Preparing For Surgery Quotes

The change which the writing wrought in me (and of which I did not write) was only a beginning; only to prepare me for the gods' surgery. They used my own pen to probe my wound.

Take me back," I tell him, shifting a little. The world tilts and steadies all at once. "Alert the medics and have a bed prepared for our arrival. In the meantime, elevate my arm and continue applying direct pressure to the wound. The bullet has broken or fractured something, and this will require surgery.

I was afraid they kept the hogs in a pen out behind the hospital. I've been prepared for surgery and the doctor says to an orderly, 'Leon, go out to the hog pen and get me a valve.

It is not only negative feelings that become blocked. The repression extends to more and more of his emotional capacity.When one is given an anesthetic in preparation for surgery, it is not merely the capacity to experience pain that is suspended; the capacity to experience pleasure goes also - because what is blocked is the capacity to experience *feeling*. The same principle applies to the repression of emotions." Chapter 1: Discovering the Unknown Self, pg. 9, Bantam Edition, 1984

The change which the writing wrought in me (and of which I did not write) was only a beginning—only to prepare me for the gods’ surgery.

Because I live in south Florida I store cans of black beans and gallons of water in my closet in preparation for hurricane season. I throw a hurricane party in January. You’re my only guest. We play Marco Polo in bed. The sheets are wet like the roof caved in. There’s a million of me in you. You try to count me as I taste the sweat on the back of your neck. I call you Sexy Sexy, and we do everything twice. After, still sweating, we drink Crystal Light out of plastic water bottles. We discuss the pros and cons of vasectomies. It’s not invasive you say. I wrap the bedsheet around my waist. Minor surgery you say. You slur the word surgery, like it’s a garnish on a dish you just prepared. I eat your hair until you agree to no longer talk about vasectomies. We agree to have children someday, and that they will be beautiful even if they’re not. As I watch your eyes grow heavy like soggy clothes, I tell you When I grow up I’m going to be a famous writer. When I’m famous I’ll sign autographs on Etch-A-Sketches. I’ll write poems about writing other poems, so other poets will get me. You open your eyes long enough to tell me that when you grow up, you’re going to be a steamboat operator. Your pores can never be too clean you say. I say I like your pores just fine. I say Your pores are tops. I kiss you with my whole mouth, and you fall asleep next to my molars. In the morning, we eat french toast with powdered sugar. I wear the sugar like a mustache. You wear earmuffs and pretend we’re in a silent movie. I mouth Olive juice, but I really do love you. This is an awesome hurricane party you say, but it comes out as a yell because you can’t gauge your own volume with the earmuffs on. You yell I want to make something cute with you. I say Let me kiss the insides of your arms. You have no idea what I just said, but you like the way I smile.

And so I recognized that my sojourn into open-heart territory was ultimately an open heart journey in another sense, a spiritual journey of awakening—to the reality that I am here in this life with a purpose, and have been from the day I was born.

For more than twenty years I have offered a very simple yet powerful ritual to people before their radiation, chemotherapy, or surgery. I suggest they meet together with some of their closest friends and family the day before their procedure. Before this meeting, I suggest they find an ordinary stone, a piece of the earth, big enough to fit in the palm of their hand, and bring it to the meeting with them. The ritual begins by having everyone sit in a circle. In any order they wish to speak, each person tells the story of a time when they too faced a crisis. People may talk about the death of important persons, the loss of jobs or of relationships, or even about their own illnesses. The person who is speaking holds the stone the patient has brought. When they finish telling their story of survival, they take a moment to reflect on the personal quality that they feel helped them come through that difficult time. People will say things such as, 'What brought me through was determination,' 'What brought me through was faith,' 'What brought me through was humor.' When they have named the quality of their strength, they speak directly to the person preparing for surgery or treatment, saying, 'I put determination into this stone for you,' or, 'I put faith into this stone for you.' After everyone has spoken the stone is given back to the patient, who takes it with them to the hospital, to keep nearby and hold in their hand when things get hard. In an environment which is highly technical and sterile, it connects them to the earth and to each other.

