain. They don’t page you during dinner. And they’ll still be dead tomorrow.

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?

Considering I'm a struggling medical resident and you're a fucking millionaire, I'm getting the short end of the stick," "Don't insult me. I'm a billionaire.

LAWS OF THE HOUSE OF GOD I Gomers don’t die. II Gomers go to ground. III At a cardiac arrest, the first procedure is to take your own pulse. IV The patient is the one with the disease. V Placement comes first. VI There is no body cavity that cannot be reached with a #14 needle and a good strong arm. VII Age + BUN = Lasix dose. VIII They can always hurt you more. IX The only good admission is a dead admission. X If you don’t take a temperature, you can’t find a fever. XI Show me a BMS who only triples my work and I will kiss his feet. XII If the radiology resident and the BMS both see a lesion on the chest X ray, there can be no lesion there. XIII The delivery of medical care is to do as much nothing as possible.

There was and still is a tremendous fear that poor and working-class Americans might one day come to understand where their political interests reside. Personally, I think the elites worry too much about that. We dumb working folk were clubbed into submission long ago, and now require only proper medication for our high levels of cholesterol, enough alcohol to keep the sludge moving through our arteries, and a 24/7 mind-numbing spectacle of titties, tabloid TV, and terrorist dramas. Throw in a couple of new flavours of XXL edible thongs, and you've got a nation of drowsing hippos who will never notice that our country has been looted, or even that we have become homeless ourselves.

As a former gas station attendant, parking lot attendant, medical resident and current Goldman Sachs screwee, I am offended.

Could it be that despite all the years I spent in medical school and residency training acquiring specialized knowledge and practical skills, that this expertise mattered little to my patients' overall health?

You will know if you are too acidic if you get sick often, get urinary tract infections, suffer from headaches, and have bad breath and body odor (when you do not use antiperspirant). Acidosis is the medical term for a blood alkalinity of less than 7.35. A normal reading is called homeostasis. It is not considered a disease; although in and of itself it is recognized as an indicator of disease. Your blood feeds your organs and tissues; so if your blood is acidic, your organs will suffer and your body will have to compensate for this imbalance somehow. We need to do all we can to keep our blood alkalinity high. The way to do this is to dramatically increase our intake of alkaline-rich elements like fresh, clean air; fresh, clean water; raw vegetables (particularly their juices); and sunlight, while drastically reducing our intake of and exposure to acid-forming substances: pollution, cigarettes, hard alcohol, white flour, white sugar, red meat, and coffee. By tipping the scales in the direction of alkalinity through alkaline diet and removal of acid waste through cleansing, and acidic body can become an alkaline one. "Bear in mind that some substances that are alkaline outside the body, like milk, are acidic to the body; meaning that they leave and acid reside in the tissues, just as many substances that are acidic outside the body, like lemons and ripe tomatoes, are alkaline and healing in the body and contribute to the body's critical alkaline reserve.

Although Garfield was dangerously ill, the idea of taking him to a hospital was never considered. Hospitals were only for people who had nowhere else to go. “No sick or injured person who could possibly be nursed at home or in a medical man’s private residence,

I enjoyed the intellectual rigor and scientific challenge of death investigation. Everyone there, from new students to the most senior doctors, seemed happy, eager to learn, and professionally challenged. None of the medical examiners had cots in their offices. “There are no emergency autopsies,” another resident pointed out to me. “Your patients never complain. They don’t page you during dinner. And they’ll still be dead tomorrow.

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?

So long as the processes of healing were not understood and man thought that the power to heal resided in substances and things outside of him, he logically sought for extrinsic means of healing, and a healing art was a logical development. The system of medicine, as we know it today, was a logical development out of the fallacy that healing power resides in extrinsic sources.

As part of this menu of services, the clinic also did abortions. Bruce Kessel had been trained in abortion care as a matter of course when he was a medical resident in the early eighties. The way Bruce told it, the years after Roe were an exuberant time, and physicians who cared, as he did, about public health and family planning rejoiced over the freedoms and possibilities that legal abortion promised women.

The troubled middle is…a place where it’s possible to truly love animals and still accept their occasional role as resources, objects, and tools. Those of us in the troubled middle believe that animals deserve to be treated well, but we don’t want to ban their use in medical research. We care enough to want livestock to be raised humanely, but don’t want to abandon meat-eating altogether. ‘Some argue that we are fence-sitters, moral wimps,’ Herzog, himself a resident of the troubled middle, writes. ‘I believe, however, that the troubled middle makes perfect sense because moral quagmires are inevitable in a species with a huge brain and a big heart. They come with the territory.

Are we really supposed to know what we want to do for the rest of our lives at the ripe old age of seventeen?” “Don’t you want to know?” “I guess? I wish I could live ten lives at once.” “Ugh. You just don’t want to choose.” “That’s not what I mean. I don’t want to get stuck doing something that doesn’t mean anything to me. This track I’m on? It goes on forever. Yale. Medical school. Residency. Marriage. Children. Retirement. Nursing home. Funeral home. Cemetery.

Surgeons are independent doers, ready to act. They prefer not to ask for help, thank you, or to place trust in much outside their own abilities. They work hard, expect perfection, and do not accept excuses. To the residents, some surgeon mentors were decent human beings; others were tyrants. Personalities aside, the central fact was this: Surgeons use their hard-earned physical skills to get results in the operating room (or create their own problems). They rely on themselves for success or failure. They are the captains of their ships. They do not need or want to rely on medication or another person to improve the quality of a patient’s life. Surgery is a specialty of instant gratification, for patient and surgeon alike.

They demanded legal clarity. So, beginning with California, states passed laws exempting doctors from prosecution if they prescribed opiates for pain within the practice of responsible health care. Numerous states approved so-called intractable pain regulations: Ohio, Oregon, Washington, and others. Soon what can only be described as a revolution in medical thought and practice was under way. Doctors were urged to begin attending to the country’s pain epidemic by prescribing these drugs. Interns and residents were taught that these drugs were now not addictive, that doctors thus had a mission, a duty, to use them. In some hospitals, doctors were told they could be sued if they did not treat pain aggressively, which meant with opiates. Russell

A note about me: I do not think stress is a legitimate topic of conversation, in public anyway. No one ever wants to hear how stressed out anyone else is, because most of the time everyone is stressed out. Going on and on in detail about how stressed out I am isn’t conversation. It’ll never lead anywhere. No one is going to say, “Wow, Mindy, you really have it especially bad. I have heard some stories of stress, but this just takes the cake.” This is entirely because my parents are immigrant professionals, and talking about one’s stress level was just totally outlandish to them. When I was three years old my mom was in the middle of her medical residency in Boston. She had been a practicing obstetrician and gynecologist in Nigeria, but in the United States she was required to do her residency all over again. She’d get up at 4:00 a.m. and prepare breakfast, lunch, and dinner for my brother and me, because she knew she wouldn’t be home in time to have dinner with us. Then she’d leave by 5:30 a.m. to start rounds at the hospital. My dad, an architect, had a contract for a building in New Haven, Connecticut, which was two hours and forty-five minutes away. It would’ve been easier for him to move to New Haven for the time of the construction of the building, but then who would have taken care of us when my mom was at the hospital at night? In my parents’ vivid imaginations, lack of at least one parent’s supervision was a gateway to drugs, kidnapping, or at the very minimum, too much television watching. In order to spend time with us and save money for our family, my dad dropped us off at school, commuted the two hours and forty-five minutes every morning, and then returned in time to pick us up from our after-school program. Then he came home and boiled us hot dogs as an after-school snack, even though he was a vegetarian and had never eaten a hot dog before. In my entire life, I never once heard either of my parents say they were stressed. That was just not a phrase I grew up being allowed to say. That, and the concept of “Me time.

