Surgeon Surgery Quotes

Surgeons can cut out everything except cause.

Every surgeon carries within himself a small cemetery, where from time to time he goes to pray – a place of bitterness and regret, where he must look for an explanation for his failures.’ René Leriche, La philosophie de la chirurgie, 1951

The surgeons' market is imaginary, since there is nothing wrong with women's faces or bodies that social change won't cure; so the surgeons depend for their income on warping female self-perception and multiplying female self-hatred.

...I became acutely aware of an unusual ability--a divine gift, I believe--of extraordinary eye and hand coordination. It’s my belief that God gives us all gifts, special abilities that we have the privilege of developing to help us serve Him and humanity. And the gift of eye and hand coordination has been an invaluable asset in surgery. This gift goes beyond eye-hand coordination, encompassing the ability to understand physical relationships, to think in three dimensions. Good surgeons must understand the consequences of each action, for they’re often not able to see what’s happening to see on the other side of the area in which the area they’re actually working.

Surgeons must always tell the truth but rarely, if ever, deprive patients of all hope. It can be very difficult to find the balance between optimism and realism.

The surgeons are playing on the myth's double standard for the function of the body. A man's thigh is for walking, but a woman's is for walking and looking "beautiful." If women can walk but believe our limbs look wrong, we feel that our bodies cannot do what they are meant to do; we feel as genuinely deformed and disabled as the unwilling Victorian hypochondriac felt ill.

There are jokes about breast surgeons. You know-- something like-- I've seen more breasts in this city than-- I don't know the punch line. There must be a punch line. I'm not a man who falls in love easily. I've been faithful to my wife. We fell in love when we were twenty-two. We had plans. There was justice in the world. There was justice in love. If a person was good enough, an equally good person would fall in love with that person. And then I met-- Ana. Justice had nothing to do with it. There once was a very great American surgeon named Halsted. He was married to a nurse. He loved her-- immeasurably. One day Halsted noticed that his wife's hands were chapped and red when she came back from surgery. And so he invented rubber gloves. For her. It is one of the great love stories in medicine. The difference between inspired medicine and uninspired medicine is love. When I met Ana, I knew: I loved her to the point of invention.

Cosmetic surgery is not "cosmetic," and human flesh is not "plastic." Even the names trivialize what it is. It's not like ironing wrinkles in fabric, or tuning up a car, or altering outmoded clothes, the current metaphors. Trivialization and infantilization pervade the surgeons' language when they speak to women: "a nip," a "tummy tuck."...Surgery changes one forever, the mind as well as the body. If we don't start to speak of it as serious, the millennium of the man-made woman will be upon us, and we will have had no choice.

Surgery was the most difficult thing I could imagine. And so I became a surgeon.

In these days before antiseptics, doctors themselves also suffered high mortality rates. Florence Nightingale, a nurse during the Crimean War (1853-1856), watched one particularly inept surgeon cut both himself and, somehow, a bystander while blundering about during an amputation. Both men contracted an infection and died, as did the patient. Nightingale commented that it was the only surgery she'd ever seen with 300 percent mortality.

We priests are the surgeons of souls, and it is our duty to deliver them of shameful secrets they would fain conceal, with hands careful to neither wound no pollute.

We have achieved most as surgeons when our patients recover completely and forget us completely. All patients are immensely grateful at first after a successful operation but if the gratitude persists it usually means that they have not been cured of the underlying problem and that they fear that they may need us in the future. They feel that they must placate us, as though we were angry gods or at least the agents of an unpredictable fate.

I stand by the bed where a young woman lies, her face postoperative, her mouth twisted in palsy, clownish. A tiny twig of the facial nerve, the one to the muscles of her mouth has been severed. She will be thus from now on. The surgeon had followed with religious fervor the curve of her flesh; I promise you that. Nevertheless, to remove the tumor in her cheek, I had to cut the little nerve. Her young husband is in the room. He stand on the opposite side of the bed and together they seem to dwell in the evening lamplight, isolated from me, private. Who are they, I ask myself, he and this wry mouth I have made, who gaze at and touch each other so generously, greedily? The young woman speaks, "Will my mouth always be like this?" she asks. "Yes," I say, "it will. It is because the nerve was cut." She nods and is silent. But the young man smiles. "I like it," he says, "It is kind of cute." "All at once I know who he is. I understand and I lower my gaze. One is not bold in an encounter with a god. Unmindful, he bends to kiss her crooked mouth and I am so close I can see how he twists his own lips to accommodate to hers, to show her that their kiss still works.

If patients were thinking rationally they would ask their surgeon how many operations he or she has performed of the sort for which their consent is being sought, but in my experience this scarcely ever happens.

There is no evidence that the complete head shaves we did in the past, which made the patients look like convicts, had any effect on infection rates, which had been the ostensible reason for doing them. I suspect the real – albeit unconscious – reason was that dehumanizing the patients made it easier for the surgeons to operate.

Informed consent’ sounds so easy in principle – the surgeon explains the balance of risks and benefits, and the calm and rational patient decides what he or she wants – just like going to the supermarket and choosing from the vast array of toothbrushes on offer. The reality is very different.

Where woman do not fit the Iron Maiden [societal expectations/assumptions about women's bodies], we are now being called monstrous, and the Iron Maiden is exactly that which no woman fits, or fits forever. A woman is being asked to feel like a monster now though she is whole and fully physically functional. The surgeons are playing on the myth's double standard for the function of the body. A man's thigh is for walking, but a woman's is for walking and looking "beautiful." If women can walk but believe our limbs look wrong, we feel that our bodies cannot do what they are meant to do; we feel as genuinely deformed and disabled as the unwilling Victorian hypochondriac felt ill.

Leola Mae Harmon. I saw a movie about her on the Lifetime channel. Leola was an air force nurse who was in a car accident and the lower part of her face got all mangled, but then Armand Assante, who plays a plastic surgeon, said he could fix her. Leola had to endure hours of painful reconstructive surgery, during which her husband left her because she didn't have any lips (which I guess is why the movie is called Why Me?). Armand Assante said he would make her a new pair of lips, only the other air force doctors didn't like the fact that he wanted to make them out of skin from Leola's vagina. But he did it anyway, and then he and Leola got married and worked together to help give other accident victims vagina lips. And the whole thing turned out to have been based on a true story.

