Surgeons Life Quotes

What if the kid you bullied at school, grew up, and turned out to be the only surgeon who could save your life?

He kissed me with color, with drumbeat, and a surgeon’s precision. He kissed me with who he was, the sum of his life—and it was all encompassing. I wondered what I kissed him with since I was only broken parts.

We always hope for the easy fix: the one simple change that will erase a problem in a stroke. But few things in life work this way. Instead, success requires making a hundred small steps go right - one after the other, no slipups, no goofs, everyone pitching in.

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

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

I’m not the only kid who grew up this way surrounded by people who used to say that rhyme about sticks and stones as if broken bones hurt more than the names we got called and we got called them all so we grew up believing no one would ever fall in love with us that we’d be lonely forever that we’d never meet someone to make us feel like the sun was something they built for us in their tool shed so broken heart strings bled the blues as we tried to empty ourselves so we would feel nothing don’t tell me that hurts less than a broken bone that an ingrown life is something surgeons can cut away that there’s no way for it to metastasize it does

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

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

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 think that is the very definition of a family: a group of individuals, bound by the essence of love, who share a life together and yet maintain their unique individuality.

This malady which Swann’s love had become had so proliferated, was so closely interwoven with all his habits, with all his actions, with his thoughts, his health, his sleep, his life, even with what he hoped for after his death, was so utterly inseparable from him, that it would have been impossible to eradicate it without almost entirely destroying him; as surgeons say, his love was no longer operable.

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

But you raised a ruckus about and threatened to perform a Julius Caesarian on anybody on anybody who calls April the cruelest month- I was Damn born out of the loins of my father in the spring of April, you claimed. Surgeon, you stood up for the month of buds and bitches like a true Kuon Kunos

Usury is the cancer of the world, which only the surgeon's knife of fascism can cut out of the life of the nations.

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

At times it felt like I was killing myself. And yet the only thing I could recall at that moment was how much fun it had been, and how wonderful it was to do this for a living.

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

No matter how much you try to maintain order in your life, no matter how careful you are to guard against mistakes, against imperfections, there is always some smudge, some flaw, lurking out of sight. Waiting to surprise you.

Betterment is perpetual labor. The world is chaotic, disorganized, and vexing, and medicine is nowhere spared that reality. To complicate matters, we in medicine are also only human ourselves. We are distractible, weak, and given to our own concerns. Yet still, to live as a doctor is to live so that one's life is bound up in others' and in science and in the messy, complicated connection between the two It is to live a life of responsibility. The question then, is not whether one accepts the responsibility. Just by doing this work, one has. The question is, having accepted the responsibility, how one does such work well.

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.

Why do we always think our pain will be less if we can make others suffer more?

Being able to switch between two languages, the researchers concluded, improves a person’s ability to maintain focus and attention.

According to the surgeon general, obesity today is officially an epidemic; it is arguably the most pressing public health problem we face, costing the health care system an estimated $90 billion a year. Three of every five Americans are overweight; one of every five is obese. The disease formerly known as adult-onset diabetes has had to be renamed Type II diabetes since it now occurs so frequently in children. A recent study in the Journal of the American Medical Association predicts that a child born in 2000 has a one-in-three chance of developing diabetes. (An African American child's chances are two in five.) Because of diabetes and all the other health problems that accompany obesity, today's children may turn out to be the first generation of Americans whose life expectancy will actually be shorter than that of their parents. The problem is not limited to America: The United Nations reported that in 2000 the number of people suffering from overnutrition--a billion--had officially surpassed the number suffering from malnutrition--800 million.

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.

Sure, a surgeon can stand to look at a mutilated body," Crawford said, crumpling his cup and stepping on the pedal of the covered wastebasket. "But I don't think a doctor can stand to see a life wasted.

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

Surgeons are a singular brotherhood, Adam. To us, people aren't sacred beings crafted in the Almighty's image, no, people are joints of meat; diseased, leathery meat, yes, but meat ready for the skewer & the spit." He mimicked my usual voice, very well. "'But why *me*, Henry, are we not friends?' Well, Adam, even friends are made out of meat.

When you speak of your neighbour, look upon your tongue as a sharp razor in the surgeon’s hand, about to cut nerves and tendons; it should be used so carefully, as to insure that no particle more or less than the truth be said.

I offer you a second way of approaching the moment where everything in your life just stops, this one from the actor Robert Duvall: "I exist very nicely between the words 'action' and 'cut.'" And even a third way: "It doesn't present as pain," I once heard an oncological surgeon say of cancer.

The possibilities and probabilities are all we have to work with in medicine, though. What we are drawn to in this imperfect science, what we in fact covet in our way, is the alterable moment-the fragile but crystalline opportunity for one's know-how, ability, or just gut instinct to change the course of another's life for the better.

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

The only meaning of death is how I live my life now and what I will have to look back upon as I lie dying.

It is an odd thing that you can easily get millions of pounds for weapons to destroy life, but it is exceedingly difficult to get thousands for weapons to preserve it.

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

When doctor saves a life, he also saves a family.

