Surgeons Day Quotes

It's a beautiful day to save lives. Let's have some fun.

Practice is funny that way. For days and days, you make out only the fragments of what to do. And then one day you've got the thing whole. Conscious learning becomes unconscious knowledge, and you cannot say precisely how.

You mean when we discovered the secret lair under the hangar where I'd been kept comatose for eight years of my life, then turned into a cyborg by some mystery surgeon before being given away to a family who didn't really want me? Yeah, Thorne, those were the good old days.

It may be a cat, a bird, a ferret, or a guinea pig, but the chances are high that when someone close to you dies, a pet will be there to pick up the slack. Pets devour the loneliness. They give us purpose, responsibility, a reason for getting up in the morning, and a reason to look to the future. They ground us, help us escape the grief, make us laugh, and take full advantage of our weakness by exploiting our furniture, our beds, and our refrigerator. We wouldn't have it any other way. Pets are our seat belts on the emotional roller coaster of life--they can be trusted, they keep us safe, and they sure do smooth out the ride.

You don't notice the dead leaving when they really choose to leave you. You're not meant to. At most you feel them as a whisper or the wave of a whisper undulating down. I would compare it to a woman in the back of a lecture hall or theater whom no one notices until she slips out.Then only those near the door themselves, like Grandma Lynn, notice; to the rest it is like an unexplained breeze in a closed room. Grandma Lynn died several years later, but I have yet to see her here. I imagine her tying it on in her heaven, drinking mint juleps with Tennessee Williams and Dean Martin. She'll be here in her own sweet time, I'm sure. If I'm to be honest with you, I still sneak away to watch my family sometimes. I can't help it, and sometimes they still think of me. They can't help it.... It was a suprise to everyone when Lindsey found out she was pregnant...My father dreamed that one day he might teach another child to love ships in bottles. He knew there would be both sadness and joy in it; that it would always hold an echo of me. I would like to tell you that it is beautiful here, that I am, and you will one day be, forever safe. But this heaven is not about safety just as, in its graciousness, it isn't about gritty reality. We have fun. We do things that leave humans stumped and grateful, like Buckley's garden coming up one year, all of its crazy jumble of plants blooming all at once. I did that for my mother who, having stayed, found herself facing the yard again. Marvel was what she did at all the flowers and herbs and budding weeds. Marveling was what she mostly did after she came back- at the twists life took. And my parents gave my leftover possessions to the Goodwill, along with Grandma Lynn's things. They kept sharing when they felt me. Being together, thinking and talking about the dead, became a perfectly normal part of their life. And I listened to my brother, Buckley, as he beat the drums. Ray became Dr. Singh... And he had more and more moments that he chose not to disbelieve. Even if surrounding him were the serious surgeons and scientists who ruled over a world of black and white, he maintained this possibility: that the ushering strangers that sometimes appeared to the dying were not the results of strokes, that he had called Ruth by my name, and that he had, indeed, made love to me. If he ever doubted, he called Ruth. Ruth, who graduated from a closet to a closet-sized studio on the Lower East Side. Ruth, who was still trying to find a way to write down whom she saw and what she had experienced. Ruth, who wanted everyone to believe what she knew: that the dead truly talk to us, that in the air between the living, spirits bob and weave and laugh with us. They are the oxygen we breathe. Now I am in the place I call this wide wide Heaven because it includes all my simplest desires but also the most humble and grand. The word my grandfather uses is comfort. So there are cakes and pillows and colors galore, but underneath this more obvious patchwork quilt are places like a quiet room where you can go and hold someone's hand and not have to say anything. Give no story. Make no claim. Where you can live at the edge of your skin for as long as you wish. This wide wide Heaven is about flathead nails and the soft down of new leaves, wide roller coaster rides and escaped marbles that fall then hang then take you somewhere you could never have imagined in your small-heaven dreams.

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.

There is a saying about surgeons, meant as a reproof: "Sometimes wrong; never in doubt." But this seemed to me their strength. Each day surgeons are faced with uncertainties. Information is inadequate; the science is ambiguous; one's knowledge and abilities are never perfect. Even with the simplest operation, it cannot be taken for granted that a patient will come through better off - or even alive. Standing at the table my first time, I wondered how the surgeon knew that he would do this patient good, that all the steps would go as planned, that the bleeding would be controlled and infection would not take hold and organs would not be injured. He didn't, of course. But still he cut.

. . . mistakes are inevitable, but what is not, and what will set us apart, is our ability to learn from them

Our department takes 1,120 calls every day. Do you know how many of the calls the public expects perfection on? 1,120. Nobody calls the fire department and says, 'Send me two dumb-ass firemen in a pickup truck.' In three minutes they want five brain-surgeon decathlon champions to come and solve all their problems.

Everything necessary to understand my grandfather lies between two stories: the story of the tiger’s wife, and the story of the deathless man. These stories run like secret rivers through all the other stories of his life – of my grandfather’s days in the army; his great love for my grandmother; the years he spent as a surgeon and a tyrant of the University. One, which I learned after his death, is the story of how my grandfather became a man; the other, which he told to me, is of how he became a child again.

Pets are our seat belts on the emotional roller coaster of life--they can be trusted, they keep us safe, and they sure do smooth out the ride.

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.

The country was lumbering towards election day. Strike turned in early on Sunday and watched the day's gaffes, counterclaims and promises being tabulated on his portable TV. There was an air of joylessness in every news report he watched. The national debt was so huge that it was diffcult to comprehend. Cuts were coming, whoever won; deep, painful cuts; and sometimes, with their weasel words, the party leaders reminded Strike of the surgeons who had told him cautiously that he might experience a degree of discomfort; they who would never personally feel the pain that was about to be inflicted.

But if the cause be not good, the king himself hath a heavy reckoning to make, when all those legs and arms and heads, chopped off in battle, shall join together at the latter day and cry all 'We died at such a place;' some swearing, some crying for a surgeon, some upon their wives left poor behind them, some upon the debts they owe, some upon their children rawly left. I am afeard there are few die well that die in a battle; for how can they charitably dispose of anything, when blood is their argument? Now, if these men do not die well, it will be a black matter for the king that led them to it; whom to disobey were against all proportion of subjection.

To become a doctor, you spend so much time in the tunnels of preparation--head down, trying not to screw up, just going from one day to the next--that it is a shock to find yourself at the other end, with someone shaking your hand and offering you a job. But the day comes.

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.

I arrived at 7.04 p.m. only to find that the bar did not open until 9.00 p.m. Incredible. No wonder people make mistakes at work. Would it be full of surgeons and flight controllers, drinking until after midnight then working the next day?

No man has to be a rocket surgeon to recognize love.

One thing we know that humans and other mammals do during sleep is to transform short-term memories stacked up during the day into memories that can last a lifetime.