For his thirtieth and fortieth birthdays, Jobs had celebrated with the stars of Silicon Valley and other assorted celebrities. But when he turned fifty in 2005, after coming back from his cancer surgery, the surprise party that his wife arranged featured mainly his closest friends and professional colleagues. It was at the comfortable San Francisco home of some friends, and the great chef Alice Waters prepared salmon from Scotland

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.

what if you were a doctor and had a patient who demanded that you stop all the silly hand-washing in preparation for surgery because it was taking too much time? 2 Clearly the patient is the boss; and yet the doctor should absolutely refuse to comply. Why? Because the doctor knows more than the patient about the risks of disease and infection. It would be unprofessional (never mind criminal) for the doctor to comply with the patient. So too it is unprofessional for programmers to bend to the will of managers who don’t understand the risks of making messes.

he’s not real I can take his space. As I get into bed beside him, the strongman vanishes. I pick up my diary and record him: was there, isn’t any more. This happened in early July, 2010. I had surgery on the first of the month, and was scheduled to stay in hospital for about nine days. The last thing the surgeon said to me, on the afternoon of the procedure: ‘For you, this is a big thing, but remember, to us it is routine.’ The operation was to relieve a stricture in my bowel, before it closed completely and created an emergency. But though we had used the latest scans in preparation, neither

Rest too long after an injury and your system powers down, preparing you for a peaceful exit. Fight your way back to your feet, however, and you trigger that magical ON switch that speeds healing hormones to everything you need to get stronger: your bones, brain, organs, ligaments, immune system, even the digestive bacteria in your belly, all get a molecular upgrade from exercise. For that, you can thank your hunter-gatherer ancestors, who evolved to stay alive by staying on the move. Today, movement-as-medicine is a biological truth for survivors of cancer, surgery, strokes, heart attacks, diabetes, brain injuries, depression, you name it.

(Beginning of Part 2) Since I cannot mend the book, I must add to it. To leave it as it was would be to die perjured; I know so much more than I did about the woman who wrote it. What began the change was the very writing itself. Let no one lightly set about such a work. Memory, once waked, will play the tyrant. I found I must set down (for I was speaking as before judges and cannot lie) passions and thoughts of my own which I had clean forgotten. The past which I wrote down was not the past that I thought I had (all these years) been remembering. I did not, even when I had finished the book, see clearly many things that I see now. The change which the writing wrought in me (and of which I did not write) was only a beginning - only to prepare me for the gods' surgery. They used my own pen to probe my words.

For inspiration, I would turn again and again to Lieutenant Jason “Jay” Redman, a Navy SEAL who had been shot seven times and had undergone nearly two dozen surgeries. He had placed a hand-drawn sign on the door to his room at Bethesda Naval Hospital. It read: ATTENTION. To all who enter here. If you are coming into this room with sorrow or to feel sorry for my wounds, go elsewhere. The wounds I received I got in a job I love, doing it for people I love, supporting the freedom of a country I deeply love. I am incredibly tough and will make a full recovery. What is full? That is the absolute utmost physically my body has the ability to recover. Then I will push that about 20% further through sheer mental tenacity. This room you are about to enter is a room of fun, optimism, and intense rapid regrowth. If you are not prepared for that, go elsewhere. From: The Management.

