Patients In Hospital Quotes

How do you tell the psychiatrists from the patients in the hospital? The patients get better and leave.

I was once thrown out of a mental hospital for depressing the other patients.

In short, physicians are getting more and more data, which requires more sophisticated interpretation and which takes more time. AI is the solution, enhancing every stage of patient care from research and discovery to diagnosis and therapy selection. As a result, clinical practice will become more efficient, convenient, personalized, and effective.

AI-powered passive monitoring is taking off and has huge advantages over the traditional way of monitoring patients. The advantage of passive monitoring, as opposed to data collected from wearables, is that it doesn’t require patients or seniors to actively wear a device at all times. Used in a hospital setting, the tech reduces healthcare workers’ risk of exposure to COVID-19 by limiting their contact with patients and automating data collection for vital signs. Also, camera-based monitoring is unpopular for the simple reason that a lot of people don’t like being watched by a camera.

One must learn to love.— This is what happens to us in music: first one has to learn to hear a figure and melody at all, to detect and distinguish it, to isolate it and delimit it as a separate life; then it requires some exertion and good will to tolerate it in spite of its strangeness, to be patient with its appearance and expression, and kindhearted about its oddity:—finally there comes a moment when we are used to it, when we wait for it, when we sense that we should miss it if it were missing: and now it continues to compel and enchant us relentlessly until we have become its humble and enraptured lovers who desire nothing better from the world than it and only it.— But that is what happens to us not only in music: that is how we have learned to love all things that we now love. In the end we are always rewarded for our good will, our patience, fairmindedness, and gentleness with what is strange; gradually, it sheds its veil and turns out to be a new and indescribable beauty:—that is its thanks for our hospitality. Even those who love themselves will have learned it in this way: for there is no other way. Love, too, has to be learned.

This life is a hospital where every patient is possessed with the desire to change beds; one man would like to suffer in front of the stove, and another believes that he would recover his health beside the window.

Dr. Fortunato," Kristine shot back at Laurie, her resentment undisguised. "You don't know how we do things in Wright. Dr. Parrish doesn't care about hospital hierarchy. He's very accessible and he'd never let his ego get in the way of patient care. Maybe you do things differently where you work-

The nurses, I have already learned, are the ones who give us the answers we’re desperate for. Unlike the doctors, who fidget like they need to be somewhere else, the nurses patiently answer us as if we are the first set of parents to ever have this kind of meeting with them, instead of the thousandth.

I know what the problem is, of course. The disorientation, the distraction, the difficulty focusing - all classic Phase One signs of deliria. But I don't care. If pneumonia felt this good I'd stand out in the snow in the winter with bare feet and no coat, or march into the hospital and kiss pneumonia patients

If you keep silent, keep silent by love: if you speak, speak by love; if you correct, correct by love; if you pardon, pardon by love; let love be rooted in you, and from the root nothing but good can grow. Love and do what you will. Love endures in adversity, is moderate in prosperity; brave under harsh sufferings, cheerful in good works; utterly reliable in temptation, utterly open-handed in hospitality; as happy as can be among true brothers and sisters, as patient as you can get among the false one's. The soul of the scriptures, the force of prophecy, the saving power of the sacraments, the fruit of faith, the wealth of the poor, the life of the dying. Love is all.

In order to master compassion, you have to spend time getting to know monsters. When you can do that you will see that there are no monsters, only people that acted like monsters because no one gave them the time or compassion to hear their story.

The hospital will never be healthy for patients if it's not a healthy environment for nurses, where their voices are heard and where they can care for their patients and use the full extent of their knowledge, abilities, and skills. After all, hospitals today have become one big intensive care unit: all patients need intensive caring.

Maybe all hospitals should import groups of rabble-rousing punk rockers to kick-start the languishing patients’ hearts.

Eric approached the octagonal nurses’ station, and a blonde nurse looked up from her computer monitor, smiled, and pointed to examining room  D. Everybody recognized the hospital shrinks from the bright red W on their lanyard IDs. The W stood for Wright, the wing that contained the locked psych unit, but the staff teased that W stood for Wackos. He’d heard all the jokes— How do you tell the psychiatrists from the patients in the hospital? The patients get better and leave. Eric told the best psychiatrist jokes, though he never told the ones about psychiatrist’s kids. He didn’t think those were funny. He lived those.

We're not hunter-gatherers anymore. We're all living like patients in the intensive care unit of a hospital. What keeps us alive isn't bravery, or athleticism, or any of those other skills that were valuable in a caveman society. It's our ability to master complex technological skills. It is our ability to be nerds. We need to breed nerds.

You get what you expect and you deserve what you tolerate.

Doctor(to patient): Give me your parent's number so that we can tell them what a bad boy you have been. Patient(Confused, unwilling): You don't need to. Doctor:Hospital Rules!!! And no matter how much i hate dead people, I hate Unpaid bills more

The street to my left was backed up with traffic and I watched the people waiting patiently in the cars. There was almost always a man and a women, staring straight ahead, not talking. It was, finally, for everyone, a matter of waiting. You waited and you waited- for the hospital, the doctor, the plumber, the madhouse, the jail, papa death himself. First the signal red, then the signal was green. The citizens of the world ate food and watched t.v. and worried about their jobs or lack of the same, while they waited.

You knew then that this was not any kind of hospital that cured, but a hospital that held, that kept their patients away from the rest of the world, a kind of ark that floated along full of life, but not participating in life.... These people no longer made progress.

I guessed that he was one of those ambitious young physicians who more and more fill the profession, opportunists with a fashionable hoodlum image, openly hostile to their patients. My brief stay at the hospital had already convinced me that the medical profession was an open door to anyone nursing a grudge against the human race.

Life is a hospital in which every patient is possessed by the desire of changing his bed. One would prefer to suffer near the fire, and another is certain he would get well if he were by the window.

The history of the world? Just voices echoing in the dark; images that burn for a few centuries and then fade; stories, old stories that sometimes seem to overlap; strange links, impertinent connections. We lie here in our hospital bed of the present (what nice clean sheets we get nowadays) with a bubble of daily news drip-fed into our arm. We think we know who we are, though we don't quite know why we're here, or how long we shall be forced to stay. And while we fret and write in bandaged uncertainty - are we a voluntary patient? - we fabulate. We make up a story to cover the facts we don't know or can't accept; we keep a few true facts and spin a new story round them. Our panic and our pain are only eased by soothing fabulation; we call it history.

When traveling in rural Africa, it's important to not actually *go* to a hospital until the patient is on the brink of expiration, otherwise things are apt to get worse.