All day you have been on my mind, a steam iron pressing the convolutions from my cortex, ironing me flat. Worrying cooks my cells feverish. I am irritable with love boiling into anxiety, till I grow furious with you, lying under the surgeon’s knife.

Such philosophical musings risk inviting depression or inefficiency. Better just to fix the problem and move on to the next one. It's all part of being a service provider at the end of the line.

Many years later when I began training as a plastic surgeon, I understood something that I had not that day in the kitchen arguing for Thalia to leave Tinos for the boarding school. I learned that the world didn't see the inside of you, that it didn't care a whit about the hopes and dreams, and sorrows, that lay masked by skin and bone. It was as simple, as absurd, and as cruel as that. My patients knew this. They saw that much of what they were, would be, or could be hinged on the symmetry of their bone structure, the space between their eyes, their chin length, the tip projection of their nose, whether they had an ideal nasofrontal angle or not. Beauty is an enormous unmerited gift given randomly, stupidly.

surgeon general Vivek Murthy in the Harvard Business Review. “Loneliness and weak social connections are associated with a reduction in life span similar to that caused by smoking 15 cigarettes a day.

During terms, Professor Marsden lives in Cambridge with his wife, chess player extraordinaire and distinguished physician and surgeon Bryony Asquith Marsden. His favorite time of day is half past six in the evening, when he meets Mrs. Marsden’s train at the station, as the latter returns from her day in London. On Sunday afternoons, rain or shine, Professor and Mrs. Marsden take a walk along The Backs, and treasure growing old together.

She had no sense of time, of what day it was, or anything beyond the bed she was on and the unceasing battle she fought with the Great Bitch of Pain. The nurses talked to her, too, explaining over and over what had happened to her, what they were doing, why they were doing it. She didn‟t care, so long as they delivered the drugs that kept the Great Bitch at bay. Of course, there came a time—way too soon, by her way of thinking— when her surgeon ordered a decrease in the drugs. He wasn‟t the one in agony, with his sternum cut in two, so what did he care? He was the one wielding the saw and scalpel, not the one on the receiving end. She had only a vague idea which of her visitors was the surgeon, but as her mind began clearing she memorized some particularly salty things she wanted to say to him. Okay, so he'd had to cut her sternum in half, but cutting her drugs in half? Bastard.

Creating gerbil strokes requires a mini-operation performed by mini-instruments on a mini-subject. All told, this was the most satisfying aspect of the project for me.

Science would not have definite answers. Frankly, neither would faith. But it only the steadfast belief that a higher power is at work - that some greater purpose awaits - which helps a wounded surgeon get through days of incomprehensible losses. Every death leaves a scar that persists for a lifetime, a reminder that you are not infallible, and would never be.

A British ship’s surgeon who used the privileges of his profession to visit some of the rebel camps, described roads crowded with carts and wagons hauling mostly provisions, but also, he noted, inordinate quantities of rum — “for without New England rum, a New England army could not be kept together.” The rebels, he calculated, were consuming a bottle a day per man.

Not all residents could stand the pressure. One was simply unable to accept blame or responsibility. He was a talented surgeon, but he could not admit when he'd made a mistake. I sat with him one day in the lounge as he begged me to help him save his career. "All you have to do," I said, "is look me in the eye and say "I'm sorry. What happened is my fault, and I won't let it happen again. " "But it was the nurse who---" "No. You have to be able to say it and mean it. Try again." "But---." "No. Say it." This went on for an hour before I knew he was doomed.

My mind went back to my school-days and an old gentleman talking to the class about careers. He had said: “If you decide to become a veterinary surgeon you will never grow rich but you will have a life of endless interest and variety.” I laughed aloud in the darkness and as I got into the car I was still chuckling. That old chap certainly wasn’t kidding. Variety. That was it—variety.

Sleep is a firestorm of brain activity. Instead of taking in new information, our brain’s subconscious is occupied defragging, deleting, and storing the prior day’s doings for long-term retrieval; cleaning out bits and pieces of discarded brain schmutz; and presenting us with immersive 3-D virtual stories in which we are the star.

It probably wasn't smart to judge them based on appearance. I, for instance, was destined to be a world-renowned surgeon, but between my long, brown braid, square-framed glasses, and boyish figure, I looked more like the kind of girl who works in a library and spends Friday nights having deep, meaningful conversations with her cats.

For folks who have that casual-dude energy coursing through their bloodstream, that's great. But gays should not grow up alienated just for us to alienate each other. It's too predictable, like any other cycle of abuse. Plus, the conformist, competitive notion that by "toning down" we are "growing up" ultimately blunts the radical edge of what it is to be queer; it truncates our colorful journey of identity. Said another way, it's like living in West Hollywood and working a gay job by day and working it in the gay nightlife, wearing delicate shiny shirts picked from up the gay dry cleaners, yet coquettishly left unbuttoned to reveal the pec implants purchased from a gay surgeon and shown off by prancing around the gay-owned-and-operated theater hopped up on gay health clinic steroids and wheat grass purchased from the friendly gay boy who's new to the city, and impressed by the monstrous SUV purchased from a gay car dealership with its rainbow-striped bumper sticker that says "Celebrate Diversity." Then logging on to the local Gay.com listings and describing yourself as "straight-acting." Let me make myself clear. This is not a campaign for everyone to be like me. That'd be a total yawn. Instead, this narrative is about praise for the prancy boys. Granted, there's undecided gender-fucks, dagger dykes, faux-mos, po-mos, FTMs, fisting-top daddies, and lezzie looners who also need props for broadening the sexual spectrum, but they're telling their own stories. The Cliff's Notes of me and mine are this: the only moments I feel alive are when I'm just being myself - not some stiff-necked temp masquerading as normal in the workplace, not some insecure gay boy aspiring to be an overpumped circuit queen, not some comic book version of swank WeHo living. If that's considered a political act in the homogenized world of twenty-first century homosexuals, then so be it. — excerpt of "Praise For The Prancy Boys," by Clint Catalyst appears in first edition (ISBN # 1-932360-56-5)

If surgeons know they are going to amputate a limb, they now often numb the nerves in the affected limb over a period of days beforehand to prepare the brain for the oncoming loss of feeling. The practice has been found to greatly reduce phantom limb pain.

H appears no different from the corpses already here. But H is different. She has made three sick people well. She has brought them extra time on Earth. To be able as a dead person to make a gift of this magnitude is phenomenal. Most people don't manage this sort of thing while they're alive. Cadavers like H are the dead's heroes. It is astounding to me and achingly sad that with 80,000 people on the waiting list for donated hearts and livers and kidneys, with sixteen a day dying there on that list, that more than half the people in the position H's family was in will say no, will choose to burn those organs or let them rot. We abide the surgeon's scalpel to save our own lives, our loved one's lives, but not to save a stranger's life. H has no heart but heartless is the last thing you'd call her.