What to Make a Game About? Your dog, your cat, your child, your boyfriend, your girlfriend, your mother, your father, your grandmother, your friends, your imaginary friends, your summer vacation, your winter in the mountains, your childhood home, your current home, your future home, your first job, your worst job, the job you wish you had. Your first date, your first kiss, your first fuck, your first true love, your second true love, your relationship, your kinks, your deepest secrets, your fantasies, your guilty pleasures, your guiltless pleasures, your break-up, your make-up, your undying love, your dying love. Your hopes, your dreams, your fears, your secrets, the dream you had last night, the thing you were afraid of when you were little, the thing you’re afraid of now, the secret you think will come back and bite you, the secret you were planning to take to your grave, your hope for a better world, your hope for a better you, your hope for a better day. The passage of time, the passage of memory, the experience of forgetting, the experience of remembering, the experience of meeting a close friend from long ago on the street and not recognizing her face, the experience of meeting a close friend from long ago and not being recognized, the experience of aging, the experience of becoming more dependent on the people who love you, the experience of becoming less dependent on the people you hate. The experience of opening a business, the experience of opening the garage, the experience of opening your heart, the experience of opening someone else’s heart via risky surgery, the experience of opening the window, the experience of opening for a famous band at a concert when nobody in the audience knows who you are, the experience of opening your mind, the experience of taking drugs, the experience of your worst trip, the experience of meditation, the experience of learning a language, the experience of writing a book. A silent moment at a pond, a noisy moment in the heart of a city, a moment that caught you unprepared, a moment you spent a long time preparing for, a moment of revelation, a moment of realization, a moment when you realized the universe was not out to get you, a moment when you realized the universe was out to get you, a moment when you were totally unaware of what was going on, a moment of action, a moment of inaction, a moment of regret, a moment of victory, a slow moment, a long moment, a moment you spent in the branches of a tree. The cruelty of children, the brashness of youth, the wisdom of age, the stupidity of age, a fairy tale you heard as a child, a fairy tale you heard as an adult, the lifestyle of an imaginary creature, the lifestyle of yourself, the subtle ways in which we admit authority into our lives, the subtle ways in which we overcome authority, the subtle ways in which we become a little stronger or a little weaker each day. A trip on a boat, a trip on a plane, a trip down a vanishing path through a forest, waking up in a darkened room, waking up in a friend’s room and not knowing how you got there, waking up in a friend’s bed and not knowing how you got there, waking up after twenty years of sleep, a sunset, a sunrise, a lingering smile, a heartfelt greeting, a bittersweet goodbye. Your past lives, your future lives, lies that you’ve told, lies you plan to tell, lies, truths, grim visions, prophecy, wishes, wants, loves, hates, premonitions, warnings, fables, adages, myths, legends, stories, diary entries. Jumping over a pit, jumping into a pool, jumping into the sky and never coming down. Anything. Everything.

My luminaries!" he sang out. "I am thrilled to have you here. I have been rereading both your works in preparation for our glorious collaboration." "Collaboration?" "You will forgive my enthusiasm and my presumption. But you must accept that what we are here today to do with each other cannot be subsumed under the mantle of medical procedure alone. For me to put the scalpel into your hand, my dearest Monsieur Arosteguy, is basically a crime, you understand. Though I fully comprehend the emotional ownership of the breast involved with the husband and the wife. In the light of that ownership, the alien surgeon is an intruder, a rapist, a violator. Why should he be allowed to sever that most beautiful organ from that beloved body? Who the fuck is he anyway? No, only the husband should have the right to do that intimate severing with all its resonances of personal history. And so on. But legally it's a crime. So what's the solution in our heads? In my head, the solution is that we are not committing surgery, but are creating an art/philosophy / crime/ surgery project. The three of us. A collective. The Arosteguy Collective Project. Do you agree?" Celestine and I glanced at each other and could see that we were immediately in sync. We were overwhelmed, horrified, and also delighted.

On the eve of my move to New York, my parents sat me down to talk. “Your mother and I understand that we have a certain responsibility to prepare you for life at a coed institution,” said my father. “Have you ever heard of oxytocin?” I shook my head. “It’s the thing that’s going to make you crazy,” my mother said, swirling the ice in her glass. “You’ll lose all the good sense I’ve worked so hard to build up in you since the day you were born.” She was kidding. “Oxytocin is a hormone released during copulation,” my father went on, staring at the blank wall behind me. “Orgasm,” my mother whispered. “Biologically, oxytocin serves a purpose,” my father said. “That warm fuzzy feeling.” “It’s what bonds a couple together. Without it, the human species would have gone extinct a long time ago. Women experience its effects more powerfully than men do. It’s good to be aware of that.” “For when you’re thrown out with yesterday’s trash,” my mother said. “Men are dogs. Even professors, so don’t be fooled.” “Men don’t attach as easily. They’re more rational,” my father corrected her. After a long pause, he said, “We just want you to be careful.” “He means use a rubber.” “And take these.” My father gave me a small, pink, shell-shaped compact of birth control pills. “Gross,” was all I could say. “And your father has cancer,” my mother said. I said nothing. “Prostate isn’t like breast,” my father said, turning away. “They do surgery, and you move on.” “The man always dies first,” my mother whispered.

