Surgeons Great Quotes

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.

If you decide to become a veterinary surgeon you will never grow rich but you will have a life of endless interest and variety.

Congress and state legislatures should not tell teachers how to teach, any more than they should tell surgeons how to perform operations.

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.

With savages, the weak in body or mind are soon eliminated; and those that survive commonly exhibit a vigorous state of health. We civilised men, on the other hand, do our utmost to check the process of elimination; we build asylums for the imbecile, the maimed, and the sick; we institute poor-laws; and our medical men exert their utmost skill to save the life of every one to the last moment. There is reason to believe that vaccination has preserved thousands, who from a weak constitution would formerly have succumbed to small-pox. Thus the weak members of civilised societies propagate their kind. No one who has attended to the breeding of domestic animals will doubt that this must be highly injurious to the race of man. It is surprising how soon a want of care, or care wrongly directed, leads to the degeneration of a domestic race; but excepting in the case of man himself, hardly any one is so ignorant as to allow his worst animals to breed. The aid which we feel impelled to give to the helpless is mainly an incidental result of the instinct of sympathy, which was originally acquired as part of the social instincts, but subsequently rendered, in the manner previously indicated, more tender and more widely diffused. Nor could we check our sympathy, if so urged by hard reason, without deterioration in the noblest part of our nature. The surgeon may harden himself whilst performing an operation, for he knows that he is acting for the good of his patient; but if we were intentionally to neglect the weak and helpless, it could only be for a contingent benefit, with a certain and great present evil. Hence we must bear without complaining the undoubtedly bad effects of the weak surviving and propagating their kind; but there appears to be at least one check in steady action, namely the weaker and inferior members of society not marrying so freely as the sound; and this check might be indefinitely increased, though this is more to be hoped for than expected, by the weak in body or mind refraining from marriage.

My mind went back to that picture in the obstetrics book. A cow standing in the middle of a gleaming floor while a sleek veterinary surgeon in a spotless parturition overall inserted his arm to a polite distance. He was relaxed and smiling, the farmer and his helpers were smiling, even the cow was smiling. There was no dirt or blood or sweat anywhere. That man in the picture had just finished an excellent lunch and had moved next door to do a bit of calving just for the sheer pleasure of it, as a kind of dessert. He hadn't crawled shivering from his bed at two o'clock in the morning and bumped over twelve miles of frozen snow, staring sleepily ahead till the lonely farm showed in the headlights. He hadn't climbed half a mile of white fell-side to the doorless barn where his patient lay.

People underestimate the importance of dilligence as a virtue. No doubt it has something to do with how supremely mundane it seems. It is defined as "the constant and earnest effort to accomplish what is undertaken."... Understood, however, as the prerequisite of great accomplishment, diligence stands as one of the most difficult challenges facing any group of people who take on tasks of risk and consequence. It sets a high, seemingly impossible, expectation for performance and human behavior.

The hoopoe said: 'Your heart's congealed like ice; When will you free yourself from cowardice? Since you have such a short time to live here, What difference does it make? What should you fear? The world is filth and sin, and homeless men Must enter it and homeless leave again. They die, as worms, in squalid pain; if we Must perish in this quest, that, certainly, Is better than a life of filth and grief. If this great search is vain, if my belief Is groundless, it is right that I should die. So many errors throng the world - then why Should we not risk this quest? To suffer blame For love is better than a life of shame. No one has reached this goal, so why appeal To those whose blindness claims it is unreal? I'd rather die deceived by dreams than give My heart to home and trade and never live. We've been and heard so much - what have we learned? Not for one moment has the self been spurned; Fools gather round and hinder our release. When will their stale, insistent whining cease? We have no freedom to achieve our goal Until from Self and fools we free the soul. To be admitted past the veil you must Be dead to all the crowd considers just. Once past the veil you understand the Way From which the crowd's glib courtiers blindly stray. If you have any will, leave women's stories, And even if this search for hidden glories Proves blasphemy at last, be sure our quest Is not mere talk but an exacting test. The fruit of love's great tree is poverty; Whoever knows this knows humility. When love has pitched his tent in someone's breast, That man despairs of life and knows no rest. Love's pain will murder him and blandly ask A surgeon's fee for managing the task - The water that he drinks brings pain, his bread Is turned to blood immediately shed; Though he is weak, faint, feebler than an ant, Love forces him to be her combatant; He cannot take one mouthful unaware That he is floundering in a sea of care.

I have visited eighteen government hospitals for veterans. In them are a total of about 50,000 destroyed men -- men who were the pick of the nation eighteen years ago. The very able chief surgeon at the government hospital; at Milwaukee, where there are 3,800 of the living dead, told me that mortality among veterans is three times as great as among those who stayed at home.   Boys

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.

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.

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.

Rivalries are funny things. They waste time and energy. They stir up mean instincts and consume us with petty emotions. Yet in doing so, rivalries also push people to greatness.

Unfortunately, I have dedicated great effort to the task of compiling this ‘sensitive words glossary,’ and I have mastered my filtering skills. I knew which words and sentences had to be cut, and I accepted the cutting as if that was the way it should be. In fact, I will often take it on myself to save time and cut a few words. I call this ‘castrated writing’ -—I am a proactive eunuch, I have already castrated myself before the surgeon raises his scalpel.

Mister God made everything, didn’t he?” There was no point in saying I didn’t really know. I said “Yes.” “Even the dirt and the stars and the animals and the people and the trees and everything, and the pollywogs?” The pollywogs were those little creatures we had seen under the microscope. I said, “Yes, he made everything.” She nodded her agreement. “Does Mister God love us truly?” “Sure thing,” I said. “Mister God loves everything.” “Oh,” she said. “well then, why does he let things get hurt and dead?” Her voice sounded as if she felt she had betrayed a sacred trust, but the question had been thought and it had to be spoken. “I don’t know,” I replied. “There’re a great many things about Mister God, we don’t know about?” “Well then,” she continued, “if we don’t know many things about Mister God, how do we know he loves us?” I could see this was going to be one of those times, but thank goodness she didn’t expect an answer to her question, for she hurried on: “Them pollywogs, I could love them till I bust, but they wouldn’t know, would they? I’m million times bigger than they are and Mister God is million times bigger than me, so how do I know what Mister God does?” She was silent for a little while. Later I thought that at this moment she was taking her last look at babyhood. Then she went on. “Fynn, Mister God doesn’t love us.” She hesitated. “He doesn’t really, you know, only people can love. I love Bossy, but Bossy don’t love me. I love the pollywogs, but they don’t love me. I love you Fynn, and you love me, don’t you?” I tightened my arm about her. “You love me because you are people. I love Mister God truly but he don’t love me.” It sounded to me like a death knell. “Damn and blast,” I thought. “Why does this have to happen to people? Now she’s lost everything.” But I was wrong. She had got both feet planted firmly on the next stepping stone. “No,” she went on, “no, he don’t love me, not like you do, its different, its millions of times bigger.” I must have made some movement or noise, for she levered herself upright and sat on her haunches and giggled. The she launched herself at me and undid my little pang of hurt, cut from the useless spark of jealousy with the delicate sureness of a surgeon. “Fynn, you can love better than any people that ever was, and so can I, cant I? But Mister God is different. You see, Fynn, people can only love outside, and can only kiss outside, but Mister God can love you right inside, and Mister God can kiss you right inside, so its different. Mister God ain’t like us; we are a little bit like Mister God, but not much yet.” It seemed to me to reduce itself to the fact that we were like God because of the similarities, but God was not like us because of our differences. Her inner fires had refined her ideas, and like some alchemist she had turned lead into gold. Gone were all the human definitions of God, like Goodness, Mercy, Love, and Justice, for these were merely props to describe the indescribable. “You see, Fynn, Mister God is different because he can finish things and we cant. I cant finish loving you because I shall be dead millions of years before I can finish, but Mister God can finish loving you, and so its not the same kind of love, is it?