Emblematic of this era was the prolific Viennese surgeon Theodor Billroth. Born in 1821, Billroth studied music and surgery with almost equal verve. (The professions still often go hand in hand. Both push manual skill to its limit; both mature with practice and age; both depend on immediacy, precision, and opposable thumbs.)

so specialized, in fact, that I feared surgeons would no longer be able to do humanitarian work. They simply wouldn’t have the array of skills necessary to treat the full gamut of injuries a single war surgeon would see in the field.

The surgery of life hurts. It helps me, though, to know that the surgeon himself, the Wounded Surgeon, has felt every stab of pain and every sorrow.

God created you. If you are up to another miracle, try with the plastic surgeon.

Frontal competence even declines if it’s keeping you from being distracted by something positive—patients are more likely to die as a result of surgery if it is the surgeon’s birthday.

Every surgeon carries within himself a small cemetery, where from time to time he goes to pray – a place of bitterness and regret, where he must look for an explanation for his failures.

He knows that there is something wrong, forbidden in what he is about to do, but he cannot help himself, for he is a fanatic. He is driven by a dark desire. To see, to feel, to discover is all. His is a passion, not a romance.

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

Modern cosmetic surgeons have a direct financial interest in a social role for women that requires them to feel ugly. They do not simply advertise for a share of a market that already exists: Their advertisements create new markets. It is a boom industry because it is influentially placed to create its own demand through the pairing of text with ads in women's magazines. The industry takes out ads and gets coverage; women get cut open. They pay their money and they takes their chances. As surgeons grow richer, they are able to command larger and brighter ad spaces.

We have been most successful, however, when our patients return to their homes and get on with their lives and never need to see us again. They are grateful, no doubt, but happy to put us and the horror of their illness behind them. Perhaps they never quite realized just how dangerous the operation had been and how lucky they were to have recovered so well. Whereas the surgeon, for a while, has known heaven, having come very close to hell.

Six witnesses affirmed that Jacoba had cured them, even after numerous doctors had given up, and one patient declared that she was wiser in the art of surgery and medicine than any master physician or surgeon in Paris. But these testimonials were used against her, for the charge was not that she was incompetent, but that—as a woman—she dared to cure at all.

Surgeons must be very careful When they take the knife! Underneath their fine incisions Stirs the Culprit—Life!

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

I was temperamentally better suited to a cognitive discipline, to an introspective field—internal medicine, or perhaps psychiatry. The sight of the operating theater made me sweat. The idea of holding a scalpel caused coils to form in my belly. (It still does.) Surgery was the most difficult thing I could imagine. And so I became a surgeon.

In America there are far more patients, and therefore more patients with such tumours. The patients are less deferential and trusting than they are in Britain. They are more like consumers than petitioners, so they are more likely to make sure that they are treated by an experienced surgeon.

There once was a very great American surgeon named Halsted. He was married to a nurse. He loved her—immeasurably. One day Halsted noticed that his wife’s hands were chapped and red when she came back from surgery. And so he invented rubber gloves. For her. It is one of the great love stories in medicine. The difference between inspired medicine and uninspired medicine is love. When I met Ana, I knew: I loved her to the point of invention.

Not only weight loss surgery is unnecessary but also it deprives human being a normal life. People after surgery would never be able to enjoy their food ever for the rest of their life whether it is Christmas or they are on their holidays or their child birthday or any other festival. List of problems and complications after the weight loss surgery operation are endless as one may get additional problems such as Hernia, Internal Bleeding, Swelling of the skin around the wounds, etc. I wonder how many weight loss surgeons advice about weight loss surgery to their own family members.

Sham ultrasound is beneficial for dental pain, placebo operations have been shown to be beneficial in knee pain (the surgeon just makes fake keyhole surgery holes in the side and mucks about for a bit as if he’s doing something useful), and placebo operations have even been shown to improve angina. That’s

Halsted’s “cancer storehouse” grew far beyond its original walls at Hopkins. His ideas entered oncology, then permeated its vocabulary, then its psychology, its ethos, and its self-image. When radical surgery fell, an entire culture of surgery thus collapsed with it. The radical mastectomy is rarely, if ever, performed by surgeons today.

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

They passed a table with five women. Margot waved but didn't stop to chat. "They look alike. Are they sisters?" "No. they just go to the same plastic surgeon," she deadpanned.

Tears wet my eyes. I’m a surgeon. I like solving things. But how do I solve this?

Do surgeons smile during appendectomies? No. Would you want them to? No. Cooking, like surgery, requires concentration.

decisions perhaps influenced by money, professional bias (for example, surgeons tend to favor surgery), and personal idiosyncrasy.

In surgery, as in anything else, skill and confidence are learned through experience

If the operation is difficult, you are not doing it properly.

Surgery itself is a kind of autopsy. “Autopsy” literally means “to see for oneself,” and, despite our knowledge and technology, when we look we’re often unprepared for what we find.

To the man with a hammer, it is said, all things look like nails. When brain surgeons look at brain scans they see things that they think require surgery and I am, alas, no exception.

Numerous spine conditions can now be treated with negligibly obtrusive surgery, taking into consideration quicker recuperation and mending time and less danger of intricacies for some patients.

No matter who you were in sixteenth-century Europe, you could be sure of two things: you would be lucky to reach fifty years of age, and you could expect a life of discomfort and pain. Old age tires the body by thirty-five, Erasmus lamented, but half the population did not live beyond the age of twenty. There were doctors and there was medicine, but there does not seem to have been a great deal of healing. Anyone who could afford to seek a doctor's aid did so eagerly, but the doctor was as likely to maim or kill as to cure. His potions were usually noxious and sometimes fatal—but they could not have been as terrible and traumatic as the contemporary surgical methods. The surgeon and the Inquisitor differed only in their motivation: otherwise, their batteries of knives, saws, and tongs for slicing, piercing, burning, and amputating were barely distinguishable. Without any anesthetic other than strong liquor, an operation was as bad as the torments of hell.

Note to self: Try to extend positive feelings associated with Scratch-Off win into all areas of life. Be bigger presence at work. Race up ladder (joyfully, w/smile on face), get raise. Get in best shape of life, start dressing nicer. Learn guitar? Make point of noticing beauty of world? Why not educate self re. birds, flowers, trees, constellations, become true citizen of natural world, walk around neighborhood w/kids, patiently teaching kids names of birds, flowers, etc. etc.? Why not take kids to Europe? Kids have never been. Have never, in Alps, had hot chocolate in mountain café, served by kindly white-haired innkeeper, who finds them so sophisticated/friendly relative to usual snotty/rich American kids (who always ignore his pretty but crippled daughter w/braids) that he shows them secret hiking path to incredible glade, kids frolic in glade, sit with crippled pretty girl on grass, later say it was most beautiful day of their lives, keep in touch with crippled girl via email, we arrange surgery here for her, surgeon so touched he agrees to do surgery for free, she is on front page of our paper, we are on front page of their paper in Alps? Ha ha. Just happy.

