Prognosis Quotes

THE MAXIMS OF MEDICINE Before you examine the body of a patient, Be patient to learn his story. For once you learn his story, You will also come to know His body. Before you diagnose any sickness, Make sure there is no sickness in the mind or heart. For the emotions in a man’s moon or sun, Can point to the sickness in Any one of his other parts. Before you treat a man with a condition, Know that not all cures can heal all people. For the chemistry that works on one patient, May not work for the next, Because even medicine has its own Conditions. Before asserting a prognosis on any patient, Always be objective and never subjective. For telling a man that he will win the treasure of life, But then later discovering that he will lose, Will harm him more than by telling him That he may lose, But then he wins. THE MAXIMS OF MEDICINE by Suzy Kassem

When you have half of Caironese in slums, when you don't have clean water, when you don't have a sewer system, when you don't have electricity, and on top of that you live under one of the most repressive regimes right now... Well, put all that together, and it's a ticking bomb. It's not of a question of threat; it is question of looking around at the present environment and making a rational prognosis.

Before asserting a prognosis on any patient, always be objective and never subjective. For telling a man that he will win the treasure of life, but then later discovering that he will lose, will harm him more than by telling him that he may lose, but then he wins.

Amateur psychiatric prognosis can be fascinating when there is absolutely nothing else to do.

As adults, these kids are mostly what you’d expect. Low IQ and poor cognitive skills. Problems with forming attachments, often bordering on autistic. Anxiety and depression galore. The longer the institutionalization, the worse the prognosis.

Dissociative Disorders have a high rate of responsiveness to therapy and that with proper treatment, their prognosis is quite good.

It is the nature of the Kali Yuga that most human beings are now held back from spiritual liberation due to the gravity of inertia, apathy and laziness, (known in Sankrit as the quality of tapas) that overwhelms this age. Despite this seemingly gloomy prognosis, there is a way out of this predicament for those with the will and stamina to awaken from the rampant lethargy, within and outside of themselves, to take action.

Block has a list of questions that she aims to cover with sick patients in the time before decisions have to be made: What do they understand their prognosis to be, what are their concerns about what lies ahead, what kinds of trade-offs are they willing to make, how do they want to spend their time if their health worsens, who do they want to make decisions if they can’t? A decade

I had no illusions that now, in some final and dramatic flash of revelation, we would understand one another. We were done. It was a fact of my life--intractable and sad--that our relationship had been a failure. Still, with her prognosis came one last chance to be her daughter. [p. 163]

A diagnosis is not a prognosis unless you let it be.

I was recently diagnosed with dyslexia and restless leg syndrome. The doctor arrived at this prognosis after my arm wouldn't stop shaking.

the prognosis for civilization’s survival is grim; as Einstein said after the Japan bombings: “I do not know how the Third World War will be fought, but I can tell you what they will use in the Fourth—rocks.

... omniscience about life and death is not within a physician's purview. A doctor should never write off a person a priori.

I'm still in The Syd Barrett Memorial Rehabilitation Centre, Cambridge, UK When and if I'm let out, I'll move on to Saucerful of Secrets. Prognosis: Uncertain.

Johann grinned. “Right. So what’s the prognosis, sweetheart?

My dearest, I write this letter by candlelight as you lie sleeping. And though I can't hear the soft sounds of your slumber, I know you are there, and soon I will be lying next to you again as I always have. And I will feel your warmth and your comfort, and your breaths will slowly guide me to the place where I dream of you and the wonderful man you are. I see the flame beside me and it reminds me of another fire, (with me in your soft clothes and you in your jeans) of me and you. I knew then we would always be together. My heart had been captured, and I knew inside that it had always been yours. Who was I to question a love that rode on shooting stars and roared like crashing waves? For that is what is was between us then and that is what it is today. You are my best friend as well as my lover, and I do not know which side of you I enjoy the most. I treasure each side, just as I have treasured our life together. You have something inside you, something beautiful and strong. Kindness, that's what I see when I look at you, that's what everyone sees. Kindness. You are the most forgiving and peaceful man I know. God is with you, He must be, for you are the closest thing to an angel that I've ever seen. We have lived a lifetime most couples never know, and yet, when I look at you, I am frightened by the knowledge that all this will be ending soon. (For we both know my prognosis and what it will mean to us.) I see your tears and I worry more about you than I do about me, because I fear the pain I know you will go through. There are no words to express my sorrow for this, and I am at a loss for words. So I love you so deeply, so incredibly much. Know that I love you, that I always will, and that no matter what happens, know I have led the greatest life possible. My life with you. I love you. I love you now as I write this, and I love you now as you read this. And I am so sorry if I am not able to tell you. I love you deeply. You are, and always have been, my dream.

Cruelty, whether physical or emotional, isn't normal. It may signal what psychologists call the dark triad of psychopathic, narcissistic and Machiavellian personality disorders. One out of about every 25 individuals has an antisocial personality disorder. Their prognosis for recovery is zero, their potential for hurting you about 100 percent. So don't assume that a vicious person just had a difficult childhood or a terrible day; most people with awful childhoods end up being empathetic, and most people, even on their worst days, don't seek satisfaction by inflicting pain. When you witness evil, if only the tawdry evil of a conversational stiletto twist, use your ninjutsu, wait for a distraction, then disappear.

Can capitalism survive? No. I do not think it can. But this opinion of mine, like that of every other economist who has pronounced upon the subject, is in itself completely uninteresting. What counts in any attempt at social prognosis is not the Yes or No that sums up the facts and arguments which lead up to it but those facts and arguments themselves.

You’re the pea and I’m the pod.

Today when I see a patient with CML, I tell them that the disease is an indolent leukemia with an excellent prognosis, that they will usually live their functional life span provided they take an oral medicine, Gleevec, for the rest of their lives.

The planet Earth is not in danger. She has millions of years to recover. It is the human species that, by degrading the ecosystem, is putting itself at risk. Nothing will be done to stem present developments, and it is already too late. The prognosis is negative.

What’s the kindest thing you almost did? Is your fear of insomnia stronger than your fear of what awoke you? Are bonsai cruel? Do you love what you love, or just the feeling? Your earliest memories: do you look through your young eyes, or look at your young self? Which feels worse: to know that there are people who do more with less talent, or that there are people with more talent? Do you walk on moving walkways? Should it make any difference that you knew it was wrong �as you were doing it? Would you trade actual intelligence for the perception of being smarter? Why does it bother you when someone at the next table is having a conversation on a cell phone? How many years of your life would you trade for the greatest month of your life? What would you tell your father, if it were possible? Which is changing faster, your body, or your mind? Is it cruel to tell an old person his prognosis? Are you in any way angry at your phone? When you pass �a storefront, do you look at what’s inside, look at your reflection, or neither? Is there anything you would die for if no one could ever know you died for it? If you could be assured that money wouldn’t make �you any small bit happier, would you still want more money? What has �been irrevocably spoiled for you? If your deepest secret became public, �would you be forgiven? Is your best friend your kindest friend? Is it in any way cruel to give a dog a name? Is there anything you feel a need to confess? You know it’s a “murder of crows” and a “wake of buzzards” but it’s a what of ravens, again? What is it about death that you’re �afraid of? How does it make you feel to know that it’s an “unkindness �of ravens”?