This life is a hospital in which each patient is possessed by the desire to change beds. One wants to suffer in front of the stove and another believes that he will get well near the window. It always seems to me that I will be better off there where I am not, and this question of moving about is one that I discuss endlessly with my soul "Tell me, my soul, my poor chilled soul, what would you think about going to live in Lisbon? It must be warm there, and you'll be able to soak up the sun like a lizard there. That city is on the shore; they say that it is built all out of marble, and that the people there have such a hatred of the vegetable, that they tear down all the trees. There's a country after your own heart -- a landscape made out of light and mineral, and liquid to reflect them!" My soul does not reply. "Because you love rest so much, combined with the spectacle of movement, do you want to come and live in Holland, that beatifying land? Perhaps you will be entertained in that country whose image you have so often admired in museums. What do you think of Rotterdam, you who love forests of masts and ships anchored at the foot of houses?" My soul remains mute. "Does Batavia please you more, perhaps? There we would find, after all, the European spirit married to tropical beauty." Not a word. -- Is my soul dead? Have you then reached such a degree of torpor that you are only happy with your illness? If that's the case, let us flee toward lands that are the analogies of Death. -- I've got it, poor soul! We'll pack our bags for Torneo. Let's go even further, to the far end of the Baltic. Even further from life if that is possible: let's go live at the pole. There the sun only grazes the earth obliquely, and the slow alternation of light and darkness suppresses variety and augments monotony, that half of nothingness. There we could take long baths in the shadows, while, to entertain us, the aurora borealis send us from time to time its pink sheaf of sparkling light, like the reflection of fireworks in Hell!" Finally, my soul explodes, and wisely she shrieks at me: "It doesn't matter where! It doesn't matter where! As long as it's out of this world!

The burn unit is often the most distant wing of a hospital, because burn victims are so susceptible to infection that they must be kept away from other patients. More important, perhaps, is that the placement minimizes the chance of visitors stumbling across a Kentucky Fried Human.

Here I want to stress that perception of losing one’s mind is based on culturally derived and socially ingrained stereotypes as to the significance of symptoms such as hearing voices, losing temporal and spatial orientation, and sensing that one is being followed, and that many of the most spectacular and convincing of these symptoms in some instances psychiatrically signify merely a temporary emotional upset in a stressful situation, however terrifying to the person at the time. Similarly, the anxiety consequent upon this perception of oneself, and the strategies devised to reduce this anxiety, are not a product of abnormal psychology, but would be exhibited by any person socialized into our culture who came to conceive of himself as someone losing his mind.

PTSD seems to have an even higher prevalence and greater severity following violence or disaster that is man-made; natural disasters, "acts of God," seem somehow easier to accept. (...). This is the case with acute stress reactions, too: I see it often with my patients in hospital, who can show extraordinary courage and calmness in facing the most dreadful diseases but fly into a rage if a nurse is late with a bedpan or a medication. The amorality of nature is accepted, whether it takes the form of a monsoon, an elephant in musth, or a disease; but being subjected helplessly to the will of others is not, for human behavior always carries (or is felt to carry) a moral charge.

It was known as the Sick Man of Europe. It was in every way poorer than now. Yet there were flowerbeds on roundabouts, libraries and post offices in every village, cottage hospitals in abundance, council housing for all who needed it. It was a country so comfortable and enlightened that hospitals maintained cricket pitches for their staff and mental patients lived in Victorian palaces. If we could afford it then, why not now? Someone needs to explain to me how it is that the richer Britain gets the poorer it thinks itself.

It’s easier to hang out with the patients in the indoor garden, with its sunlight and picnic tables. Easier to forget that someone’s ill when you’re not surrounded by the antiseptic reek of hospital-issue debris.

Each patient is precious. Be careful. If a patient dies, it is just one more hospital death for the doctor. But for the unfortunate family, it is a permanent loss.

A landmark 2010 study from the Massachusetts General Hospital had even more startling findings. The researchers randomly assigned 151 patients with stage IV lung cancer, like Sara’s, to one of two possible approaches to treatment. Half received usual oncology care. The other half received usual oncology care plus parallel visits with a palliative care specialist. These are specialists in preventing and relieving the suffering of patients, and to see one, no determination of whether they are dying or not is required. If a person has serious, complex illness, palliative specialists are happy to help. The ones in the study discussed with the patients their goals and priorities for if and when their condition worsened. The result: those who saw a palliative care specialist stopped chemotherapy sooner, entered hospice far earlier, experienced less suffering at the end of their lives—and they lived 25 percent longer. In other words, our decision making in medicine has failed so spectacularly that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality.

Such is the demographic paradox of a junior physician's relationship with his patients: I worry about how to extend their lives. This anxiety inevitably shortens my own.

The world is a hospital: people are patients, truth is the doctor, and love is the remedy.

Why indeed should we perpetually be thinking whether things are good for us, as if we were patients lying in a hospital?

Tears are part of the leeway of the common areas of a hospital, since so many have to do their crying away from the patient's bed. You don't care who sees you cry in the lobby: it was port of entry for all the sorrows, and one gave up all one's previous citizenship at the border.

To: Anna Oliphant From: Etienne St. Clair Subject: HAPPY CHRISTMAS Have you gotten used to the time difference? Bloody hell,I can't sleep. I'd call,but I don't know if you're awake or doing the family thing or what. The bay fog is so thick that I can't see out my window.But if I could, I am quite certain I'd discover that I'm the only person alive in San Francisco. To: Anna Oliphant From: Etienne St. Clair Subject: I forgot to tell you. Yesterday I saw a guy wearing an Atlanta Film Festival shirt at the hospital.I asked if he knew you,but he didn't.I also met an enormous,hair man in a cheeky Mrs. Claus getup. he was handing out gifts to the cancer patients.Mum took the attached picture. Do I always look so startled? To: Anna Oliphant From: Etienne St. Clair Subject: Are you awake yet? Wake up.Wake up wake up wake up. To: Etienne St. Clair From: Anna Oliphant Subject: re: Are you awake yet? I'm awake! Seany started jumping on my bed,like,three hours ago. We've been opening presents and eating sugar cookies for breakfast. Dad gave me a gold ring shaped like a heart. "For Daddy's sweetheart," he said. As if I'm the type of girl who'd wear a heart-shaped ring. FROM HER FATHER. He gave Seany tons of Star Wars stuff and a rock polishing kit,and I'd much rather have those.I can't beleive Mom invited him here for Christmas. She says it's because their divorce is amicable (um,no) and Seany and I need a father figure in our lives,but all they ever do is fight.This morning it was about my hair.Dad wants me to dye it back, because he thinks I look like a "common prostitute," and Mom wants to re-bleach it.Like either of them has a say. Oops,gotta run.My grandparents just arrived,and Granddad is bellowing for his bonnie lass.That would be me. P.S. Love the picture.Mrs. Claus is totally checking out your butt. And it's Merry Christmas, weirdo. To: Anna Oliphant From: Etienne St. Clair Subject: HAHAHA@ Was it a PROMISE RING? Did your father give you a PROMISE RING? To: Etienne St. Clair From: Anna Oliphant Subject: Re: HAHAHA! I am so not responding to that.

Corunda Base Hospital itself continued to function on doctors, nurses, domestic staff, food preparers, and ancillary staff in the same old way, so that the patients lived (or died) in relative ignorance of the drama going on at an executive level. Indeed, it was a rare patient even knew that a hospital had executives.

Zlata Dromenko was a stout Cossack about my height with a thick single eyebrow giving her a serious, severe look. I found out she’d been a mail-order bride who came over from Ukraine to marry a local farmer, a Russian immigrant. He died, though, and now Mrs. Dromenko worked in the hospital bullying patients like me. I called her “Hun,” because she made me think of Attila. I was curious as to how Mr. Dromenko died but was afraid to ask.