One day over breakfast, a medical resident asked how Dr. Apgar would make a systematic assessment of a newborn. “That’s easy,” she replied. “You would do it like this.” Apgar jotted down five variables (heart rate, respiration, reflex, muscle tone, and color) and three scores (0, 1, or 2, depending on the robustness of each sign). Realizing that she might have made a breakthrough that any delivery room could implement, Apgar began rating infants by this rule one minute after they were born. A baby with a total score of 8 or above was likely to be pink, squirming, crying, grimacing, with a pulse of 100 or more—in good shape. A baby with a score of 4 or below was probably bluish, flaccid, passive, with a slow or weak pulse—in need of immediate intervention. Applying Apgar’s score, the staff in delivery rooms finally had consistent standards for determining which babies were in trouble, and the formula is credited for an important contribution to reducing infant mortality. The Apgar test is still used every day in every delivery room.

attention deficit disorder in his own son. “I had worked in an ADHD clinic during my residency, and had strong feelings that this was overdiagnosed,” he said. “That it was a ‘savior’ diagnosis for too many kids whose parents wanted a medical reason to drug their children, or to explain their kids’ bad behavior.

A study of 222 white medical students and residents published in the Proceedings of the National Academy of Sciences in 2016 showed that half of the students and residents endorsed at least one false idea about biological differences between Black people and white people, including that Black people’s nerve endings are less sensitive than those of white people.

As we stood on our doorsteps and clanged our pans, politicians were handing out billion-pound contracts to their mates. As we put rainbows in our windows, nursing home residents were being all but murdered by their idiotic policies. And throughout, as NHS staff put their lives at risk, as they worked double and triple shifts, as the PPE cut into their faces, as they moved out of their family homes for months on end, the ghouls in charge seemed far more concerned with their own appearances and legacies. And there’s still nothing approaching an assurance that the NHS won’t be sold off in five years’ time, plunging us into an unfair insurance-based system that mostly benefits the former politicians who stuff the boardrooms of private medicine.

I do believe in teaching and all that crap, and I was excited about having medical students when I first started out in residency. But since then, I’ve learned a very important lesson: most medical students are very annoying. Occasionally, we’ll get some rare gem who is just wonderful and who makes our lives easier. But the vast majority seem to be lazy, whiny, and disinterested.

If there is anything in life I know to be true, it is that life itself is a matter of the spirit. A man with a broken spirit, whose soul nourished nothing except the belief that the poison within his own heart is shared by the whole human race, and hopes anything beyond the desire that everyone he meets will share in his misery, is sick indeed, and his body, however healthy in its potential, is on a path toward corruption; but the person with a purpose, warmed by the impression that, for all his other shortcomings, something resides within him that is capable of loving and of being loved, can bear all things, believe all things, endure all things. That person's body will heal faster than medical minds imagine. It will overcome pain; in many cases, it will not feel it at all.

When we think of an institution, we can usually see it as embodied in a building: the Vatican, the Pentagon, the Sorbonne, the Treasury, the Massachusetts Institute of Technology, the Kremlin, the Supreme Court. What we cannot see, until we become close students of the institution, are the ways in which power is maintained and transferred behind the walls and beneath the domes, the invisible understandings which guarantee that it shall reside in certain hands but not in others, that information shall be transmitted to this one but not to that one, the hidden collusions and connections with other institutions of which it is supposedly independent. When we think of the institution of motherhood, no symbolic architecture comes to mind, no visible embodiment of authority, power, or of potential or actual violence. Motherhood calls to mind the home, and we like to believe that the home is a private place. Perhaps we imagine row upon row of backyards, behind suburban or tenement houses, in each of which a woman hangs out the wash, or runs to pick up a tear-streaked two-year-old; or thousands of kitchens, in each of which children are being fed and sent off to school. Or we think of the house of our childhood, the woman who mothered us, or of ourselves. We do not think of the laws which determine how we got to these places, the penalties imposed on those of us who have tried to live our lives according to a different plan, the art which depicts us in an unnatural serenity or resignation, the medical establishment which has robbed so many women of the act of giving birth, the experts—almost all male—who have told us how, as mothers, we should behave and feel. We do not think of the Marxist intellectuals arguing as to whether we produce “surplus value” in a day of washing clothes, cooking food, and caring for children, or the psychoanalysts who are certain that the work of motherhood suits us by nature. We do not think of the power stolen from us and the power withheld from us, in the name of the institution of motherhood.

Expertise is the mantra of modern medicine. In the early twentieth century, you needed only a high school diploma and a one-year medical degree to practice medicine. By the century’s end, all doctors had to have a college degree, a four-year medical degree, and an additional three to seven years of residency training in an individual field of practice—pediatrics, surgery, neurology, or the like. In recent years, though, even this level of preparation has not been enough for the new complexity of medicine.

I can’t give this letter a storybook ending in the world’s eyes. Today finds Bob back to his regular schedule and the boys spending extra time talking with me flopped across the foot of my bed, which seems to be my permanent residence for now. My head symptoms have not changed. The medication has not settled well, and so the struggle continues. Whether I am in the valley or soaring above the mountain tops, God is there with me. I thank God that I am able to be His child. Now that’s a true storybook ending!

I came across Nell like you would a Robert Mapplethorpe at a street art fair, gobsmacked that something so valuable would be lumped in with a bunch of other crap like that. She’d been slumped against the bathroom wall in Butterfields, a dorm we later took to calling Butterfingers, for the lacrosse team residents who manhandled girls made Gumby-legged by Popov vodka. Even with her mouth hanging open, her tongue dry and pebbled white from all the medically sanctioned stimulants, there was no question that she had a movie star face. “Hey,” I said, my

I started to question what was being taught—I didn’t get much guidance in medical school or residency on what to do when your patient can’t pay for health insurance or when she has lost childcare for the third time in two months and is being fired from her job. Instead, I was taught to prescribe medications or provide psychotherapy for issues that were clearly systemic. While there is certainly a great need for both of these medical interventions, the lack of attention to the inhumanity of our social policies left me feeling powerless—just like my patients.

How the sadness is handled by the physician has a powerful impact on the medical care received by the patients. If the grief is relentlessly suppressed--as in Eva's experience during residency--the result can be a numb physician who is unable to invest in a new patient. This lack of investment can lead to rote medical care--impersonal at best, shoddy at worst. At the other end of the spectrum is the doctor who is inundated with grief and can't function because of the overwhelming sorrow. Burnout is significant in both these cases, and that erodes the quality of medical care.

The benefits of gun ownership have generally gone ignored in medical journals that have studied gun ownership, what is called the public health literature. There is no mention that widespread gun ownership deters criminals from breaking into homes. There is no mention that gun ownership helps protect residents from harm in the event of a break-in, or that mass public shooters consistently attack gun-free zones where they don’t have to worry about victims being able to defend themselves. And gun owners—contrary to what the media advises—should not unquestioningly store their guns locked and unloaded. That defeats the purpose of being ready at a moment’s notice.

A 2016 study published in Proceedings of the National Academy of Sciences of the United States of America suggested that health care providers may underestimate black patients' pain in part due to a belief that they simply don't actually feel as much pain - a myth that dates all the way back to the days of slavery. For centuries, the claim that black people were biologically different from whites was 'championed by scientists, physicians, and slave owners alike to justify slavery and the inhumane treatment of black men and women in medical research,' the authors wrote. Black people were thought to have 'thicker skulls, less sensitive nervous systems,' and a super-human ability to 'tolerate surgical operations with little, if any, pain at all.' In the first phase of the study, over two hundred white medical students and residents were asked whether a series of statements about differences between black and white patients were true or false. Some of the statements were true, while others - for example, 'blacks' skin is thicker than whites' and 'blacks' nerve endings are less sensitive than whites' - were false. They found that a full half of the respondents thought that one or more the false statements - many of which were 'fantastical in nature' - were possibly, probably, or definitely true. Also, notably, many of them didn't agree with the statements that were actually true; only half of the residents knew that white patients are less likely to have heart disease than black patients are. When asked to read case studies of two patients complaining of pain, one white and one black, the respondents who had endorsed more false beliefs were more likely to believe that the black patient felt less pain, and undertreated them accordingly.

In the horrible places, the battle for control escalates until you get tied down or locked into your Geri-chair or chemically subdued with psychotropic medications. In the nice ones, a staff member cracks a joke, wags an affectionate finger, and takes your brownie stash away. In almost none does anyone sit down with you and try to figure out what living a life really means to you under the circumstances, let alone help you make a home where that life becomes possible. This is the consequence of a society that faces the final phase of the human life cycle by trying not to think about it. We end up with institutions that address any number of societal goals—from freeing up hospital beds to taking burdens off families’ hands to coping with poverty among the elderly—but never the goal that matters to the people who reside in them: how to make life worth living when we’re weak and frail and can’t fend for ourselves anymore.