I hated funerals. I hated any rite of passage that emphasized how fleeting and fragile our physical lives were. I hated that children died. Even knowing what I knew about life and the afterlife and the momentary condition of our existence on earth, I hated it. It was better on the other side. I knew that. I’d been told by countless departed, but I hated this part nonetheless. And just for the record, telling the living how their loved ones were in a better place rarely helped. Nothing helped apart from time, and even then, the long-term prognosis was sketchy. Most recovered. Many did not. Not really. Not fully.

If you think about it, the public perception of funky brain chemistry has been as varied and weird as the symptoms, historically speaking. If I had been born a Native American in another time, I might have been lauded as a medicine man. My voices would have been seen as the voices of ancestors imparting wisdom. I would have been treated with great mystical regard. If I had lived in biblical times, I might have been seen as a prophet, because, let’s face it, there are really only two possibilities: either prophets were actually hearing God speaking to them, or they were mentally ill. I’m sure if an actual prophet surfaced today, he or she would receive plenty of Haldol injections, until the sky opened up and the doctors were slapped silly by the Hand of God. In the Dark Ages my parents would have sent for an exorcist, because I was clearly possessed by evil spirits, or maybe even the Devil himself. And if I lived in Dickensian England, I would have been thrown into Bedlam, which is more than just a description of madness. It was an actual place—a “madhouse” where the insane were imprisoned in unthinkable conditions. Living in the twenty-first century gives a person a much better prognosis for treatment, but sometimes I wish I’d lived in an age before technology. I would much rather everyone think I was a prophet than some poor sick kid.

I can confirm by a modern dream the element of prognosis (or precognition) that can be found in an old dream quoted by Artemidorus of Daldis, in the second century A.D.: A man dreamed that he saw his father die in the flames of a house on fire. Not long afterward, he himself died in a phlegmone (fire, or high fever), which I presume was pneumonia.

Those are my last thoughts as a person with a healthy, normal, functioning brain.

My greatest fear was appearing stupid; a fear I will carry with me for the rest of my life—a tattoo across my forehead only I can see. All I wanted was to be invisible.

it nevertheless makes the prognosis look more hopeful, as I have often observed. In border-line cases such as this a real psychological understanding is often a matter of life and death.

Attachment is our connection with the world. In the earliest attachment relationships, we gain or lose the ability to stay open, self-nurturing and healthy. In those early attachment bonds, we learned to experience anger or to fear it and repress it. There we developed our sense of autonomy or suffered its atrophy. Connection is also vital to healing. Study after study concludes that people without social contact—the lonely ones—are at greatest risk for illness. People who enjoy genuine emotional support face a better prognosis, no matter what the disease.

No one had told me that sleep disturbances affect most head-injured folk, sometimes permanently, or that a lack of sleep would significantly hamper rehabilitation. I would never have another normal

The sound my skull makes as it hits the rock is like no sound I have heard before. It’s an assault. One part crack, one part slosh, one part thump. My brain shudders inside my skull. I feel it move.3 When

Social democracy as we now know it underwent its moment of speciation when Eduard Bernstein began to question the orthodoxy of revolution. His essential postulate was the absence of crises. The Steven Pinker of socialism, he pointed to the empirical fact that no serious crisis had rocked the capitalist economy for the past two or three decades, which invalidated the Marxian prophecy of a system trending towards collapse. Since it was not prone to malfunctioning, the idea of seizing power, smashing decrepit capitalism and installing a completely different order had become redundant; instead social democracy could continue to grow in strength, extract piecemeal reforms and gradually lift the working class out of the mire. Rosa Luxemburg very famously objected that the crisis tendencies had merely been postponed. In the near future, they would burst forth with even more dreadful violence. Ignoring her prognosis, the social democrats in the making went ahead and presently gave their first demonstration of how they dealt with catastrophe: by expediting it through consent.

The doc began waving a medical Pentracorder over Hadrian. “Oh dear! Fractured ego, sprained confidence, dislocated immodesty, and broken bravado! Can this even be cured? Extensive long-term damage is the sad prognosis, alas.

The ultimate goal of parents, educators, and professionals who interact with children with autism is to unlock their potential to become self-reliant, fully-integrated, contributing members of society. We have the power to unlock this potential by implementing an effectively structured intervention—that which takes the development of the whole child into account.

Like the teachings of Hippocrates, the Charaka Samhita describes the qualities needed by a physician, and instructs how he should go about examining a patient to find the root cause of a disease, and how to make a prognosis and prescribe treatments. These treatments are minimally invasive, and involve specific diets and exercises and more than 2,000 plant-based remedies. The emphasis throughout the Charaka Samhita is on preventing illness by maintaining good hygiene and a healthy diet.

I glance over my shoulder, at the car following close behind us. It’s impossible to see the driver. To tell if it’s Cassian. After a moment, it pulls around and passes us. I sigh. “Why do I get the feeling that I’m abducting you? Should I be on alert for sirens in the rearview mirror?” “I left willingly.” I force a grin and tease, “I don’t think you’ll get arrested.” “Great. You don’t ‘think.’ That’s encouraging.” He gives me a wincing smile. “But maybe not. I am eighteen, after all—” “You’re eighteen? But you’re a sophomore.” An uneasy look passes over his face. “I missed a lot of school a few years back. Half of seventh grade and all of eighth, in fact. I was sick.” “Sick?” I echo. That reminder of his mortality crashes down on me. It’ll always be there, smoke rising between us. Xander had mentioned Will being ill, but I never imagined it as anything serious. “How? I mean, what . . .” He shrugs like it’s nothing, but he won’t glance at me. He stares at the road. “Leukemia. But I’m better now. Completely cured.” “Were you very . . . bad off?” “For about a year. The prognosis wasn’t—” He stops suddenly, like he’s said too much, and I get that sense again. The feeling that he’s not telling me something. That he’s holding back. A muscle in his jaw ripples with tension. “Look, don’t worry about it. Aren’t I a perfect male specimen now?” He sends me a wink. “Don’t I look healthy?” I really didn’t like when I found out that Will was actually 18 years old, instead of the 16 that Jacinda was.

Once I had been diagnosed with a terminal illness, I began to view the world through two perspectives; I was starting to see death as both doctor and patient. As a doctor, I knew not to declare “Cancer is a battle I’m going to win!” or ask “Why me?” (Answer: Why not me?) I knew a lot about medical care, complications, and treatment algorithms. I quickly learned from my oncologist and my own study that stage IV lung cancer today was a disease whose story might be changing, like AIDS in the late 1980s: still a rapidly fatal illness but with emerging therapies that were, for the first time, providing years of life. While being trained as a physician and scientist had helped me process the data and accept the limits of what that data could reveal about my prognosis, it didn’t help me as a patient. It didn’t tell Lucy and me whether we should go ahead and have a child, or what it meant to nurture a new life while mine faded. Nor did it tell me whether to fight for my career, to reclaim the ambitions I had single-mindedly pursued for so long, but without the surety of the time to complete them. Like my own patients, I had to face my mortality and try to understand what made my life worth living—and I needed Emma’s help to do so. Torn between being a doctor and being a patient, delving into medical science and turning back to literature for answers, I struggled, while facing my own death, to rebuild my old life—or perhaps find a new one. —

Although it has become the most visible of American suburban landscapes, the edge node has few architectural defenders. Even developers despair: 'Shopping centers built only in the 1960s are already being abandoned. Their abandonment brings down the values of nearby neighbourhoods. Wal-Marts built five years ago are already being abandoned for superstores. We have built a world of junk, a degraded environment. It may be profitable for a short-term, but its long-term economic prognosis is bleak.' -Dolores Hayden quoting Robert Davis, 'Postscript,' in Congress for the New Urbanism, Charter of the New Urbanism, 2002.