I think timing is better left up to God to decide then religious leaders. I once met a man that brought his wife flowers in the hospital. They held hands, kissed and were as affectionate as any cute couple could be. They were both in their eighties. I asked them how long they were married. I expected them to tell me fifty years or longer. To my surprise, they said only five years. He then began to explain to me that he was married thirty years to someone that didn’t love him, and then he remarried a second time only to have his second wife die of cancer, two years later. I looked at my patient (his wife) sitting in the wheelchair next to him smiling. She added that she had been widowed two times. Both of her marriages lasted fifteen years. I was curious, so I asked them why they would even bother pursuing love again at their age. He looked at me with astonishment and said, “Do you really think that you stop looking for a soulmate at our age? Do you honestly believe that God would stop caring about how much I needed it still, just because I am nearing the end of my life? No, he left the best for last. I have lived through hell, but if I only get five years of happiness with this woman then it was worth the years of struggle I have been through.

Real faith, however, is required to endure this necessary but painful developmental process. As things unfold, sometimes in full view, let us be merciful with each other. We certainly do not criticize hospital patients amid intensive care for looking pale and preoccupied. Why then those recovering from surgery on their souls? No need for us to stare; those stitches will finally come out. And in this hospital, too, it is important for everyone to remember that the hospital chart is not the patient. Extending our mercy to someone need not wait upon our full understanding of their challenges! Empathy may not be appreciated or reciprocated, but empathy is never wasted.

Life is a sanatorium: the ignorant are patients, wisdom is the doctor, and knowledge is the remedy. The world is a hospital: people are patients, truth is the doctor, and love is the remedy. The universe is a clinic: sinners are patients, light is the doctor, and God is the remedy.

Even in big city hospitals there is no such thing as “disposable” supplies. Bandages are washed and reused. Nurses go from room to room using the same syringe on every patient. They know this is dangerous, but they have no choice.

This is not really me. I am not like this. I am like you. I am not a patient from a mental hospital. I am just an ordinary woman whose mind has gone temporarily wrong.

CHURCH is like a hospital. It’s where people who are sick, broken, bruised, beaten, and battered with life because of sin and unrighteousness come for help. It’s okay if you are here and don’t have all your life together. If you had all your life together, you wouldn’t need to be here. However, hospitals do not tolerate sick people hanging around who don’t want to get better. No doctor is going to keep fooling with a patient

People tend to forget they are patients. Once they leave the doctor’s office or the hospital, they simply put it out of their minds. But you are all permanent patients, like it or not. I am the doctor, you the patient. Doctor doesn’t cease being doctor at close of day. Neither should patient. People expect doctor to go about things with the utmost seriousness, skill and experience. But what about patient? How professional is he?

I know part of the problem, of course. The disorientation, the distraction, the difficulty focusing-all classic Phase one signs of deliria. But I don't care. If pneumonia felt this good I'd stand out in the snow in the winter with bare feet and no coat on, or march into the hospital and kiss pneumonia patients.

American prisons and jails housed an estimated 356,268 [people] with severe mental illness.… [a] figure [that] is more than 10 times the number of mentally ill patients in state psychiatric hospitals [in 2012, the last year for reliable data]—about 35,000 people.

Once a patient goes brain dead and relatives sign his organ donation consent form, he will get the best medical treatment of his life. A hospital code blue may be a call for doctors to rush to the bedside of a beating heart cadaver who needs his or her heart defibrillated.

Although, in principle, the psychoanalytical theory of borderlines is not punitive, in practice 'borderline' is almost always used to indicate that the patient is hostile, demanding, unpleasant, manipulative, attention-seeking, and prone to regression and dependency if admitted to hospital; in other words patient is a witch by Malleus Maleficarum criteria. The term 'borderline' functions to rationalize sadistic counter-transference, and to legitimize rejecting triaging decisions within the health-care system. Actually, most of the time, in my experience, the splitting is coming from the staff, not the patient, and it is the mental-health professionals who are using projection and denial. This is an example of 'blaming the victim,' which is a fundamental borderline psychodynamic.

Back in the 1970s, dissidents in the Soviet Union were often hospitalized in mental institutions and given drugs similar to the ones used to treat depression today. The reasoning was that you had to be insane to be unhappy in the Socialist Workers' Utopia. When the people treating depression receive status and prestige from the very system that their patients are unhappy with, they are unlikely to affirm the basic validity of the patient's withdrawal from life. "The system has to be sound -- after all, it validates my professional status -- therefore the problem must be with you.

I’d also like to take a moment to salute the many caregivers out there working in hospitals, nursing homes, and in patients’ houses. These often-unsung heroes heal the sick and comfort the suffering on a daily basis, going about their work with diligence, dignity, and pride. You care. Thank you.

I don’t understand hospital chaplains that try to rob my patients of their anger. Sometimes anger is a key motivator that gets people to take action. Anger can push a cancer patient to jump out of his hospital bed, walk down to the nurses station and scream, “I am getting the hell out of here!”. There is a misconception that God is simply sweet and passive. Actually, God can be quite cunning, manipulative and relentless with his children. What we consider as negative traits are actually helpful in molding us. He will use a negative emotion if needed to push people to do things that will change them for the better. He will allow people or situations to derail us if there is a chance that those interactions will push us forward. Personally, I don’t want a God that is going to send some church member to my deathbed with a plate of cookies and tell me to have faith. Actually, I rather have a God that screams, “Get the hell off your ass, stop feeling sorry for yourself. Walk down the hall with that Physical Therapist so you can get on with your life!" A little anger in a person can push them to do amazing things.

the hospital treated 11,602 patients, sixty-four a day, for injuries and ailments that suggest that the mundane sufferings of people have not changed very much over the ages. The list included: 820 cases of diarrhea; 154, constipation; 21, hemorrhoids; 434, indigestion; 365, foreign bodies in the eyes; 364, severe headaches; 594 episodes of fainting, syncope , and exhaustion; 1 case of extreme flatulence; and 169 involving teeth that hurt like hell.

So Medicare decided to pay hospitals like ours for internship and residency training programs, get it? It’s a win-win, as they say—the hospital gets patients cared for by interns and residents around the clock,people like us who live on site, and whose stipend is a bloody fraction of what the hospital would pay full-time physicians. And Medicare delivers health care to the poor.

As good surgical doctor works on a patient in the theater with varied kinds of surgical instruments, so a true leader also needs a clean bag of leadership characters that vary from task to task. One-way leaders are obvious failures!

One might have complained about the soot and ashes or about the pipes and curtain rods that hung crazily from the ceiling, but patients never lived in a hospital ward so nearly free of bacteria as this one that was sterilized by fire.

Doctors tend to enter the arenas of their profession's practice with a brisk good cheer that they have to then stop and try to mute a bit when the arena they're entering is a hospital's fifth floor, a psych ward, where brisk good cheer would amount to a kind of gloating. This is why doctors on psych wards so often wear a vaguely fake frown of puzzled concentration, if and when you see them in fifth-floor halls. And this is why a hospital M.D.--who's usually hale and pink-cheeked and poreless, and who almost always smells unusually clean and good--approaches any psych patient under this care with a professional manner somewhere between bland and deep, a distant but sincere concern that's divided evenly between the patient's subjective discomfort and the hard facts of the case.