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)

According to my almond-eyed little spy, the great surgeon, may his own liver rot, lied to me when he declared yesterday with a deathhead's grin that the operazione had been perfetta. Well, it had been so in the sense Euler called zero the perfect number. Actually, they ripped me open, cast one horrified look at my decayed fegato, and without touching it sewed me up again.

I know a plastic surgeon who put the gun/ in his mouth, fired, and lived./ Thing of the echo. The brain in its great hall/ banqueting, then besieged.

A good doctor cures the disease, but a great doctor cures the cause.

Boston is a great center of learning. That surgeon was a tantric Buddha,” said Ram in admiration, “The smell of cautery is the finest incense. It sharpens the mind.

Every great advance in music, biology, and astronomy, in literature and technology has involved overturning orthodoxy and doing what the experts said couldn’t or shouldn’t be done.

Unfortunately, not every dead body goes to what might be considered “noble ends.” There is a slim possibility that your donated head will be the head, the head that holds the key to the mysteries of the twenty-first century’s great disease epidemics. But it is equally possible your body will end up being used to train a new crop of Beverly Hills plastic surgeons in the art of the facelift. Or dumped out of a plane to test parachute technology. Your body is donated to science in a very . . . general way. Where your parts go is not up to you.

It is almost impossible for contemporaries to judge the true value of discoveries, or to give the proper position to the men of their own time who make these discoveries. The Surgeon-General of the Public Health Service expected the greatest results to flow from his commission of medical officers, but the conclusions of the Board turned out to be all wrong, while he did not notice the report from his own subordinate, Dr. H. R. Carter, which turned out to be pure gold and was one of the great steps in establishing the true method of the transmission of Yellow Fever.

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.

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.

My blade, sharp. My incision, perfect. A Surgeon Warrior. I can use a knife to take a life or to save one. We were trained to revel in action, to translate perceptions into instant judgements, and these jugements into actions that were at times- irrevocable, monumentous and dreadful. We did all this with lightning speed, in conditions of great stress and in an environment of high tension in which what was expected of "us" was the impossible, yet we delivered just that.

The humourless men seated round the table before me were part of the great industry of personal injury compensation, with its army of suave and accomplished lawyers and assured expert witnesses, rooting in a great trough of insurance premiums.

Physically he was tired and his body relaxed throughout its entire length; his mind was in much the same state, floating free, detached, as though he had taken his old favourite, the tincture of laudanum. He felt no particular anxiety. The attempt must either succeed or fail: he hoped with all his heart for success, but 'all his heart' did not amount to a great deal now that some essential part of its core seemed to have died. Yet on the other hand he felt more able to command success in that it meant no less to him - to command it with a strength that arose not from a fundamental indifference to his own fate but from something resembling it that he could not define; it had a resemblance to despair, but a despair long past, with the horror taken out of it.

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.

Scientifically speaking, though, we still do not really understand why we dream—not in the way we understand why we breathe, eat, and have sex. It remains, as the journal Science noted in its 125th anniversary issue, one of nature’s great unsolved mysteries.

Surgeon General’s Advice to Avoid Influenza Avoid needless crowding. . . . Smother your coughs and sneezes. . . . Your nose not your mouth was made to breathe thru. . . . Remember the 3 Cs, clean mouth, clean skin, and clean clothes. . . . Food will win the war. . . . [H]elp by choosing and chewing your food well. . . . Wash your hands before eating. . . . Don’t let the waste products of digestion accumulate. . . . Avoid tight clothes, tight shoes, tight gloves—seek to make nature your ally not your prisoner. . . . When the air is pure breathe all of it you can—breathe deeply.

The glory of a surgeon is like that of an actor: they live only so long as they are alive, and their talent leaves no trace when they are gone. Actors and surgeons, like great singers too, like the executants who by their performance increase the power of music tenfold, are all the heroes of a moment.

The great man is too often all of a piece; it is the little man that is a bundle of contradictory elements. He is inexhaustible. You never come to the end of the surprises he has in store for you. For my part I would much sooner spend a month on a desert island with a veterinary surgeon than a prime minister.

Dr. Chanter, in his brilliant History of Human Thought in the Twentieth Century, has made the suggestion that only a very small proportion of people are capable of acquiring new ideas of political or social behaviour after they are twenty-five years old. On the other hand, few people become directive in these matters until they are between forty and fifty. Then they prevail for twenty years or more. The conduct of public affairs therefore is necessarily twenty years or more behind the living thought of the times. This is what Dr. Chanter calls the "delayed realisation of ideas". In the less hurried past this had not been of any great importance, but in the violent crises of the Revolutionary Period it became a primary fact. It is evident now that whatever the emergency, however obvious the new problem before our species in the nineteen-twenties, it was necessary for the whole generation that had learned nothing and could learn nothing from the Great War and its sequelae, to die out before any rational handling of world affairs could even begin. The cream of the youth of the war years had been killed; a stratum of men already middle-aged remained in control, whose ideas had already set before the Great War. It was, says Chanter, an inescapable phase. The world of the Frightened Thirties and the Brigand Forties was under the dominion of a generation of unteachable, obstinately obstructive men, blinded men, miseducating, misleading the baffled younger people for completely superseded ends. If they could have had their way, they would have blinded the whole world for ever. But the blinding was inadequate, and by the Fifties all this generation and its teachings and traditions were passing away, like a smoke-screen blown aside. Before a few years had passed it was already incredible that in the twenties and thirties of the twentieth century the whole political life of the world was still running upon the idea of competitive sovereign empires and states. Men of quite outstanding intelligence were still planning and scheming for the "hegemony" of Britain or France or Germany or Japan; they were still moving their armies and navies and air forces and making their combinations and alliances upon the dissolving chess-board of terrestrial reality. Nothing happened as they had planned it; nothing worked out as they desired; but still with a stupefying inertia they persisted. They launched armies, they starved and massacred populations. They were like a veterinary surgeon who suddenly finds he is operating upon a human being, and with a sort of blind helplessness cuts and slashes more and more desperately, according to the best equestrian rules. The history of European diplomacy between 1914 and 1944 seems now so consistent a record of incredible insincerity that it stuns the modern mind. At the time it seemed rational behaviour. It did not seem insincere. The biographical material of the period -- and these governing-class people kept themselves in countenance very largely by writing and reading each other's biographies -- the collected letters, the collected speeches, the sapient observations of the leading figures make tedious reading, but they enable the intelligent student to realise the persistence of small-society values in that swiftly expanding scene. Those values had to die out. There was no other way of escaping from them, and so, slowly and horribly, that phase of the moribund sovereign states concluded.