He ran long at the White House, and arrived late to his next meeting with Hillary Clinton, Jake Sullivan and Frank Ruggiero—their first major strategy session on Taliban talks after the secret meeting with A-Rod. She was waiting in her outer office, a spacious room paneled in white and gilt wood, with tasseled blue and pink curtains and an array of colorfully upholstered chairs and couches. In my time reporting to her later, I only ever saw Clinton take the couch, with guests of honor in the large chair kitty-corner to her. She’d left it open for him that day. “He came rushing in. . . . ” Clinton later said. “And, you know, he was saying ‘oh I’m so sorry, I’m so sorry.’ ” He sat down heavily and shrugged off his coat, rattling off a litany of his latest meetings, including his stop-in at the White House. “That was typical Richard. It was, like, ‘I’m doing a million things and I’m trying to keep all the balls in the air,’ ” she remembered. As he was talking, a “scarlet red” flush went up his face, according to Clinton. He pressed his hands over his eyes, his chest heaving. “Richard, what’s the matter?” Clinton asked. “Something horrible is happening,” he said. A few minutes later, Holbrooke was in an ambulance, strapped to a gurney, headed to nearby George Washington University Hospital, where Clinton had told her own internist to prepare the emergency room. In his typically brash style, he’d demanded that the ambulance take him to the more distant Sibley Memorial Hospital. Clinton overruled him. One of our deputies on the SRAP team, Dan Feldman, rode with him and held his hand. Feldman didn’t have his BlackBerry, so he scrawled notes on a State Department expense form for a dinner at Meiwah Restaurant as Holbrooke dictated messages and a doctor assessed him. The notes are a nonlinear stream of Holbrooke’s indomitable personality, slashed through with medical realities. “Call Eric in Axelrod’s office,” the first read. Nearby: “aortic dissection—type A . . . operation risk @ > 50 percent”—that would be chance of death. A series of messages for people in his life, again interrupted by his deteriorating condition: “S”—Secretary Clinton—“why always together for medical crises?” (The year before, he’d been with Clinton when she fell to the concrete floor of the State Department garage, fracturing her elbow.) “Kids—how much love them + stepkids” . . . “best staff ever” . . . “don’t let him die here” . . . “vascular surgery” . . . “no flow, no feeling legs” . . . “clot” . . . and then, again: “don’t let him die here want to die at home w/ his fam.” The seriousness of the situation fully dawning on him, Holbrooke turned to job succession: “Tell Frank”—Ruggiero—“he’s acting.” And finally: “I love so many people . . . I have a lot left to do . . . my career in public service is over.” Holbrooke cracked wise until they put him under for surgery. “Get me anything you need,” he demanded. “A pig’s heart. Dan’s heart.

critical thinking Scenario 1 Mrs. Hernandez is an 85-yearold female admitted to surgery for insertion of a hip prosthesis to treat a hip fracture. The surgical technologist assigned to transport the patient to the preoperative holding area performed a routine review of the patient’s medical chart in the emergency department. The medical chart indicates that Mrs. Hernandez is being treated forchronic hypertension. 1. Knowing that she has a concurrent diagnosis of hypertension, which additional related items should be checked on her chart? 2. How might this situation affect the preparations going on in the surgery department? 3. What action or actions should the surgical technologist take prior to bringing the patient to preoperative holding? Scenario 2 Mr. Van Nguyen is a 47-yearold male admitted to surgery for repair of a retinal detachment under general anesthesia. 1. Which diuretic may be administered intraoperatively? 2. The circulator should check the preference card for a standing order for what preoperative preparation of the patient specific to this situation? 124

To get the most out of this chapter, first find where you are on this map of the cancer journey: Critical stress points. When you have just been diagnosed with cancer or learned that your cancer has recurred or is not responding to treatment. Treatment preparation. When you are anticipating surgery, radiation, chemotherapy, or molecular target therapies. Side effect management. When you are undergoing treatment and need ways (instead of or in addition to drugs) to manage its side effects. Post-treatment. When you are adjusting to the end of active treatment, usually after the final chemotherapy cycle. This situation can, perhaps surprisingly, prove quite stressful. Remission maintenance. Although definitely good news, remission introduces its own issues, most notably fear of recurrence. Remission is also when you will be most determined to take back your life from cancer.