War crimes, you say? No matter how many policies you put on paper, in reality, there are no rights and wrongs in war. War itself is a crime. War cannot be justified. I believe, the only people, in this world, whose opinions matter, are the ones who go the extra mile to help other people expecting nothing in return. Soldiers who fight fiercely for their country, the doctors in Sri Lanka's public hospitals attending to hundreds of patients at a time for no extra pay , the nuns who voluntarily teach English and math to children of refugee camps in the north, the monks who collect food to feed entire villages during crises, they are the people worth listening to, their opinion matters. So find me one of them who will say: they wish the war didn't end in 2009, that they wish Sri Lanka was divided into two parts. Find me one of them who agrees with the international war crime allegations against Sri Lanka, and I will listen. But I will not listen to the opinions of those who are paid to find faults in a war they were never a part of, a war they never experienced themselves. I will not listen to the opinions of those who watched the war on tv or read about it on the internet or were moved by a documentary on Al Jazeera. The war is over. The damage is done. Let Sri Lanka move on. So our children will never have to see what we've seen.

Lister understood that being in a hospital could be a terrifying experience and followed his own golden rule: “Every patient, even the most degraded, should be treated with the same care and regard as though he were the Prince of Wales himself.

how many of those I called Bad Boys and Bad Girls were, in reality, spiritually thirsty and spiritually sick. Perhaps they were the most sensitive, the most easily hurt of all my patients, the most tortured by the human fate of knowing we are going to die.

Persons Are Turned against Themselves Evil also turns a person against herself so that self is used against self. The case of the woman who received a dismissal letter from her pastor comes to mind again. The psychological decompensation she suffered was successfully used by her husband to intercede with a psychiatrist of his choosing to commit her to the mental unit of a hospital for an extended involuntary stay, which further worsened her condition. Additional examples abound. Some patients report cults using induced hypnotic states to encourage a subject's dissociated hands and arms to do something hurtful to someone else. In such cases, the subject is encouraged to watch the hand that is hers but not hers (because it is dissociated from her). The end result is often extreme guilt. self-loathing, and distrust of one's self and motives.An incestuous parent may use a child's own natural bodily responses to repeated sexual stimulation to make the point that the child really "wants and enjoys“ what is being forced upon her.

When you identify hearing voices with illness and try to kill the voices with neuroleptic medication, you just miss the personal problems that lay at the roots of hearing voices—and you will not help the person solving those problems. You just make a chronic patient.

I peered around the corner into the main recovery ward. All I could see were surgeons. Surgeons filling out those incessant forms. Surgeons bringing cups of tea and little sandwich triangles to patients. Surgeons laying in a lethargic stupor, recovering from eye surgery.

A patient on the way to surgery travels at twice the speed of a patient on the way to the morgue. Gurneys that ferry the living through hospital corridors move forward in an aura of purpose and push, flanked by caregivers with long strides and set faces, steadying IVs, pumping ambu bags, barreling into double doors. A gurney with a cadaver commands no urgency. It is wheeled by a single person, calmly and with little notice, like a shopping cart(167).

Much they saw, and far they went, and many homes they visited, but always with a happy end. The Spirit stood beside sick beds, and they were cheerful; on foreign lands, and they were close at home; by struggling men, and they were patient in their greater hope; by poverty, and it was rich. In alms-house, hospital, and jail, in misery’s every refuge, where vain man in his little brief authority had not made fast the door, and barred the Spirit out, he left his blessing, and taught Scrooge his prospects.

The Press Ganey patient surveys, it turned out, had an unintended effect in this context. It was to subtly pressure doctors to write unnecessary scripts for opiates. A doctor reluctant to write them was more likely to get a poor patient evaluation. Too many bad scores and a hospital began asking questions.

I later learned that while Elsie was at Crownsville, scientists often conducted research on patients there without consent, including one study titled "Pneumoencephalographic and skull X-ray studies in 100 epileptics." Pneumoencephalography was a technique developed in 1919 for taking images of the brain, which floats in a sea of liquid. That fluid protects the brain from damage, but makes it very difficult to X-ray, since images taken through fluid are cloudy. Pneumoencephalography involved drilling holes into the skulls of research subjects, draining the fluid surrounding their brains, and pumping air or helium into the skull in place of the fluid to allow crisp X-rays of the brain through the skull. the side effects--crippling headaches, dizziness, seizures, vomiting--lasted until the body naturally refilled the skull with spinal fluid, which usually took two to three months. Because pneumoencephalography could cause permanent brain damage and paralysis, it was abandoned in the 1970s. "There is no evidence that the scientists who did research on patients at Crownsville got consent from either the patients of their parents. Bases on the number of patients listed in the pneumoencephalography studyand the years it was conducted, Lurz told me later, it most likely involved every epileptic child in the hospital including Elsie. The same is likely true of at lest on other study called "The Use of Deep Temporal Leads in the Study of Psychomotor Epilepsy," which involved inserting metal probes into patients' brains.

Consider the case of La Crosse, Wisconsin. Its elderly residents have unusually low end-of-life hospital costs. During their last six months, according to Medicare data, they spend half as many days in the hospital as the national average, and there’s no sign that doctors or patients are halting care prematurely. Despite average rates of obesity and smoking, their life expectancy outpaces the national mean by a year.

Appalled at his own voice, he wondered why he couldn’t have said he was a social worker or a hospital executive. Would the kids have cared? Why was he spilling his guts instead? Did he think it might make him more interesting in Epstein’s eyes? But what was “interesting” about having been a mental patient? “—anyway, I was locked up there,” he concluded, and he wondered if Pamela and the others were embarrassed for him.

A modern hospital is like Grand Central Station—all noise and hubbub, and is filled with smoking physicians, nurses, orderlies, patients and visitors. Soft drinks are sold on each floor and everybody guzzles these popular poisons. The stench of chemicals offends the nose, while tranquillizers substitute for quietness.

By listening to the “unspoken voice” of my body and allowing it to do what it needed to do; by not stopping the shaking, by “tracking” my inner sensations, while also allowing the completion of the defensive and orienting responses; and by feeling the “survival emotions” of rage and terror without becoming overwhelmed, I came through mercifully unscathed, both physically and emotionally. I was not only thankful; I was humbled and grateful to find that I could use my method for my own salvation. While some people are able to recover from such trauma on their own, many individuals do not. Tens of thousands of soldiers are experiencing the extreme stress and horror of war. Then too, there are the devastating occurrences of rape, sexual abuse and assault. Many of us, however, have been overwhelmed by much more “ordinary” events such as surgeries or invasive medical procedures. Orthopedic patients in a recent study, for example, showed a 52% occurrence of being diagnosed with full-on PTSD following surgery. Other traumas include falls, serious illnesses, abandonment, receiving shocking or tragic news, witnessing violence and getting into an auto accident; all can lead to PTSD. These and many other fairly common experiences are all potentially traumatizing. The inability to rebound from such events, or to be helped adequately to recover by professionals, can subject us to PTSD—along with a myriad of physical and emotional symptoms.