One attribute associated with human intelligence is language, which, when defined as the use of sign sequences within a complex grammar, appears to be uniquely human. What’s interesting about language — at least from a neuroscientist’s perspective — is that it resides on only one side of the brain (the left side in most right-handers). What makes it mind-boggling is that the two sides of a human brain appear nearly identical in both large- and small-scale organization. In other words, there appears to be no physical difference between the two halves. Neuroscientists know of no circuit or structure or cell unique to the left side of the brain that would explain its language capacity compared to the lack of it on the right side. Yet, as seen in patients whose left and right brain halves have been disconnected for medical reasons, the left side is capable of carrying on a conversation about recent experience, but the right side is not.

Distraction leaches the authenticity out of our communications. When we are not emotionally present, we are gliding over the surface of our interactions and we never tangle in the depths where the nuances of our skills are tested and refined. A medical professor describes the easy familiarity with which her digital-native resident students master medical electronic records—but is troubled by the fact that they enter data with their eyes focused on their digital devices, not on the patient in the room with them. Preoccupation with technology acts as a screen between the student and the patient’s real emotion, real fear, and real concern. It may also prevent these residents from noticing physical symptoms that the patient fails to mention. The easy busyness of medical record entry is a way to sidestep the more challenging dynamics of human connection. But experienced physicians know that interpersonal skills are essential to mastering the art and science of medical diagnosis.

Because nobody brought that up to you?” “No, we had no idea that there were any problems that would suggest that.” Besides, as she pointed out later in her testimony, she was not an expert on poison. Dr. Henry testified that Peru was not mentioned in papers on tropical sprue, and that even where the disease was common, those who contracted it had lived in the area for a long time, at least a year. Typhoid fever didn’t fit either. “Even though it’s an acute infection, [it] does not cause a tremendous elevation of the white blood cell count.” Dr. Henry believed that Mike had been septic more than once during his three hospitalizations. Dr. Pam McCoy, the ER physician at the UK Medical Center, testified next. “I work with residents and medical students. I teach them how to work in an emergency department. And usually . . . I go see patients, they go see patients with me; we talk about how you see a patient in the emergency department, how you take care of people, how you put in stitches, that sort of thing.

Yet the homogeneity of contemporary humanity is most apparent when it comes to our view of the natural world and of the human body. If you fell sick a thousand years ago, it mattered a great deal where you lived. In Europe, the resident priest would probably tell you that you had made God angry and that in order to regain your health you should donate something to the church, make a pilgrimage to a sacred site, and pray fervently for God’s forgiveness. Alternatively, the village witch might explain that a demon had possessed you and that she could cast it out using song, dance, and the blood of a black cockerel. In the Middle East, doctors brought up on classical traditions might explain that your four bodily humors were out of balance and that you should harmonize them with a proper diet and foul-smelling potions. In India, Ayurvedic experts would offer their own theories concerning the balance between the three bodily elements known as doshas and recommend a treatment of herbs, massages, and yoga postures. Chinese physicians, Siberian shamans, African witch doctors, Amerindian medicine men—every empire, kingdom, and tribe had its own traditions and experts, each espousing different views about the human body and the nature of sickness, and each offering their own cornucopia of rituals, concoctions, and cures. Some of them worked surprisingly well, whereas others were little short of a death sentence. The only thing that united European, Chinese, African, and American medical practices was that everywhere at least a third of all children died before reaching adulthood, and average life expectancy was far below fifty.14 Today, if you happen to be sick, it makes much less difference where you live. In Toronto, Tokyo, Tehran, or Tel Aviv, you will be taken to similar-looking hospitals, where you will meet doctors in white coats who learned the same scientific theories in the same medical colleges. They will follow identical protocols and use identical tests to reach very similar diagnoses. They will then dispense the same medicines produced by the same international drug companies. There are still some minor cultural differences, but Canadian, Japanese, Iranian, and Israeli physicians hold much the same views about the human body and human diseases. After the Islamic State captured Raqqa and Mosul, it did not tear down the local hospitals. Rather, it launched an appeal to Muslim doctors and nurses throughout the world to volunteer their services there.15 Presumably even Islamist doctors and nurses believe that the body is made of cells, that diseases are caused by pathogens, and that antibiotics kill bacteria.

Did you know that if you’re a middle-aged woman, you have only a small window of opportunity between the beginning of perimenopause and the start of menopause to start estrogen replacement therapy to protect not only your brain but also your bones and cardiovascular system? I did not, until I dug into the science, because as a woman who was diagnosed with a stage 0 breast lump, I was scared off like so many of us from the results of the Women’s Health Initiative, which got blasted out all over the news and initially showed a link between estrogen replacement therapy and breast cancer, but guess what? That study had so many flaws, its findings are little more than useless and possibly harmful. Worse, women like me without uteri show a decrease in breast cancer with estrogen replacement therapy. But this information never made it either into the headlines or into our gynecologists’ offices. I had to find it in scientific publications such as The Lancet online. In fact, get this: Our medical system barely trains gynecologists in menopausal medicine. A recent study found that only 20 percent of ob-gyn residency programs in the U.S. provide any menopause training. Yes, any. Which means that 80 percent of all gynecological residents in school today are getting no training whatsoever in post-reproductive women’s health. These are people whose job it is to know everything going on in our ladyparts, but they have not been taught the basic tenets of how to care for either us or our plumbing after we stop menstruating. And by “us” I mean 30 percent of all women alive on earth at any given moment. Half of my middle-aged female friends deal with chronic urinary tract infections. Oh, well, we think, throwing up our hands in defeat and consuming far too many antibiotics than are rational or safe or even good for the future safety of humanity. It took Dr. Rachel Rubin, a urologist in Washington, D.C., reaching out to me over Twitter to explain that UTIs in menopausal women do not have to be recurrent. They can be mitigated with, yes, vaginal estrogen. Not once was I ever

Throughout medical school, residency, specialties, and subspecialties some feel we have allowed the science to overshadow the art.

Technology was supposed to bring the latest fiber-optic cables into every house in Celebration. It promised a computerized community network that would let any resident pull up his or her medical records at the hospital, monitor his or her child's network at school and communicate with teachers and administrators, or simply chat with neighbors or order carry out from one of the restaurants.

Singer’s lethal potion is concocted of hundreds of outlandish facts and quotes—he is a tenacious reporter—and a style that barely suppresses his own amusement. It works particularly well on the buccaneers who continue to try the patience of the citizenry, as proved by his profile in The New Yorker of the developer Donald Trump. Noting that Trump “had aspired to and achieved the ultimate luxury, an existence unmolested by the rumbling of a soul,” Singer describes a visit to Mar-a-Lago, the Palm Beach spa converted by Trump from the 118-room Hispano-Moorish-Venetian mansion built in the 1920s by Marjorie Merriweather Post and E. F. Hutton: Evidently, Trump’s philosophy of wellness is rooted in a belief that prolonged exposure to exceptionally attractive young spa attendants will instill in the male clientele a will to live. Accordingly, he limits his role to a pocket veto of key hiring decisions. While giving me a tour of the main exercise room, where Tony Bennett, who does a couple of gigs at Mar-a-Lago each season and had been designated an “artist-in-residence,” was taking a brisk walk on a treadmill, Trump introduced me to “our resident physician, Dr. Ginger Lee Southall”—a recent chiropractic-college graduate. As Dr. Ginger, out of earshot, manipulated the sore back of a grateful member, I asked Trump where she had done her training. “I’m not sure,” he said. “Baywatch Medical School? Does that sound right? I’ll tell you the truth. Once I saw Dr. Ginger’s photograph, I didn’t really need to look at her résumé or anyone else’s. Are you asking, ‘Did we hire her because she trained at Mount Sinai for fifteen years?’ The answer is no. And I’ll tell you why: because by the time she’s spent fifteen years at Mount Sinai, we don’t want to look at her.