Logically—for what had a more gloomy prognosis than life?—every morning one should say to one’s friends: ‘I grieve for your irrevocable death’, as to anyone suffering from an incurable disease, and was the universal omission of this minimal gesture of sympathy the model for their reluctance to discuss the dreams?)

(Logically–for what had a more gloomy prognosis than life?–every morning one should say to one's friends: 'I grieve for your irrevocable death,' as to anyone suffering from an incurable disease, and was the universal omission of this minimal gesture of sympathy the model for their reluctance to discuss the dreams?)

Go to every IEP with a plan of your own. Be the expert. Teachers and therapists know general information only. You, on the other-hand, know the specifics about your child – you are your child’s only real expert. Pop in unexpectedly to observe. Keep educators on their toes. Be kind and push gently. If needed, push hard.

Something like elephantiasis, only worse, affecting both arms and both legs. Drastic amputations indicated. Eye-sockets. Burns. Multiple and compound fractures. Punctured and incised wounds. Traumatism, ecchymosis, extensive extravasations, oedema. Profound systemic shock. The prognosis, however, seems to be favorable,

What’s the kindest thing you almost did? Is your fear of insomnia stronger than your fear of what awoke you? Are bonsai cruel? Do you love what you love, or just the feeling? Your earliest memories: do you look though your young eyes, or look at your young self? Which feels worse: to know that there are people who do more with less talent, or that there are people with more talent? Do you walk on moving walkways? Should it make any difference that you knew it was wrong as you were doing it? Would you trade actual intelligence for the perception of being smarter? Why does it bother you when someone at the next table is having a conversation on a cell phone? How many years of your life would you trade for the greatest month of your life? What would you tell your father, if it were possible? Which is changing faster, your body, or your mind? Is it cruel to tell an old person his prognosis? Are you in any way angry at your phone? When you pass a storefront, do you look at what’s inside, look at your reflection, or neither? Is there anything you would die for if no one could ever know you died for it? If you could be assured that money wouldn’t make you any small bit happier, would you still want more money? What has been irrevocably spoiled for you? If your deepest secret became public, would you be forgiven? Is your best friend your kindest friend? Is it any way cruel to give a dog a name? Is there anything you feel a need to confess? You know it’s a “murder of crows” and a “wake of buzzards” but it’s a what of ravens, again? What is it about death that you’re afraid of? How does it make you feel to know that it’s an “unkindness of ravens”?

The main reason why clinicians may not diagnose personality disorders is that they think that doing so supports therapeutic pessimism. Recent research has shown this is not true; most patients get better, either with time or with treatment, that the prognosis is actually better than in many patients with severe mood and anxiety disorders.

And I certainly don’t look as though I have anything wrong with my brain. Apart from my left eye, which, people are telling me, struggles to keep pace with my right.

No matter what I did I couldn’t seem to turn on my brain. Its power had been drained.

It took brain damage to make me realize how arrogant I’d been.

A delusion can be a handy thing to cling to, and by not writing—and therefore not failing at it—I could kid myself into thinking I still had the possibility of succeeding.

The number eighty sloshes around inside my head, like dirty water inside a bucket.

Sostituendo un imbroglio con un cancro è riuscito a trasporre in termini comprensibili agli altri una realtà troppo particolare e privata. Avrebbe preferito davvero essere malato di cancro piuttosto che di menzogna – perché anche la menzogna era una malattia, con la sua eziologia, i suoi rischi di metastasi, la sua prognosi riservata –, ma il destino aveva voluto che si ammalasse di menzogna, e non era colpa sua.

I hadn’t slept in more than a week. Moments after I fell asleep, I felt my mother’s hand on my leg. “He’s gone.” He had clung to life knowing I was there beside him. He needed me to leave, to allow him to die.

I saw how men died. I saw how they bore pain. I saw what hope looked like, fear and relief; I saw the dark lines that despair drew on a face; I saw courage and steadfastness. I saw faith shine in the eyes of those who trusted in what I could only think was an illusion and I saw the gallantry that made a man greet the prognosis of death with an ironic joke because he was too proud to let those about him see the terror of his soul.

Before you examine the body of a patient, Be patient to learn his story. For once you learn his story, You will also come to know His body. Before you diagnose any sickness, Make sure there is no sickness in the mind or heart. For the emotions in a man's moon or sun, Can point to the sickness in Any one of his other parts. Before you treat a man with a condition, Know that not all cures can heal all people. For the chemistry that works on one patient, May not work for the next, Because even medicine has its own Conditions. Before asserting a prognosis on any patient, Always be objective and never subjective. For telling a man that he will win the treasure of life, But then later discovering that he will lose, Will harm him more than by telling him That he may lose, But then he wins. THE MAXIMS OF MEDICINE by Suzy Kassem Copyright 1993-1994 - THE SPRING FOR WISDOM

If Israel is to survive as a nation state, not a pariah, it will have to get Palestine off its back; otherwise, the prognosis for the two is mutual annihilation. There is no other alternative but to end the occupation, with a complete separation of the two states. For too long, Israel has depended on cheap Palestinian labour to build the very settlements they hate. What is created by this bizarre interaction of profitability and hate is two dysfunctional societies that have put a gun to each other’s heads.

In four hours over four consecutive weeks, I had convinced her I would never be a rider. Riding was the first of many things for which I exhibited no talent. Next came the piano, then the violin, and then anything that involved numbers or foreign languages.

What happened to your eye?” “What’s wrong with it?” I ask. He peers in and looks at me closely. “Your left eye has turned inward slightly. And it doesn’t seem to move.” “I got thrown off a horse,” I say. “Yesterday.” “You need to see an eye doctor. Now. I’ll find someone.

So when people like the folks you’ll read about in the next few chapters healed themselves using the placebo effect, what did they do differently? First, they didn’t accept the finality of their diagnosis, prognosis, or treatment. Nor did they believe in the most probable outcome or future destiny that their doctors had authoritatively outlined. Finally, they didn’t surrender to the diagnosis, prognosis, or suggested treatment. Because they had a different attitude from those who did accept, believe, and surrender, they were in a different state of being.