He had no longer free energy enough for spontaneous research and speculative thinking, but by the bedside of patients the direct external calls on his judgment and sympathies brought the added impulse needed to draw him out of himself. It was not simply that beneficent harness of routine which enables silly men to live respectably and unhappy men to live calmly - it was a perpetual claim on the immediate fresh application of thought, and on the consideration of another's need and trial. Many of us looking back through life would say that the kindest man we have ever known has been a medical man, or perhaps that surgeon whose fine tact, directed by deeply-informed perception, has come to us in our need with a more sublime beneficence than that of miracle-workers. Some of that twice-blessed mercy was always with Lydgate in his work at the Hospital or in private houses, serving better than any opiate to quiet and sustain him under anxieties and his sense of mental degeneracy.

They've started to say "life-limiting" instead now. "Children and young people with life-limiting conditions..." The nurse says it gently as she explains that the hospital has started to offer a counseling service for young patients whose conditions are "terminal." She falters, flushing red. "Sorry, I meant life-limiting." Would I like to sign up? I could have the counselor come to my bed, or I could go to the special counseling room for teenagers. They have a TV in there now. The options seem endless, but the term is not new to me. I have spent many days at the airport. Years. And still, I have not flown away.

I thought back to med school, when a patient had told me that she always wore her most expensive socks to the doctor's office, so that when she was in a patient's gown and shoeless, the doctor would see the socks and know she was a person of substance, to be treated with respect. (Ah, there's the problem - I was wearing hospital-issue socks, which I had been stealing for years!

Where there were once several competing approaches to medicine, there is now only one that matters to most hospitals, insurers, and the vast majority of the public. One that has been shaped to a great degree by the successful development of potent cures that followed the discovery of sulfa drugs. Aspiring caregivers today are chosen as much (or more) for their scientific abilities, their talent for mastering these manifold technological and pharmaceutical advances as for their interpersonal skills. A century ago most physicians were careful, conservative observers who provided comfort to patients and their families. Today they act: They prescribe, they treat, they cure. They routinely perform what were once considered miracles. The result, in the view of some, has been a shift in the profession from caregiver to technician. The powerful new drugs changed how care was given as well as who gave it.

I don’t think the people today who start hearing voices, stop eating and sleeping, and run amuck are likely to get good treatment. Having more knowledge, better diagnostic capabilities, better medications with fewer side effects, can’t make up for the fact that most patients are being treated by doctors, therapists, and hospitals, who are operating under constraints and incentives that reward non-treatment, non-hospitalization, non-therapy, non-follow-up, non-care. Lost to follow-up is the best outcome a health insurer can hope for.

When we play it safe, we sabotage our chance to make our mark in a memorable, authentic way. Health care organizations confront pressures to provide more responsive, personal care with cost efficiency, striving to provide the industry’s “patient-centered care” goal. However, when every hospital system and specialty clinic cautiously claims to provide “patient-centered care”— because all of their competitors claim to provide “patient-centered care”—their claim becomes so safe that they disappear into the din of their competitors’ identical claims.

Hospitals are filled with caring staff, but resilience and determination are prized as highly as empathy. In the vernacular, it comes down to whether someone’s “got the balls” to make x, y, or z happen. The contrast between the empathy we’re supposed to have and constant talk of “growing a set” or “who’s got the cojones to . . .” can be jarring, but a big rock, no kidding, needs a nurse with the stones to move it.

Christian hope frees us to act hopefully in the world. It enables us to act humbly and patiently, tackling visible injustices in the world around us without needing to be assured that our skill and our effort will somehow rid the world of injustice altogether. Christian hope, after all, does not need to see what it hopes for (Heb. 11:1); and neither does it require us to comprehend the end of history. Rather, it simply requires us to trust that even the most outwardly insignificant of faithful actions - the cup of cold water given to the child, the widow's mite offered at the temple, the act of hospitality shown to the stranger, none of which has any overall strategic socio-political significance so far as we can now see - will nevertheless be made to contribute in some significant way to the construction of God's kingdom by the action of God's creative and sovereign grace.

Hopkins was one of the top hospitals in the country. It was built in 1889 as a charity hospital for the sick and poor, and it covered more than a dozen acres where a cemetery and insane asylum once sat in East Baltimore. The public wards at Hopkins were filled with patients, most of them black and unable to pay their medical bills. David drove Henrietta nearly twenty miles to get there, not because they preferred it, but because it was the only major hospital for miles that treated black patients. This was the era of Jim Crow—when black people showed up at white-only hospitals, the staff was likely to send them away, even if it meant they might die in the parking lot. Even Hopkins, which did treat black patients, segregated them in colored wards, and had colored-only fountains. So when the nurse called Henrietta from the waiting room, she led her through a single door to a colored-only exam room—one in a long row of rooms divided by clear glass walls that let nurses see from one to the next.

The child's heart beat: but she was growing in the wrong place inside her extraordinary mother, south of safe...she and her mother were rushed to the hospital, where her mother was operated on by a brisk cheerful diminutive surgeon who told me after the surgery that my wife had been perhaps an hour from death from the pressure of the child growing outside the womb, the mother from the child growing, and the child from growing awry; and so my wife did not die, but our mysterious child did...Not uncommon, an ectopic pregnancy, said the surgeon...Sometimes, continued the surgeon, sometimes people who lose children before they are born continue to imagine the child who has died, and talk about her or him, it's such an utterly human thing to do, it helps deal with the pain, it's healthy within reason, and yes, people say to their other children that they actually do, in a sense, have a sister or brother, or did have a sister or brother, and she or he is elsewhere, has gone ahead, whatever the language of your belief or faith tradition. You could do that. People do that, yes. I have patients who do that, yes... One summer morning, as I wandered by a river, I remembered an Irish word I learned long ago, and now whenever I think of the daughter I have to wait to meet, I find that word in my mouth: dunnog, little dark one, the shyest and quietest and tiniest of sparrows, the one you never see but sometimes you sense, a flash in the corner of your eye, a sweet sharp note already fading by the time it catches your ear.

They also bring to mind what sometimes seems to be a rapt predilection of small but influential cults of intellectuals or esthetes for what is generally regarded as perverse dispirited or distastefully unintelligible. The award of a Nobel Prize in literature to Andre Gide who in his work fervently and openly insists that pederasty is the superior and preferable way of life for adolescent boys furnishes a memorable example of such judgments. Renowned critics and some professors in our best universities reverently acclaim as the superlative expression of genius James Joyce's Finnegan's Wake a 628page collection of erudite gibberish indistinguishable to most people from the familiar word salad produced by hebephrenic patients on the back wards of any state hospital.

Callahan found that the common first reaction to news of cancer, strokes, heart attacks, or the failure of some major organ was one of betrayal. The patient was astounded to find that such a close (and, up to now at least, fully understood) friend as one’s own body could be so sluggard as to lie down on the job. The reaction which followed close on the heels of the first was the thought that a friend who would let one down so cruelly was not worth having. The conclusion that followed these reactions was that it didn’t matter if this friend was worth having or not. One could not refuse to speak to one’s traitorous body, or get up a petition against it, or pretend that one was not at home when it called. The final thought in this hospital-bed train of reasoning was the hideous possibility that one’s body might not be a friend at all, but an enemy implacably dedicated to destroying the superior force that had used it and abused it ever since the disease of reason set in.