While the experience of the Second World War has to a large extent shaped the political makeup and destinies of all European societies in the second half of the twentieth century, Poland has been singularly affected. It was over the territory of the pre-1939 Polish state that Hitler and Stalin first joined in a common effort (their pact of nonaggression signed in August 1939 included a secret clause dividing the country in half) and then fought a bitter war until one of them was eventually destroyed. As a result, Poland suffered a demographic catastrophe without precedent; close to 20 percent of its population died of war-related causes. It lost its minorities - Jews in the Holocaust, and Ukrainians and Germans following border shifts and population movements after the war. Poland's elites in all walks of life were decimated. Over a third of its urban residents were missing at the conclusion of the war. Fifty-five percent of the country's lawyers were no more, along with 40 percent of its medical doctors and one-third of its university professors and Roman Catholic clergy. Poland was dubbed 'God's playground' by a sympathetic British historian, but during that time it must have felt more like a stomping ground of the devil.

They determined that the death count based solely on the medical autopsies had underestimated the damage. Between 14 and 20 July, 739 more Chicago residents died than in a typical week for that month. In fact, public health scholars have established that the proportional death toll from the heat wave in Chicago has no equal in the record of U.S. heat disasters.

The disaster also has a social etiology, which no meteorological study, medical autopsy, or epidemiological report can uncover. The human dimensions of the catastrophe remain unexplored. This book is organized around a social autopsy of the 1995 Chicago heat wave. Just as the medical autopsy opens the body to determine the proximate physiological causes of mortality, this inquiry aims to examine the social organs of the city and identify the conditions that contributed to the deaths of so many Chicago residents that July. If the idea of conducting a social autopsy sounds peculiar, this is largely because modern political and medical institutions have attained monopolistic roles in officially explaining, defining, and classifying life and death, in establishing the terms and categories that structure the way we see and do not see the world.

However, Pauling’s interest in these carotenoids and flavonoids was confined to their chemical structures and the influence of structure on optical properties; he did not address their health functions. In 1941 Pauling was diagnosed with Bright’s disease, or glomerulonephritis, which was at the time an often-fatal kidney disorder. On the advice of physicians at the Rockefeller Institute, he went to San Francisco for treatment by Thomas Addis, an innovative Stanford nephrologist. Addis prescribed a diet low in salt and protein, plenty of water, and supplementary vitamins and minerals that Pauling followed for nearly 14 years and completely recovered. This was dramatic firsthand experience of the therapeutic value of the diet. Revelations When Pauling cast about for a new research direction in the 1950s, he realized that mental illness was a significant public health problem that had not been sufficiently addressed by scientists. Perhaps his mother’s megaloblastic madness and premature death caused by B12 deficiency underlay this interest. At about this time, Pauling’s eldest son, Linus Jr., began a residency in psychiatry, which undoubtedly prompted Pauling to consider the nature of mental illness. Thanks to funding from the Ford Foundation, Pauling investigated the role of enzymes in brain function but made little progress. When he came across a copy of Niacin Therapy in Psychiatry (1962) by Abram Hoffer in 1965, Pauling was astonished to learn that simple substances needed in minute amounts to prevent deficiency diseases could have therapeutic application in unrelated diseases when given in very large amounts. This serendipitous and key event was critically responsible for Pauling’s seminal paper in his emergent medical field. Later, Pauling was especially excited by Hoffer’s observations on the survival of patients with advanced cancer who responded well to his micronutrient and dietary regimen, originally formulated to help schizophrenics manage their illness.19,20 The regimen includes large doses of B vitamins, vitamin C, vitamin E, beta-carotene, selenium, zinc, and other micronutrients. About 40 percent of patients treated adjunctively with Hoffer’s regimen lived, on average, five or more years, and about 60 percent survived four times longer than controls. These results were even better than those achieved by Scottish surgeon Ewan Cameron, Pauling’s close clinical collaborator, in Scotland. After a long and extremely productive career at Caltech,

In the cloudy swirl of misleading ideas surrounding public discussion of addiction, there’s one that stands out: the misconception that drug taking by itself will lead to addiction — in other words, that the cause of addiction resides in the power of the drug over the human brain. It is one of the bedrock fables sustaining the so-called “War on Drugs.” It also obscures the existence of a basic addiction process of which drugs are only one possible object, among many. Compulsive gambling, for example, is widely considered to be a form of addiction without anyone arguing that it’s caused by a deck of cards. The notion that addiction is drug-induced is often reinforced. Clearly, if drugs by themselves could cause addiction, we would not be safe offering narcotics to anyone. Medical evidence has repeatedly shown that opioids prescribed for cancer pain, even for long periods of time, do not lead to addiction except in a minority of susceptible people. During my years working on a palliative care ward I sometimes treated terminally ill cancer patients with extraordinarily high doses of narcotics — doses that my hardcore addict clients could only dream of. If the pain was alleviated by other means — for example, when patient was successfully given a nerve block for bone pain due to malignant deposits in the spine — the morphine could be rapidly discontinued. Yet if anyone had reason to seek oblivion through narcotic addiction, it would have been these terminally ill human beings. An article in the Canadian Journal of Medicine in 2006 reviewed international research covering over six thousand people who had received narcotics for chronic pain that was not cancerous in origin. There was no significant risk of addiction, a finding common to all studies that examine the relationship between addiction and the use of narcotics for pain relief. “Doubts or concerns about opioid efficacy, toxicity, tolerance, and abuse or addiction should no longer be used to justify withholding opioids,” concluded a large study of patients with chronic pain due to rheumatic disease. We can never understand addiction if we look for its sources exclusively in the actions of chemicals, no matter how powerful they are.

Owen is utterly out of whatever closet he may once have been in. Is resident Concerned Gay Medical Personnel, or some such. This being so, everything is devoted to the political aspect of homosexuality. And this means exclusivity. His is a polarized view. There are homos in the world and then there are heteros. Nothing else. A bipolar existence. Table d’hôte enforced. Either Lunch A or Lunch B. No à la carte. All of his stories have a homo conclusion; all of his references are to the “gay community”; all conclusions point to a closed and intensely self-conscious group society. Part of the reason, of course, is that he is talking to me. But another part is that he has committed himself. And when you do this, you invest. Political preference takes over. You become a card-carrying Catholic, a card-carrying Communist, a card-carrying Cocksucker.

Addiction is a human problem that resides in people, not in the drug or in the drug’s capacity to produce physical effects,” writes Lance Dodes, a psychiatrist at the Harvard Medical School Division on Addictions. It is true that some people will become hooked on substances after only a few times of using, with potentially tragic consequences, but to understand why, we have to know what about those individuals makes them vulnerable to addiction. Mere exposure to a stimulant or narcotic or to any other mood-altering chemical does not make a person susceptible. If she becomes an addict, it’s because she’s already at risk. Heroin is considered to be a highly addictive drug — and it is, but only for a small minority of people, as the following example illustrates. It’s well known that many American soldiers serving in the Vietnam War in the late 1960s and early 1970s were regular users. Along with heroin, most of these soldier addicts also used barbiturates or amphetamines or both. According to a study published in the Archives of General Psychiatry in 1975, 20 per cent of the returning enlisted men met the criteria for the diagnosis of addiction while they were in Southeast Asia, whereas before they were shipped overseas fewer than 1 per cent had been opiate addicts. The researchers were astonished to find that “after Vietnam, use of particular drugs and combinations of drugs decreased to near or even below preservice levels.” The remission rate was 95 per cent, “unheard of among narcotics addicts treated in the U.S.” “The high rates of narcotic use and addiction there were truly unlike anything prior in the American experience,” the researchers concluded. “Equally dramatic was the surprisingly high remission rate after return to the United States.” These results suggested that the addiction did not arise from the heroin itself but from the needs of the men who used the drug. Otherwise, most of them would have remained addicts. As with opiates so, too, with the other commonly abused drugs. Most people who try them, even repeatedly, will not become addicted. According to a U.S. national survey, the highest rate of dependence after any use is for tobacco: 32 per cent of people who used nicotine even once went on to long-term habitual use. For alcohol, marijuana and cocaine the rate is about 15 per cent and for heroin the rate is 23 per cent. Taken together, American and Canadian population surveys indicate that merely having used cocaine a number of times is associated with an addiction risk of less than 10 per cent. This doesn’t prove, of course, that nicotine is “more” addictive than, say, cocaine. We cannot know, since tobacco — unlike cocaine — is legally available, commercially promoted and remains, more or less, a socially tolerated object of addiction. What such statistics do show is that whatever a drug’s physical effects and powers, they cannot be the sole cause of addiction.