Most of what happened yesterday, let alone last week or last year, is literally deleted from your brain at night.

people who spoke more than one language developed symptoms of dementia about four years later than people who spoke only one.

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

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

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.

If men were to consider what they were at - if if they were to look around them, and reflect upon the cost of life in a universe where prisons, brothels, madhouses, and regiments of men armed and trained to kill other men are so very common - why, I doubt we should see many of these poor mewling little larval victims, so often a present misery to their parents and a future menace to their kind.

I’m a dinosaur, he thought, lumbering through a world where truthtellers are despised.

We abide the surgeon’s scalpel to save our own lives, our loved ones’ lives, but not to save a stranger’s life. H has no heart, but heartless is the last thing you’d call her.

In any career, whether as a surgeon, a musician, or a secretary, one needs to have a confidence that says, “I can do anything, and if I can’t do it, I know how to get help.

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

Rest, you call that? The brain never rests. So essential to life are the myriad activities the brain engages in during sleep that without it, we die.

Sleep is not a suppression of brain activity. Quite the opposite. Sleep calls on deep powers of the brain never used during wakefulness.

your brain cells use more blood when they’re hard at work, just like your muscle cells do when you’re running.)

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

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

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

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

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

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

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

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

Psychologists talk of the ‘endowment effect’ – that we are more concerned about losing things than gaining them. Once we own something, we are averse to losing it, even if we are offered something of greater value in exchange.

We were learning that all the training and all the caring in the world were not going to solve every problem. This wasn't medical school. We weren't going to ace every exam. Silver-haired professors weren't going to pat us on the head and marvel at our intellectual acumen. We weren't going to win every battle.

Character? I should have thought it needed a good deal of character to throw up a career after half an hour’s meditation, because you saw in another way of living a more intense significance. And it required still more character never to regret the sudden step. I wondered if Abraham really had made a hash of life. Is to do what you most want, to live under the conditions that please you, in peace with yourself, to make a hash of life; and is it success to be an eminent surgeon with ten thousand a year and a beautiful wife? I suppose it depends on what meaning you attach to life, the claim which you acknowledge to society, and the claim of the individual. But again I held my tongue, for who am I to argue with a knight?

I will never be a brain surgeon, and I will never play the piano like Glenn Gould. But what keeps me up late at night, and constantly gives me reason to fret, is this: I don’t know what I don’t know. There are universes of things out there — ideas, philosophies, songs, subtleties, facts, emotions — that exist but of which I am totally and thoroughly unaware. This makes me very uncomfortable. I find that the only way to find out the fuller extent of what I don’t know is for someone to tell me, teach me or show me, and then open my eyes to this bit of information, knowledge, or life experience that I, sadly, never before considered. Afterward, I find something odd happens. I find what I have just learned is suddenly everywhere: on billboards or in the newspaper or SMACK: Right in front of me, and I can’t help but shake my head and speculate how and why I never saw or knew this particular thing before. And I begin to wonder if I could be any different, smarter, or more interesting had I discovered it when everyone else in the world found out about this particular obvious thing. I have been thinking a lot about these first discoveries and also those chance encounters: those elusive happenstances that often lead to defining moments in our lives. […] I once read that the definition of insanity is doing the same thing over and over and expecting different results. I fundamentally disagree with this idea. I think that doing the same thing over and over and expecting different results is the definition of hope. We might keep making mistakes but the struggle gives us a sense of empathy and connectivity that we would not experience otherwise. I believe this empathy improves our ability to see the unseen and better know the unknown. Lives are shaped by chance encounters and by discovering things that we don’t know that we don’t know. The arc of a life is a circuitous one. … In the grand scheme of things, everything we do is an experiment, the outcome of which is unknown. You never know when a typical life will be anything but, and you won’t know if you are rewriting history, or rewriting the future, until the writing is complete. This, just this, I am comfortable not knowing.

English heart surgeon Martyn Lloyd-Jones asserted, “Most unhappiness in life is due to the fact that you are listening to yourself rather than talking to yourself.

Medicines ensures lengthy life but not necessarily healthy life.