I deeply respect doctors, but I want to be very clear on something: at every hospital in the United States, many doctors are doing the wrong things, pushing pills and interventions when an ultra-aggressive stance on diet and behavior would do far more for the patient in front of them. Suicide and burnout rates are astronomical in health care, with approximately four hundred doctors per year killing themselves. (That’s equivalent to about four medical school graduating classes just dropping dead every year by their own hand.) Doctors have twice the rate of suicide as the general population. Based on my own experience with depression as a young surgeon, I think a contributor to this phenomenon is an insidious spiritual crisis about the efficacy of our work and a sense of being trapped in a system

Our society has tried to make death invisible, thinking that if we ignore it long enough it will go away. Often we as family and loved ones are so afraid of death that even mentioning the word to terminal patients is taboo. We think the dying are oblivious to what is happening to them. Sadly, a dying person frequently feels afraid to bring it up him or herself. When I enter a hospital room I often hear a sigh of relief. At last, someone is here to help the family come to terms with what is playing out before them. Death has too long been the elephant in the living room, while everyone awkwardly discusses the weather.

Within the mental-health system in North America, the borderline victim of severe childhood trauma is usually blamed for her behaviour, which is regarded as having no legitimate basis and being self-indulgent; her trauma history is ignored and not talked about; and she is given as little treatment and follow-up as possible. At St Boniface Hospital in Winnipeg, many staff members expressed the opinion, in my presence, that borderlines and multiple personality disorder patients did not have a legitimate right to in-patient treatment, and the out-patient department would not accept patients with either diagnosis. (1995)

Ritual abuse diagnosis research – excerpt from a chapter in: Lacter, E. & Lehman, K. (2008).Guidelines to Differential Diagnosis between Schizophrenia and Ritual Abuse/Mind Control Traumatic Stress. In J.R. Noblitt & P. Perskin(Eds.), Ritual Abuse in the Twenty-first Century: Psychological, Forensic, Social and Political Considerations, pp. 85-154. Bandon, Oregon: Robert D. Reed Publishers. quotes: A second study revealed that these results were unrelated to patients’ degree of media and hospital milieu exposure to the subject of Satanic ritual abuse. “In fact, less media exposure was associated with production of more Satanic content in patients reporting ritual abuse, evidence that reports of ritual abuse are not primarily the product of exposure contagion.” Responses are consistent with the devastating and pervasive abuse these victims have experienced, so often including immediate family members.

On September 16, in defiance of the cease-fire, Ariel Sharon’s army circled the refugee camps of Sabra and Shatila, where Fatima and Falasteen slept defenselessly without Yousef. Israeli soldiers set up checkpoints, barring the exit of refugees, and allowed their Lebanese Phalange allies into the camp. Israeli soldiers, perched on rooftops, watched through their binoculars during the day and at night lit the sky with flares to guide the path of the Phalange, who went from shelter to shelter in the refugee camps. Two days later, the first western journalists entered the camp and bore witness. Robert Fisk wrote of it in Pity the Nation: They were everywhere, in the road, the laneways, in the back yards and broken rooms, beneath crumpled masonry and across the top of garbage tips. When we had seen a hundred bodies, we stopped counting. Down every alleyway, there were corpses—women, young men, babies and grandparents—lying together in lazy and terrible profusion where they had been knifed or machine-gunned to death. Each corridor through the rubble produced more bodies. The patients at the Palestinian hospital had disappeared after gunmen ordered the doctors to leave. Everywhere, we found signs of hastily dug mass graves. Even while we were there, amid the evidence of such savagery, we could see the Israelis watching us. From the top of the tower block to the west, we could see them staring at us through field-glasses, scanning back and forth across the streets of corpses, the lenses of the binoculars sometimes flashing in the sun as their gaze ranged through the camp. Loren Jenkins [of the Washington Post] cursed a lot. Jenkins immediately realized that the Israeli defense minister would have to bear some responsibility for this horror. “Sharon!” he shouted. “That fucker [Ariel] Sharon! This is Deir Yassin all over again.

New Rule: Republicans must stop pitting the American people against the government. Last week, we heard a speech from Republican leader Bobby Jindal--and he began it with the story that every immigrant tells about going to an American grocery store for the first time and being overwhelmed with the "endless variety on the shelves." And this was just a 7-Eleven--wait till he sees a Safeway. The thing is, that "endless variety"exists only because Americans pay taxes to a government, which maintains roads, irrigates fields, oversees the electrical grid, and everything else that enables the modern American supermarket to carry forty-seven varieties of frozen breakfast pastry.Of course, it's easy to tear government down--Ronald Reagan used to say the nine most terrifying words in the Englishlanguage were "I'm from the government and I'm here to help." But that was before "I'm Sarah Palin, now show me the launch codes."The stimulus package was attacked as typical "tax and spend"--like repairing bridges is left-wing stuff. "There the liberals go again, always wanting to get across the river." Folks, the people are the government--the first responders who put out fires--that's your government. The ranger who shoos pedophiles out of the park restroom, the postman who delivers your porn.How stupid is it when people say, "That's all we need: the federal government telling Detroit how to make cars or Wells Fargo how to run a bank. You want them to look like the post office?"You mean the place that takes a note that's in my hand in L.A. on Monday and gives it to my sister in New Jersey on Wednesday, for 44 cents? Let me be the first to say, I would be thrilled if America's health-care system was anywhere near as functional as the post office.Truth is, recent years have made me much more wary of government stepping aside and letting unregulated private enterprise run things it plainly is too greedy to trust with. Like Wall Street. Like rebuilding Iraq.Like the way Republicans always frame the health-care debate by saying, "Health-care decisions should be made by doctors and patients, not government bureaucrats," leaving out the fact that health-care decisions aren't made by doctors, patients, or bureaucrats; they're made by insurance companies. Which are a lot like hospital gowns--chances are your gas isn't covered.

But the history of Hopkins Hospital certainly isn’t pristine when it comes to black patients. In 1969, a Hopkins researcher used blood samples from more than 7,000 neighborhood children—most of them from poor black families—to look for a genetic predisposition to criminal behavior. The researcher didn’t get consent. The American Civil Liberties Union filed suit claiming the study violated the boys’ civil rights and breached confidentiality of doctor-patient relationships by releasing results to state and juvenile courts. The study was halted, then resumed a few months later using consent forms. And in the late nineties, two women sued Hopkins, claiming that its researchers had knowingly exposed their children to lead, and hadn’t promptly informed them when blood tests revealed that their children had elevated lead levels—even when one developed lead poisoning. The research was part of a study examining lead abatement methods, and all families involved were black. The researchers had treated several homes to varying degrees, then encouraged landlords to rent those homes to families with children so they could then monitor the children’s lead levels. Initially, the case was dismissed. On appeal, one judge compared the study to Southam’s HeLa injections, the Tuskegee study, and Nazi research, and the case eventually settled out of court. The Department of Health and Human Services launched an investigation and concluded that the study’s consent forms “failed to provide an adequate description” of the different levels of lead abatement in the homes.