When we prioritized being together and gave our word to each other that our relationship would come first, everything else that took so much time and seemed to make it impossible to find the time for a date just seemed to contract and open up a window for being together. Even when Rachel was in medical residency working 110 hours a week, even when we had newborn twins, even when I was working two jobs and commuting five hours a day round-trip, we still found time for date night.

found you on the CRISP website. I was looking for someone at UCSF with an R01 doing research in kidney disease,” I said. CRISP, now called the NIH RePORTER, was the National Institutes of Health’s searchable database of all federally funded biomedical research projects. I knew that the NIH’s R01 grant mechanism, which was awarded to researchers who no longer needed a research mentor, allowed the researcher to apply for smaller research grants to support someone from backgrounds underrepresented in medicine—Blacks, Hispanics, or Native Americans, individuals with a physical or mental disability, or those who grew up in poverty—at every level of education, from a high school student to a college student, a medical student, resident, or fellow.

Were the travelers aware of the power of reciprocity to affect their behavior? Not at all. But once reciprocity kicks in, self-justification will follow: “I’ve always wanted a copy of the Bhagavad Gita; what is it, exactly?” The power of the flower is unconscious. “It’s only a flower,” the traveler says. “It’s only a pizza,” the medical resident says. “It’s only a small donation for an educational symposium,” the physician says. Yet the power of the flower is one reason that the amount of contact doctors have with pharmaceutical representatives is positively correlated with the cost of the drugs the doctors later prescribe.

We expect that life will be better once we are done with premed, medical school, and residency. But it doesn’t get better. It will stay the same … unless you change your mentality. Enjoy the now. Enjoy studying for the organic chemistry test if you are a premedical student. Enjoy rotating through general surgery as a medical student. Enjoy working 80-hour weeks as a resident. If you do not enjoy your current situation, you will not enjoy your future one.

You think Dad wanted to psuh an orderly cart all these years?" Mom demands. "He did it to put food on our table." Because the state licensure board wouldn't honor his medical degree from China without him going through a residency he couldn't afford with a wife and baby on the way. Because this world crushes all our dreams. I know; God, I know. This time, she doesn't add what she often does: But it's worth it. You got to grow up in America. You'll have opportunities we can't even dream of.” And grown up I have, knowing that it falls to me, as the elder child, to earn back the cost of two lives.

You think Dad wanted to push an orderly cart all these years?" Mom demands. "He did it to put food on our table." Because the state licensure board wouldn't honor his medical degree from China without him going through a residency he couldn't afford with a wife and baby on the way. Because this world crushes all our dreams. I know; God, I know. This time, she doesn't add what she often does: But it's worth it. You got to grow up in America. You'll have opportunities we can't even dream of.” And grown up I have, knowing that it falls to me, as the elder child, to earn back the cost of two lives.

you think Dad wanted to push an orderly cart all these years?" Mom demands. "he did it to put food on our table." Because the state licensure board wouldn't honor his medical degree from China without him going through a residency he couldn't afford with a wife and baby on the way. Because this world crushes all our dreams. I know; God, I know. This time, she doesn't add what she often does: But it's worth it. You got to grow up in America. You'll have opportunities we can't even dream of.

We convince ourselves that life will be better after we get married, have a baby, then another. Then we're frustrated that the kids aren't old enough and we'll be more content when they are. After that, we're frustrated that we have teenagers to deal with. We'll certainly be happy when they're out of that stage. We tell ourselves that our life will be complete when our spouse gets his or her act together, when we get a nicer car, are able to go on a nice vacation, when we retire. The truth is, there's no better time to be happy than right now. If not now, when? Your life will always be filled with challenges. It's best to admit this to yourself and decide to be happy anyway...

murder cases are more likely to be solved when the crime occurs in private residences or bars and stores rather than in open public areas. Those cases are also more likely to be closed if detectives arrive at the crime scene within a half hour of that crime being reported and if those investigators are followed by the prompt arrival of medical examiners and crime lab technicians.

Additionally, after a thirty-hour shift without sleep, residents make 460 percent more diagnostic mistakes in the intensive care unit than when well rested after enough sleep. Throughout the course of their residency, one in five medical residents will make a sleepless-related medical error that causes significant, liable harm to a patient.

of menopause—not to mention a potentially increased risk of Alzheimer’s disease, as we’ll see in chapter 9. Medicine 2.0 would rather throw out this therapy entirely, on the basis of one clinical trial, than try to understand and address the nuances involved. Medicine 3.0 would take this study into account, while recognizing its inevitable limitations and built-in biases. The key question that Medicine 3.0 asks is whether this intervention, hormone replacement therapy, with its relatively small increase in average risk in a large group of women older than sixty-five, might still be net beneficial for our individual patient, with her own unique mix of symptoms and risk factors. How is she similar to or different from the population in the study? One huge difference: none of the women selected for the study were actually symptomatic, and most were many years out of menopause. So how applicable are the findings of this study to women who are in or just entering menopause (and are presumably younger)? Finally, is there some other possible explanation for the slight observed increase in risk with this specific HRT protocol?[*3] My broader point is that at the level of the individual patient, we should be willing to ask deeper questions of risk versus reward versus cost for this therapy—and for almost anything else we might do. The fourth and perhaps largest shift is that where Medicine 2.0 focuses largely on lifespan, and is almost entirely geared toward staving off death, Medicine 3.0 pays far more attention to maintaining healthspan, the quality of life. Healthspan was a concept that barely even existed when I went to medical school. My professors said little to nothing about how to help our patients maintain their physical and cognitive capacity as they aged. The word exercise was almost never uttered. Sleep was totally ignored, both in class and in residency, as we routinely worked twenty-four hours at a stretch. Our instruction in nutrition was also minimal to nonexistent. Today, Medicine 2.0 at least acknowledges the importance of healthspan, but the standard definition—the period of life free of disease or disability—is totally insufficient, in my view. We want more out of life than simply the absence of sickness or disability. We want to be thriving, in every way, throughout the latter half of our lives. Another, related issue is that longevity itself, and healthspan in particular, doesn’t really fit into the business model of our current

In a ten-year period, for example, 176 rural hospitals and associated medical centers closed, forcing residents to drive long distances, sometimes for hours, even for emergency treatment.

Note: The first incident happened after the arrest by the Netherlands police in May 1980. I suffered from that, which destroyed my career, future, health, and life. I tried and tried to investigate that, but the police didn't even register the first information report (FIR). It stayed, refusing since 1980 until now, which creates suspicious questions about what the reasons are for not filing the case. It mirrors whether the Netherlands government victimised me or whether the hired ones of the international intelligence agencies have been a hindrance or the criminal groups. - The second incident happened in the shape of uncurable cancer; it was a deliberate mistake and ignorance of the Netherlands Urologists, who did not follow even the primary medical borderlines for the checkup during one year from 2016 to 2017. After the diagnosis, they are hiding the reality, and they still do not take it seriously. I still hope that the Netherlands' neutral and free media will awaken to help me investigate the incident. It will save millions of lives around the world. In God's name, take it seriously to protect me and others. I feel suspicious elements around me. I cry and pray day and night for God's protection since I do not exclude the Qadeyanis witches and magicians, who keep doing black magic continuously that the West does not understand. My Real Story In A Poem *** I never thought I would suffer from cancer The metastatic prostate gland I still cannot decide that It is natural or human-made Since everything is possible In the medical-criminal world How it happened in Western society; Civilized urologists ignored it deliberately From 2016 to 2017 Telling that nothing was wrong Whereas I was suffering from Bleeding, burning, and pain During urinating I begged urologists for a wide-scale checkup With MRI scans and other new technologies But urologists stayed rejecting; Whereas I was paying insurance for that Consequently, at the beginning of 2017 The diagnosis became a time bomb that I had metastatic prostate gland cancer, Which was not curable, They listed me on the death list, Treating for longer life expectancy However, they do tell not the truth And stay suspicious It confuses me and creates grave fear Since then I am bearing terrible side effects Factually, I became victimized twice By criminals, Intelligence Agencies And underground-mafias Which I am unable to trace alone In this regard, I approached Western Media, Ministries, police, courts, Euro Union Unfortunately, none of those responded Even my motherland media cruelly ignored It seems as if I am in the grip of the demon And The Prisoner Of The Hague Everyone has left me alone in pain, Stress, fear, depression Even my children don't care And realize my tears Where resides sympathy, empathy, And humanity? I feel death before death It is a silent cruelty Ah, where should I ask and beg For justice, help, and investigation That civilized world should know An innocent is under victimization I believe God will help and protect And someone from somewhere Appear to hold my hands To eliminate all criminals and demons My cancer will be curable With a longer life expectancy, in some ways Amen, O' merciful God amen.