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

But still these days I've often wondered, Who in the world am I? And very seriously at that. If you took away my career as a plastic surgeon, & the happy environment I'm living in, & threw me out in the world, with no explanation, & with everything stripped away - what in the world would I be?

My first day in the hospital, the chief resident said to me, "Neurosurgery residents aren't just the best surgeons -- we're the best doctors in the hospital. That's your goal. Make us proud." The chairman, passing through the ward: "Always eat with your left hand. You've got to learn to be ambidextrous.

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

ON A DAY LATE THAT JANUARY, I READ AGAIN “EAST Coker” by the poet T. S. Eliot, and saw something that I had forgotten: the stark but beautiful metaphor by which he described God as a wounded surgeon whose bleeding hands apply a scalpel to his patients so that “Beneath the bleeding hands we feel / The sharp compassion of the healer’s art.

We always assume we have time. There’s never any time. Every day we’re alive is borrowed against the unforeseen.

Don’t let anyone or anything, anywhere, anytime, or anyplace take away my ability to enjoy my day.

If Every-day People Could Use Athletes’ Excuses (Surgeon, after patient dies: “I don’t know. I just came out a little flat. You can’t get hyped up every single day.”)

My philosophy is that they get fifteen hours to do what they want the rest of the day; they can give me sixty minutes.

fragmented sleep often felt worse than no sleep at all. And the morning after was still a full fourteen-hour work day that required as much focus as one could muster.

But I will tell you another misery that is not to be denied. In the common, natural course of events physicians, surgeons and apothecaries are faced with enormous demands for sympathy: they may come into immediate contact with half a dozen deeply distressing cases in a single day. Those who are not saints are in danger of running out of funds and becoming bankrupt; a state which deprives them of a great deal of their humanity. If the man is in private practice he is obliged to utter more or less appropriate words to preserve his connexion, his living;and the mere adoption of a compassionate face as you have no doubt observed goes some little way towards producing at least the ghost of pity. But our patients cannot leave us. They have no alternative. We are not required to put on a conciliating expression, for our inhumanity in no way affects our livelihood. We have a monopoly; and I believe that many of us pay a very ugly price for it in the long run. You must already have met a number of callous idle self-important self-indulgent hardhearted pragmatic brutes wherever the patients have no free choice.

Could anyone among us have an inkling or a clue What magic feats or wizardry and voodoo you can do? And who would ever guess what powers you possess And who would not be stunned to see you prove There's more to us than surgeons can remove So much more than we ever knew So much more were we born to do Should you draw back the curtain, this I am certain You'll be impressed with you

But you don’t have to spend a week hiking in the forest to have your creativity nourished by the outdoors. Even a half-hour walk near your home, office, or school will do. Einstein made a habit of walking the mile and a half to and from his office at Princeton University every day. A little exercise, some fresh air, the passing of the seasons: it’s all fuel for your creative brain.

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.

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.

When I closed the door Grandmother was already seated at her spinning wheel. Her foot was on the treadle but her eyes were thoughtfully on me. The spinner was beautifully carved of dark oak with leaves twining their way round and round the outer rim. It must have been very old, as the designs were too fanciful to have been made i the new England. She called to me and asked me if I could spin. I told her yes, well enough, but that I could sew better, which was a statement only half true. A camp surgeon would have a better hand with a cleaver to a limb than I with a needle on the cloth. She spun the wool through knotted fingers glistening with sheep's oil and wrapped the threads neatly around the bobbin. Gently probing, she teased out the story of our days in Billerica just as she teased out the fine thread from the mix and jumble of the coarse wool in her hands.

A year on, Eleanor remained haunted by what happened to her. She still had no idea where the bacteria came from. Perhaps the foot soak and pedicure she had gotten at a small hair-and-nail shop the day before that wedding.

But Band-Aids for my disease aren’t what I’m after. I want a surgeon to perform an operation that leaves a deep incision where something nasty used to be, followed by a scar to remind me every day that it’s over and I survived.

Please, if necessary, blame my British indoctrination or blame my affiliation to the MSPCA (the Massachusetts Society for the Prevention of Cruelty to Animals refuses to perform ear cropping, tail docking, debarking, or cat declawing), but I have a problem with slicing off a hefty chunk of healthy skin and associated cartilage and then submitting an animal to weeks of ridiculous taping and splinting as you strive to achieve the desirable degree of erectness.

When the cure for insecurity and meaningful conversation is to slap a cell phone against your ear, hide within your iPod, or tap out a cryptic instant message, is it any wonder that we find comfort and solace in hairy, furry, and scaly companions?

The Peacemaker Colt has now been in production, without change in design, for a century. Buy one to-day and it would be indistinguishable from the one Wyatt Earp wore when he was the Marshal of Dodge City. It is the oldest hand-gun in the world, without question the most famous and, if efficiency in its designated task of maiming and killing be taken as criterion of its worth, then it is also probably the best hand-gun ever made. It is no light thing, it is true, to be wounded by some of the Peacemaker’s more highly esteemed competitors, such as the Luger or Mauser: but the high-velocity, narrow-calibre, steel-cased shell from either of those just goes straight through you, leaving a small neat hole in its wake and spending the bulk of its energy on the distant landscape whereas the large and unjacketed soft-nosed lead bullet from the Colt mushrooms on impact, tearing and smashing bone and muscle and tissue as it goes and expending all its energy on you. In short when a Peacemaker’s bullet hits you in, say, the leg, you don’t curse, step into shelter, roll and light a cigarette one-handed then smartly shoot your assailant between the eyes. When a Peacemaker bullet hits your leg you fall to the ground unconscious, and if it hits the thigh-bone and you are lucky enough to survive the torn arteries and shock, then you will never walk again without crutches because a totally disintegrated femur leaves the surgeon with no option but to cut your leg off. And so I stood absolutely motionless, not breathing, for the Peacemaker Colt that had prompted this unpleasant train of thought was pointed directly at my right thigh. Another thing about the Peacemaker: because of the very heavy and varying trigger pressure required to operate the semi-automatic mechanism, it can be wildly inaccurate unless held in a strong and steady hand. There was no such hope here. The hand that held the Colt, the hand that lay so lightly yet purposefully on the radio-operator’s table, was the steadiest hand I’ve ever seen. It was literally motionless. I could see the hand very clearly. The light in the radio cabin was very dim, the rheostat of the angled table lamp had been turned down until only a faint pool of yellow fell on the scratched metal of the table, cutting the arm off at the cuff, but the hand was very clear. Rock-steady, the gun could have lain no quieter in the marbled hand of a statue. Beyond the pool of light I could half sense, half see the dark outline of a figure leaning back against the bulkhead, head slightly tilted to one side, the white gleam of unwinking eyes under the peak of a hat. My eyes went back to the hand. The angle of the Colt hadn’t varied by a fraction of a degree. Unconsciously, almost, I braced my right leg to meet the impending shock. Defensively, this was a very good move, about as useful as holding up a sheet of newspaper in front of me. I wished to God that Colonel Sam Colt had gone in for inventing something else, something useful, like safety-pins.

the brain doesn’t actually sit inside the skull; it floats, protected by a natural shock absorber called cerebrospinal fluid, or CSF for short. CSF is produced at a rate of about two cups per day from inside the brain’s deep, hidden chambers: the ventricles.