Artificial Disc Replacement is intended to perform the same capacities as the first plate, in particular to protect versatility and keep up dependability and backing for the encompassing vertebrae.

Reach our best spine surgeon specialist now and counsel about the best treatment alternatives for your case.spine expert for any kind of framework. He is also a remarkable pioneer and skilled expert.

The hypothalamus, located directly below the thalamus, is only the size of a plump grape, but it regulates hormones that control blood pressure, body temperature, growth, and more. It is a no-fly zone during surgery.

The plastic surgeon like a sculptor will create or restore shapes. It seems obvious that these shapes should be beautiful and natural but not rigid like a mask or a statue: no, they should be beautiful, natural and vibrant.

How are you feeling?’ I asked. ‘Fine,’ he replied with a tired smile. ‘Well done!’ I replied, as I think patients need to be congratulated for their surviving just as much as the surgeons should be congratulated for doing their job well. ‘It’s

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

The door slowly opens, and a tall, thin person ducks inside. He’s wearing the same green surgeon scrubs, face mask, and blue gloves that the pre-op nurses wear, but his wavy brown hair is peeking out from under a clear surgical cap. His eyes find mine and I let go of the railings in surprise. “What are you doing here?” I whisper, watching as Will sits down in a chair beside me, scooting it back to make sure he’s a safe distance away. “It’s your first surgery without Abby,” he says in explanation, a new expression I don’t quite recognize filling his blue eyes. It’s not mocking or jokey, it’s totally and completely open. Almost earnest. I swallow hard, trying to stop the emotions that come bubbling up, tears clouding my eyes.

WORTH IT? It is no credit to our phase of civilization if it is fear rather than ambition that drives most of those who bankrupt themselves on the vanities, or who end up under the surgeon's knife. It is the fear of falling short, of being inadequate in the eyes of others, including loved ones. [...] It is unfitting, one might say, improper, treating one's owm body as a tool rather than a part of oneself. [...] The bottom line is that it dishonors ourselves, for we ought to think better of ourselves than that.

I had heard rumors that some doctors stop surgery halfway through and demand more money from the patient, and if the patient doesn’t pay up, the surgeon just leaves them there, opened up on the operating table with their stomach and intestines exposed to the cold air.

As I was editing this chapter, a survey of more than thirty-five hundred Australian surgeons revealed a culture rife with bullying, discrimination, and sexual harassment, against women especially (although men weren’t untouched either). To give you a flavor of professional life as a woman in this field, female trainees and junior surgeons “reported feeling obliged to give their supervisors sexual favours to keep their jobs”; endured flagrantly illegal hostility toward the notion of combining career with motherhood; contended with “boys’ clubs”; and experienced entrenched sexism at all levels and “a culture of fear and reprisal, with known bullies in senior positions seen as untouchable.”68 I came back to this chapter on the very day that news broke in the state of Victoria, Australia, where I live, of a Victorian Equal Opportunity and Human Rights Commission report revealing that sexual discrimination and harassment is also shockingly prevalent in the Victorian Police, which unlawfully failed to provide an equal and safe working environment.69 I understand that attempts to identify the psychological factors that underlie sex inequalities in the workplace are well-meaning. And, of course, we shouldn’t shy away from naming (supposedly) politically unpalatable causes of those inequalities. But when you consider the women who enter and persist in highly competitive and risky occupations like surgery and policing—despite the odds stacked against them by largely unfettered sex discrimination and harassment—casual scholarly suggestions that women are relatively few in number, particularly in the higher echelons, because they’re less geared to compete in the workplace, start to seem almost offensive. Testosterone

The sick suffer alone, they undergo procedures and surgeries alone, and in the end, they die alone. Transplant is different. Transplant is all about having someone else join you in your illness. It may be in the form of an organ from a recently deceased donor, a selfless gift given by someone has never met you, or a kidney or liver from a relative, friend or acquaintance. In every case, someone is saying, in effect, “Let me join you in the recovery, your suffering, your fear of the unknown, your desire to become healthy, to get your life back. Let me bear some of your risk with you.

it would be interesting in surgery if you could swallow the surgeon. You put the mechanical surgeon inside the blood vessel and it goes into the heart and “looks” around. (Of course the information has to be fed out.) It finds out which valve is the faulty one and takes a little knife and slices it out.

Robots may be used as surgeons as well as cooks and musicians. For example, one important limitation of surgery is the dexterity and accuracy of the human hand. Surgeons, like all people, become fatigued after many hours and their efficiency drops. Fingers begin to tremble. Robots may solve these problems.

First, do no harm . . .’   Commonly attributed to Hippokrates of Kos, c. 460 BC ‘Every surgeon carries within himself a small cemetery, where from time to time he goes to pray – a place of bitterness and regret, where he must look for an explanation for his failures.’ René Leriche, La philosophie de la chirurgie, 1951

Certain brain areas are considered near-inviolable, like the primary motor cortex, damage to which results in paralysis of affected body parts. But the most sacrosanct regions of the cortex are those that control language. Usually located on the left side, they are called Wernicke's & Broca's areas; one is for understanding language & the other for producing it. […]If both areas are damaged, the patient becomes an isolate, something central to her humanity stolen forever. After someone suffers a head trauma or stroke, the destruction of these areas restrains the surgeon's impulse to save a life: what kind of life exists without language?

In some way, it may be in the nature of surgery itself to want to come to grips with the uncertainties and dilemmas of practical medicine. Surgery has become as high tech as medicine gets, but the best surgeons retain a deep recognition of the limitations of both science and human skill. Yet still they must act decisively.

His information was multifaceted, almost colorful. Had he not delivered it with such impassivity, spinning on his backless chair as if he were at the center of some odd carousel - we the horses, each with our own rigid purpose: names for me, numbers for my father, promises for my mother - it would have been a speech worth remembering.