Those fuckers aren’t like me. They aren’t damaged and deranged, even though the damage I’ve endured has forced them into being. They’ll try to “help,” but that’s like sending out a medical resident to perform fucking brain surgery. They aren’t cut out for this.

When, a few months later, Goldman Sachs announced it was setting aside $542,000 per employee for the 2006 bonus pool, he wrote again: “As a former gas station attendant, parking lot attendant, medical resident and current Goldman Sachs screwee, I am offended.” In

Don’t…ever… Talk negatively about another program, applicant or your medical school.

How Long Will It Take? You can’t blame people for wanting instant results. Time is money, and quickness, especially quick OODA loops, is good. But when it comes to adopting maneuver conflict / Boyd’s principles to your business, there is a lot to be learned and a lot to be done. Consider that: •   According to its principle creator, Taiichi Ohno, it took 28 years (1945-1973) to create and install the Toyota Production System, which is maneuver conflict applied to manufacturing. •   It takes roughly 15 years of experience—and recognition as a leader in one’s technical field—to qualify as a susha (development manager) for a new Toyota vehicle.150 •   Studies of people regarded as the top experts in a number of fields suggest that they practice about four hours a day, virtually every day, for 10 years before they achieve a recognized level of mastery.151 •   It takes a minimum of 8 years beyond a bachelor’s degree to train a surgeon (4 years medical school and 4 or more years of residency.) •   It takes four to six years on the average beyond a bachelor’s degree to complete a Ph.D. •   It takes three years or so to earn a black belt (first degree) in the martial arts and four to six years beyond that to earn third degree, assuming you are in good physical condition to begin with. •   It takes a bare minimum of five years military service to qualify for the Special Forces “Green Beret” (minimum rank of corporal / captain with airborne qualification, then a 1-2 year highly rigorous and selective training program.) •   It takes three years to achieve proficiency as a first level leader in an infantry unit—a squad leader.152 It is no less difficult to learn to fashion an elite, highly competitive company. Yet for some reason, otherwise intelligent people sometimes feel they should be able to attend a three-day seminar and return home experts in maneuver conflict as applied to business. An intensive orientation session may get you started, but successful leaders study their art for years—Patton, Rommel, and Grant were all known for the intensity with which they studied military history and current campaigns. Then-LTC David Hackworth had commanded 10 other units before taking over the 4th Battalion, 39th Infantry in Vietnam in 1969, as he described in Steel My Soldiers’ Hearts. You may also recall the scene in We Were Soldiers where LTC Hal Moore unloaded armfuls of strategy and history books as he was moving into his quarters at Ft. Benning. At that point, he had been in the Army 20 years and had commanded at every level from platoon to battalion.

neurosurgeon. I graduated from the University of North Carolina at Chapel Hill in 1976 with a major in chemistry and earned my M.D. at Duke University Medical School in 1980. During my eleven years of medical school and residency training at Duke as well as Massachusetts General Hospital and Harvard, I focused on neuroendocrinology, the study of the interactions between the nervous system and the endocrine system—the series of glands that release the hormones that direct most of your body’s activities. I also spent two of those eleven years investigating how blood vessels in one area of the brain react pathologically when there is bleeding into it from an aneurysm—a syndrome known as cerebral vasospasm. After completing a fellowship in cerebrovascular neurosurgery in Newcastle-Upon-Tyne in the United Kingdom, I spent fifteen years on the faculty of Harvard Medical School as an associate professor of surgery, with a specialization in neurosurgery. During those years I operated on countless patients, many of them with severe, life-threatening brain conditions.

to contain. At that thought, he wondered if any feeders had been brought to the Estate tonight, he‘d have to get Alexander to check.  They had two or three resident feeders; people who lived on the Estate and worked there or studied during the day and were available to Julius and his staff for feeding when necessary.  Julius encouraged his staff to go off the Estate and find donors in the clubs and bars of the City.  He enforced a strict code of conduct when it came to feeding; donors had to be willing, there was to be no violence in the act and the donor’s memories had to be cleared of anything to do with being bitten and fed on.  But occasionally someone needed blood urgently or didn’t have time to go ‘hunting’, and this was what the feeders were for.  He only allowed the feeders to stay for a few months at the most; they usually left with some memory about undertaking a medical experiment and a decent bank account, so it worked for all parties concerned.  Julius wasn’t sure what Gabi would make of that, but they did have to feed somehow, he was trying to do it in the most humane way he could.

You might be wondering why the Bible instructs us to speak against darkness, rather than think against it, if the real power is in what we think. While it’s true that there can be great power in the words that we speak, this is only true when our words reflect our inner-most thoughts, and our inner-most thoughts are the things we believe in our spirit. Our spirit is where faith resides. And it is faith that God and the rest of the spiritual world recognize and respond to. If our words tell a demon to leave, while our spirit is transmitting thoughts of fear, the demon will perceive that we are afraid, and it will not leave. It is only when our words match the thoughts of our spirit—and we are single-minded—that the spirit world responds to what we say.

And isn’t this really what it’s all about? Control. Even in the face of overwhelming evidence to the contrary, many of us persist in believing that more choice equals more freedom. Making choices gives us the illusion that we are in control. For instance, some Americans keep guns “for protection” despite the fact that it makes death by a firearm in one’s residence more rather than less likely. Gun ownership gives us the (false) sense that we are in control over our safety. Or consider football. National Football League head coaches (before it was made illegal) often called timeout right before an opposing team lined up for a game-winning try — despite the fact that doing so made the second field goal attempt more rather than less likely to succeed. It also gave them a (false) sense of control. And even in the face of clear evidence that a medical intervention would make a particular sickness worse rather than better, we often go ahead with the treatment nonetheless, rather than do nothing and let the body heal itself. “Doing something” helps convince us that we have some control in a vulnerable and difficult situation. This

On the other hand, the shortage of primary care physicians is so severe that 43.7 percent of the 21,885 residency positions in internal medicine in 2005 were filled by graduates of foreign medical schools30—because most of those coming out of American medical schools opt for training as specialists. This

At OBSS   An unexpected occurrence did come of this escapade, even though I didn’t care for the program. Andy, you may or may not be aware that Outward Bound teaches interpersonal and leadership skills, not to mention wilderness survival. The first two skillsets were not unlike our education at the Enlightened Royal Oracle Society (E.R.O.S.) or the Dale Carnegie course in which I had participated before leaving Malaya for school in England. It was the wilderness survival program I abhorred. Since I wasn’t rugged by nature (and remain that way to this day), this arduous experience was made worse by your absence. In 1970, OBSS was under the management of Singapore Ministry of Defence, and used primarily as a facility to prepare young men for compulsory ’National Service,’ commonly known as NS. All young and able 18+ Singaporean male citizens and second-generation permanent residents had to register for National Service compulsorily. They would serve either a two-year or twenty-two-month period as Full Time National Servicemen after completing the Outward Bound course. Pending on their individual physical and medical fitness, these young men would enter the Singapore Armed Forces (SAF), Singapore Police Force (SPF), or the Singapore Civil Defense Force (SCDF). Father, through his extensive contacts, enrolled me into the twenty-one-day Outward Bound summer course. There were twenty boys in my class. We were divided into small units under the guidance of an instructor. During the first few days at the base camp, we trained for outdoor recreation activities such as adventure racing, backpacking, cycling, camping, canoeing, canyoning, fishing, hiking, kayaking, mountaineering, horseback riding, photography, rock climbing, running, sailing, skiing, swimming, and a variety of sporting activities.

Adium is an open source project led by Evan Schoenberg. There wasn’t much information about him on the website, so I called him up. It turned out he was an ophthalmologist finishing his fourth year of medical residency.

Thanks to subsequent years of conversations with evolutionists, especially Williams, and with medical school residents and faculty, he has found that an evolutionary perspective on patients’ disorders has become steadily more natural and useful.