Depending on where it falls, the prognosis for a water molecule varies widely. If it lands in fertile soil it will be soaked up by plants or reevaporated directly within hours or days. If it finds its way down to the groundwater, however, it may not see sunlight again for many years—thousands if it gets really deep. When you look at a lake, you are looking at a collection of molecules that have been there on average for about a decade. In the ocean the residence time is thought to be more like a hundred years. Altogether about 60 percent of water molecules in a rainfall are returned to the atmosphere within a day or two. Once evaporated, they spend no more than a week or so—Drury says twelve days—in the sky before falling again as rain. Evaporation is a swift process, as you can easily gauge by the fate of a puddle on a summer’s day. Even something as large as the Mediterranean would dry out in a thousand years if it were not continually replenished. Such an event occurred a little under six million years ago and provoked what is known to science as the Messinian Salinity Crisis. What happened was that continental movement closed the Strait of Gibraltar. As the Mediterranean dried, its evaporated contents fell as freshwater rain into other seas, mildly diluting their saltiness—indeed, making them just dilute enough to freeze over larger areas than normal. The enlarged area of ice bounced back more of the Sun’s heat and pushed Earth into an ice age. So at least the theory goes. What is certainly true, as far as we can tell, is that a little change in the Earth’s dynamics can have repercussions beyond our imagining. Such an event, as we shall see a little further on, may even have created us.

To be a Christian is to participate in this very common human enterprise of diagnosis, prescription, and prognosis, but to do so from inside a Christian view of the world, a view that has been constructed from Scripture and that centers on Jesus Christ the Savior, "the Lamb of God who takes away the sin of the world" (John 1:29). Christian hope centers on Jesus Christ, the Lord of the whole cosmos, the one "through [whom] God was pleased to reconcile to himself all things" (Col. 1:20). Moreover, classical Christian hope centers on Jesus Christ alone, rejecting his rivals as pseudo-Saviors. Christians trust "no other name under heaven" (Acts 4:12).

She was always saying, ‘I know I am dying from radium poisoning,’” remembered one of her physicians. “I convinced her she wasn’t; that she was going to get better. It is tact of a physician not to reveal a fatal prognosis.”17 Martland wasted no time enlightening the world about the evolution of radium’s MO. He had seen enough cases now to know that these latent sarcomas—which could leave a victim healthy for years after her exposure to radium, before coming horribly to life and taking over her body—were the new phase of this terrifying poisoning. He added: “When I first described this disease, there was a strong tendency among some of those interested in the production and therapeutic use of radium to place the entire blame on mesothorium… In the cases autopsied recently, the mesothorium has disappeared while the radium persists.”18 He could reach only one conclusion: “I am now of the opinion that the normal radioactivity of the human body should not be increased; [to do so] is dangerous.”19 It had to be, for each week another dial-painter presented another sarcoma, each in a new location—her spine, her leg, her knee, her hip, her eye… Irene’s family couldn’t believe how fast she was fading from them. But she still had grit in her. On May 4, 1931, as she lay dying in hospital, she filed a claim for damages

Then the events leading up to her collapse came back to her in a flash. Her hands flew automatically to her belly and she was only partially reassured to feel the tight ball there. Was her baby okay? Was she herself okay? She blinked harder to bring the room more into focus. There was light shining through a crack in the bathroom door. A glance at the blinds told her that it was dark outside. Then her gaze fell on the chair beside her bed and she found Ryan staring at her, his gaze intense. She flinched away from the raw emotion shining in his blue eyes. “Hey,” he said quietly. “How are you feeling?” “Numb,” she answered before she could think better of it. “Kind of blank. My head doesn’t hurt anymore. Are my feet still swollen?” He carefully picked up the sheet and pushed it over her feet. “Maybe a little. Not as bad as they were. They’ve been giving you meds and they’re monitoring the baby.” “How is she?” Kelly asked, a knot of fear in her throat. “For now, she’s doing fine. Your blood pressure stabilized, but they might have to do a C-section if it goes back up or if the baby starts showing signs of distress.” Kelly closed her eyes and then suddenly Ryan was close to her, holding her, his lips pressed against her temple. “Don’t worry, love,” he murmured. “You’re supposed to stay calm. You’re getting the best possible care. I’ve made sure of it. They’re monitoring you round-the-clock. And the doctor said the baby has an excellent prognosis at thirty-four weeks’ gestation.” She sagged against the pillow and closed her eyes. Relief pulsed through her but she was so tired she couldn’t muster the energy to do anything more than lie there thanking God that her baby was okay. “I’m going to take care of you, Kell,” Ryan said softly against her temple. “You and our baby. Nothing will ever hurt you again. I swear it.” Tears burned her eyelids. She was emotionally and physically exhausted and didn’t have the strength to argue. Something inside her was broken and she had no idea how to fix it. She felt so…disconnected.

Little good comes from a head injury, but it does cut down the wait when you show up unannounced at the emergency room. Mentioning the words “horse,” “thrown,” and “head” pushes you right up to the front of the line, ahead of everyone apart from people who have stopped breathing, people whose hearts have given out, and people with severed limbs.

My fellow resident Jeff and I worked traumas together. When he called me down to the trauma bay because of a concurrent head injury, we were always in sync. He'd assess the abdomen, then ask for my prognosis on a patient's cognitive function. "Well, he could still be a senator," I once replied, "but only from a small state." Jeff laughed, and from that moment on, state population became our barometer for head-injury severity. "Is he a Wyoming or a California?" Jeff would ask, trying to determine how intensive his care plan should be. Or I'd say, "Jeff, I know his blood pressure is labile, but I gotta get him to the OR or he's gonna go from Washington to Idaho---can you get him stabilized?

cellular activity in your tumor . . . well, prognosis can range from six months to . . . um, it’s difficult to say. Although certainly there have been some successful cases . . .” “Okay then,” I said, grabbing my bag off the back of the chair. “I’ll be in touch.” “Elizabeth! I’d really like you to meet with a counselor—” I left before he had a chance to finish, the taste of cold pennies on my tongue, as though I’d consented to chemo and already started injecting liquid poison into my bloodstream. Oncologists, nurses, radiologists, palliative care specialists: I was all too familiar with the cancer routine, and I wasn’t interested. Not one bit. My twin brother, Paul, once told me that there’s healthy denial,

When you are depressed, you may have a tendency to confuse feeling with facts. Your feelings of hopelessness and total despair are just symptoms of depressive illness, not facts. If you think you are hopeless, you will naturally feel this way. Your feelings only trace the illogical pattern of your thinking. Only an expert, who has treated hundreds of depressed individuals, would be in a position to give a meaningful prognosis for recovery. Your suicidal urge merely indicates the need for treatment. Thus, your conviction that you are "hopeless" nearly always proves you are not. Therapy, not suicide, is indicated. Although generalizations can be misleading, I let the following rule of thumb guide me: Patients who feel hopeless never actually are hopeless. The conviction of hopelessness is one of the most curious aspects of depressive illness. In fact, the degree of hopelessness experienced by seriously depressed patients who have an excellent prognosis is usually greater than in terminal malignancy patients with a poor prognosis. It is of great importance to expose the illogic that lurks behind your hopelessness as soon as possible in order to prevent an actual suicide attempt. You may feel convinced that you have an insoluble problem in your life. You may feel that you are caught in a trap from which there is no exit. This may lead to extreme frustration and even to the urge to kill yourself as the only escape.