One of the students was a doctor, a German woman, and I used to watch her scouring garbage pails as though she were preparing a room for surgery.

I remained with Lark in the hospital room until Aaron arrived out of breath from running. “My muse,” he said, taking her hand. Leaving them alone to prepare for the surgery, I walked into the waiting room. Cooper patted the chair next to him and I joined him. “She’ll be okay,” he said, sounding convincing. I didn’t feel like talking, so I texted Dylan, Harlow, Mom, and Dad to let them know what was happening. Cooper spoke quietly on the phone with Farah who was on her way with Tawny. First, Dick and Maryann arrived then Raven not long afterwards with Bailey. “We were shopping when you called,” Bailey announced as Raven hurried to Lark’s room. Joining her brother, Bailey tapped her foot and stared at the door. “How long will it take?” “Patience,” Cooper muttered then returned to talking with Farah. Bailey changed seats, so she was next to me. “Don’t be scared. Pixies are powerful creatures.” Smiling softly, I took Bailey’s hand and waited.

(I also woefully underestimated my recovery time. Two weeks of dinner delivery was by no means enough coverage. Little did I know that in my case it would be six to eight weeks before I’d make significant strides toward recovery.)

When you’re not starving, when you have glucose, you can prepare for the battle of the bulge with some of the classic self-control strategies, starting with precommitment. The ultimate surefire form of precommitment—the true equivalent of Odysseus tying himself to the mast—would be gastric bypass surgery, which would physically prevent you from eating, but there are lots of more modest forms. You can begin by simply keeping fattening food out of reach and out of sight. You’ll conserve willpower (as the women in the experiment did when the M&M’s were moved out of reach) at the same time that you’re avoiding calories. In one experiment, office workers ate a third less candy when it was kept inside a drawer rather than on top of their desks. A simple commitment strategy for avoiding late-night snacking is to brush your teeth early in the evening, while you’re still full from dinner and before the late-night-snacking temptation sets in. Although it won’t physically prevent you from eating, brushing your teeth is such an ingrained pre-bedtime habit that it unconsciously cues you not to eat anymore. On a conscious level, moreover, it makes snacking seem less attractive: You have to balance your greedy impulse for sugar against your lazy impulse to avoid having to brush your teeth again.

Now take a few moments to consider how obesity has affected you. Complete your first activity: on the following page, write your personal story of obesity, making sure to include how obesity affects you emotionally, how long you’ve lived with obesity, how your excess weight interferes with your life, and any obesity-related health problems you experience.

The first step in developing realistic expectations is to calculate your excess weight. Now that you know your BMI, it’s time to calculate your excess weight. The amount of excess weight you’re carrying is defined as the amount of weight you need to lose to reach the normal BMI range (18.5 to 24.9). Look at the following table to determine how much you need to weigh to have a BMI of 22 (middle of the normal range). The amount of weight you can expect to lose depends, in part, on surgery type, but losing 40 to 70 percent of excess weight is a good WLS outcome (Norris 2007). It’s important to remember that we are talking about percent of excess weight, not percent of total weight.

Consider how obesity has affected your social life. Are there social activities you avoid? How are your relationships affected by your weight? In the following space, describe how obesity affects your social interactions. My obesity affects my social interactions by:

Below, write about how you perceive your health. Do you feel unhealthy because of your weight? If you do feel unhealthy, what is it about being obese that makes you feel unhealthy?