And as for those high school students who tell me they would rather be a cat than an MD because they prefer to deal with animals and not to deal with people, I let them know they have it all wrong. Veterinarians get to work with animals. We get to work for people.

You have a cough that won’t go away—and then? It’s not science you call upon but a doctor. A doctor with good days and bad days. A doctor with a weird laugh and a bad haircut. A doctor with three other patients to see and, inevitably, gaps in what he knows and skills he’s still trying to learn.

Our bones lose mass at a rate of about 1 percent a year from late middle age onward, which is of course why elderly people and broken bones are so unhappily synonymous. Broken hips are especially challenging for the elderly. About 40 percent of people over seventy-five who break their hips are no longer able to care for themselves. For many, it is a kind of last straw. Ten percent die within thirty days, and nearly 30 percent die within twelve months. As the British surgeon and anatomist Sir Astley Cooper liked to quip, “We enter the world through the pelvis and leave it through the hip.

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

In 1833, the surgeon Peter Gaskell had published a thoroughly researched manuscript entitled The Manufacturing Population of England, focusing chiefly on the moral, social, and physical toll of silver-working machinery on British labourers. It had gone largely unheeded at the time, except by the Radicals, who were known to exaggerate everything. Now, the antiwar papers ran excerpts from it every day, reporting in grisly detail the coal dust inhaled by small children forced to wriggle into tunnels that adults could not, the fingers and toes lost to silver-powered machines working at inhuman speeds, the girls who’d been strangled by their own hair caught in whirring spindles and looms.

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.

I wanted to analyze and dissect my cross, to know how long I would have to carry it and how my carrying it would glorify God. Like a groggy patient fighting to sit upright amid her operation so she can monitor her surgeon’s progress, I wanted to stand outside my suffering and scrutinize God’s work in my soul as He accomplished it. Jesus, I realized, wanted none of this. He did not need my supervision, and he was not asking me to understand my cross. He was asking me to carry it. He wanted me to wake up each morning, bend a knee on the cold wooden floor beside my bed, and offer that day’s suffering and joys for whatever purposes he wished to use them. He wanted me to joyfully embrace my daily duties and leave the big picture to him.

English heart surgeon Martyn Lloyd-Jones asserted, “Most unhappiness in life is due to the fact that you are listening to yourself rather than talking to yourself.” What kind of voices do you hear? When you face new experiences, does a voice in your head say you’re going to fail? If you’re hearing negative messages, you need to learn to give yourself positive mental pep talks.

General Taylor participated in the celebration of the Fourth of July, a very hot day, by hearing a long speech from the Hon. Henry S. Foote, at the base of the Washington Monument. Returning from the celebration much heated and fatigued, he partook too freely of his favorite iced milk with cherries, and during that night was seized with a severe colic, which by morning had quite prostrated him. It was said that he sent for his son-in-law, Surgeon Wood, United States Army, stationed in Baltimore, and declined medical assistance from anybody else. Mr. Ewing visited him several times, and was manifestly uneasy and anxious, as was also his son-in-law, Major Bliss, then of the army, and his confidential secretary. He rapidly grew worse, and died in about four days.

We have now reached a level in which many people are not merely unacquainted with the fundamentals of punctuation, but don’t evidently realize that there are fundamentals. Many people—people who make posters for leading publishers, write captions for the BBC, compose letters and advertisements for important institutions—seem to think that capitalization and marks of punctuation are condiments that you sprinkle through any collection of words as if from a salt shaker. Here is a headline, exactly as presented, from a magazine ad for a private school in York: “Ranked by the daily Telegraph the top Northern Co-Educational day and Boarding School for Academic results.” All those capital letters are just random. Does anyone really think that the correct rendering of the newspaper is “the daily Telegraph”? Is it really possible to be that unobservant? Well, yes, as a matter of fact. Not long ago, I received an e-mail from someone at the Department for Children, Schools and Families asking me to take part in a campaign to help raise appreciation for the quality of teaching in Great Britain. Here is the opening line of the message exactly as it was sent to me: “Hi Bill. Hope alls well. Here at the Department of Children Schools and Families…” In the space of one line, fourteen words, the author has made three elemental punctuation errors (two missing commas, one missing apostrophe; I am not telling you more than that) and gotten the name of her own department wrong—this from a person whose job is to promote education. In a similar spirit, I received a letter not long ago from a pediatric surgeon inviting me to speak at a conference. The writer used the word “children’s” twice in her invitation, spelling it two different ways and getting it wrong both times. This was a children’s specialist working in a children’s hospital. How long do you have to be exposed to a word, how central must it be to your working life, to notice how it is spelled?