Contingent on what, though? Some bases for feeling good about oneself may be worse than others. Jennifer Crocker, a psychologist at Ohio State University, and her colleagues have shown that the prognosis is particularly bad when self-esteem hinges on outdoing others (competitive success), approval by others, physical appearance, or academic achievement.47 Consider the last of those. When children’s self-esteem rises or falls with how well they do at school, achievement can resemble an addiction, “requiring ever greater success to avoid feelings of worthlessness.” And if it looks as though success is unlikely, kids may “disengage from the task, deciding it doesn’t matter, rather than suffer the loss of self-esteem that accompanies failure.

Depending on where it falls, the prognosis for a water molecule varies widely. if it lands in fertile soil it will be soaked up by plants or reevaporated directly within hours or days. If it finds its way down to the groundwater, however, it may not see sunlight again for many years- thousands if it get really deep. When you look at a lake, you are looking at a collection of molecules that have been there on average for about a decade. In the ocean the residence time is thought to be more like a hundred years. Altogether about 60 percent of water molecules in a rainfall are returned to the atmosphere within a day or two. Once evaporated, they spend no more than a week or so- Drury says twelve days- in the sky before falling again as rain. p265

Penn, in so many ways, we’re so lucky. In so many ways, I’m grateful this is what our kid got, gender dysphoria instead of cancer or diabetes or heart disease or any of the other shit kids get. The treatment for those isn’t necessarily clearer. The drugs are harsher and the prognosis scarier and the options life-and-death but never black-and-white, and my heart breaks every time for those kids and those parents. But those are more or less medical issues. This is a medical issue, but mostly it’s a cultural issue. It’s a social issue and an emotional issue and a family dynamic issue and a community issue. Maybe we need to medically intervene so Poppy doesn’t grow a beard. Or maybe the world needs to learn to love a person with a beard who goes by “she” and wears a skirt.

Josh’s father felt Josh should bond with his fellow injured patients in the ward. This was something I really dissuaded Josh from doing. I didn’t want him to hear the hardships, battles, and frustrations that others were going through. I also didn’t want Josh to take on their fears and frustrations. We were always pleasant and polite to everyone else in the ward, but my only concern was Josh, and it was enough for us to focus just on his issues. I found the whole Acute Spinal Ward experience extremely negative and distressingly sad with no great healing or recovery objective. The message from the medical team was always, without fail, acceptance of the prognosis. This was totally the opposite message of what we presented and instilled into Josh. We slowly gained evidence that our non-traditional approach was working.

First time they met was on a cruise, if you think of “cruise” in maybe more of a specialized way. In the wake of her separation, back in what still isn’t quite The Day, from her then husband, Horst Loeffler, after too many hours indoors with the blinds drawn listening on endless repeat to Stevie Nicks singing “Landslide” on a compilation tape she ignored the rest of, drinking horrible Crown Royal Shirley Temples and chasing them with more grenadine directly from the bottle and going through a bushel per day of Kleenex, Maxine finally allowed her friend Heidi to convince her that a Caribbean cruise would somehow upgrade her mental prognosis. One day she went sniffling down the hall from her office and into the In ’n’ Out Travel Agency, where she found undusted surfaces, beat-up furniture, a disheveled model of an ocean liner that shared a number of design elements with RMS Titanic. “You’re in luck. We’ve just had a . . .” Long pause, no eye contact. “Cancellation,” suggested Maxine. “You could say.” The price was irresistible. To anyone in their right mind, too much so.

We may need to take our labels and our experts far more lightly. Some years ago...[I heard of] a farmer who had done exceptionally well despite a dire prognosis. He had taken the same attitude toward his physician's prognosis that he took toward the words of the government soil experts who analyzed his fields. As they were educated men, he respected them and listened carefully as they showed him the findings of their tests and told him that the corn would not grow in this field. He valued their opinions. But, as he said, 'A lot of the time, the corn grows anyway.' What would it be like if more people allowed for the presence of the unknown, and accepted the words of experts in this same way? Like a diagnosis, a label is an attempt to assert control and manage uncertainty. It may allow us the security and comfort of a mental closure and encourage us not to think about things again. But life never comes to a closure, life is process, even mystery. Life is known only by those who have found a way to be comfortable with change and the unknown. Given the nature of life, there may be no security, but only adventure.

After surgery, we talked again, this time discussing chemo, radiation, and prognosis. By this point, I had learned a couple of basic rules. First, detailed statistics are for research halls, not hospital rooms. The standard statistic, the Kaplan-Meier curve, measures the number of patients surviving over time. It is the metric by which we gauge progress, by which we understand the ferocity of a disease. For glioblastoma, the curve drops sharply until only about 5 percent of patients are alive at two years. Second, it is important to be accurate, but you must always leave some room for hope. Rather than saying, “Median survival is eleven months” or “You have a ninety-five percent chance of being dead in two years,” I’d say, “Most patients live many months to a couple of years.” This was, to me, a more honest description. The problem is that you can’t tell an individual patient where she sits on the curve: Will she die in six months or sixty? I came to believe that it is irresponsible to be more precise than you can be accurate. Those apocryphal doctors who gave specific numbers (“ The doctor told me I had six months to live”): Who were they, I wondered, and who taught them statistics?

I planted a lawn last year. I went to a garden shop and bought long rolls of grass that I laid out like a carpet over a bare patch of ground. Six months later, around two-thirds of my newly planted lawn had started to grow, but the remainder was parched and brown despite regular watering, fertilizer, and lawn pellets. Nearly twelve months later, the healthy parts of the lawn were thriving and slowly creeping across the areas where the new grass had previously refused to grow. I will never lay another lawn: gardening, it turns out, is not one of my talents. But the lawn is a good metaphor for the way in which the brain compensates for damaged cells. Eventually (perhaps in years to come), the healthy parts of the lawn will be so hardy that no one will notice the bald patches of dead grass. After my chance meeting in the park, that was my new hope for my brain.

In the future, white supremacy will no longer need white people,” the artist Lorraine O’Grady said in 2018, a prognosis that seemed, at least on the surface, to counter what James Baldwin said fifty years ago, which is that “the white man’s sun has set.” Which is it then? What prediction will hold? As an Asian American, I felt emboldened by Baldwin but haunted and implicated by O’Grady. I heard the ring of truth in her comment, which gave me added urgency to finish this book. Whiteness has already recruited us to become their junior partners in genocidal wars; conscripted us to be antiblack and colorist; to work for, and even head, corporations that scythe off immigrant jobs like heads of wheat. Conscription is every day and unconscious. It is the default way of life among those of us who live in relative comfort, unless we make an effort to choose otherwise. Unless we are read as Muslim or trans, Asian Americans are fortunate not to live under hard surveillance, but we live under a softer panopticon, so subtle that it’s internalized, in that we monitor ourselves, which characterizes our conditional existence. Even if we’ve been here for four generations, our status here remains conditional; belonging is always promised and just out of reach so that we behave, whether it’s the insatiable acquisition of material belongings or belonging as a peace of mind where we are absorbed into mainstream society. If the Asian American consciousness must be emancipated, we must free ourselves of our conditional existence. But what does that mean? Does that mean making ourselves suffer to keep the struggle alive? Does it mean simply being awake to our suffering? I can only answer that through the actions of others. As of now, I’m writing when history is being devoured by our digital archives so we never have to remember. The administration has plans to reopen a Japanese internment camp in Oklahoma to fill up with Latin American children. A small band of Japanese internment camp survivors protest this reopening every day. I used to idly wonder whatever happened to all the internment camp survivors. Why did they disappear? Why didn’t they ever speak out? At the demonstration, protester Tom Ikeda said, “We need to be the allies for vulnerable communities today that Japanese Americans didn’t have in 1942.” We were always here.