And yet it has been estimated that in the developed world, 75 per cent of our lifetime medical costs are incurred in the last six months of our lives. This is the price of hope, hope which, by the laws of probability, is so often unrealistic. And thus we often end up inflicting both great suffering on ourselves and unsustainable expense on society.

Silently, I mouthed the word to Demetri: “Epilepsy?” He nodded. I should have known: The kids were being fed a diet of fat, fat, and more fat. Only fat. More than a hundred years ago, physicians discovered that a diet consisting almost entirely of cream, oil, butter, and other fats could greatly decrease or even eliminate seizures in children with epilepsy.

A volunteer nurse for the British Red Cross, she followed her surgeon husband, Sir John Bradford, to northern France at the outbreak of the war and spent the duration of the conflict performing the remarkable yet unsung role of "hospital letter writer" for injured soldiers either too unwell or too illiterate to communicate with family members scattered across the globe.

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.

He was a man who didn’t own a mobile phone, as a matter of principle and stubborn pride. He loved it when people were shocked to discover he had never owned one, never would own one. He truly believed it made him morally superior, which drove Joy bananas because, excuse me, he was not. The way he talked about his “stance” on mobile phones, you would think he were the lone person in the crowd not giving the Nazi salute. Before their retirement he told people, “I don’t need a phone, I’m a tennis coach, not a surgeon. There are no tennis emergencies.” There were so tennis emergencies, and more than once over the years she’d been furious when she couldn’t contact him and she was left in a tricky situation that would have been instantly solved if he’d owned a phone. Also, his principles didn’t prevent him from happily picking up the landline and calling Joy on her mobile when she was at the shops, to ask how much longer she’d be, or to please buy more chili crackers, but when Stan was gone, he was gone, and if she thought about that too much and all it implied she could tap into a great well of rage, so she didn’t think about it.

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?

He watched Richard Gordon lurching down the street until he was out of sight in the shadow from the big trees whose branches dipped down to grow into the ground like roots. What he was thinking as he watched him was not pleasant. It is a mortal sin, he thought, a grave and deadly sin and a great cruelty, and while technically one's religion may permit the ultimate result, I cannot pardon myself. On the other hand, a surgeon cannot desist while operating for fear of hurting the patient. But why must, all operations in life be performed with out an anesthetic? If I had been a better man I would have let him beat me up. It would have been better for him. The poor stupid man. The poor homeless man. I ought to stay with him, but I know that is too much for him to bear. I am ashamed and disgusted with myself and I hate what I have done. It all may turn out badly too. But I must not think about that. I will now return to the anesthetic I have used for seventeen years and will not need much longer. Although it is probably a vice now for which I only invent excuses. Though at least it is a vice for which I am suited. But I wish I could help that poor man who I am wronging.

granted equal knowledge, are there great generals as there are great surgeons, who, when the symptoms exhibited by two cases of illness are identical to the outward eye, nevertheless feel, for some infinitesimal reason, founded perhaps on their experience, but interpreted afresh, that in one case they ought to do this, in another case that; that in one case it is better to operate, in another to wait?

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.

Hence we may, with proper precautions, regard a certain humility as the overall characteristic of medieval art. Of the art; not always of the artists. Self-esteem may arise within any occupation at any period. A chef, a surgeon, or a scholar, may be proud, even to arrogance, of his skill; but his skill is confessedly the means to an end beyond itself, and the status of the skill depends wholly on the dignity or necessity of that end. I think it was then like that with all the arts. Literature exists to teach what is useful, to honour what deserves honour, to appreciate what is delightful. The useful, honourable, and delightful things are superior to it: it exists for their sake; its own use, honour, or delightfulness is derivative from theirs. In that sense the art is humble even when the artists are proud; proud of their proficiency in the art, but not making for the art itself the high Renaissance or Romantic claims. Perhaps they might not all have fully agreed with the statement that poetry is infima inter omnes doctrinas.17 But it awoke no such hurricane of protest as it would awake today. In this great change something has been won and something lost. I take it to be part and parcel of the same great process of Internalisation18 which has turned genius from an attendant daemon into a quality of the mind. Always, century by century, item after item is transferred from the object’s side of the account to the subject’s. And now, in some extreme forms of Behaviourism, the subject himself is discounted as merely subjective; we only think that we think. Having eaten up everything else, he eats himself up too. And where we ‘go from that’ is a dark question.

If a memory or a particular sadness we feel is capable of disappearing, to the point where we no longer notice it, it can also return and sometimes remain there for a long time. There were evenings when, as I crossed the town on my way to the restaurant, I felt so great a pang of longing for Mme de Guermantes that it took my breath away: it was as if part of my breast had been cut out by a skilled anatomist and replaced by an equal part of immaterial suffering, by an equivalent degree of nostalgia and love. And however neat the surgeon’s stitches are, life is rather painful when longing for another person is substituted for the intestines; it seems to occupy more space than they do; it is a constantly felt presence; and then, how utterly unsettling it is to be obliged to think with part of the body! Yet it does somehow make us feel more authentic.

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.

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.