Obesity interferes with my mood by:

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. After their residencies, most young doctors today are going on to do fellowships, adding one to three further years of training in, say, laparoscopic surgery, or pediatric metabolic disorders, or breast radiology, or critical care.

I recall vividly the night before one of my own early surgeries, an eight-hour affair that would alter my body permanently. I was twenty-seven and unmarried at the time. Late in the evening a pleasant elderly woman, a technical aide, had come to my hospital room to shave my abdomen in preparation for the procedure. As she went about this humble task with great skill, she had asked me about the next day's surgery. Filled with resentment, self-pity, and a sense of victimhood, I told her what was planned and burst into tears. She had seemed quite surprised. "How would YOU feel if they were going to do this to YOU tomorrow?" I asked her angrily. she had taken my question literally and had thought it over. Then, patting me gently, she had said, "If I needed it to live, I would be glad for the help." Her answer had changed everything.

It is not only negative feelings that become blocked. The repression extends to more and more of his emotional capacity. When one is given an anesthetic in preparation for surgery, it is not merely the capacity to experience pain that is suspended; the capacity to experience pleasure goes also — because what is blocked is the capacity to experience feeling. The same principle applies to the repression of emotions. It must be recognized, of course, that emotional repression is a matter of degree; in some individuals it is far more profound and pervasive than in others. But what remains true for everyone is that to diminish one's capacity to experience pain is to diminish also one's capacity to experience pleasure.

positive impact on my recovery. (It also helps you sleep if used before bed.) Warning: Start slow. I tried to copy Amelia and did 20-plus minutes my first session. The next day, I felt like I’d been put in a sleeping bag and swung against a tree for a few hours. Rolling your foot on top of a golf ball on the floor to increase “hamstring” flexibility. This is infinitely more helpful than a lacrosse ball. Put a towel on the floor underneath the golf ball, lest you shoot your dog’s eye out. Concept2 SkiErg for training when your lower body is injured. After knee surgery, Amelia used this low-impact machine to maintain cardiovascular endurance and prepare for the 2014 World’s Toughest Mudder, which she won 8 weeks post-op. Kelly Starrett (page 122) is also a big fan of this device. Dry needling: I’d never heard of this before meeting Amelia. “[In acupuncture] the goal is not to feel the needle. In dry-needling, you are sticking the needle in the muscle belly and trying to get it to twitch, and the twitch is the release.” It’s used for super-tight, over-contracted muscles, and the needles are not left in. Unless you’re a masochist, don’t have this done on your calves. Sauna for endurance: Amelia has found using a sauna improves her endurance, a concept that has since been confirmed by several other athletes, including cyclist David Zabriskie, seven-time U.S. National Time Trial Championship winner. He considers sauna training a more practical replacement for high-altitude simulation tents. In the 2005 Tour de France, Dave won the Stage 1 time trial, making him the first American to win stages in all three Grand Tours. Zabriskie beat Lance Armstrong by seconds, clocking an average speed of 54.676 kilometers per hour (!). I now use a sauna at least four times per week. To figure out the best protocols, I asked another podcast guest, Rhonda Patrick. Her response is on page 7. * Who do you think of when you hear the word “successful”?