This is not a hypothetical example. In the middle of the nineteenth century Karl Marx reached brilliant economic insights. Based on these insights he predicted an increasingly violent conflict between the proletariat and the capitalists, ending with the inevitable victory of the former and the collapse of the capitalist system. Marx was certain that the revolution would start in countries that spearheaded the Industrial Revolution – such as Britain, France and the USA – and spread to the rest of the world. Marx forgot that capitalists know how to read. At first only a handful of disciples took Marx seriously and read his writings. But as these socialist firebrands gained adherents and power, the capitalists became alarmed. They too perused Das Kapital, adopting many of the tools and insights of Marxist analysis. In the twentieth century everybody from street urchins to presidents embraced a Marxist approach to economics and history. Even diehard capitalists who vehemently resisted the Marxist prognosis still made use of the Marxist diagnosis. When the CIA analysed the situation in Vietnam or Chile in the 1960s, it divided society into classes. When Nixon or Thatcher looked at the globe, they asked themselves who controls the vital means of production. From 1989 to 1991 George Bush oversaw the demise of the Evil Empire of communism, only to be defeated in the 1992 elections by Bill Clinton. Clinton’s winning campaign strategy was summarised in the motto: ‘It’s the economy, stupid.’ Marx could not have said it better. As people adopted the Marxist diagnosis, they changed their behaviour accordingly. Capitalists in countries such as Britain and France strove to better the lot of the workers, strengthen their national consciousness and integrate them into the political system. Consequently when workers began voting in elections and Labour gained power in one country after another, the capitalists could still sleep soundly in their beds. As a result, Marx’s predictions came to naught. Communist revolutions never engulfed the leading industrial powers such as Britain, France and the USA, and the dictatorship of the proletariat was consigned to the dustbin of history. This is the paradox of historical knowledge. Knowledge that does not change behaviour is useless. But knowledge that changes behaviour quickly loses its relevance. The more data we have and the better we understand history, the faster history alters its course, and the faster our knowledge becomes outdated.

Auto-Zoomar. Talbert knelt in the a tergo posture, his palms touching the wing-like shoulder blades of the young woman. A conceptual flight. At ten-second intervals the Polaroid projected a photograph on to the screen beside the bed. He watched the auto-zoom close in on the union of their thighs and hips. Details of the face and body of the film actress appeared on the screen, mimetized elements of the planetarium they had visited that morning. Soon the parallax would close, establishing the equivalent geometry of the sexual act with the junctions of this wall and ceiling. ‘Not in the Literal Sense.’Conscious of Catherine Austin’s nervous hips as she stood beside him, Dr Nathan studied the photograph of the young woman. ‘Karen Novotny,’ he read off the caption. ‘Dr Austin, may I assure you that the prognosis is hardly favourable for Miss Novotny. As far as Talbert is concerned the young woman is a mere modulus in his union with the film actress.’ With kindly eyes he looked up at Catherine Austin. ‘Surely it’s self-evident - Talbert’s intention is to have intercourse with Miss Taylor, though needless to say not in the literal sense of that term.’ Action Sequence. Hiding among the traffic in the near-side lane, Koester followed the white Pontiac along the highway. When they turned into the studio entrance he left his car among the pines and climbed through the perimeter fence. In the shooting stage Talbert was staring through a series of colour transparencies. Karen Novotny waited passively beside him, her hands held like limp birds. As they grappled he could feel the exploding musculature of Talbert’s shoulders. A flurry of heavy blows beat him to the floor. Vomiting through his bloodied lips, he saw Talbert run after the young woman as she darted towards the car. The Sex Kit.‘In a sense,’ Dr Nathan explained to Koester, ‘one may regard this as a kit, which Talbert has devised, entitled “Karen Novotny” - it might even be feasible to market it commercially. It contains the following items: (1) Pad of pubic hair, (2) a latex face mask, (3) six detachable mouths, (4) a set of smiles, (5) a pair of breasts, left nipple marked by a small ulcer, (6) a set of non-chafe orifices, (7) photo cut-outs of a number of narrative situations - the girl doing this and that, (8) a list of dialogue samples, of inane chatter, (9) a set of noise levels, (10) descriptive techniques for a variety of sex acts, (11) a torn anal detrusor muscle, (12) a glossary of idioms and catch phrases, (13) an analysis of odour traces (from various vents), mostly purines, etc., (14) a chart of body temperatures (axillary, buccal, rectal), (15) slides of vaginal smears, chiefly Ortho-Gynol jelly, (16) a set of blood pressures, systolic 120, diastolic 70 rising to 200/150 at onset of orgasm . . . ’ Deferring to Koester, Dr Nathan put down the typescript. ‘There are one or two other bits and pieces, but together the inventory is an adequate picture of a woman, who could easily be reconstituted from it. In fact, such a list may well be more stimulating than the real thing. Now that sex is becoming more and more a conceptual act, an intellectualization divorced from affect and physiology alike, one has to bear in mind the positive merits of the sexual perversions. Talbert’s library of cheap photo-pornography is in fact a vital literature, a kindling of the few taste buds left in the jaded palates of our so-called sexuality.

the cancer was successfully treated and her prognosis was good. It’s entirely normal to feel scared when one gets such a diagnosis, but for some reason her body and mind were unable to shut down that automatic stress reaction as they should have. And since she couldn’t sleep, there was very little chance that they would do so.

liked to stick around. He liked to be on the move. Two days in one place was about his limit. But he was stuck for alternatives. He couldn’t hint at anything to Alex Rodin. Couldn’t give him a call-me-if-you-need-me number. For one thing, he didn’t have a phone. For another, a guy as squared away and cautious as Alex Rodin was would worry away at the hint until something began to unravel. He would make the link to the Pentagon easily enough. Reacher had even asked did she get my name from the Pentagon? That had been a careless mistake. So Alex Rodin would put two and two together, eventually. He would figure there’s something extra here, and I can find out what it is from the Pentagon. The Pentagon would stonewall him, of course. But Rodin wouldn’t like being stonewalled. He would go to the media. Ann Yanni, probably. She would be ready for another network story. And at bottom Rodin would be insecure enough about losing the case to simply have to know. He wouldn’t give up on it. And Reacher didn’t want the story out there. Not unless it was absolutely necessary. Gulf War vets had it hard enough, with the chemical stuff and the uranium poisoning. All they had going for them was the conflict’s spotless just-war reputation. They didn’t need defaming by association with people like Barr and his victims. People would say hey, they were all doing it. And they weren’t all doing it, in Reacher’s experience. That had been a good army. So he didn’t want the story out there, unless it was absolutely necessary, and he wanted to judge that for himself. So, no hints to Alex Rodin. No call-me contingencies. So . . . what, exactly? He decided to stick around for twenty-four hours. Maybe there would be a clearer prognosis on Barr’s condition after that. Maybe somehow he could check with Emerson and get a better feel for the evidence. Then maybe he could feel OK about leaving things with Alex Rodin’s office, on a kind of forensic autopilot. If there were problems down the road maybe he would read about them in a newspaper somewhere, far in the future, on a beach or in a bar, and then he could come