Asking a writer why they like to write {in the theoretical sense of the question} is like asking a person why they breathe. For me, writing is a natural reflex to the beauty, the events, and the people I see around me. As Anais Nin put it, "We write to taste life twice." I live and then I write. The one transfers to the other, for me, in a gentle, necessary way. As prosaic as it sounds, I believe I process by writing. Part of the way I deal with stressful situations, catty people, or great joy or great trials in my own life is by conjuring it onto paper in some way; a journal entry, a blog post, my writing notebook, or my latest story. While I am a fair conversationalist, my real forte is expressing myself in words on paper. If I leave it all chasing round my head like rabbits in a warren, I'm apt to become a bug-bear to live with and my family would not thank me. Some people need counselors. Some people need long, drawn-out phone-calls with a trusted friend. Some people need to go out for a run. I need to get away to a quiet, lonesome corner--preferably on the front steps at gloaming with the North Star trembling against the darkening blue. I need to set my pen fiercely against the page {for at such moments I must be writing--not typing.} and I need to convert the stress or excitement or happiness into something to be shared with another person. The beauty of the relationship between reading and writing is its give-and-take dynamic. For years I gathered and read every book in the near vicinity and absorbed tale upon tale, story upon story, adventures and sagas and dramas and classics. I fed my fancy, my tastes, and my ideas upon good books and thus those aspects of myself grew up to be none too shabby. When I began to employ my fancy, tastes, and ideas in writing my own books, the dawning of a strange and wonderful idea tinged the horizon of thought with blush-rose colors: If I persisted and worked hard and poured myself into the craft, I could create one of those books. One of the heart-books that foster a love of reading and even writing in another person somewhere. I could have a hand in forming another person's mind. A great responsibility and a great privilege that, and one I would love to be a party to. Books can change a person. I am a firm believer in that. I cannot tell you how many sentiments or noble ideas or parts of my own personality are woven from threads of things I've read over the years. I hoard quotations and shadows of quotations and general impressions of books like a tzar of Russia hoards his icy treasures. They make up a large part of who I am. I think it's worth saying again: books can change a person. For better or for worse. As a writer it's my two-edged gift to be able to slay or heal where I will. It's my responsibility to wield that weapon aright and do only good with my words. Or only purposeful cutting. I am not set against the surgeon's method of butchery--the nicking of a person's spirit, the rubbing in of a salty, stinging salve, and the ultimate healing-over of that wound that makes for a healthier person in the end. It's the bitter herbs that heal the best, so now and again you might be called upon to write something with more cayenne than honey about it. But the end must be good. We cannot let the Light fade from our words.

So much not to ask. It was a great art, that one. He had learned to deploy it as skillfully as a surgeon his art, or a poet his. To listen; to nod; to act on what he was told as though he understood it; not to offer criticism or advice, except of the mildest kind, just to show his interest and concern; to puzzle out. To stroke Sophie's hair, and try not to deflect her sadness; to wonder how she had gone on with such a life, with such a sorrow at its heart, and never ask.

Of all the students in Desplein’s hospital, Horace Bianchon was one of those to whom he most warmly attached himself. Before being a house surgeon at the Hotel-Dieu, Horace Bianchon had been a medical student lodging in a squalid boarding house in the Quartier Latin, known as the Maison Vauquer. This poor young man had felt there the gnawing of that burning poverty which is a sort of crucible from which great talents are to emerge as pure and incorruptible as diamonds, which may be subjected to any shock without being crushed.

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.

The two men were slowly pacing the terrace in front of Dr. Raymond’s house. The sun still hung above the western mountain-line, but it shone with a dull red glow that cast no shadows, and all the air was quiet; a sweet breath came from the great wood on the hillside above, and with it, at intervals, the soft murmuring call of the wild doves. Below, in the long lovely valley, the river wound in and out between the lonely hills, and, as the sun hovered and vanished into the west, a faint mist, pure white, began to rise from the hills. Dr. Raymond turned sharply to his friend. “Safe? Of course it is. In itself the operation is a perfectly simple one; any surgeon could do it.

To “trip out,” you have to trip up your frontal lobes. Although creativity arises from the frontal lobes, it almost always takes a backseat to the dominant responsibility of those same lobes: the executive and planning function that aims to get through the day as efficiently as possible. So with time, mental habits take hold that reinforce efficient behavior by forming preferential electrical pathways and networks, like freeways directing the major flow between major cities. What psychedelics are thought to do is to disassemble the freeways temporarily, leaving only a dense and evenly distributed network of roads. This dissolution greatly expands the diversity of connections and, as a result, allows unexpected and original thoughts.

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.

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

One of the most severe and challenging of all pains is said to be phantom limb pain, when the sufferer perceives agonies in a part of the body that has been lost to accident or amputation. It is an obvious irony that one of the greatest pains we feel can be in a part of us that is no longer there. Worse, unlike normal pain, which usually abates as a wound heals, phantom pain may go on for a lifetime. No one can yet explain why. One theory is that in the absence of receiving any signal from the nerve fibers in the missing body part, the brain interprets this as an injury so severe that the cells have died, and so sends out an unending call of distress, like a burglar alarm that won’t turn off. 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.

Lament for the Makaris (Makers) I who enjoyed good health and gladness am overwhelmed now by life’s terrible sickness and enfeebled with infirmity ... how the fear of Death dismays me! our presence here is mere vainglory; the false world is but transitory; the flesh is frail; the Fiend runs free ... how the fear of Death dismays me! the state of man is changeable: now sound, now sick, now blithe, now dull, now manic, now devoid of glee ... how the fear of Death dismays me! no state on earth stands here securely; as the wild wind shakes the willow tree, so wavers this world’s vanity ... how the fear of Death dismays me! Death leads the knights into the field (unarmored under helm and shield) sole Victor of each red mêlée ... how the fear of Death dismays me! that strange, despotic Beast tears from its mother’s breast the babe, full of benignity ... how the fear of Death dismays me! He takes the champion of the hour, the captain of the highest tower, the beautiful damsel in her tower ... how the fear of Death dismays me! He spares no lord for his elegance, nor clerk for his intelligence; His dreadful stroke no man can flee ... how the fear of Death dismays me! artist, magician, scientist, orator, debater, theologist, must all conclude, so too, as we: “how the fear of Death dismays me!” in medicine the most astute sawbones and surgeons all fall mute; they cannot save themselves, or flee ... how the fear of Death dismays me! i see the Makers among the unsaved; the greatest of Poets all go to the grave; He does not spare them their faculty ... how the fear of Death dismays me! i have seen the Monster pitilessly devour our noble Chaucer, poetry’s flower, and Lydgate and Gower (great Trinity!) ... how the fear of Death dismays me! since He has taken my brothers all, i know He will not let me live past the fall; His next prey will be — poor unfortunate me! ... how the fear of Death dismays me! there is no remedy for Death; we all must prepare to relinquish breath so that after we die, we may be set free from “the fear of Death dismays me

Bread!--Yes, I think it might honestly be called bread that Walter Drake had ministered. It had not been free from chalk or potatoes: bits of shell and peel might have been found in it, with an occasional bit of dirt, and a hair or two; yes, even a little alum, and that is _bad_, because it tends to destroy, not satisfy the hunger. There was sawdust in it, and parchment-dust, and lumber-dust; it was ill salted, badly baked, sad; sometimes it was blue-moldy, and sometimes even maggoty; but the mass of it was honest flour, and those who did not recoil from the look of it, or recognize the presence of the variety of foreign matter, could live upon it, in a sense, up to a certain pitch of life. But a great deal of it was not of his baking at all--he had been merely the distributor--crumbling down other bakers' loaves and making them up again in his own shapes. In his declining years, however, he had been really beginning to learn the business. Only, in his congregation were many who not merely preferred bad bread of certain kinds, but were incapable of digesting any of high quality.