Perched upon the stones of a bridge The soldiers had the eyes of ravens Their weapons hung black as talons Their eyes gloried in the smoke of murder To the shock of iron-heeled sticks I drew closer in the cripple’s bitter patience And before them I finally tottered Grasping to capture my elusive breath With the cockerel and swift of their knowing They watched and waited for me ‘I have come,’ said I, ‘from this road’s birth, I have come,’ said I, ‘seeking the best in us.’ The sergeant among them had red in his beard Glistening wet as he showed his teeth ‘There are few roads on this earth,’ said he, ‘that will lead you to the best in us, old one.’ ‘But you have seen all the tracks of men,’ said I ‘And where the mothers and children have fled Before your advance. Is there naught among them That you might set an old man upon?’ The surgeon among this rook had bones Under her vellum skin like a maker of limbs ‘Old one,’ said she, ‘I have dwelt In the heat of chests, among heart and lungs, And slid like a serpent between muscles, Swum the currents of slowing blood, And all these roads lead into the darkness Where the broken will at last rest. ‘Dare say I,’ she went on,‘there is no Place waiting inside where you might find In slithering exploration of mysteries All that you so boldly call the best in us.’ And then the man with shovel and pick, Who could raise fort and berm in a day Timbered of thought and measured in all things Set the gauge of his eyes upon the sun And said, ‘Look not in temples proud, Or in the palaces of the rich highborn, We have razed each in turn in our time To melt gold from icon and shrine And of all the treasures weeping in fire There was naught but the smile of greed And the thick power of possession. Know then this: all roads before you From the beginning of the ages past And those now upon us, yield no clue To the secret equations you seek, For each was built of bone and blood And the backs of the slave did bow To the laboured sentence of a life In chains of dire need and little worth. All that we build one day echoes hollow.’ ‘Where then, good soldiers, will I Ever find all that is best in us? If not in flesh or in temple bound Or wretched road of cobbled stone?’ ‘Could we answer you,’ said the sergeant, ‘This blood would cease its fatal flow, And my surgeon could seal wounds with a touch, All labours will ease before temple and road, Could we answer you,’ said the sergeant, ‘Crows might starve in our company And our talons we would cast in bogs For the gods to fight over as they will. But we have not found in all our years The best in us, until this very day.’ ‘How so?’ asked I, so lost now on the road, And said he, ‘Upon this bridge we sat Since the dawn’s bleak arrival, Our perch of despond so weary and worn, And you we watched, at first a speck Upon the strife-painted horizon So tortured in your tread as to soak our faces In the wonder of your will, yet on you came Upon two sticks so bowed in weight Seeking, say you, the best in us And now we have seen in your gift The best in us, and were treasures at hand We would set them humbly before you, A man without feet who walked a road.’ Now, soldiers with kind words are rare Enough, and I welcomed their regard As I moved among them, ’cross the bridge And onward to the long road beyond I travel seeking the best in us And one day it shall rise before me To bless this journey of mine, and this road I began upon long ago shall now end Where waits for all the best in us. ―Avas Didion Flicker Where Ravens Perch

Reading through the newspapers and medical journals of the day, what stands out is not just the breadth of remedies proposed, but the breadth of people involved in the discussion: surgeons, nurses, patent medicine quacks, public-health authorities, armchair chemists, all writing the Times and the Globe (or buying classified advertising there) with news of the dependable cure they had concocted.

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.

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.

Our pleasures, however refined or easily acquired, are by their very nature fleeting. They begin to subside the instant they arise, only to be replaced by fresh desires or feelings of discomfort. You can’t get enough of your favorite meal until, in the next moment, you find you are so stuffed as to nearly require the attention of a surgeon—and yet, by some quirk of physics, you still have room for dessert. The pleasure of dessert lasts a few seconds, and then the lingering taste in your mouth must be banished by a drink of water. The warmth of the sun feels wonderful on your skin, but soon it becomes too much of a good thing. A move to the shade brings immediate relief, but after a minute or two, the breeze is just a little too cold. Do you have a sweater in the car? Let’s take a look. Yes, there it is. You’re warm now, but you notice that your sweater has seen better days. Does it make you look carefree or disheveled? Perhaps it is time to go shopping for something new. And so it goes. We seem to do little more than lurch between wanting and not wanting. Thus, the question naturally arises: Is there more to life than this? Might it be possible to feel much better (in every sense of better) than one tends to feel? Is it possible to find lasting fulfillment despite the inevitability of change? Spiritual life begins with

Many people still don’t understand what I have since learned: that ECT, when properly administered, is the fastest, most effective treatment for depression and bipolar disorder when medications have failed to work. Up to 90 percent of people with major depression for whom nothing else worked find relief in days or weeks, and the effects on memory are usually ( but not always) modest. It is also sometimes given soon after the onset of schizophrenia.

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.

On examination, it was pronounced that she had received serious hurts, but that they of themselves were far from hopeless; the danger lay mainly in the nervous shock. By the surgeon's directions, her bed was carried into that room and laid upon the great table: which happened to be well suited to the dressing of her injuries. When I saw her again, an hour afterwards, she lay indeed where I had seen her strike her stick, and had heard her say that she would lie one day.

Dr. Richard Selzer is a surgeon and a favorite author of mine. He writes the most beautiful and compassionate descriptions of his patients and the human dramas they confront. In his book Letters to a Young Doctor, he said that most young people seem to be protected for a time by an imaginary membrane that shields them from horror. They walk in it every day but are hardly aware of its presence. As the immune system protects the human body from the unseen threat of harmful bacteria, so this mythical membrane guards them from life-threatening situations. Not every young person has this protection, of course, because children do die of cancer, congenital heart problems, and other disorders. But most of them are shielded—and don’t realize it. Then, as years roll by, one day it happens. Without warning, the membrane tears, and horror seeps into a person’s life or into the life of a loved one. It is at this moment that an unexpected theological crisis presents itself.

It is astounding to me, and achingly sad, that with eighty thousand people on the waiting list for donated hearts and livers and kidneys, with sixteen a day dying there on that list, that more than half of the people in the position H’s family was in will say no, will choose to burn those organs or let them rot. We abide the surgeon’s scalpel to save our own lives, our loved ones’ lives, but not to save a stranger’s life. H has no heart, but heartless is the last thing you’d call her.

Each of my three recommendations for boosting creativity have a common thread: I am urging you to break the routine and spend more time goofing around. Sleep, dream, play, take a walk: do anything but work. And I say this to you as someone who, remember, went through years of medical school, graduate school, and neurosurgery training. I certainly understand the need for work and focus, for studying, for spending eighteen hours a day at it. But human beings are not automatons. We are called for greater things.

It is cold in my cell. Outside, the harsh winds of February are blowing and I am told it has once again begun to snow. I sit on my cot, a blanket draped over my shoulders, and remember how the delicious heat had enveloped us like a cloak on the day we walked the streets of Livadia. To the north of that Greek town, there are two springs which were known in ancient times as Lethe and Mnemosyne. Forgetfulness and Memory. We drank from both springs, you and I, and then we fell asleep in the dappled shade of an olive grove.

I slept. And then I awoke, late that same afternoon, I awoke full in the knowledge that I was alone. I have now seen a great many children in the same place I found myself in that day, orphans, feeling themselves abandoned and left open before all the elements of the world, and I have seen how some explode in tantrum while others walk in an almost stupor, how some cry for days and others move with an uncanny focus, addressing only the moment before them. Some part of them has died, and like surgeons, they know that amputation must be immediate.

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.

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

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.