Finland compared the surgery with “sham surgery”—that is, surgeons took patients with knee pain and a torn meniscus to operating rooms, made incisions, faked surgeries, and sewed them back up and sent them to physical therapy—they found that sham surgery worked just as well. Most people with a torn meniscus, it turns out, don’t have any symptoms

I fear the democratization of plastic surgery, when it's so cheap that everyone - the butcher, the baker, and the candlestick maker - goes under the knife and winds up looking like these tightly pulled, slightly surprised-looking society and celebrity aliens from Planet Botox. . . . When I was young, I could have bottled up my self-loathing and filled a mile of train cars with it. Now that I'm old, I can't think of anyone I'd rather be than me. . . . That's what we need now: surgeons who can slice away the self-consciousness, the fear, the loneliness, and inject a little hope instead. A little love. Or a doctor who implants only high spirits, penchants for practical jokes, or the ability to cha-cha even to a dirge beat.

Surgeons, as a group, adhere to a curious egalitarianism. They believe in practice, not talent. People often assume that you have to have great hands to become a surgeon, but it’s not true. When I interviewed to get into surgery programs, no one made me sew or take a dexterity test or checked if my hands were steady. You do not even need all ten fingers to be accepted. To be sure, talent helps. Professors say every two or three years they’ll see someone truly gifted come through a program—someone who picks up complex manual skills unusually quickly, sees the operative field as a whole, notices trouble before it happens. Nonetheless, attending surgeons say that what’s most important to them is finding people who are conscientious, industrious, and boneheaded enough to stick at practicing this one difficult thing day and night for years on end. As one professor of surgery put it to me, given a choice between a Ph.D. who had painstakingly cloned a gene and a talented sculptor, he’d pick the Ph.D. every time. Sure, he said, he’d bet on the sculptor being more physically talented; but he’d bet on the Ph.D. being less “flaky.” And in the end that matters more. Skill, surgeons believe, can be taught; tenacity cannot.

After surgery, he told his doctors that the pain was exactly as it was, but he did not feel it as greatly. “It’s as if,” he had said, a cool blandness in his eyes, “the pain is not being done to me.” One day, maybe in a ten years, or fifty years, a surgeon will be able to do this with disturbing precision, destroy a whirlpool of memory, an entire system of feelings, but in the meantime it’s like taking a hatchet to a spider’s web.

A friend of mine (Albert R. Hibbs)* suggests a very interesting possibility for relatively small machines. He says that, although it is a very wild idea, it would be interesting in surgery if you could swallow the surgeon. You put the mechanical surgeon inside the blood vessel and it goes into the heart and “looks” around. (Of course the information has to be fed out.) It finds out which valve is the faulty one and takes a little knife and slices it out.

In the 1980s and 1990s, the plastic surgery industry, including the association of plastic surgeons, led a campaign to convince women that having small breasts was actually a physical deficiency. According to the American Society of Plastic and Reconstructive Surgeons, small breasts are not only a deformity but “a disease which in most patients results in feelings of inadequacy.” Thus millions of women have been led to change their breasts, not their image of themselves.

Here we see the word "brain" occurring for the first time in human speech, as far as it is known to us; and in discussing injuries affecting the brain, we note the surgeon's effort to delimit his terms as he selects for specialization a series of common and current words to designate three degrees of injury to the skull indicated in modern surgery by the terms "fracture", "compound fracture," and "compound comminuted fracture," all of which the ancient commentator carefully explains.

The bullet didn’t come out. I’ve got to go in and get it.” “Have you ever done that?” she asked, quickly thrusting the bottle into my hands. I guess she thought whoever possessed the bottle had to perform the surgery. “I filled in pot holes, Jen. Not much call for field surgery in that line of work.” “What about before that?” she grasped. “Oh yeah sure, I left a lucrative and life-fulfilling job as a highly skilled surgeon to live the prosaic life of a road crew man. Filling holes seemed a much nobler profession.” “Don’t

Be bigger presence at work. Race up ladder (joyfully, w/smile on face), get raise. Get in best shape of life, start dressing nicer. Learn guitar? Make point of noticing beauty of world? Why not educate self re. birds, flowers, trees, constellations, become true citizen of natural world, walk around neighborhood w/kids, patiently teaching kids names of birds, flowers, etc. etc.? Why not take kids to Europe? Kids have never been. Have never, in Alps, had hot chocolate in mountain café, served by kindly white- haired innkeeper, who finds them so sophisticated/friendly relative to usual snotty/rich American kids (who always ignore his pretty but crippled daughter w/braids) that he shows them secret hiking path to incredible glade, kids frolic in glade, sit with crippled pretty girl on grass, later say it was most beautiful day of their lives, keep in touch with crippled girl via email, we arrange surgery here for her, surgeon so touched he agrees to do surgery for free, she is on front page of our paper, we are on front page of their paper in Alps? Ha ha.

His speed was so mighty that once he accidentally sliced off the testicles of the patient. A free castration, to boot! Another time, he accidentally cut off the fingers of his assistant (who often held the leg in place); during the procedure, one of the onlookers dropped dead from terror when the knife slashed close enough to cut his coat. Unfortunately, the patient died. The poor assistant also later died of gangrene from the finger amputations, and thus Liston became the proud surgeon who could now boast a stunning 300 percent mortality rate from one surgery.

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

Medical ministry belongs in the work of every physician. The surgeon should have recourse to it as much and as often as the neurologist or psychiatrist. It is only that the goal of medical ministry is different and goes deeper that that of the surgeon. When the surgeon has completed an amputation, he takes off his rubber gloves and appears to have done his duty as a physician. But if the patient then commits suicide because he cannot bear living as a cripple - of what use has the surgical therapy been? Is it not also part of the physician's work to do something about the patient's attitude toward the pain of surgery or the handicap that results from it?

had mapped out this whole forty-year career for myself—the first twenty as a surgeon-scientist, the last twenty as a writer. But now that I am likely well into my last twenty years, I don’t know which career I should be pursuing.” “Well, I can’t tell you that,” she said. “I can only say that you can get back to surgery if you want, but you have to figure out what’s most important to you.” “If I had some sense of how much time I have left, it’d be easier. If I had two years, I’d write. If I had ten, I’d get back to surgery and science.” “You know I can’t give you a number.” Yes, I knew. It was up to me, to quote her oft-repeated refrain, to find my values.

One day, Matthew, the little boy with the brain tumor who had charmed the ward a few years back, was readmitted. His hypothalamus had, in fact, been slightly damaged during the operation to remove his tumor; the adorable eight-year-old was now a twelve-year-old monster. He never stopped eating; he threw violent fits. His mother’s arms were scarred with purple scratches. Eventually Matthew was institutionalized: he had become a demon, summoned by one millimeter of damage. For every surgery, a family and a surgeon decide together that the benefits outweigh the risks, but this was still heartbreaking. No one wanted to think about what Matthew would be like as a three-hundred-pound twenty-year-old.