She was not enjoying her match half so much as Edmund had enjoyed his; not because she had any doubt about hitting the apple but because Susan was so tender-hearted that she almost hated to beat someone who had been beaten already. The Dwarf watched her keenly as she drew the shaft to her ear. A moment later, with a little soft thump which they could all hear in that quiet place, the apple fell to the grass with Susan’s arrow in it. “Oh, well done, Su,” shouted the other children. “It wasn’t really any better than yours,” said Susan to the Dwarf. “I think there was a tiny breath of wind as you shot.” “No, there wasn’t,” said Trumpkin. “Don’t tell me. I know when I am fairly beaten. I won’t even say that the scar of my last wound catches me a bit when I get my arm well back--” “Oh, are you wounded?” asked Lucy. “Do let me look.” “It’s not a sight for little girls,” began Trumpkin, but then he suddenly checked himself. “There I go talking like a fool again,” he said. “I suppose you’re as likely to be a great surgeon as your brother was to be a great swordsman or your sister to be a great archer.

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.

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].

Albert Einstein once said, “Most people say that it is the intellect which makes a great scientist. They are wrong: it is character.” . . . On one level, science is a collection of facts about the world, and adding to that collection does require discoveries. But science is also something larger. It’s a mindset, a process, a way of reasoning about the world that allows us to expose wishful thinking and biases and replace them with deeper, more reliable truths. Considering how vast the world is, there’s no way to check every reported experiment yourself and personally verify it. At some point, you have to trust other people’s claims—which means those people need to be honorable, need to be worthy of trusting. Moreover, science is an inherently social process. Results cannot be kept secret; they have to be verified by the wider community, or science simply doesn’t work. And given what a deeply social process science is, acts that damage society by shortchanging human rights or ignoring human dignity will almost always cost you in the end—by destroying people’s trust in science and even undermining the very conditions that make science possible.

Looking back on all my interviews for this book, how many times in how many different contexts did I hear about the vital importance of having a caring adult or mentor in every young person’s life? How many times did I hear about the value of having a coach—whether you are applying for a job for the first time at Walmart or running Walmart? How many times did I hear people stressing the importance of self-motivation and practice and taking ownership of your own career or education as the real differentiators for success? How interesting was it to learn that the highest-paying jobs in the future will be stempathy jobs—jobs that combine strong science and technology skills with the ability to empathize with another human being? How ironic was it to learn that something as simple as a chicken coop or the basic planting of trees and gardens could be the most important thing we do to stabilize parts of the World of Disorder? Who ever would have thought it would become a national security and personal security imperative for all of us to scale the Golden Rule further and wider than ever? And who can deny that when individuals get so super-empowered and interdependent at the same time, it becomes more vital than ever to be able to look into the face of your neighbor or the stranger or the refugee or the migrant and see in that person a brother or sister? Who can ignore the fact that the key to Tunisia’s success in the Arab Spring was that it had a little bit more “civil society” than any other Arab country—not cell phones or Facebook friends? How many times and in how many different contexts did people mention to me the word “trust” between two human beings as the true enabler of all good things? And whoever thought that the key to building a healthy community would be a dining room table? That’s why I wasn’t surprised that when I asked Surgeon General Murthy what was the biggest disease in America today, without hesitation he answered: “It’s not cancer. It’s not heart disease. It’s isolation. It is the pronounced isolation that so many people are experiencing that is the great pathology of our lives today.” How ironic. We are the most technologically connected generation in human history—and yet more people feel more isolated than ever. This only reinforces Murthy’s earlier point—that the connections that matter most, and are in most short supply today, are the human-to-human ones.

The curate called everything Helen's. He had a great contempt for the spirit of men who marry rich wives and then lord it over their money, as if they had done a fine thing in get- ting hold of it, and the wife had been but keeping it from its rightful owner. They do not know what a confession their whole bear- ing is, that but for their wives' money, they would be the merest, poorest nobodies. So small are they that even that suffices to make them feel big ! But Helen did not like it, especially when he would ask her if he might have this or that, or do so and so. Any com- mon man who heard him would have thought him afraid of his wife; but a large-hearted woman would at once have understood, as did Helen, that it came all of his fine sense of truth, and reality, and obligation. Still Helen would have had him forget all such matters in con- nection with her. They were one beyond obligation. She had given him herself, and what were bank-notes after that ? But he thought of her always as an angel who had taken him in, to comfort, and bless, and cherish him with love, that he might the better do the work of his God and hers ; therefore his obligation to her was his glory.

I did not turn up at Saint-Loup’s restaurant in the same frame of mind every evening. If a memory or a particular sadness we feel is capable of disappearing, to the point where we no longer notice it, it can also return and sometimes remain there for a long time. There were evenings when, as I crossed the town on my way to the restaurant, I felt so great a pang of longing for Mme de Guermantes that it took my breath away: it was as if part of my breast had been cut out by a skilled anatomist and replaced by an equal part of immaterial suffering, by an equivalent degree of nostalgia and love. And, however neat the surgeon’s stitches are, life is rather painful when longing for another person is substituted for the intestines; it seems to occupy more space than they do; it is a constantly felt presence; and then how utterly unsettling it is to be obliged to think with part of the body! Yet it does somehow make us feel more authentic. The whisper of a breeze makes us sigh with oppression, but also with languor. I would look up at the sky. If it was cloudless, I would think: “Perhaps she has gone to the country; she’s looking at the same stars, and perhaps when I arrive at the restaurant Robert will say to me: ‘Good news. I’ve just heard from my aunt. She wants to see you. She’s coming down here.’ ” My

Gentlemen,” the king called out, “and ladies, First Meal is getting cold.” Which was the cue for everyone to head back to the dining room and actually eat what had been only studiously ignored up until now. With Payne safe and at home, appetites were free to roam once more . . . although as God was his witness he was not going to think about what the hell that surgeon and his sister were no doubt about to get into. As he groaned, Jane tightened her arm around his waist. “Are you all right?” He glanced down at his shellan. “I don’t think my sister is old enough to have sex.” “V, she’s the same age you are.” He frowned for a moment. Was she? Or had he been born first? Yeah, only one place to go for the answer to that. Shit, he hadn’t even thought of his mother in all this. And now that he was . . . he had absolutely no desire or interest to pop up there and announce that Payne was doing great, fuck you very much. Nope. If the Scribe Virgin wanted to keep tabs on what her “children” were up to? She could look into those fakakta seeing bowls she liked so much. He kissed his shellan. “I don’t care what the calendar says or about the birth order. That’s my baby sister, and she’s never going to be old enough to . . . ‘um, yeah.’ ” Jane laughed and retucked herself under his arm. “You are a very sweet male.” “Nah.” “Yeah.” Leading her into the dining room and over to the table, he gallantly pulled her chair out for her, and then he sat to her left so that she was at his dagger hand. - Vishous & Jane

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.