THAT DAY, while we were in school, four men in a jeep came to visit Ghosh. They took him away as if he were a common criminal, his hands jacked up behind his back. They slapped him when he tried to protest. Hema learned this from W. W. Gonad, who told the men they were surely mistaken in taking away Missing’s surgeon. For his impertinence W.W. got a boot in his stomach. Hema refused to believe Ghosh was gone. She ran home, certain that she’d find him sunk into his armchair, his sockless feet up on the stool, reading a book. In anticipation of seeing him, in the certainty that he would be there, she was already furious with him. She burst through the front door of our bungalow. “Do you see how dangerous it is for us to associate with the General? What have I been telling you? You could get us all killed!” Whenever she came at him like that, all her cylinders firing, it was Ghosh’s habit to flourish an imaginary cape like a matador facing a charging bull. We found it funny, even if Hema never did. But the house was quiet. No matador. She went from room to room, the jingle of her anklets echoing in the hallways. She imagined Ghosh with his arm twisted behind his back, being punched in the face,

Of greatest concern is the growing body of evidence linking regular marijuana use to an increased risk of developing severe psychiatric illnesses, especially during adolescence. In 2017, just over 37 percent of twelfth graders used it at least once during the year, and 5.9 percent used it every day—a huge jump over 1992, when only 1.9 percent were daily users. The more regularly a teen uses marijuana and the higher the potency, the greater his or her risk of becoming schizophrenic. Heavy users are also more likely than others to be depressed; and, what’s worse, marijuana use during depression reduces the rate of recovery.

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.

And sleep training? Guess who proposed that unique technique? Why, a surgeon-turned-sportswriter, of course, who wrote under the pseudonym Stonehenge. If babies “are left to go to sleep in their cots, and allowed to find out that they do not get their way by crying, they at once become reconciled, and after a short time will go to bed even more readily in the cot than on the lap,” Dr. John Henry Walsh wrote in his Manual of Domestic Economy in 1857. Besides doling out advice on infant sleep, John Henry also authored several books about guns, including The Shot-Gun and Sporting Rifle and The Modern Sportsman’s Gun and Rifle. (And he lost a big chunk of his left hand one day when a gun exploded in his grasp.)

A young person for Monsieur Jagiello,’ said the guard, with a grin. He stood away from the door, and there was the young person, holding a cloth-covered basket, blushing and hanging her pretty head. The others walked away to the window and talked in what they meant to be a detached, natural way; but few could help stealing glances at the maiden, and none could fail to hear Jagiello cry, ‘But my dear, dear Mademoiselle, I asked for black pudding and apples, no more. And here is foie gras, a gratin of lobster, a partridge, three kinds of cheese, two kinds of wine, a strawberry tart . . . ’ ‘I made it myself,’ said the young person. ‘I am sure it is wonderfully good: but it is much more than I can ever afford.’ ‘You must keep up your strength. You can pay for it later – or in some other way – or however you like.’ ‘But how?’ asked Jagiello, in honest amazement. ‘By a note of hand, do you mean?’ ‘Pray step into the passage,’ said she, pinker still. ‘There you are again,’ said Jack, drawing Stephen into another room. ‘Yesterday it was a thundering great patty, with truffles; and tomorrow we shall see a wedding-cake for his pudding, no doubt. What they see in him I cannot conceive. Why Jagiello, and the others ignored? Here is Fenton, for example, a fine upstanding fellow with side-whiskers that are the pride of the service – with a beard as thick as a coconut – has to shave twice a day – as strong as a horse, and a very fair seaman; but there are no patties for him.

I feel like it's comically obvious whose meal is whose. Benny's fish is beautifully seared, with a lemon-rosemary glaze and sitting on a bed of wild rice with grilled asparagus on the side. It's becoming clearer to me all the time that the boy understated his abilities that first day, telling me he could only do pasta and pastries. Anyone who can whip something like that up without a recipe at their side is a pro in my book. On the other hand, my dish is straight out of a heart surgeon's worst nightmares. Piles of fried fish still shimmery with grease and heavily salted and peppered, next to mashed potatoes with an extra pat of butter on top, as if the multiple sticks that went into their preparation weren't enough. It's stick-to-your-ribs, clog-your-arteries goodness.

The tulips are too excitable, it is winter here. Look how white everything is, how quiet, how snowed-in. I am learning peacefulness, lying by myself quietly As the light lies on these white walls, this bed, these hands. I am nobody; I have nothing to do with explosions. I have given my name and my day-clothes up to the nurses And my history to the anesthetist and my body to surgeons. They have propped my head between the pillow and the sheet-cuff Like an eye between two white lids that will not shut. Stupid pupil, it has to take everything in. The nurses pass and pass, they are no trouble, They pass the way gulls pass inland in their white caps, Doing things with their hands, one just the same as another, So it is impossible to tell how many there are. My body is a pebble to them, they tend it as water Tends to the pebbles it must run over, smoothing them gently. They bring me numbness in their bright needles, they bring me sleep. Now I have lost myself I am sick of baggage—— My patent leather overnight case like a black pillbox, My husband and child smiling out of the family photo; Their smiles catch onto my skin, little smiling hooks. I have let things slip, a thirty-year-old cargo boat stubbornly hanging on to my name and address. They have swabbed me clear of my loving associations. Scared and bare on the green plastic-pillowed trolley I watched my teaset, my bureaus of linen, my books Sink out of sight, and the water went over my head. I am a nun now, I have never been so pure. I didn’t want any flowers, I only wanted To lie with my hands turned up and be utterly empty. How free it is, you have no idea how free—— The peacefulness is so big it dazes you, And it asks nothing, a name tag, a few trinkets. It is what the dead close on, finally; I imagine them Shutting their mouths on it, like a Communion tablet. The tulips are too red in the first place, they hurt me. Even through the gift paper I could hear them breathe Lightly, through their white swaddlings, like an awful baby. Their redness talks to my wound, it corresponds. They are subtle : they seem to float, though they weigh me down, Upsetting me with their sudden tongues and their color, A dozen red lead sinkers round my neck. Nobody watched me before, now I am watched. The tulips turn to me, and the window behind me Where once a day the light slowly widens and slowly thins, And I see myself, flat, ridiculous, a cut-paper shadow Between the eye of the sun and the eyes of the tulips, And I have no face, I have wanted to efface myself. The vivid tulips eat my oxygen. Before they came the air was calm enough, Coming and going, breath by breath, without any fuss. Then the tulips filled it up like a loud noise. Now the air snags and eddies round them the way a river Snags and eddies round a sunken rust-red engine. They concentrate my attention, that was happy Playing and resting without committing itself. The walls, also, seem to be warming themselves. The tulips should be behind bars like dangerous animals; They are opening like the mouth of some great African cat, And I am aware of my heart: it opens and closes Its bowl of red blooms out of sheer love of me. The water I taste is warm and salt, like the sea, And comes from a country far away as health. --"Tulips", written 18 March 1961

The schedule took a toll. As residents, we were working as much as one hundred hours a week; though regulations officially capped our hours at eighty-eight, there was always more work to be done. My eyes watered, my head throbbed, I downed energy drinks at two A.M. At work, I could keep it together, but as soon as I walked out of the hospital, the exhaustion would hit me. I staggered through the parking lot, often napping in my car before driving the fifteen minutes home to bed. Not all residents could stand the pressure. One was simply unable to accept blame or responsibility. He was a talented surgeon, but he could not admit when he’d made a mistake. I sat with him one day in the lounge as he begged me to help him save his career. “All you have to do,” I said, “is look me in the eye and say, ‘I’m sorry. What happened was my fault, and I won’t let it happen again.’ ” “But it was the nurse who—” “No. You have to be able to say it and mean it. Try again.” “But—” “No. Say it.” This went on for an hour before I knew he was doomed.