Then there will be blood." "You fear that. Even though the blood will most likely fall from our veins." "I don't want any blood to fall," I said. "It's like surgery," Robin said. "When a patient will die without the surgeon's knife, then you need to cut into the body. Blood falls, but the patient is saved." "And Aeland needs a surgeon," I sat up. My head pounded, but it was a muffled thump, at least. "To cut out the thing that's killing it. That's what you're saying." "Do you disagree?" I didn't dare shake my head. "I don't. But—" "Every patient fears the risks. And only the worst doctors pretend there aren't any. People die in surgery. It's dangerous," Robin said. "But if you just leave it, the patient will die without that intervention.

Let me explain: There are all sorts of reasons why women pick one colorist over another. Some will go to you if you have the same kind of dog or because they like the way you look. Some will only go to a man, because they want to feel a man’s hands on them. Then, of course, you have the editorial mongrels, who will go only to whoever is in this month’s Elle or Allure. But no matter what brings them to you in the first place, they’ll drop you cold if you’re not a good colorist. Which means no mistakes. Not ever. Brain surgeons are allowed more mistakes than hair colorists. Don’t misunderstand me. I’m not saying that what I do is brain surgery or in any way important. Between you and me, it’s just hair. But a certain kind of woman cares about her hair. A lot.

Be big enough to offer the truth to people and if it short circuits them I think that's tragic. I think that's sad but, I will not strike no unholy bargains to self erase. I wont do it. I don't care how many people fucked up their lives. I don't care how many bad choices people have made. I don't care how much pettiness they've consumed and spat out. I don't care how much viciousness , rage, abuse, spanking they've dealt out. I am gonna tell the truth as I see it and I'm going to be who I fucking am and if that causes the world to shift in it's orbit and half the evil people get thrown off the planet and up into space well, you shouldn't of been standing in evil to begin with because, there is gravity in goodness. So, sorry; I have to be who I am. Everyone ells is taken. There is no other place I can go than in my own head. I can't jump from skull to skull until I find one that suits bad people around me better. I don't have that choice. So, be your fucking self. Speak your truth and if there are people around you who tempt you with nonexistence , blast through that and give them the full glory of who you are. Do not withhold yourself from the world. Do not piss on the incandescent gift of your existence. Don't drown yourself in the petty fog and dustiness of other peoples ancient superstitions, beliefs, aggressions, culture, and crap. No, be a flare. We're all born self expressive. We are all born perfectly comfortable with being incredibly inconvenient to our parents. We shit, piss, wake up at night, throw up on their shoulders, scream, and cry. We are in our essence, in our humanity, perfectly comfortable with inconveniencing others. That's how we are born. That's how we grow. That's how we develop. Well, I choose to retain the ability to inconvenience the irrational. You know I had a cancer in me last year and I'm very glad that the surgeons knife and the related medicines that I took proved extremely inconvenient to my cancer and I bet you my cancer was like "Aw shit. I hate this stuff man." Good. I'm only alive because medicine and surgery was highly inconvenient to the cancer within me. That's the only reason I'm alive. So, be who you are. If that's inconvenient to other people that's their goddamn business, not yours. Do not kill yourself because other people are dead. Do not follow people into the grave. Do not atomize yourself because, others have shredded themselves into dust for the sake of their fears and their desire to conform with the history of the dead.

We also had some fun with another hard-drinking and know-it-all reporter from one of the ‘red top’ tabloids. I solemnly informed him that his luck was in, because one of our trainee surgeons was a real wizard at organ transplantion. We told him that, if he was shot through the belly, we would try to exchange his worn-out liver for a new one – and then he could start his prodigious drinking career all over again. While that was sinking in, we even asked if he had any objection to receiving an Argentine donor organ if one became available. It was all a bit of military black humour of course, but the poor chap went white-faced, and tried to make me swear on the Bible that I’d never arrange such a procedure, and would finish him off with a lethal injection instead. Transplant surgery in a Forward Dressing Station? Come alongside, Jack…

attending surgeons say that what’s most important to them is finding people who are conscientious, industrious, and boneheaded enough to stick at practicing this one difficult thing day and night for years on end. As one professor of surgery put it to me, given a choice between a Ph.D. who had painstakingly cloned a gene and a talented sculptor, he’d pick the Ph.D. every time. Sure, he said, he’d bet on the sculptor being more physically talented; but he’d bet on the Ph.D. being less “flaky.” And in the end that matters more. Skill, surgeons believe, can be taught; tenacity cannot. It’s an odd approach to recruitment, but it continues all the way up the ranks, even in top surgery departments. They take minions with no experience in surgery, spend years training them, and then take most of their faculty from these same homegrown ranks. And it works.

For the duration of the war, American surgery remained crude, and wound infections spread unchecked. The bullet-riddled arms and legs of more than thirty thousand Union soldiers were amputated by battlefield surgeons, many of whom had little or no experience of treating trauma patients. Knives and saws were wiped free of gore with nothing more than dirty rags, if at all. Surgeons never washed their hands and were often covered in the blood and guts of previous patients at the commencement of a new operation. When linen and cotton were scarce, army surgeons used cold, damp earth to pack open wounds. When these wounds inevitably began to suppurate, they were praised for their laudable pus. Many surgeons had never even witnessed a major amputation or treated gunshot wounds when they joined their regiments, much to the detriment of those who fell under their care.

We know that multitasking can even be fatal when lives are at stake. In fact, we fully expect pilots and surgeons to focus on their jobs to the exclusion of everything else. And we expect that anyone in their position who gets caught doing otherwise will always be taken severely to task. We accept no arguments and have no tolerance for anything but total concentration from these professionals. And yet, here the rest of us are—living another standard. Do we not value our own job or take it as seriously? Why would we ever tolerate multitasking when we’re doing our most important work? Just because our day job doesn’t involve bypass surgery shouldn’t make focus any less critical to our success or the success of others. Your work deserves no less respect. It may not seem so in the moment, but the connectivity of everything we do ultimately means that we each not only have a job to do, but a job that deserves to be done well.