His prescription to experience a deep sense of meaning, then, was remarkably pragmatic. He had three recommendations: 1. Have a project to work on, some reason to get out of bed in the morning and preferably something that serves other people. 2. Have a redemptive perspective on life’s challenges. That is, when something difficult happens, recognize the ways that difficulty also serves you. 3. Share your life with a person or people who love you unconditionally. Frankl called this treatment logotherapy, or a therapy of meaning. And surprisingly, it worked. He was put in charge of the mental-health division of the Viennese hospital system because they had lost far too many patients to suicide. When Frankl came aboard, he had more than thirty thousand suicidal patients under his care. The challenge was phenomenal. Frankl created community groups for the patients and taught counselors to identify projects the patients could contribute to, serious work the world needed that would give them a reason to get out of bed in the morning. Frankl also had the patients circle the difficult experiences they’d had and while allowing them to grieve, also asked them to list benefits that had come from their pain. The result of the program was transformational. Not one patient committed suicide on Frankl’s watch.

It was not easy to go from being one of the seven righteous pillars holding up the whole planet and human race to being just another mental patient. I remember talking to a woman who was ending racism and asking her if it was part of a bigger program or if racism was the whole deal. As someone who had gone back to the beginning of time and dealt with issues of whether or not life itself was a good idea, I wasn’t sure that just getting rid of racism was a big enough prize. ....In the eighties when I was called out of retirement to defeat communism, it was over my strenuous objections. “I don’t even dislike communism all that much,” I objected. “It seems so beside the point.” “The Republicans are going to take credit for this and ride it into the ground,” I correctly predicted. After winning many many preliminary rounds which I honestly hoped I’d lose, I was smuggled into what was thought to be just another psychiatric hospital where the Russian bear took one look at me, declined to dance, and the rest is history. My delusional world always felt kind of tinny and hollow, but that never helped me get out of it.

You think you know what a man is? You have no idea what a man is. You think you know what a daughter is? You have no idea what a daughter is. You think you know what this country is? You have no idea what this country is. You have a false image of everything. All you know is what a fucking glove is. This country is frightening. Of course she was raped. What kind of company do you think she was keeping? Of course out there she was going to get raped. This isn't Old Rimrock, old buddy - she's out there, old buddy, in the USA. She enters that world, that loopy world out there, with whats going on out there - what do you expect? A kid from Rimrock, NJ, of course she didn't know how to behave out there, of course the shit hits the fan. What could she know? She's like a wild child out there in the world. She can't get enough of it - she's still acting up. A room off McCarter Highway. And why not? Who wouldn't? You prepare her for life milking the cows? For what kind of life? Unnatural, all artificial, all of it. Those assumptions you live with. You're still in your olf man's dream-world, Seymour, still up there with Lou Levov in glove heaven. A household tyrannized by gloves, bludgeoned by gloves, the only thing in life - ladies' gloves! Does he still tell the one about the woman who sells the gloves washing her hands in a sink between each color? Oh where oh where is that outmoded America, that decorous America where a woman had twenty-five pairs of gloves? Your kid blows your norms to kingdom come, Seymour, and you still think you know what life is?" Life is just a short period of time in which we are alive. Meredith Levov, 1964. "You wanted Ms. America? Well, you've got her, with a vengeance - she's your daughter! You wanted to be a real American jock, a real American marine, a real American hotshot with a beautiful Gentile babe on your arm? You longed to belong like everybody else to the United States of America? Well, you do now, big boy, thanks to your daughter. The reality of this place is right up in your kisser now. With the help of your daughter you're as deep in the sit as a man can get, the real American crazy shit. America amok! America amuck! Goddamn it, Seymour, goddamn you, if you were a father who loved his daughter," thunders Jerry into the phone - and the hell with the convalescent patients waiting in the corridor for him to check out their new valves and new arteries, to tell how grateful they are to him for their new lease on life, Jerry shouts away, shouts all he wants if it's shouting he wants to do, and the hell with the rules of hte hospital. He is one of the surgeons who shouts; if you disagree with him he shouts, if you cross him he shouts, if you just stand there and do nothing he shouts. He does not do what hospitals tell him to do or fathers expect him to do or wives want him to do, he does what he wants to do, does as he pleases, tells people just who and what he is every minute of the day so that nothing about him is a secret, not his opinions, his frustrations, his urges, neither his appetite nor his hatred. In the sphere of the will, he is unequivocating, uncompromising; he is king. He does not spend time regretting what he has or has not done or justifying to others how loathsome he can be. The message is simple: You will take me as I come - there is no choice. He cannot endure swallowing anything. He just lets loose. And these are two brothers, the same parents' sons, one for whom the aggression's been bred out, the other for whom the aggression's been bred in. "If you were a father who loved your daughter," Jerry shouts at the Swede, "you would never have left her in that room! You would have never let her out of your sight!

Silver mining in the United States didn’t start, like hard-core, until the mid-1850s,” Louis said. “And only really got big when the Comstock Lode was discovered in 1859 in California.” “It was bad work. Dangerous. Like any mining. But silver also lets out fumes when it’s mined. Even Pliny the Elder wrote about how harmful the fumes were, especially to animals. You know Pliny the Elder?” “The problem with the silver fumes,” Louis continued, “is that, over time, they gave the miners delusions. Bad enough that they had to stop mining. Their health deteriorated. And a bunch of them even died.” Hard to make fun of something like that, so Pepper didn’t. “Do you know what people would say, in these mining towns, when they saw one of these miners falling apart? Walking through town muttering and swinging at phantoms? They said the Devil in Silver got them. It became shorthand. Like someone might say, ‘What happened to Mike?’ And the answer was always the same. ‘The Devil in Silver got him.’ ” Louis sat straight and crossed his arms and surveyed the table. “Do you understand what I’m trying to tell you?” “You’re saying we’re just making this thing up,” Pepper said quietly. Louis seemed disappointed. He dropped his hands into his lap and folded them there. He looked at his sister and Pepper. He turned his head to take in the other patients gathered with their family members there in the hospital. “I’m saying they were dying,” Louis said. “They definitely weren’t making that up. But it wasn’t a monster that was killing them. It was the mine.

Bear in mind that Mother Teresa’s global income is more than enough to outfit several first-class clinics in Bengal. The decision not to do so, and indeed to run instead a haphazard and cranky institution which would expose itself to litigation and protest were it run by any branch of the medical profession, is a deliberate one. The point is not the honest relief of suffering but the promulgation of a cult based on death and suffering and subjection. Mother Teresa (who herself, it should be noted, has checked into some of the finest and costliest clinics and hospitals in the West during her bouts with heart trouble and old age) once gave this game away in a filmed interview. She described a person who was in the last agonies of cancer and suffering unbearable pain. With a smile, Mother Teresa told the camera what she told this terminal patient: “You are suffering like Christ on the cross. So Jesus must be kissing you.” Unconscious of the account to which this irony might be charged, she then told of the sufferer’s reply: “Then please tell him to stop kissing me.” There are many people in the direst need and pain who have had cause to wish, in their own extremity, that Mother Teresa was less free with her own metaphysical caresses and a little more attentive to actual suffering.