My book contains texts that I wrote during college, medical school and during my residency of neurosurgery. I could set the book �Thoughts from the hospital" as clippings thoughts

The CIA again used public health workers in Pakistan in 2011. According to an editorial in Scientific American, titled “How the CIA’s Fake Vaccination Campaign Endangers Us All,” the CIA, hoping to identify Osama bin Laden’s family, used a sham hepatitis B vaccination project to collect DNA from residents in Abbottabad who were living close to bin Laden’s suspected hideout (1). After bin Laden’s capture and death on May 2, 2011, the fake scheme came to light, and villagers along the Afghanistan-Pakistan border chased off vaccination workers, accusing them of being spies. The misuse of public health workers had repercussions. In December 2012, nine female Pakistani workers were gunned down while administering polio vaccinations, prompting the UN to withdraw vaccination teams. A similar attack occurred in Nigeria in February 2013, when nine female vaccination workers were massacred. These attacks are presumed to be retaliation for the vaccinator ruse in the capture of bin Laden. In January 2013, several deans of US schools of public health signed a letter to President Barack Obama stating their belief that public health programs should not be used as cover for covert operations and urging the president to assure the public that this type of practice would not be repeated (2). The president did not respond.

Although he was considered to be a dictatorial boss by his enemies, Mayor Hague was thought of as a hero and benefactor by most of his constituents. Serving as the mayor of Jersey City, New Jersey 30 years, from 1917 to 1947, he was adored by his constituents and feared by his enemies. Known as the boss he served as the mayor of Jersey City, New Jersey from 1917 to 1947. If anyone in the city had a problem, they could go to one of his Ward Heelers to get help. Hospitalization at the Medical Center, the art deco hospital complex, built on the center slope of the city, was free to any Jersey City resident, lacking the money for the care they received. My sister was treated there prior to her death, and my brother was born at the Margaret Hague Maternity Hospital. By the same token, contractors judiciously selected to do work for the city, knew that they would have to give the mayor a hefty kick back. That’s just the way it was.… ‘Nuf said!

As we’ve seen, up to 25 percent of employed seniors from our top universities are heading to financial services each year. Our financial services industry (and to a lesser extent its attendant legal industry) plays an equivalent role to the oil industry in Saudi Arabia in terms of talent attraction. You can see a similar dynamic at work in other fields with fixed slots. There were 682 orthopedic surgery residents in the United States in 2012. That number is set because there are only so many funded residency slots in teaching hospital programs throughout the country.4 If I were to kick butt in medical school and get one of these residencies, I would be on the way to becoming an orthopedic surgeon, probably the most coveted residency due to money, lifestyle, low morbidity of patients, gratification from restoring mobility, and other factors. But let’s say that I didn’t make it and fell short—there would still be 682 orthopedic surgeons five years from now because the next guy would have gotten that slot. We’re all competing to fit through the same finite gate. The value difference if I perform really strongly and get one of these coveted spots is not one more surgeon—it’s the gap between me and the 683rd person who didn’t get it (and perhaps went into a less prestigious or less lucrative specialty). From a value creation standpoint, it’s not ideal for a massive level of talent to be going to existing enterprises that have captured large economic rents or where people are fighting for a set of finite slots. The rents and slots will stay essentially constant. Contrast this with new business formation. If I were to say, “There are only going to be 682 new successful businesses started in the United States next year,” people would instantly regard that as ridiculous. It’s unknown and unknowable. But we all know that if another enterprising team comes along and starts a cool company, that number goes up by one.

When Zev still didn’t say anything, Toby visibly stiffened, seemingly steeling his courage, and then continued speaking. “Is something going on with Jonah?” “We haven’t talked about Jonah since he moved away,” Zev answered after a short pause. “I know.” “That was three and a half years ago,” Zev continued. “I know.” He probably should have been surprised that Toby had known he’d kept in touch with Jonah, but Zev wasn’t. Lori was pretty perceptive, and she probably knew exactly where Zev went when he traveled for business. And what Lori knew, Toby knew. Whether they were aware of the nature of Zev’s feelings for the human wasn’t clear, but Zev was too tired to try to make excuses. “He’s gonna go to medical school.” Zev still hadn’t moved his arm from his face, so he couldn’t see Toby’s reaction. “Medical school?” Toby’s voice was tempered but confused. “That’s, like, four years of school and then four years of residency. Which means eight more years away from Etzgadol.” Eight more years away from me. The last part was really the crux of the problem, but Zev didn’t dare say it out loud. It’d give away too much. Still, it didn’t make sense. A few years away so they could grow up and be old enough to tie when they came back together, Zev was almost able to understand. But that time had passed, Zev had figured out how to tie with a male, and he was ready for his mate to join him. Why would nature give him a mate who insisted on staying away? Zev felt like he was missing something. Like there was a lesson he should be learning, but he had no clue what it was. Instead, he just felt frustrated and angry. So many thoughts were swirling in his mind that he hadn’t registered Toby’s long silence until the other man spoke again. “You know my mom works with Doc Carson.” The change in topic was weird, but welcome, so Zev engaged Toby in the conversation. “Yeah, I know.” “So I was asking her the other day if she thinks he’d take me on at the clinic when I get my nursing degree, and you know what she told me?” The conversation was about as interesting as watching paint peel, but at least it got Zev thinking about something other than Jonah. Almost.

After completing medical school and serving my residency in obstetrics and gynecology, I felt knowledgeable enough to be a parent. Between

Again, those who wrote about personal traumas had fewer visits to the student health center, and their improved health correlated with improved immune function, as measured by the action of T lymphocytes (natural killer cells) and other immune markers in the blood. This effect was most obvious directly after the experiment, but it could still be detected six weeks later. Writing experiments from around the world, with grade school students, nursing home residents, medical students, maximum-security prisoners, arthritis sufferers, new mothers, and rape victims, consistently show that writing about upsetting events improves physical and mental health.

would find that residency has grown more stressful at the same time that the faculty claim that training programs have been scourged of past abusive practices.

pregnant woman applying to the Coombe for intern midwifery care was required to present a recommendation to the resident medical officer signed by a patron, patroness, vice-patron, vice-patroness, governor, subscriber, collector or clergyman.

Loser buys drinks for the rest of the weekend.” “Considering I’m a struggling medical resident and you’re a fucking millionaire, I’m getting the short end of the stick.” “Don’t insult me. I’m a billionaire. But if you have little faith in your skiing ability…” He shrugged. “We can call it off.” I scowled. I hated his reverse psychology bullshit, yet I always fell for it. “I have plenty of faith in my athleticism, desk jockey. It’s a deal.” Alex let out a soft laugh, unperturbed by the desk jockey insult. He made a shit ton of money sitting behind his desk, so I guess I wouldn’t be bothered either if I were him.

Still magic continued, the sort of practical magic that cured and healed and helped both with love desired and love gone wrong. Everyday people had their horoscopes written out and visited fortune-tellers on Miller Street, also known as Mud Avenue after downpours in the spring. There were magical items for sale in many of the markets, often hidden behind the counter or found in a back room or kept under cloths. Most residents did not trust doctors, who were often unschooled and lost more patients than they saved, using worthless remedies: saltpeter, tinctures of distilled powdered human bone used as a cure-all, a false remedy that was called skull moss, a plant grown from the remains of violent criminals who had been hanged which was inserted into a patient’s nostrils and was said to staunch bleeding and stop fainting and fatigue. Folk medicine was far less dangerous than the work of medical doctors. Practitioners of the Nameless Art were held in high regard when it came to their talents and their knowledge of curative tonics, seeds to induce sleep or cure insomnia, packets of dried lavender and rose hips for teas that would calm the nerves.