That must be my surgeon coming aboard. You will like him; a reading man too, most amazing learned; a full-blown physician into the bargain, and my particular friend. But I must tell you this, Yorke; he is wealthy – ‘ In point of fact Captain Aubrey had little idea of his surgeon’s fortune, apart from knowing that he owned a good deal of hilly land in Catalonia with a tumbledown castle on it. But Stephen had done pretty well out of the Mauritius campaign; his manner of living was Spartan – one suit of clothes every five years and perhaps a couple of shirts – and apart from books he had no visible expenses at all. Jack was no Macchiavel, but he did know that to the rich it should be given; that capital possessed a mystical significance; that even the most perfectly disinterested respected it and its owner; and that although a naval surgeon was ordinarily a person of no great consequence, the same man moved into quite a different category the moment he was endowed with comfortable private means. In short, that whereas an ordinary surgeon, living on his pay, might not readily be indulged in room for exotic livestock, an imperfectly- preserved giant squid, and several tons of natural specimens, in a stranger’s ship, a wealthy natural philosopher might meet with more consideration; and Jack knew how Stephen prized the collection he had made during their arduous voyage. ‘ – he is wealthy, and he only comes with me because of the opportunities for natural philosophy; though he is a first-rate surgeon, too, and we are lucky to have him. But this voyage the opportunities have been prodigious, and he has turned the Leopard into a down-right Ark. Most of the Desolation creatures are stuffed or pickled but there are some from New Holland that skip and bound about: I hope you are not too crowded in La Fleche?

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.

He is thinking if there is any way by which he can explain just how and what it is he suffers. He is wondering if there is anyone in the whole wide world with a heart big enough to comprehend what it is he wants to tell. There are so many little things to say first, and will anyone have the patience to listen to the end? Suffering is no one thing: it is composed of invisible atoms infinite in number, each one a universe in the great macrocosm of pain. He could begin anywhere, with anything, with a silly word even, a word such as flapdoodle, and he could erect a cathedral of staggering dimensions which would not occupy so much as a pocket in the crevice of the tiniest atom. To say nothing of the surrounding terrain, of the circumambient aura, of things like coast lines, volcanic craters, fathomless lagoons, pearl studs and tons of chicken feathers. The musician has an instrument to work with, the surgeon has his implements, the architect his plans, the general his pawns, the idiot his idiocy, but the one who is suffering has everything in the universe except relief. He can run out to the periphery a trillion times but the circle never straightens out. He knows every diameter but no egress. Every exit is closed, whether it be an inch away or a billion light years distant. You crash a gate made of arms and legs only to get a butt blow behind the ear. You pick up and run on bloody, sawed-off stumps, only to fall into an endless ravine. You sit in the very center of emptiness, whimpering inaudibly, and the stars blink at you. You fall into a coma, and just when you think you've found your way back to the womb they come after you with pick and shovel, with acetylene torches. Even if you found the place of death they would find a way to blow you out of it. You know time in all its curves and infidelities. You have lived longer than it takes to grow all the countless separate parts of a thousand new universes. You have watched them grow and fall apart again. And you are still intact, like a piece of music which goes on being played forever. The instruments wear out, and the players too, but the notes are eternal, and you are made of nothing but invisible notes which even the faintest zephyr can shake a tune out of.

• 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.

Surgeons report that after a great victory, for instance, the wounds of the soldiers, as has been noticed in many similar instances, heal much more rapidly than the wounds of the soldiers in the defeated army, showing that the mental exhilaration, which accompanies the consciousness of victory, is a stimulant, a tonic, while conversely the despondency, which accompanies defeat, is also a physical depressant.

never hesitated. I mean, I always suspected I was a bit of a psychopath, but as we all know...psychopaths aren’t necessarily monsters. They’re just...unemotional. Detached. Able to become such great surgeons, CEOs, lawyers...even profilers for the FBI...

psychopaths aren’t necessarily monsters. They’re just...unemotional. Detached. Able to become such great surgeons, CEOs, lawyers...even profilers for the FBI...

A man called Thomson went to a surgeon and asked him to castrate him. The surgeon demurred, but when the man persisted and argued he eventually agreed, and took him into hospital. The morning after the operation Thomson woke up in great discomfort. He noticed that the man in the next bed was in pain and was groaning. He leant towards him over the side of the bed. “What did they do to you,” he called. The man replied: “I’ve been circumcised.” “Good Lord,” Thomson exclaimed, “that’s the word I couldn’t remember when the surgeon asked me what I wanted done.

With only their eyes for tools, through no fault of their own, naturalists were stuck at the surface level of biology for thousands of years. Although dissection allowed some progress in understanding large-scale internal anatomy, it too was often misleading. For example, arteries and veins could be seen in dissected animal bodies. Yet the fact that they connected to each other through tiny capillaries in a closed circulatory system escaped even the great Roman surgeon Galen, who thought blood was pumped out by the heart to sink into the tissues, much as water in irrigation canals in his day sank into the ground. His mistaken ideas were taught for thirteen hundred years.

In the days of his health and strength, Owen would have confidently refuted this picture of hopelessness, but he was tired and ill. His room now remained unheated most of the time and he was racked with coughs and ominous chest pains. In the long, miserable hours when sleep would not come, he found his eyes turning to that mouldy stain upon the wall, and he began to harbour dark thoughts. What was all this talk of the soul anyway? It could not be weighed or measured; die surgeon never discovered it. In any case it could not grant insight into stock market prices, could create no visible wealth. Indeed, there were brilliant people with titles like 'professor', people whose name trailed endless letters, who even after the most rigorous deliberations, most elegant applications of logic, doubted that such a thing as the soul existed at all. And after all, was not The City full of Smugsbys who possessed no discernible soul, yet lived after their fashion? The Great Mystery was nothing to them. They did not seek the Great Answer; they were not aware that there had ever been a Great Question! What business had he, a starving wretch, in seeking to nurture through his writings an invisible, odourless, weightless abstraction of dubious commercial value, when the very process merely drew attention away from the 'real' business of getting on? "The White Road

Donaldson's Hospital in Edinburgh, of which great things were expected, fails to excite even a passing remark; while the High School, the fragments of the National Monument, Dugald Stewart's Monument, Surgeon's Hall, and the Institution on the Mound, continue to illuminate their respective localities with the light of truth and beauty, giving to our northern metropolis an air of refinement which no other city in the kingdom possesses.

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

Chinese surgeons are the best in the world cos they’re always dealing with kids with four legs or two heads in China, but Chinese doctors are rubbish when it comes to getting rid of a rash or a cold. There’s a Chinese medicine shop round the corner from where I live and they give you twigs and leaves to eat if you have some eczema or flu. This shows the Chinese are not as up-to-date with everyday illnesses, yet they are great when it comes to removing an extra head.

A great deal of the American medical community’s resources is geared to addressing the cosmetic needs of both women and men whom fear that by showing the deleterious effects of aging their marital relationship is in jeopardy. The most ethical plastic surgeons decline to perform impetuous work; the less ethical, but often the wealthiest professionals, perform all requested work irrespective of the long-term viability of the services rendered. The plastic surgeon’s sales pitch is predictable: everyone can receive the face that he or she can afford.