on a seagull poo–like texture when mixed into cold water. Amelia saved my palate and joints by introducing me to the Great Lakes hydrolyzed version (green label), which blends easily and smoothly. Add a tablespoon of beet root powder like BeetElite to stave off any cow-hoof flavor, and it’s a whole new game. Amelia uses BeetElite pre-race and pre-training for its endurance benefits, but I’m much harder-core: I use it to make tart, low-carb gummy bears when fat Tim has carb cravings. RumbleRoller: Think foam roller meets monster-truck tire. Foam rollers have historically done very little for me, but this torture device had an immediate positive impact on my recovery. (It also helps you sleep if used before bed.) Warning: Start slow. I tried to copy Amelia and did 20-plus minutes my first session. The next day, I felt like I’d been put in a sleeping bag and swung against a tree for a few hours. Rolling your foot on top of a golf ball on the floor to increase “hamstring” flexibility. This is infinitely more helpful than a lacrosse ball. Put a towel on the floor underneath the golf ball, lest you shoot your dog’s eye out. Concept2 SkiErg for training when your lower body is injured. After knee surgery, Amelia used this low-impact machine to maintain cardiovascular endurance and prepare for the 2014 World’s Toughest Mudder, which she won 8 weeks post-op. Kelly Starrett (page 122) is also a big fan of this device. Dry needling: I’d never heard of this before meeting Amelia. “[In acupuncture] the goal is not to feel the needle. In dry-needling, you are sticking the needle in the muscle belly and trying to get it to twitch, and the twitch is the release.” It’s used for super-tight, over-contracted muscles, and the needles are not left in. Unless you’re a masochist, don’t have this done on your calves. Sauna for endurance: Amelia has found using a sauna improves her endurance, a concept that has since been confirmed by several other athletes, including cyclist David Zabriskie, seven-time U.S. National Time Trial Championship winner. He considers sauna training a more practical replacement for high-altitude simulation tents. In the 2005 Tour de France, Dave won the Stage 1 time trial, making him the first American to win stages in all three Grand Tours. Zabriskie beat Lance Armstrong by seconds, clocking an average speed of 54.676 kilometers per hour (!). I now use a sauna at least four times per week. To figure out the best protocols, I asked

But on January 6th for the first time, I was more afraid to work at the Capitol than my entire deployment to Iraq,” Aquilino told the committee. “In Iraq, we expected armed violence because we were in a war zone, but nothing in my experience in the Army or as a law enforcement officer prepared me for what we confronted on January 6th.” During the riot, Aquilino said, he was kicked, pushed, shoved, spit on, and sprayed with chemical irritants. Someone targeted his eyes with a laser. He was attacked with hammers, rebars, batons, police shields, rods, and a metal pole flying an American flag. Aquilino said the rioters tried to pull him into the crowd, and one of them beat him with his own baton. “I, too, was being crushed by the rioters,” Aquilino said. “I could feel myself losing oxygen and thinking to myself, ‘This is how I’m going to die, defending this entrance.’ ” Aquilino suffered injuries to both hands, his left shoulder, right calf, and right foot. His foot and shoulder wounds—a labrum tear and rotator cuff damage—required painful surgery.

Sometimes I worry (and I know I worry too much, too seriously) that I will have the same self-doubts and uneasiness as a man as I have a woman. I worry that I will fail to find the happiness I think I will. But as I wash myself and prepare for this surgery, when I buy my new shirts and look at my breasts and think they are sexy (!), I know I'll come out of this a better person.

Similarly, a comprehensive 1977 study by McKinlay and McKinlay, formerly required reading in almost all American medical schools, found that all medical interventions, including vaccines, surgeries, and antibiotics, contributed only about 1 percent of the decline and at most 3.5 percent.17 Both CDC and the McKinlays attributed the disappearance of infectious disease mortalities not to doctors and health officials, but to improved nutrition and sanitation—the latter credited to strict regulation of food preparation, electric refrigerators, sewage treatment, and chlorinated water. The McKinlays joined Harvard’s iconic infectious disease pioneer, Edward Kass, in warning that a self-serving medical cartel would one day try to claim credit for these public health improvements as a pretense for imposing unwarranted medical interventions (e.g., vaccines) on the American public.

There’s a ritualization to some of these recovery modalities that shouldn’t be overlooked. In a recent editorial, Jonas Bloch Thorlund from the University of South Denmark deconstructed why arthroscopic surgery for meniscal tears remains popular, despite compelling evidence that these procedures are essentially placebos, no better than sham surgery.11 Thorlund notes that surgery represents a ritualistic activity that fosters expectations, much like the way shamans do. There’s the journey to a healing place (the hospital), anointment with a purifying liquid (the presurgical skin prep), and an encounter with the masked healer. As I read this description, I felt a glimmer of recognition, thinking about my experiences visiting recovery centers. In each case, you’re greeted by an empathetic caregiver who walks you through a series of rituals that require various forms of preparation and waiting. It makes me wonder how much power resides in the simple act of putting your trust in a healer and taking part in the ritual on offer.