Nearly every doctor I worked with dreamed as a child about curing disease and worked like crazy to become a doctor. They studied tirelessly to learn science, entered medical school with idealistic visions, and became the pride of their family. They entered residency with hundreds of thousands of dollars of student loan debt and initially saw the chronic sleep deprivation and verbal abuse by their superiors as integral parts of the experience—because “great achievement is born of great sacrifice.” But almost universally among doctors I have met, this idealism eventually turns to cynicism. My colleagues in residency talked often about questioning their sanity, of wondering whether this was all worth it. I spoke with successful surgeons who’d drafted their resignation letters dozens of times. Another had a recurring daydream of leaving everything behind and becoming a baker. Many of my supervising physicians were desperate to spend more time with their children. I witnessed more than one tearful breakdown in the operating room when surgical cases were delayed and led to yet another missed bedtime for their kids. Several had dealt with suicidal depression. I understood why doctors had the highest burnout and suicide rate of any profession. Inevitably, these conversations led to an insight that I believe is whispered by doctors in every hospital in America: they feel trapped inside a broken system.

Forgive and Remember tells a different story. This narrative shows how seriously mistakes—especially those understood as normative and quasi-normative—are treated during residency training.

Dr David Ford Wilson's first experience of working with the human mind was when he was involved in neuroscience research at the University of Michigan. After this initial exposure, Dr David Ford Wilson enrolled in medical school before completing a residency at what he considers to be a life-changing residency at the University of Iowa Hospitals and Clinics.

The Sayanim: Mossad’s International Volunteers by Michael Ellmer April 16, 2021 In the Hebrew language, Sayanim translates to mean “helpers” or “assistants”. In the Mossad, the Sayanim are a volunteer network of Jews across the world who are loyal to the nation of Israel and willing to help the agency in their global mission. According to a comparative study of HUMINT in counterterrorism between Israel and France, Amy Kirchheimer writes that Israel has “the challenge of collecting intelligence on a vast array of targets with a comparatively small number of intelligence officers, and the Sayanim network helped the Mossad Katsas (case officers) somewhat lessen this problem.” According to Gordon Thomas in his book Gideon’s Spies: Mossad’s Secret Warriors, the Sayanim were a creation of Mier Amit, the Chief Director of the Mossad from 1963-1968. Thomas writes, “Each Sayan was an example of historical cohesiveness of the world Jewish community. Regardless of allegiance to his or her country, in the final analysis, a Sayan would recognize a greater loyalty: the mystical one to Israel, and a need to help protect it from its enemies”. The loyalty of the Sayanim is what fuels their mission and none reside on a Mossad payroll. The flexibility and diversity in their roles give the Mossad a unique operational capability with increased protection from detection and a way to avoid budget restraints or accountability. Most Sayanim fulfil various roles that can themselves be used to support Mossad operations. For example, Thomas writes, “A car Sayan, running a rental agency, provided a Katsa with a vehicle without the usual documentation. A letting agency Sayan offered accommodation. A bank Sayan might unlock funds outside normal hours. A Sayan physician would give medical assistance – treating a bullet wound for example – without informing the authorities”.

Halsted founded the surgical training program at Johns Hopkins Hospital in Baltimore, Maryland, in May 1889. As chief of the Department of Surgery, his influence was considerable, and his beliefs about how young doctors must apply themselves to medicine, formidable. The term “residency” came from Halsted’s belief that doctors must live in the hospital for much of their training, allowing them to be truly committed in their learning of surgical skills and medical knowledge. Halsted’s mentality was difficult to argue with, since he himself practiced what he preached, being renowned for a seemingly superhuman ability to stay awake for apparently days on end without any fatigue. But Halsted had a dirty secret that only came to light years after his death, and helped explain both the maniacal structure of his residency program and his ability to forgo sleep. Halsted was a cocaine addict.

The exhausting residency program, which persists in one form or another throughout all US medical schools to this day, has left countless patients hurt or dead in its wake—and likely residents, too.

Trained Obstetrician and Gynaecologist in Dubai Dr Elsa de Menezes Fernandes is a UK trained Obstetrician and Gynaecologist. She completed her basic training in Goa, India, graduating from Goa University in 1993. After Residency, she moved to the UK, where she worked as a Senior House Officer in London at the Homerton, Southend General, Royal London and St. Bartholomew’s Hospitals in Obstetrics and Gynaecology. She completed five years of Registrar and Senior Registrar training in Obstetrics and Gynaecology in London at The Whittington, University College, Hammersmith, Ealing and Lister Hospitals and Gynaecological Oncology at the Hammersmith and The Royal Marsden Hospitals. During her post-graduate training in London she completed Membership from the Royal College of Obstetricians and Gynaecologists. In 2008 Dr Elsa moved to Dubai where she worked as a Consultant Obstetrician and Gynaecologist at Mediclinic City Hospital until establishing her own clinic in Dubai Healthcare City in March 2015. She has over 20 years specialist experience. Dr Elsa has focused her clinical work on maternal medicine and successfully achieved the RCOG Maternal Medicine Special Skills Module. She has acquired a vast amount of experience working with high risk obstetric patients and has worked jointly with other specialists to treat patients who have complex medical problems during pregnancy. During her training she gained experience in Gynaecological Oncology from her time working at St Bartholomew’s, Hammersmith and The Royal Marsden Hospitals in London. Dr Elsa is experienced in both open and laparoscopic surgery and has considerable clinical and operative experience in performing abdominal and vaginal hysterectomies and myomectomies. She is also proficient in the technique of hysteroscopy, both diagnostic and operative for resection of fibroids and the endometrium. The birth of your baby, whether it is your first or a happy addition to your family, is always a very personal experience and Dr Elsa has built a reputation on providing an experience that is positive and warmly remembered. She supports women’s choices surrounding birth and defines her role in the management of labour and delivery as the clinician who endeavours to achieve safe motherhood. She is a great supporter of vaginal delivery. Dr Elsa’s work has been published in medical journals and she is a member of the British Maternal and Fetal Medicine Society. She was awarded CCT (on the Specialist Register) in the UK. Dr Elsa strives to continue her professional development and has participated in a wide variety of courses in specialist areas, including renal diseases in pregnancy and medical complications in pregnancy.

Telomeres have been called “cellular clocks,” in that they are a measure of biological rather than chronological age. Two people, even identical twins, could be the same age as computed in years, months, weeks, and days, yet one may be biologically older than the other, depending on how much stress, adversity, or trauma they have endured. That’s because stress shortens telomeres. (Doctors should take special heed: the telomeres of medical residents suffer greater attrition than those of other young adults in their age group.)

And doctors could lose the respect of their patients if they didn’t act like authority figures. The young residents at MCMC did not enhance their status by their propensities for introducing themselves by their first names, wearing blue jeans under their white coats, carrying their medical charts in little backpacks, and drinking their coffee from Tommee Tippee cups. Doctors could get into trouble if they failed to take the Hmong’s religious beliefs into account. For example, it was important never to compliment a baby’s beauty out loud, lest a dab overhear and be unable to resist snatching its soul.

When no interpreter was present, the doctor and the patient stumbled around together in a dense fog of misunderstanding whose hazards only increased if the patient spoke a little English, enough to lull the doctor into mistakenly believing some useful information had been transferred. When an interpreter was present, the duration of every diagnostic interview automatically doubled. (Or tripled. Or centupled. Because most medical terms had no Hmong equivalents, laborious paraphrases were often necessary. In a recently published Hmong-English medical glossary, the recommended Hmong translation for “parasite” is twenty-four words long; for “hormone,” thirty-one words; and for “X chromosome,” forty-six words.) The prospect of those tortoise-paced interviews struck fear into the heart of every chronically harried resident.

Dr. David Ford Wilson, a seasonedpsychiatrist, balances family life with a passion for mental health. After a background in neuroscience, he pursued a medical degree at Des Moines University, followed by a 5-year psychiatry residency. He now practices at Salt Lake Behavioral Health, aspiring to grow his practice in both adult and pediatric psychiatry.

documentation issues were more common in small private hospitals, where records were less standardized and notes were sparse because only the patient’s physician writes progress notes. In teaching hospitals, by contrast, there are multiple notes by residents, medical students, and nurses as well.

Residents and interns are the grunts of the medical profession, tasked, simply, with getting everything done. The practical side of the clinical buck stops with them (even if the ultimate clinical and legal responsibility rests with the attendings), and the house staff do whatever it takes to get everything done. With their scut lists in hand, their coat pockets doubling as supply cabinets, they are the embodiment of the pragmatic. While many still retain their interest in the theories and mechanisms of disease, the overriding modus operandi is utilitarian, because unlike the electricians, housekeepers, therapists, technicians, orderlies, dietitians, even the nurses and senior doctors, their job description has no bounds.