As it turned out, the two decades immediately following the popularization of anesthesia saw surgical outcomes worsen. With their newfound confidence about operating without inflicting pain, surgeons became ever more willing to take up the knife, driving up the incidences of postoperative infection and shock. Operating theaters became filthier than ever as the number of surgeries increased. Surgeons still lacking an understanding of the causes of infection would operate on multiple patients in succession using the same unwashed instruments on each occasion. The more crowded the operating theater became, the less likely it was that even the most primitive sanitary precautions would be taken. Of those who went under the knife, many either died or never fully recovered and then spent the rest of their lives as invalids. This problem was universal. Patients worldwide came to further dread the word “hospital,” while the most skilled surgeons distrusted their own abilities.

Size Matters. A lot. How much you have and more importantly how much space it will take up in a movingtruck are the first things you need to know when planning a long distance move. Professional movers charge by weight because it is an easier and more uniform way to determine exactly how much you have. They literally drive the truck onto a large scale before loading your goods to get a light weight and return after loading your stuff to get a heavy weight, with the difference being the weight of your shipment. The moving company’s estimate, however, is based on coming to your home and surveying the total cubic feet, or estimated size of all your household goods. They then convert that figure into a weight estimate by multiplying the cubic feet (cubes) by the average density of 6.5 pounds per cubic foot. A small 2-bedroom house for example might have 1,000 cubic feet which when multiplied by a density of 6.5 (lbs) would equal 6,500 lbs. If this sounds like brain surgery then I would ask you to try and remember the last furniture mover you met who struck you as brain surgeon-ish.

How very small she seemed, tucked in the corner of the library with her knees drawn up. For the past hour and a half, she had been a commanding figure, strung tight with energy, her gaze stern and steely. She had worked in millimeters, doing tiny, crucial things to veins and cellular tissue with astonishing precision. Although West knew nothing about surgery, he'd understood that he was witnessing someone perform with rare skill. Now, in her exhaustion, the brilliant surgeon resembled an anxious schoolgirl who had taken a wrong turn on the way home. West liked her a great deal. In fact, he was rather sorry now that he'd kept shrugging off Helen's efforts to introduce them. He'd envisioned the female doctor as a severe matron, probably hostile toward men, and Helen's assurances that Dr. Gibson was quite pretty hadn't been at all convincing. Helen, with her completely unjustified affection for humanity, loved to overestimate people. But Garrett Gibson was more than pretty. She was riveting. An intelligent, accomplished woman with an elusive quality... a suggestion of hidden tenderness... that intrigued him.

This Sarah Perez had the most beautiful eyes in the world, those green eyes spangled with gold that you love so much: the eyes of Antinous. In Rome, such eyes would have made her a concubine of Adrian; in Madrid they helped her become the princess of Eboli ensconced in the bed of the king. But Philip II was extremely jealous of those wonderful emerald eyes and their delicate transparency, and the princess - who was bored with the funereal palace and the even more funereal society of the king - had the fancy and the misfortune to cast her admirable gaze upon the Marquis de Posa while she was leaving church one day. It was on the threshold of the chapel, and the princess believed herself to be alone with her camarera mayor, but the vigilance of the clergy was equal to the challenge. She was betrayed, and that very evening, in the intimacy of their bedroom, in the course of some violent argument or tempestuous tussle, Philip threw his mistress to the floor. Blind with rage he leapt upon her, tore out her eye and devoured it in a single gulp. 'Thus was the princess covered in blood - a good title for a conte cruel, that, which Villiers de l'Isle Adam has somehow omitted to write! The princess was henceforth one-eyed: the royal pet had a gaping hole in her face. Philip II, who had the Jewess in his blood, could not cleave so closely to a princess who had only one eye. He made amends to her with some new titles and estates in the provinces and - regretful of the beautiful green eye that he had spoiled - he caused to be inserted into the empty and bloody orbit a superb emerald enshrined in silver, upon which surgeons then inscribed the semblance of a gaze. Oculists have made progress since then; the Princess of Eboli, already hurt by the ruination of her eye, died some little time afterwards, of the effects of the operation. The ways of love and surgery were equally barbarous in the time of Philip II! 'Philip, the inconsolable lover, gave the order to remove the emerald from the face of the dead princess before she was laid in the tomb, and had it mounted in a ring. He wore it about his finger, and would never take it off, even when he went to sleep - and when he died in his turn, he had the ring bearing the green tear clasped in his right hand.

KNEE SURGERY I’D FIRST HURT MY KNEES IN FALLUJAH WHEN THE WALL FELL on me. Cortisone shots helped for a while, but the pain kept coming back and getting worse. The docs told me I needed to have my legs operated on, but doing that would have meant I would have to take time off and miss the war. So I kept putting it off. I settled into a routine where I’d go to the doc, get a shot, go back to work. The time between shots became shorter and shorter. It got down to every two months, then every month. I made it through Ramadi, but just barely. My knees started locking and it was difficult to get down the stairs. I no longer had a choice, so, soon after I got home in 2007, I went under the knife. The surgeons cut my tendons to relieve pressure so my kneecaps would slide back over. They had to shave down my kneecaps because I had worn grooves in them. They injected synthetic cartilage material and shaved the meniscus. Somewhere along the way they also repaired an ACL. I was like a racing car, being repaired from the ground up. When they were done, they sent me to see Jason, a physical therapist who specializes in working with SEALs. He’d been a trainer for the Pittsburgh Pirates. After 9/11, he decided to devote himself to helping the country. He chose to do that by working with the military. He took a massive pay cut to help put us back together. I DIDN’T KNOW ALL THAT THE FIRST DAY WE MET. ALL I WANTED to hear was how long it was going to take to rehab. He gave me a pensive look. “This surgery—civilians need a year to get back,” he said finally. “Football players, they’re out eight months. SEALs—it’s hard to say. You hate being out of action and will punish yourselves to get back.” He finally predicted six months. I think we did it in five. But I thought I would surely die along the way. JASON PUT ME INTO A MACHINE THAT WOULD STRETCH MY knee. Every day I had to see how much further I could adjust it. I would sweat up a storm as it bent my knee. I finally got it to ninety degrees. “That’s outstanding,” he told me. “Now get more.” “More?” “More!” He also had a machine that sent a shock to my muscle through electrodes. Depending on the muscle, I would have to stretch and point my toes up and down. It doesn’t sound like much, but it is clearly a form of torture that should be outlawed by the Geneva Convention, even for use on SEALs. Naturally, Jason kept upping the voltage. But the worst of all was the simplest: the exercise. I had to do more, more, more. I remember calling Taya many times and telling her I was sure I was going to puke if not die before the day was out. She seemed sympathetic but, come to think of it in retrospect, she and Jason may have been in on it together. There was a stretch where Jason had me doing crazy amounts of ab exercises and other things to my core muscles. “Do you understand it’s my knees that were operated on?” I asked him one day when I thought I’d reached my limit. He just laughed. He had a scientific explanation about how everything in the body depends on strong core muscles, but I think he just liked kicking my ass around the gym. I swear I heard a bullwhip crack over my head any time I started to slack. I always thought the best shape I was ever in was straight out of BUD/S. But I was in far better shape after spending five months with him. Not only were my knees okay, the rest of me was in top condition. When I came back to my platoon, they all asked if I had been taking steroids.