Dear patient (first name, last name)! You are presently located in our experimental state hospital. The measures taken to save your life were drastic, extremely drastic (circle one). Our finest surgeons, availing themselves of the very latest achievements of modern medicine, performed one, two, three, four, five, six, seven, eight, nine, ten operations (circle one) on you. They were forced, acting wholly in your interest to replace certain parts of your organism with parts obtained from other persons, in strict accordance with Federal Law (Rev. Stat. Comm. 1-989/0-001/89/1). The notice you are now reading was thoughtfully prepared in order to help you make the best possible adjustment to these new if somewhat unexpected circumstances in your life, which, we hasten to remind you, we have saved. Although it was found necessary to remove your arms, legs, spine, skill, lungs, stomach, kidneys, liver, other (circle one or more), rest assured that these mortal remains were disposed of in a manner fully in keeping with the dictates of your religion; they were, with the proper ritual, interred, embalmed, mummified, buried at sea, cremated with the ashes scattered in the wind—preserved in an urn—thrown in the garbage (circle one). The new form in which you will henceforth lead a happy and healthy existence may possibly occasion you some surprise, but we promise that in time you will become, as indeed all our dear patients do, quite accustomed to it We have supplemented your organism with the very best, the best, perfectly functional, adequate, the only available (circle one) organs at our disposal, and they are fully guaranteed to last a year, six months, three months, three weeks, six days (circle one).

In airplane crashes and chemical industry accidents, in the infrequent but serious nuclear plant accidents, in the NASA Challenger and Columbia disasters, and in the British Petroleum gulf spill, a common finding is that lower-ranking employees had information that would have prevented or lessened the consequences of the accident, but either it was not passed up to higher levels, or it was ignored, or it was overridden. When I talk to senior managers, they always assure me that they are open, that they want to hear from their subordinates, and that they take the information seriously. However, when I talk to the subordinates in those same organizations, they tell me either they do not feel safe bringing bad news to their bosses or they’ve tried but never got any response or even acknowledgment, so they concluded that their input wasn’t welcome and gave up. Shockingly often, they settled for risky alternatives rather than upset their bosses with potentially bad news. When I look at what goes on in hospitals, in operating rooms, and in the health care system generally, I find the same problems of communication exist and that patients frequently pay the price. Nurses and technicians do not feel safe bringing negative information to doctors or correcting a doctor who is about to make a mistake. Doctors will argue that if the others were “professionals” they would speak up, but in many a hospital the nurses will tell you that doctors feel free to yell at nurses in a punishing way, which creates a climate where nurses will certainly not speak up. Doctors engage patients in one-way conversations in which they ask only enough questions to make a diagnosis and sometimes make misdiagnoses because they don’t ask enough questions before they begin to tell patients what they should do.

I believe the perception of what people think about DID is I might be crazy, unstable, and low functioning. After my diagnosis, I took a risk by sharing my story with a few friends. It was quite upsetting to lose a long term relationship with a friend because she could not accept my diagnosis. But it spurred me to take action. I wanted people to be informed that anyone can have DID and achieve highly functioning lives. I was successful in a career, I was married with children, and very active in numerous activities. I was highly functioning because I could dissociate the trauma from my life through my alters. Essentially, I survived because of DID. That's not to say I didn't fall down along the way. There were long term therapy visits, and plenty of hospitalizations for depression, medication adjustments, and suicide attempts. After a year, it became evident I was truly a patient with the diagnosis of DID from my therapist and psychiatrist. I had two choices. First, I could accept it and make choices about how I was going to deal with it. My therapist told me when faced with DID, a patient can learn to live with the live with the alters and make them part of one's life. Or, perhaps, the patient would like to have the alters integrate into one person, the host, so there are no more alters. Everyone is different. The patient and the therapist need to decide which is best for the patient. Secondly, the other choice was to resist having alters all together and be miserable, stuck in an existence that would continue to be crippling. Most people with DID are cognizant something is not right with themselves even if they are not properly diagnosed. My therapist was trustworthy, honest, and compassionate. Never for a moment did I believe she would steer me in the wrong direction. With her help and guidance, I chose to learn and understand my disorder. It was a turning point.

Stepfather—January 6, 1980 In addition to imitation mayonnaise, fake fur, sugar substitutes and plastic that wears like iron, the nuclear family has added another synthetic to its life: step-people. There are stepmothers, stepfathers, stepsons and stepdaughters. The reception they get is varied. Some are looked upon as relief pitchers who are brought in late but are optimistic enough to try to win the game. Some are regarded as double agents, who in the end will pay for their crimes. There are few generalizations you can make about step-people, except they’re all locked into an awkward family unit none of them are too crazy about. I know. I’ve been there. Perhaps you’ve heard of me. I became a hyphenated child a few years after my “real” father died. I was the only stepchild in North America to have a stepfather who had the gall to make me go to bed when I was sleepy, do homework before I went to school, and who yelled at me for wearing bedroom slippers in the snow. My real father wouldn’t have said that. My stepfather punished me for sassing my mother, wouldn’t allow me to waste food and wouldn’t let me spend money I didn’t have. My real father wouldn’t have done that. My stepfather remained silent when I slammed doors in his face, patient when I insisted my mother take “my side” and emotionless when I informed him he had no rights. My real father wouldn’t have taken that. My stepfather paid for my needs and my whims, was there through all my pain of growing up...and checked himself out of the VA hospital to give me away at my wedding. My real father...was there all the time, and I didn’t know it. What is a “real” mother, father, son or daughter? “Real” translates to something authentic, genuine, permanent. Something that exists. It has nothing to do with labor pains, history, memories or beginnings. All love begins with one day and builds. “Step” in the dictionary translates to “a short distance.” It’s shorter than you think.

I trudge toward the porch, entertaining the idea of running the other way. But technically, I shouldn't be in any trouble. It wasn't my car. I'm not the one who got a ticket. Samantha Forza did. And the picture on Samantha Forza's driver's license looks a lot like Rayna. She told Officer Downing that she swerved to keep from hitting a camel, which Officer Downing graciously interpreted as a deer after she described it as "a hairy animal with four legs and a horn." Since no one formed a search party to look for either a camel or a unicorn, I figured we were in the clear. But from Mom's expression, I'm miles from clear. "Hi," I say as I reach the steps. "We'll see about that," she says, grabbing my face and shining a pen light in my eyes. I slap it away. "Really? You're checking my pupils? Really?" "Hal said you looked hazy," she says, clipping the pen back on the neckline of her scrubs. "Hal? Who's Hal?" "Hal is the paramedic who took your signature when you declined medical treatment. He radioed in to the hospital after he left you." "Oh. Well, then Hal would have noticed I was just in an accident, so I might have been a little out of it. Doesn't mean I was high." So it wasn't small-town gossip, it was small-county gossip. Good ole Hal's probably transported hundreds of patients to my mom in the ER two towns over. She scowls. "Why didn't you call me? Who is Samantha?" I sigh and push past her. There's no reason to have this conversation on the porch. She follows me into the house. "She's Galen's sister. I didn't call because I didn't have a signal on my cell. We were on a dead road." "Where was Galen? Why were you driving his car?" "He was home. We were just taking it for a drive. He didn't want to come." Technically, all these statements are true, so they sound believable when I say them. Mom snorts and secures the dead bolt on the front door. "Probably because he knows his sister is life threatening behind the wheel." "Probably.