This last thought took such possession of her conscience as to give her no peace, and by three o’clock of a fine December day Miss Stafford might have been seen stepping from a car at the corner of Kirkland Row, a short cross street that separated two great thoroughfares and. seemed to be almost entirely given up to physicians. At least, as Miss Stafford gazed at the doors she was amazed to see rows of placards announcing the office hours of any number of “Physicians and Surgeons.” “Dear me!” she said, as she passed the dozenth announcement of the kind. “It can’t be that any of the people on this street are ever ill; or else they all are, always. I wonder why the doctors huddle together in this way? So that if the one sought happens to be out, the luck may chance to fall on one of the others, I suppose.

The truth is, that as long as men reject Christ and do not savingly believe in him, however they may be awakened, and however strict and conscientious and laborious they may be in religion, they have the wrath of God abiding on them, they are his enemies and the children of the devil (as the Scripture calls all that be not savingly converted, Matt. 13:38; 1 John 3:10), and it is uncertain whether they shall ever obtain mercy. God is under no obligation to show them mercy, nor will he be if they fast and pray and cry never so much; and they are then especially provoking God under those terrors, in that they stand it out against Christ, and will not accept of an offered Savior, though they see so much need of him; and seeing this is the truth, they should be told so, that they may be sensible what their case indeed be. To blame a minister for thus declaring the truth to those who are under awakenings, and not immediately administering comfort to them, is like blaming a surgeon because, when he has begun to thrust in his lance, whereby he has already put his patient to great pain, and he shrieks and cries out with anguish, he is so cruel that he will not stay his hand, but goes on to thrust it in further, until he comes to the core of the wound. Such a compassionate physician, who, as soon as his patient began to flinch, should withdraw his hand and go about immediately to apply a plaster to skin over the wound and leave the core untouched, would be one that would heal the hurt slightly, crying "peace, peace," when there is no peace. Indeed

The Word of God is nothing short of a Surgeon’s scalpel which will lay you bare and show the real you

Who are we, the people who have ADHD? We are the problem kid who drives his parents crazy by being totally disorganized, unable to follow through on anything, incapable of cleaning up a room, or washing dishes, or performing just about any assigned task; the one who is forever interrupting, making excuses for work not done, and generally functioning far below potential in most areas. We are the kid who gets daily lectures on how we’re squandering our talent, wasting the golden opportunity that our innate ability gives us to do well, and failing to make good use of all that our parents have provided. We are also sometimes the talented executive who keeps falling short due to missed deadlines, forgotten obligations, social faux pas, and blown opportunities. Too often we are the addicts, the misfits, the unemployed, and the criminals who are just one diagnosis and treatment plan away from turning it all around. We are the people Marlon Brando spoke for in the classic 1954 film On the Waterfront when he said, “I coulda been a contender.” So many of us coulda been contenders, and shoulda been for sure. But then, we can also make good. Can we ever! We are the seemingly tuned-out meeting participant who comes out of nowhere to provide the fresh idea that saves the day. Frequently, we are the “underachieving” child whose talent blooms with the right kind of help and finds incredible success after a checkered educational record. We are the contenders and the winners. We are also imaginative and dynamic teachers, preachers, circus clowns, and stand-up comics, Navy SEALs or Army Rangers, inventors, tinkerers, and trend setters. Among us there are self-made millionaires and billionaires; Pulitzer and Nobel prize winners; Academy, Tony, Emmy, and Grammy award winners; topflight trial attorneys, brain surgeons, traders on the commodities exchange, and investment bankers. And we are often entrepreneurs. We are entrepreneurs ourselves, and the great majority of the adult patients we see for ADHD are or aspire to be entrepreneurs too. The owner and operator of an entrepreneurial support company called Strategic Coach, a man named Dan Sullivan (who also has ADHD!), estimates that at least 50 percent of his clients have ADHD as well.

Elder Oaks describes his colleague as a 'spiritually sensitive man of great faith who does not let his remarkable worldly knowledge deflect him from the impressions of the Spirit or from his insights of the gospel. His spiritual influence is that everyone becomes more spiritual in his presence. When he comes into the room, you remember who You are (my emphasis). He is a radiant spiritual being.' Quote from Russell M. Nelson: Father, Surgeon, Apostle

The 21-Day Habit theory was first presented by Maxwell Maltz, a plastic surgeon in the 1960s. He noticed that his patients who had a face operation would need 21 days to get used to seeing their new face.

30th. No trade yet; but our Traders came on board to-day and informed us the people had burnt four towns, so that to-morrow we expect Slaves off. “31st. Fair weather, but no trade yet; we see each night towns burning, but we hear the Sestro men are many of them killed by the inland Negroes, so that we fear this war will be unsuccessful. “The 2d of January. Last night we saw a prodigious fire break out about eleven o’clock, and this morning saw the town of Sestro burnt down to the ground, (it contained some hundred houses) so that we find their enemies are too hard for them at present; consequently our trade spoiled here, so that about seven o’clock we weighed anchor, as did also the three other vessels, to proceed lower down.” Here follows another relation taken from an original Journal of a Surgeon who sailed out of New-York, “Being on the Coast of Guinea at a place called Basalia, the Commander of the vessel, according to custom, sent a person on shore, with a present to the King, acquainting him with his arrival, and informing him they wanted a cargo of Slaves. The King promised to furnish them, and in order to do it, set out to war against his enemies; designing also to surprise some town, and take all the people prisoners: Some time after, the King sent them word, he had not yet met with the desired success, having been twice repulsed in attempting to break up two towns; but that he still hoped to procure a number of Slaves for them, and in this design persisted,

It’s incredibly hard to make people care. It’s also difficult to convince them they’ve been living inside a medical system that secretly keeps them sick to farm them for money. Instead, set an example. Get metabolically healthy, look great, and live a more active life.

Stephen Maturin sipped his scalding coffee, the right Mocha berry, brought back from Arabia Felix in the pilgrim dhows, and considered. He was naturally a reserved and even a secretive man: his illegitimate birth (his father was an Irish officer in the service of His Most Catholic Majesty, his mother a Catalan lady) had to do with this; his activities in the cause of the liberation of Ireland had more; and his voluntary, gratuitous alliance with naval intelligence, undertaken with the sole aim of helping to defeat Bonaparte, whom he loathed with all his heart as a vile tyrant, a wicked cruel vulgar man, a destroyer of freedom and of nations, and as a betrayor of all that was good in the Revolution, had even more. Yet the power of keeping his mouth shut was innate; so perhaps was the integrity that made him one of the Admiralty’s most valued secret agents, particularly in Catalonia – a calling very well disguised by his also being an active naval surgeon, as well as a natural philosopher of international renown, one whose name was familiar to all those who cared deeply about the extinct solitaire of Rodriguez (close cousin to the dodo), the great land tortoise Testudo aubreii of the Indian Ocean, or the habits of the African aardvark. Excellent agent though he was, he was burdened with a heart, a loving heart that had very nearly broken for a woman named Diana Villiers: she had preferred an American to him – a natural preference, since Mr. Johnson was a fine upstanding witty intelligent man, and very rich, whereas Stephen was a plain bastard at the best, sallow with odd pale eyes, sparse hair and meager limbs, and rather poor.