It was said of Liston by his colleagues that when he amputated, “the gleam of his knife was followed so instantaneously by the sound of sawing as to make the two actions appear almost simultaneous.” His left arm was reportedly so strong that he could use it as a tourniquet, while he wielded the knife in his right hand. This was a feat that required immense strength and dexterity, given that patients often struggled against the fear and agony of the surgeon’s assault. Liston could remove a leg in less than thirty seconds, and in order to keep both hands free, he often clasped the bloody knife between his teeth while working. Liston’s speed was both a gift and a curse. Once, he accidentally sliced off a patient’s testicle along with the leg he was amputating. His most famous (and possibly apocryphal) mishap involved an operation during which he worked so rapidly that he took off three of his assistant’s fingers and, while switching blades, slashed a spectator’s coat. Both the assistant and the patient died later of gangrene, and the unfortunate bystander expired on the spot from fright. It is the only surgery in history said to have had a 300 percent fatality rate.

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.

The evening was a string of miserable minutes strung together in tiny clusters. Three minutes for a man shot through the shoulder; Ellis put first a finger in the entry wound and then another in the exit and when his fingers touched, he decided the man was only lightly injured and didn’t need a surgeon. Three minutes to set a broken wrist and splint it with a strip of cowhide and a piece of wood from a sycamore tree. Two minutes to tourniquet a leg, then extract a piece of wire deep in the meat of it. A minute to peek under a pink, saturated bandage several inches below a slender belly button; he saw thin, red water leaking from a hole and smelled urine, knew the ball had breached the bladder. It would either heal or it wouldn’t, but nothing to do about it so he set the soul aside, a case not to be operated upon. He turned a man’s head looking for the source of a trickle of blood and had ten terrible minutes trying to stop torrential bleeding from under his clavicle; frantic moments during which he could get neither a finger nor a clamp around the pulsating source. All bleeding stops eventually though, and the case did not violate the rule. He took two minutes to settle his own breathing, then four minutes sewing a torn scalp, and half a minute saying a prayer over a fat, cigar-shaped dead man. After awhile, he had the impression he wasn’t seeing men, but parts—an exploded chest, a blood swolled thigh, a busted jaw with its teeth spat to the wind or swallowed. It was more than a man could take and a lot less than there was to be seen.

If they’re not practicing deliberately, even experts can see their skills backslide. Ericsson shared with me an incredible example of this. Even though you might be inclined to trust the advice of a silver-haired doctor over one fresh out of medical school, it’s been found that in a few fields of medicine, doctors’ skills don’t improve the longer they’ve been practicing. The diagnostic accuracy of professional mammographers, for example, doesn’t get more accurate over the years. Why would that be? For most mammographers, practicing medicine is not deliberate practice, according to Ericsson. It’s more like putting into a tin cup than working with a coach. That’s because mammographers usually only find out if they missed a tumor months or years later, if at all, at which point they’ve probably forgotten the details of the case and can no longer learn from their successes and mistakes. One field of medicine in which this is definitively not the case is surgery. Unlike mammographers, surgeons tend to get better with time. What makes surgeons different from mammographers, according to Ericsson, is that the outcome of most surgeries is usually immediately apparent—the patient either gets better or doesn’t—which means that surgeons are constantly receiving feedback on their performance. They’re always learning what works and what doesn’t, always getting better. This finding leads to a practical application of expertise theory: Ericsson suggests that mammographers regularly be asked to evaluate old cases for which the outcome is already known. That way they can get immediate feedback on their performance.

As it happened, the child’s mother was a radiologist. The tumor looked malignant—the mother had already studied the scans, and now she sat in a plastic chair, under fluorescent light, devastated. “Now, Claire,” the surgeon began, softly. “Is it as bad as it looks?” the mother interrupted. “Do you think it’s cancer?” “I don’t know. What I do know—and I know you know these things, too—is that your life is about to—it already has changed. This is going to be a long haul, you understand? You have got to be there for each other, but you also have to get your rest when you need it. This kind of illness can either bring you together, or it can tear you apart. Now more than ever, you have to be there for each other. I don’t want either of you staying up all night at the bedside or never leaving the hospital. Okay?” He went on to describe the planned operation, the likely outcomes and possibilities, what decisions needed to be made now, what decisions they should start thinking about but didn’t need to decide on immediately, and what sorts of decisions they should not worry about at all yet. By the end of the conversation, the family was not at ease, but they seemed able to face the future. I had watched the parents’ faces—at first wan, dull, almost otherworldly—sharpen and focus. And as I sat there, I realized that the questions intersecting life, death, and meaning, questions that all people face at some point, usually arise in a medical context. In the actual situations where one encounters these questions, it becomes a necessarily philosophical and biological exercise. Humans are organisms, subject to physical laws, including, alas, the one that says entropy always increases. Diseases are molecules misbehaving; the basic requirement of life is metabolism, and death its cessation. While all doctors treat diseases, neurosurgeons work in the crucible of identity: every operation on the brain is, by necessity, a manipulation of the substance of our selves, and every conversation with a patient undergoing brain surgery cannot help but confront this fact. In addition, to the patient and family, the brain surgery is