Cognitive issues Unfortunately, surrogates frequently do not understand the clinical status of the patients whom they represent. Some studies have shown that less than half of surrogates, regardless of educational level, had adequate knowledge of what was going on and what would happen to the patient. Sometimes, the surrogate lacks capacity to make the relevant decisions. But even when the surrogate has capacity, there are three key iatrogenic causes of surrogate misunderstanding. First, providers often fail to explain clearly the patient's condition and prognosis with clear, jargon-free language. Second, providers may place undue pressure on the surrogate and fail to allow sufficient time to process information. Third, different specialists often supply the surrogate with uncoordinated, even conflicting, information.

N-TERMINAL-PRO-B-type NATRIURETIC PEPTIDE (NT-proBNP) A "non-traditional" blood protein made in the heart and found in the blood. High levels are associated with increased risks of cardiovascular disease, heart attack, and heart failure development. High levels are associated with development of heart failure and worse prognosis. Goal values Less than 125 pg/mL

Block has a list of questions that she aims to cover with sick patients in the time before decisions have to be made: What do they understand their prognosis to be, what are their concerns about what lies ahead, what kinds of trade-offs are they willing to make, how do they want to spend their time if their health worsens, who do they want to make decisions if they can’t?

Block has a list of questions that she aims to cover with sick patients in the time before decisions have to be made: What do they understand their prognosis to be, what are their concerns about what lies ahead, what kinds of trade-offs are they willing to make, how do they want to spend their time if their health worsens, who do they want to make decisions if they can’t? A decade earlier, her seventy-four-year-old father, Jack Block, a professor emeritus of psychology at the University of California at Berkeley, was admitted to a San Francisco hospital with symptoms from what proved to be a mass growing in the spinal cord of his neck. She flew out to see him. The neurosurgeon said that the procedure to remove the mass carried a 20 percent chance of leaving him quadriplegic, paralyzed from the neck down. But without it he had a 100 percent chance of becoming quadriplegic. The evening before surgery, father and daughter chatted about friends and family, trying to keep their minds off what was to come, and then she left for the night. Halfway across the Bay Bridge, she recalled, “I realized, ‘Oh, my God, I don’t know what he really wants.’” He’d made her his health care proxy, but they had talked about such situations only superficially. So she turned the car around.

It’s not easy to keep moving forward with a positive outlook. I have the sense that I’m teetering on a very thin line. When I take my pills in the morning, I imagine them working toward ensuring the 93 percent chance at life that I have. When I eat ice cream or a piece of birthday cake, I remember the 7 percent and picture the tiny granules of sugar dispersing into some vulnerable area of my body, feeding any possible lingering, hungry cancer cells the surgeon missed. To an outsider, 7 percent might seem like a great prognosis. Tig, why are you even going into this? This is great news! And it is great news and a great prognosis. But when it’s your prognosis, you never forget the 7 percent. You just keep going.

She was expected to recover, but the prognosis was uncertain as to whether she might have

Hey, I’m worried here. What’s the prognosis?

ST-9 This point is a bilateral point that is found on both sides of the neck and is located about 1.5 inches to the outside of the edge of the Adam’s apple of the throat. The fact that the point lays directly over the carotid artery allows strikes to have an immediate reaction to the flow of blood to the brain and head in general. It has a cryptic name in Chinese, Ren Ying,9 which means “Man’s Prognosis” and provides no clues to its location or use from a martial standpoint. Its proximity to the carotid artery allows this point to be one of the weakest points on the human body and regardless of the size and muscular strength of an opponent it is extremely sensitive. The superior thyroid artery, the anterior jugular vein, the internal jugular vein, the carotid artery, the cutaneous cervical nerve, the cervical branch of the facial nerve, the sympathetic trunk, and the ascending branch of the hypoglossal and vagus nerves are all present. Just the structurally aspects of all these sensitive and vital nerves, arteries and veins should place it high on the list of potential targets. I personally consider it as one of the most important Vital Points because of this alone. Additionally, ST-9 is an intersection point for the Stomach Meridian, Gall Bladder Meridian and the Yin Heel Vessel. Strikes to this point can kill due to the overall structural weakness of the area. Strikes should be aimed toward the center of the spine on a 90-degree angle. A variety of empty hand weapons can be employed in striking this point. Forearms, edge of hand strikes, punches, kicks, and elbow strikes are all effective. The same defensive tactics outlined under the SI-16 should be employed against attacks to this extremely vital point. CV-22 This is one of the two most important acupuncture points to the martial arts that is concerned with the hostile actions of life-or-death combatives. It sets in the horseshoe notch located at the extreme upper part of the chest structure and at the centerline of the front of the neck. Resting under it is the trachea, or commonly known as the “windpipe,” and a hard and vicious strike to this point can cause the surrounding tissue to swell, which can shut off the body’s ability to pull oxygen into the lungs. A hard strike to this point can be deadly. Attacking this point should only be done in the most extreme life-or-death situations. Energetically, the Conception Vessel and the Yin Linking Vessel intersect at this point. The implications of that, from a Traditional Chinese Medicine perspective, is included in this book. Additionally, the structure of the suprasternal notch is an excellent “touch point” for situations when sight is reduced and you find yourself at extremely close range with your opponent. This allows for utilization of this point in a self-defense situation that is not as extreme as full force strikes, as only a finger or two are inserted and rolled to the backside of the notch causing pain for the opponent.

It is our inability to accurately predict when people will die that usually keeps us from preparing patients for death. In one survey of dialysis patients published in the Clinical Journal of the American Society of Nephrology in 2010, less than 10 percent reported that any doctor had ever discussed prognosis with them.

While tools to estimate prognosis among dialysis patients and tools to estimate prognosis among patients with advanced kidney disease are in development, without a crystal ball it is doubtful that any tool will ever have enough precision for nephrologists to feel assured of accuracy for the patient before us. However, since the vast majority of patients and families only have their experience with illness up to the present moment, our clinical knowledge and experiences with similar patients about what the future may hold are invaluable—and should be shared.

Yet published research studies suggest that patients and family members want to be given information about life expectancy, even if prognosis is poor. Others have shown that those engaged in shared (as in with input from their doctor), informed decision-making are more likely to make decisions about dialysis and end-of-life care consistent with their personal values—often resulting in preferences for less aggressive care and more conservative management.

Cancer, in the realest way, can cost an individual their quality of life, even with a good prognosis.