Yet there is dynamism in our house. Day to day, week to week, Cady blossoms: a first grasp, a first smile, a first laugh. Her pediatrician regularly records her growth on charts, tick marks indicating her progress over time. A brightening newness surrounds her. As she sits in my lap smiling, enthralled by my tuneless singing, an incandescence lights the room. Time for me is now double-edged: every day brings me further from the low of my last relapse but closer to the next recurrence—and, eventually, death. Perhaps later than I think, but certainly sooner than I desire. There are, I imagine, two responses to that realization. The most obvious might be an impulse to frantic activity: to “live life to its fullest,” to travel, to dine, to achieve a host of neglected ambitions. Part of the cruelty of cancer, though, is not only that it limits your time; it also limits your energy, vastly reducing the amount you can squeeze into a day. It is a tired hare who now races. And even if I had the energy, I prefer a more tortoiselike approach. I plod, I ponder. Some days, I simply persist. If time dilates when one moves at high speeds, does it contract when one moves barely at all? It must: the days have shortened considerably. With little to distinguish one day from the next, time has begun to feel static. In English, we use the word time in different ways: “The time is two forty-five” versus “I’m going through a tough time.” These days, time feels less like the ticking clock and more like a state of being. Languor settles in. There’s a feeling of openness. As a surgeon, focused on a patient in the OR, I might have found the position of the clock’s hands arbitrary, but I never thought them meaningless. Now the time of day means nothing, the day of the week scarcely more. Medical training is relentlessly future-oriented, all about delayed gratification; you’re always thinking about what you’ll be doing five years down the line. But now I don’t know what I’ll be doing five years down the line. I may be dead. I may not be. I may be healthy. I may be writing. I don't know. And so it's not all that useful to spend time thinking about the future - that is, beyond lunch.

Five years later, Albert Sabin published the results of an alternative polio vaccine he had used in an immunization campaign in Toluca, Mexico, a city of a hundred thousand people, where a polio outbreak was in progress. His was an oral vaccine, easier to administer than Salk’s injected one. It was also a live vaccine, containing weakened but intact poliovirus, and so it could produce not only immunity but also a mild contagious infection that would spread the immunity to others. In just four days, Sabin’s team managed to vaccinate more than 80 percent of the children under the age of eleven—26,000 children in all. It was a blitzkrieg assault. Within weeks, polio had disappeared from the city. This approach, Sabin argued, could be used to eliminate polio from entire countries, even the world. The only leader in the West who took him up on the idea was Fidel Castro. In 1962, Castro’s Committee for the Defense of the Revolution organized 82,366 local committees to carry out a succession of weeklong house-to-house national immunization campaigns using the Sabin vaccine. In 1963, only one case of polio occurred in Cuba.

We do have some strong traditions of community in the United States, but it’s interesting to me that our traditionally patriotic imagery in this country celebrates the individual, the solo flier, independence. We celebrate Independence Day; we don’t celebrate We Desperately Rely on Others Day. Oh, I guess that’s Mother’s Day [laughter]. It does strike me that our great American mythology tends to celebrate separate achievement and separateness, when in fact nobody does anything alone. Nobody in this auditorium is wearing clothing that you made yourself from sheep that you sheared and wool that you spun. It’s ridiculous to imagine that we don’t depend on others for the most ordinary parts of our existence, let alone the more traumatic parts when we need a surgeon or someone to put out the fire in our home. In everyday ways we are a part of a network. I guess it’s a biological way of seeing the world. And I don’t understand the suggestion that interdependence is a weakness. Animals don’t pretend to be independent from others of their kind—I mean no other animal but us. It seems like something we should get over [laughter].

Despite the beauty of our world and the scope of human accomplishment, it is hard not to worry that the forces of chaos will triumph—not merely in the end but in every moment. Our pleasures, however refined or easily acquired, are by their very nature fleeting. They begin to subside the instant they arise, only to be replaced by fresh desires or feelings of discomfort. You can’t get enough of your favorite meal until, in the next moment, you find you are so stuffed as to nearly require the attention of a surgeon—and yet, by some quirk of physics, you still have room for dessert. The pleasure of dessert lasts a few seconds, and then the lingering taste in your mouth must be banished by a drink of water. The warmth of the sun feels wonderful on your skin, but soon it becomes too much of a good thing. A move to the shade brings immediate relief, but after a minute or two, the breeze is just a little too cold. Do you have a sweater in the car? Let’s take a look. Yes, there it is. You’re warm now, but you notice that your sweater has seen better days. Does it make you look carefree or disheveled? Perhaps it is time to go shopping for something new. And so it goes.

The books began to arrive, boxes of them. At first I could not open a single one, but was taken by them as objects. The covers were all so attractive. The jacket copy made each one sound great, blurbs from established literary icons told me why I should like it. The fat books were praised for being fat, the skinny books were praised for being skinny, old writers were great because they were old, young writers were talents because of their youth, every one was startling, ground-breaking, warm, chilling, original, honest and human. I would have found refreshing: "Jo Blow’ s new novel takes on the mundane and leaves it right where it is. The prose is clear and pedestrian. The moves are tried and true. Yet the book is not so alarmingly dishonest. The characters are as wooden as the ones we meet in real life. This is a torturous journey through the banal. The novel is ordinary but not insipid, pointless but not meaningless, savorless but not stale. Jo Blow is a middle aged writer with a family and no discernible special features. He lives in a house and is about as smart as his last novel." So, I opened the first book and I loved it. Actually, I enjoyed reading. The book sucked. But I did enjoy reading it and so I read another and another. I read three in one night and the better part of the next day. All three were sterile, well-constructed, predictable fare. I decided that perhaps I was jaded. I was familiar with novels the way a surgeon is familiar with blood. I would have to contact my innocent, inner self, the part of me that could be amazed by the dull and commonplace.