Once, I was doing a late-night case with one of the neurosurgery attendings, a suboccipital craniectomy for a brain-stem malformation. It’s one of the most elegant surgeries, in perhaps the most difficult part of the body—just getting there is tricky, no matter how experienced you are. But that night, I felt fluid: the instruments were like extensions of my fingers; the skin, muscle, and bone seemed to unzip themselves; and there I was, staring at a yellow, glistening bulge, a mass deep in the brain stem. Suddenly, the attending stopped me. “Paul, what happens if you cut two millimeters deeper right here?” He pointed. Neuroanatomy slides whirred through my head. “Double vision?” “No,” he said. “Locked-in syndrome.” Another two millimeters, and the patient would be completely paralyzed, save for the ability to blink. He didn’t look up from the microscope. “And I know this because the third time I did this operation, that’s exactly what happened.” Neurosurgery requires a commitment to one’s own excellence and a commitment to another’s identity. The decision to operate at all involves an appraisal of one’s own abilities, as well as a deep sense of who the patient is and what she holds dear. Certain brain areas are considered near-inviolable, like the primary motor cortex, damage to which results in paralysis of affected body parts. But the most sacrosanct regions of the cortex are those that control language. Usually located on the left side, they are called Wernicke’s and Broca’s areas; one is for understanding language and the other for producing it. Damage to Broca’s area results in an inability to speak or write, though the patient can easily understand language. Damage to Wernicke’s area results in an inability to understand language; though the patient can still speak, the language she produces is a stream of unconnected words, phrases, and images, a grammar without semantics. If both areas are damaged, the patient becomes an isolate, something central to her humanity stolen forever. After someone suffers a head trauma or a stroke, the destruction of these areas often restrains the surgeon’s impulse to save a life: What kind of life exists without language? When I was a med student,

In Hiding - coming summer of 2020 WAYNE ANTHONY SEEKS REDEMPTION FROM A BAD DAY - Although warned about getting the stitches wet, he believed a hot shower was the only road to his redemption. Experienced taught him the best way to relieve the tightness in his lower back was by standing beneath the near-scalding water. Dropping the rest of his clothing, he turned the shower on full blast. The hot water rushed from the showerhead filling the tiny room with steam, instantly the small mirror on the medicine cabinet fogged up. The man quietly pulled the shower curtain back and entered the shower stall without a sound. Years of acting as another’s shadow had trained him to live soundlessly. The hot water cascaded over his body as the echo from the pounding water deadened slightly. Grabbing the sample sized soap, he pulled the paper off and tossed the wrapper over the curtain rail. Wayne rubbed the clean smelling block until his large hands disappeared beneath the lather. He ignored the folded washcloth, opting to use his hands across his body. Gently he cleaned the injury allowing the slime of bacterial soap to remove the residual of the rust-colored betadine. All that remained when he finished was the pale orange smear from the antiseptic. This scar was not the only mar to his body. The water cascaded down hard muscles making rivulets throughout the thatches of dark hair. He raised his arms gingerly as he washed beneath them; the tight muscles of his abdomen glistened beneath the torrent of water. Opening a bottle of shampoo-slash-conditioner, he applied a dab then ran his hands across his scalp. Finally, the tension in his square jaw had eased, making his handsome face more inviting. The cords of his neck stood out as he rinsed the shampoo from his hair. It coursed down his chest leading down to his groin where the scented wash caught in his pelvic hair. Wayne's body was one of perfection for any woman; if that was, she could ignore the mutilations. Knife injuries left their mark with jagged white lines. Most of these, he had doctored himself; his lack of skill resulted in crude scars. The deepest one, undulated along the left side of his abdomen, that one had required the art of a surgeon. Dropping his arms, he surrenders himself to the pelting deluge from the shower. The steamy water cascaded down his body, pulling the soap toward the drain. Across his back, it slid down several small indiscernible pockmarks left by gunshot wounds, the true extent of their damage far beneath his skin. Slowly the suds left his body, snaking down his muscular legs. It slithered down the scars on his left knee, the result of replacement surgery after a thug took a bat to it. Wayne stood until the hot water cooled, and ran translucent over his body. Finally, he washes the impact of the long day from his mind and spirit.

• No matter how open we as a society are about formerly private matters, the stigma around our emotional struggles remains formidable. We will talk about almost anyone about our physical health, even our sex lives, but bring depression, anxiety or grief , and the expression on the other person would probably be "get me out of this conversation" • We can distract our feelings with too much wine, food or surfing the internet, • Therapy is far from one-sided; it happens in a parallel process. Everyday patients are opening up questions that we have to think about for ourselves, • "The only way out is through" the only way to get out of the tunnel is to go through, not around it • Study after study shows that the most important factor in the success of your treatment is your relationship with the therapist, your experience of "feeling felt" • Attachment styles are formed early in childhood based on our interactions with our caregivers. Attachment styles are significant because they play out in peoples relationships too, influencing the kind of partners they pick, (stable or less stable), how they behave in a relationship (needy, distant, or volatile) and how the relationship tend to end (wistfully, amiably, or with an explosion) • The presenting problem, the issue somebody comes with, is often just one aspect of a larger problem, if not a red herring entirely. • "Help me understand more about the relationship" Here, here's trying to establish what’s known as a therapeutic alliance, trust that has to develop before any work can get done. • In early sessions is always more important for patients to feel understood than it is for them to gain any insight or make changes. • We can complain for free with a friend or family member, People make faulty narratives to make themselves feel better or look better in the moment, even thought it makes them feel worse over time, and that sometimes they need somebody else to read between the lines. • Here-and-now, it is when we work on what’s happening in the room, rather than focusing on patient's stories. • She didn't call him on his bullshit, which this makes patients feel unsafe, like children's whose parent's don’t hold them accountable • What is this going to feel like to the person I’m speaking to? • Neuroscientists discovered that humans have brain cells called mirror neurons, that cause them to mimic others, and when people are in a heightened state of emotion, a soothing voice can calm their nervous system and help them stay present • Don’t judge your feelings; notice them. Use them as your map. Don’t be afraid of the truth. • The things we protest against the most are often the very things we need to look at • How easy it is, I thought, to break someone’s heart, even when you take great care not to. • The purpose on inquiring about people's parent s is not to join them in blaming, judging or criticizing their parents. In fact it is not about their parents at all. It is solely about understanding how their early experiences informed who they are as adults so that they can separate the past from the present (and not wear psychological clothing that no longer fits) • But personality disorders lie on a spectrum. People with borderline personality disorder are terrified of abandonment, but for some that might mean feeling anxious when their partners don’t respond to texts right away; for others that may mean choosing to stay in volatile, dysfunctional relationships rather than being alone. • In therapy we aim for self compassion (am I a human?) versus self esteem (Am I good or bad: a judgment) • The techniques we use are a bit like the type of brain surgery in which the patient remains awake throughout the procedure, as the surgeons operate, they keep checking in with the patient: can you feel this? can you say this words? They are constantly calibrating how close they are to sensitive regions of the brain, and if they hit one, they back up so as not to damage it.