Several years ago, I realized that I didn’t want to spend all my life in medicine. It had me in a sort of spiritual box, like a plant whose roots are getting crowded. I felt I wasn’t growing. So I promised myself that I would quit while I still had the energy to get involved in something new. There’s nothing wrong with medicine. There’s more paperwork, more lawsuits, less understanding between doctors and patients. But it’s still a great business. But not for me - not any longer.

This was typical Trevor, refusing to reach out for help. “The marines provide guard services at all the navy hospitals. My little brother guards the office of the surgeon general. Since you’re conducting this study at the behest of the surgeon general, I expect the military might provide security.” For the first time, Trevor perked up. “They would do that?” “It couldn’t hurt to ask. Wait . . . I’ll ask. I don’t want you making a hash out of this.” A ghost of a smile hovered on his mouth. “Are you suggesting you’re better at dealing with people than I am?” She stood and shook out her skirt. “Trevor, on any given day you might beat me in trigonometry. Or chemistry. Or a footrace. On very rare occasions you will beat me in a spelling contest. But you will never, not even on your best day, beat me in the category of basic human warmth.” Amusement lurked in his dark eyes. “You’re probably right.” He stood and, to her great surprise, took her hand and kissed the back of it. “Thanks, Kate.” Then he let go of her hand and sauntered off in that long-legged stride of his. The spot where his lips had touched her hand tingled during the entire walk home.

Writing, as most art, is considered to be essentially superfluous. Who is an artist before a surgeon? Or a scientist? But the fact that tyrants and political forces of every age have been threatened by art again and again, condemned it as degenerate or poisonous, and have silenced, brutalized, or murdered artists because of their work only serves to illustrate how significant art is, that it is our one greatest power. I would even go so far as to say that the tyrant ‘understands’ art more than the devotee, for the latter is generally too ‘pious’ and adoring, almost like a simple-minded believer overwrought by faith who simply loves and finds everything ‘great,’ whereas the former suffers the transformative threat of art more, is even endangered by it, hence their terror.

It was during his career as a military surgeon that he published his most celebrated essay on “The conservation of force”, where “force” had the meaning, then common, of “energy”. There is no doubt that this essay imparted a very great impulse to the problem of understanding the role and meaning of this basic principle of physics. In particular, Helmholtz clarified the assumptions that have to be made about a mechanical system in order to ensure that energy is conserved. As a result of his work the principle of conservation of energy became the unfailing guide to organizing physical facts and theories in a clear scheme.

I finally found a place near the North Railroad Station, a workers' district. It was a bombed out building, barely repaired. We moved in. Father came from Dorohoi, we were again together. It took quite a while to get Mother in better shape. She needed a skin graft, a new procedure at that time. It was innovative surgery. For a long time she had difficulty eating, since the lip had not healed properly. I remember with great gratitude the kindly Jewish surgeon, Dr. Brochovici, a man of real compassion and of great capability. In all this hardship, we had some luck.

reached beneath the folds of her cloak and brought forth a lamp, a delicate thing hanging on a slender chain. “To light your way in the darkness,” I heard her murmur. She let the chain slide through her fingers, and the lantern dropped gently into the pit on top of the other things. Then she raised her voice and said, “Her name was Ismene. Let it be known. She was a sister of our familia. A gladiatrix of House Achillea. She fought as we fight, with bravery and with skill. Five days ago, she fought to win honor in a match with a warrior maid of the House Amazona. She won, but Ismene was grievously wounded in that fight. Our surgeons did what they could for her. Last night the goddess Nemesis, she of the midnight brow, in her great wisdom called Ismene to the realm of heroes and sent forth Mercury to guide her there. She feasts now in the halls of Dis, she spars with Minerva, and she waits for all of us to join her there, and we mourn her absence even as others have this very day joined our ranks here.

Good surgeons can do any operation. Great surgeons take care of their own complications.

A more concrete example happened in 1984, when a surgeon at Loma Linda University in California attempted to replace the defective heart of “Baby Fae” with the heart of a baboon. Not surprisingly, the poor baby died a few days later due to immune rejection. An Australian radio crew interviewed the surgeon, Dr. Leonard Bailey, and asked him why he didn’t use a more closely related primate, such as a chimpanzee, and avoid the possibility of immune rejection, given the baboon’s great evolutionary distance from humans. Bailey said, “Er, I find that difficult to answer. You see, I don’t believe in evolution.” If Bailey had performed the same experiment in any other medical institution except Loma Linda (which is run by the creationist Seventh-Day Adventist Church), his experiments would be labeled dangerous and unethical, and he would have been sued for malpractice and his medical license revoked

Nearly every doctor I worked with dreamed as a child about curing disease and worked like crazy to become a doctor. They studied tirelessly to learn science, entered medical school with idealistic visions, and became the pride of their family. They entered residency with hundreds of thousands of dollars of student loan debt and initially saw the chronic sleep deprivation and verbal abuse by their superiors as integral parts of the experience—because “great achievement is born of great sacrifice.” But almost universally among doctors I have met, this idealism eventually turns to cynicism. My colleagues in residency talked often about questioning their sanity, of wondering whether this was all worth it. I spoke with successful surgeons who’d drafted their resignation letters dozens of times. Another had a recurring daydream of leaving everything behind and becoming a baker. Many of my supervising physicians were desperate to spend more time with their children. I witnessed more than one tearful breakdown in the operating room when surgical cases were delayed and led to yet another missed bedtime for their kids. Several had dealt with suicidal depression. I understood why doctors had the highest burnout and suicide rate of any profession. Inevitably, these conversations led to an insight that I believe is whispered by doctors in every hospital in America: they feel trapped inside a broken system.

The bird life, was, as ever, of great interest to ship’s surgeon McCormick. On seeing hovering over the ship what he believed to be a new species of Lestris, or Arctic Yager, described by Audubon, the great American bird illustrator, as an ‘indefatigable teaser of the smaller gulls’, he took a pot-shot at it. His shot failed to despatch the bird cleanly and, after descending near the deck, it recovered and flew away with one leg broken. McCormick, unusually, felt compelled to justify himself: ‘For notwithstanding that my duties as ornithologist compel me to take the lives of these most beautiful and interesting creatures . . . I never do so without a sharp sting of pain and qualm of conscience, so fond am I of all the feathered race.’ So fond, indeed, that on the same night he recorded that ‘Between midnight and one a.m. I succeeded in adding two more of the elegant white petrel to my collection, one falling dead on the quarter-deck and the other on the gun-room skylight . . . a third I shot . . . fell overboard into the sea.