Because I have already had a long leave I get none on Sundays. So the last Sunday before I go back to the front my father and eldest sister come over to see me. All day we sit in the Soldiers’ Home. Where else could we go? We don’t want to stay in the camp. About midday we go for a stroll on the moors. The hours are a torture; we do not know what to talk about, so we speak of my mother’s illness. It is now definitely cancer, she is already in the hospital and will be operated on shortly. The doctors hope she will recover, but we have never heard of cancer being cured. ”Where is she then?” I ask. ”In the Luisa Hospital,” says my father. ”In which class?” ”Third. We must wait till we know what the operation costs. She wanted to be in the third herself. She said that then she would have some company. And besides it is cheaper.” ”So she is lying there with all those people. If only she could sleep properly.” My father nods. His face is broken and full of furrows. My mother has always been sickly; and though she has only gone to the hospital when she has been compelled to, it has cost a great deal of money, and my father’s life has been practically given up to it. ”If only I knew how much the operation costs,” says he. ”Have you not asked?” ”Not directly, I cannot do that–the surgeon might take it amiss and that would not do; he must operate on mother.” Yes, I think bitterly, that’s how it is with us, and with all poor people. They don’t dare ask the price, but worry themselves dreadfully beforehand about it; but the others, for whom it is not important, they settle the price first as a matter of course. And the doctor does not take it amiss from them. ”The dressings afterwards are so expensive,” says my father. ”Doesn’t the Invalid’s Fund pay anything toward it, then?” I ask. ”Mother has been ill too long.” ”Have you any money at all?” He shakes his head: ”No, but I can do some overtime.” I know. He will stand at his desk folding and pasting and cutting until twelve o’clock at night. At eight o’clock in the evening he will eat some miserable rubbish they get in exchange for their food tickets, then he will take a powder for his headache and work on.

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.

Though it’s best not to be born a chicken at all, it is especially bad luck to be born a cockerel. From the perspective of the poultry farmer, male chickens are useless. They can’t lay eggs, their meat is stringy, and they’re ornery to the hens that do all the hard work of putting food on our tables. Commercial hatcheries tend to treat male chicks like fabric cutoffs or scrap metal: the wasteful but necessary by-product of an industrial process. The sooner they can be disposed of—often they’re ground into animal feed—the better. But a costly problem has vexed egg farmers for millennia: It’s virtually impossible to tell the difference between male and female chickens until they’re four to six weeks old, when they begin to grow distinctive feathers and secondary sex characteristics like the rooster’s comb. Until then, they’re all just indistinguishable fluff balls that have to be housed and fed—at considerable expense. Somehow it took until the 1920s before anyone figured out a solution to this costly dilemma. The momentous discovery was made by a group of Japanese veterinary scientists, who realized that just inside the chick’s rear end there is a constellation of folds, marks, spots, and bumps that to the untrained eye appear arbitrary, but when properly read, can divulge the sex of a day-old bird. When this discovery was unveiled at the 1927 World Poultry Congress in Ottawa, it revolutionized the global hatchery industry and eventually lowered the price of eggs worldwide. The professional chicken sexer, equipped with a skill that took years to master, became one of the most valuable workers in agriculture. The best of the best were graduates of the two-year Zen-Nippon Chick Sexing School, whose standards were so rigorous that only 5 to 10 percent of students received accreditation. But those who did graduate earned as much as five hundred dollars a day and were shuttled around the world from hatchery to hatchery like top-flight business consultants. A diaspora of Japanese chicken sexers spilled across the globe. Chicken sexing is a delicate art, requiring Zen-like concentration and a brain surgeon’s dexterity. The bird is cradled in the left hand and given a gentle squeeze that causes it to evacuate its intestines (too tight and the intestines will turn inside out, killing the bird and rendering its gender irrelevant). With his thumb and forefinger, the sexer flips the bird over and parts a small flap on its hindquarters to expose the cloaca, a tiny vent where both the genitals and anus are situated, and peers deep inside. To do this properly, his fingernails have to be precisely trimmed. In the simple cases—the ones that the sexer can actually explain—he’s looking for a barely perceptible protuberance called the “bead,” about the size of a pinhead. If the bead is convex, the bird is a boy, and gets thrown to the left; concave or flat and it’s a girl, sent down a chute to the right.

The seventh day, and no wind—the burning sun Blister’d and scorch’d, and, stagnant on the sea, They lay like carcasses; and hope was none, Save in the breeze that came not; savagely They glared upon each other—all was done, Water, and wine, and food,—and you might see The longings of the cannibal arise (Although they spoke not) in their wolfish eyes. At length one whisper’d his companion, who Whisper’d another, and thus it went round, And then into a hoarser murmur grew, An ominous, and wild, and desperate sound; And when his comrade’s thought each sufferer knew, ’Twas but his own, suppress’d till now, he found: And out they spoke of lots for flesh and blood, And who should die to be his fellow’s food. But ere they came to this, they that day shared Some leathern caps, and what remain’d of shoes; And then they look’d around them and despair’d, And none to be the sacrifice would choose; At length the lots were torn up, and prepared, But of materials that much shock the Muse— Having no paper, for the want of better, They took by force from Juan Julia’s letter. The lots were made, and mark’d, and mix’d, and handed, In silent horror, and their distribution Lull’d even the savage hunger which demanded, Like the Promethean vulture, this pollution; None in particular had sought or plann’d it, ’Twas nature gnaw’d them to this resolution, By which none were permitted to be neuter— And the lot fell on Juan’s luckless tutor. He but requested to be bled to death: The surgeon had his instruments, and bled Pedrillo, and so gently ebb’d his breath, You hardly could perceive when he was dead. He died as born, a Catholic in faith, Like most in the belief in which they’re bred, And first a little crucifix he kiss’d, And then held out his jugular and wrist. The surgeon, as there was no other fee, Had his first choice of morsels for his pains; But being thirstiest at the moment, he Preferr’d a draught from the fast-flowing veins: Part was divided, part thrown in the sea, And such things as the entrails and the brains Regaled two sharks, who follow’d o’er the billow The sailors ate the rest of poor Pedrillo. The sailors ate him, all save three or four, Who were not quite so fond of animal food; To these was added Juan, who, before Refusing his own spaniel, hardly could Feel now his appetite increased much more; ’Twas not to be expected that he should, Even in extremity of their disaster, Dine with them on his pastor and his master. ’Twas better that he did not; for, in fact, The consequence was awful in the extreme; For they, who were most ravenous in the act, Went raging mad—Lord! how they did blaspheme! And foam and roll, with strange convulsions rack’d, Drinking salt water like a mountain-stream, Tearing, and grinning, howling, screeching, swearing, And, with hyaena-laughter, died despairing. Their numbers were much thinn’d by this infliction, And all the rest were thin enough, Heaven knows; And some of them had lost their recollection, Happier than they who still perceived their woes; But others ponder’d on a new dissection, As if not warn’d sufficiently by those Who had already perish’d, suffering madly, For having used their appetites so sadly. And if Pedrillo’s fate should shocking be, Remember Ugolino condescends To eat the head of his arch-enemy The moment after he politely ends His tale: if foes be food in hell, at sea ’Tis surely fair to dine upon our friends, When shipwreck’s short allowance grows too scanty, Without being much more horrible than Dante.