ST-9 This point is a bilateral point that is found on both sides of the neck and is located about 1.5 inches to the outside of the edge of the Adam’s apple of the throat. The fact that the point lays directly over the carotid artery allows strikes to have an immediate reaction to the flow of blood to the brain and head in general. It has a cryptic name in Chinese, Ren Ying,9 which means “Man’s Prognosis” and provides no clues to its location or use from a martial standpoint. Its proximity to the carotid artery allows this point to be one of the weakest points on the human body and regardless of the size and muscular strength of an opponent it is extremely sensitive. The superior thyroid artery, the anterior jugular vein, the internal jugular vein, the carotid artery, the cutaneous cervical nerve, the cervical branch of the facial nerve, the sympathetic trunk, and the ascending branch of the hypoglossal and vagus nerves are all present. Just the structurally aspects of all these sensitive and vital nerves, arteries and veins should place it high on the list of potential targets. I personally consider it as one of the most important Vital Points because of this alone. Additionally, ST-9 is an intersection point for the Stomach Meridian, Gall Bladder Meridian and the Yin Heel Vessel. Strikes to this point can kill due to the overall structural weakness of the area. Strikes should be aimed toward the center of the spine on a 90-degree angle. A variety of empty hand weapons can be employed in striking this point. Forearms, edge of hand strikes, punches, kicks, and elbow strikes are all effective. The same defensive tactics outlined under the SI-16 should be employed against attacks to this extremely vital point.

ST-12 Chinese Point name: Que Pen;7 English translation: “Empty Basin;” Special Attributes: It is an intersection point of the Stomach Meridian and the Yin Heel Vessel. It is bilateral and is one of the 36 Vital Points listed in the Bubishi; Location: At the midpoint of the collarbone, which is about four inches lateral from the centerline of the body; and bilateral. Western Anatomy: The transverse cervical artery, intermediate supraclavicular nerve and the supraclavicular portion of the brachial plexus are present; Comments: This point is an excellent target when your opponent is at close range. By gripping the collarbone you can dig your fingers down behind the natural curve of the bone and towards the centerline of the body. It is most active when your opponent has their arms raised, given the structural weakness of the body at this location, will drop the majority of attackers. A sharp thrust down into this point will cause your opponents knees to bend. ST-9 Chinese Point name: Ren Ying;8 English translation: “Man’s Prognosis;” Special Attributes: ST-9 is an intersection point for the Stomach Meridian, Gall Bladder Meridian and the Yin Heel Vessel. It is a bilateral point that sets over the carotid artery. It is one of the 36 Vital Points listed in the Bubishi; Location: About 1.5 inches to the outside of the Adam’s apple on the throat; Western Anatomy: The superior thyroid artery, the anterior jugular vein, the internal jugular vein, the carotid artery, the cutaneous cervical nerve, the cervical branch of the facial nerve, the sympathetic trunk, and the ascending branch of the hypoglossal and vagus nerves are all present; Comments: This is one of the weakest points on the human body and regardless of the size and muscular strength of an opponent it is extremely sensitive. Strikes to this point can kill due to the structural weakness of the area. Strikes should be aimed toward the center of the spine on a 90-degree angle. A variety of empty hand weapons can be employed in striking this point. Forearms, edge of hand strikes, punches, kicks, and elbow strikes are all effective. BL-1 Chinese Point name: Jing Ming;9 English translation: “Bright Eyes;” Special Attributes: It is an intersection point of the Small Intestine Meridian, Bladder Meridian, Stomach Meridian, Yin Heel Vessel and the Yang Heel Vessel. It is also bilateral; Location: About .25 of an inch from the inner corner of the eye; Western Anatomy: The angular artery and vein and branches of the oculomotor and ophthalmic nerve are present; Comments: Strike this point slightly upward and towards the centerline of the head. This point is fairly difficult to strike in a combative situation due to the location. Forceful strikes to the eye socket area can activate this point, as well as traumatize the eye and possible breaking the bone structure in the general area.

Living wills are much easier to draft when you are living instead of possibly dying; they’re the ultimate hypotheticals. And what difference would it have made if we’d had that conversation? Before you get sick, you have absolutely no idea of how you’re going to feel once you do. You can imagine you’ll be brave, but it’s just as possible you’ll be terrified. You can hope that you’ll find a way to accept death, but you could just as easily end up raging against it. You have no idea what your particular prognosis is going to be, or how you’ll react to it, or what options you’ll have.

I turn off the notification app for good, no longer needing to know exactly how many gone. After all, clinging to life is what we have always done best. We are still trying to hide from the truth of things and who can blame us.

No diagnosis, no prognosis.

breast tumors that amplified Ullrich’s gene tended to be more aggressive, more metastatic, and more likely to kill. Her-2 amplification marked the tumors with the worst prognosis.

But I have trained myself to deal with emotions outside medical appointments and to focus on the prognosis.

One of the epithets the Buddha acquired over the years was “the Doctor of the World.” A reason for this is that the central insight and framework that he taught, known as the Four Noble Truths, is cast in the formulation of a classical Indian medical diagnosis. The format begins with the nature of the symptom. In this particular kind of psychological or spiritual disease, the symptom is dukkha, the experience of dissatisfaction; this is the First Noble Truth. The second element in this diagnostic format is the cause of that symptom, which the Buddha outlined as being self-centered craving, greed, hatred, and delusion. These are the toxins that Matthieu referred to, the negative afflictive emotions, habits, and qualities that the mind gets caught up in and that poison the heart; this is the Second Noble Truth. The third element is the prognosis, and the good news is that it is curable. This is the Third Noble Truth, that the experience of dissatisfaction can end; we can be free from it. The fourth element—and the Fourth Noble Truth—is the methodology of treatment: what the Buddha laid out as the way to heal this wound. It’s known in some expressions as the Eightfold Path, but it can be outlined in three fundamental elements: first, responsible behavior or virtue, living a moral and ethical life; second, mental collectedness, meditation, and mind training; and third, the development of insightful understanding in accordance with reality, or wisdom. These three elements are the fundamental treatment for this psychological, spiritual ailment of dissatisfaction. I should underline that the Buddha didn’t make any claim to have a monopoly on truth. When somebody once asked him, “Is it the case that you’re the only one who really understands the way things are, and that all other spiritual teachings are incorrect, all other paths are erroneous?” He said, “No, by no means.” It’s not a matter of the way the teachings are framed, the language or symbolism that one uses. It is simply the presence or absence of these three central qualities: ethical behavior, mental collectedness, and wisdom. If any spiritual path contains those three elements, then it will certainly lead to the possibility and the actuality of freedom, peace, a harmony within oneself, and an easefulness in life. If it doesn’t contain those elements, then it cannot lead to easefulness, peace, and liberation.

Both of us yearning to be parents, we each thought of the other. Lucy hoped I had years left, but understanding my prognosis, she felt that the choice—whether to spend my remaining time as a father—should be mine.

The smells ran instantly up my nostrils like some sort of acid vapour, taking my thoughts back several years to the morning we’d rocked up here after discovering Mum’d had that tumour in her chest. Doctors had said her prognosis was good. (Do they tell everyone that?) We’d pulled into the car park and Dad’d commented, ‘Oh well, it’s a nice view of the ocean at least.’ Like that’s all that mattered. Like we were having a snug little holiday by the sea. Like we were going to be enjoying the ocean views and the docks and the rolling coastline over bacon and eggs and buttered chemotherapy every fucking morning.