It was that summer, too, that I began the cutting, and was almost as devoted to it as to my newfound loveliness. I adored tending to myself, wiping a shallow red pool of my blood away with a damp washcloth to magically reveal, just above my naval: queasy. Applying alcohol with dabs of a cotton ball, wispy shreds sticking to the bloody lines of: perky. I had a dirty streak my senior year, which I later rectified. A few quick cuts and cunt becomes can't, cock turns into back, clit transforms to a very unlikely cat, the l and i turned into a teetering capital A. The last words I ever carved into myself, sixteen years after I started: vanish. Sometimes I can hear the words squabbling at each other across my body. Up on my shoulder, panty calling down to cherry on the inside of my right ankle. On the underside of a big toe, sew uttering muffled threats to baby, just under my left breast. I can quiet them down by thinking of vanish, always hushed and regal, lording over the other words from the safety of the nape of my neck. Also: At the center of my back, which was too difficult to reach, is a circle of perfect skin the size of a fist. Over the years I've made my own private jokes. You can really read me. Do you want me to spell it out for you? I've certainly given myself a life sentence. Funny, right? I can't stand to look myself without being completely covered. Someday I may visit a surgeon, see what can be done to smooth me, but now I couldn't bear the reaction. Instead I drink so I don't think too much about what I've done to my body and so I don't do any more. Yet most of the time that I'm awake, I want to cut. Not small words either. Equivocate. Inarticulate. Duplicitous. At my hospital back in Illinois they would not approve of this craving. For those who need a name, there's a gift basket of medical terms. All I know is that the cutting made me feel safe. It was proof. Thoughts and words, captured where I could see them and track them. The truth, stinging, on my skin, in a freakish shorthand. Tell me you're going to the doctor, and I'll want to cut worrisome on my arm. Say you've fallen in love and I buzz the outlines of tragic over my breast. I hadn't necessarily wanted to be cured. But I was out of places to write, slicing myself between my toes - bad, cry - like a junkie looking for one last vein. Vanish did it for me. I'd saved the neck, such a nice prime spot, for one final good cutting. Then I turned myself in.

It was the first time I had ever seen someone die, and it wasn't what I expected...I stood there waiting for something momentous to happen, for someone to say something profound, but there was nothing...I still had the childish notion that since my life was so important, all lives were so important. Since my death would be so cataclysmic, all deaths would be so cataclysmic.

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.

I was surrounded by the surgeons and residents and nurses who helped me stay alive when I was born blue and if it weren’t for them I would be dead now. All those people I didn’t even know, I couldn’t pick them out of a lineup if I had to, but they had worked their whole lives to get the knowledge that ended up saving my life. It was because of them that I was in this magnificent wave of people and music.

And of course she's sad about losing her leg, but she says it's made her realise how many things she hasn't lost...it's like a millionaire who loses a thousand dollars- he's sad, but he's still not that bad off.

If to be human is to be limited, then the role of caring professions and institutions - from surgeons to nursing homes - ought to be aiding people in their struggle with those limits. Sometimes we can offer a cure, sometimes only a salve, sometimes not even that. But whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the large aims of a person's life. When we forget that, the suffering we inflict can be barbaric. When we remember it, the good we do can be breathtaking.

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

Henrietta died in 1951 from a vicious case of cervical cancer, he told us. But before she died, a surgeon took samples of her tumor and put them in a petri dish. Scientists had been trying to keep human cells alive in culture for decades, but they all eventually died. Henrietta’s were different: they reproduced an entire generation every twenty-four hours, and they never stopped. They became the first immortal human cells ever grown in a laboratory.

He had no longer free energy enough for spontaneous research and speculative thinking, but by the bedside of patients the direct external calls on his judgment and sympathies brought the added impulse needed to draw him out of himself. It was not simply that beneficent harness of routine which enables silly men to live respectably and unhappy men to live calmly - it was a perpetual claim on the immediate fresh application of thought, and on the consideration of another's need and trial. Many of us looking back through life would say that the kindest man we have ever known has been a medical man, or perhaps that surgeon whose fine tact, directed by deeply-informed perception, has come to us in our need with a more sublime beneficence than that of miracle-workers. Some of that twice-blessed mercy was always with Lydgate in his work at the Hospital or in private houses, serving better than any opiate to quiet and sustain him under anxieties and his sense of mental degeneracy.

To my lovely starling, Maybe there are magical words that will make you understand, but if so, I do not know them. Words are your domain. I've always been better with pictures. I fear you think I am a monster. It's true I've disrupted many graves. The way I see it, the dead are dead. If, after their death, we can learn things from the about the human form - things that will increase the sum of human knowledge and the possibilities of art - what harm is that? After death, new life, new beauty. How can that be wrong? My friends and I have made use of some of the bodies as models. some we sell to surgeons who study them with the hopes of learning something about the frail mechanisms of the human body. I don't know exactly what Dottor de Gradi does in his workshop on the Rialto, and I was as surprised as you were to stumble on it. He couldn't - he wouldn't tell me if your friend's body ended up there. But he did assure me all of his work is focused solely on extending human life. I won't lie. I did it for the money as well. Don Loredan is holding a private exhibition in his palazzo tomorrow. The entry fee was quite steep but two of my paintings were accepted. This could be the beginning for me. I could find my own patrons. I could be more than just a peasant. Tommaso's assistant. So yes; a little for money. But mostly I did for the art. I don't expect these words to change how you feel. I simply want you not to see me as a monster. I don't want to be a monster. Not anymore. Not after meeting you. I know that we disrupted you dear friend's body, and for that I am deeply regretful. But if we had not done so, if I had not lingered in the San Domenico churchyard after standing guard for my friends, you and I might never have met. Meeting you is one thing I will never regret. I hope you like the painting. Consider tit a wedding gift. How stupid of me to let my heart go. It was a lovely fantasy while it lasted, though, wasn't it? Yours, Falco

Were you ever in Elsinore, Mr Jagiello?’ asked Jack. Oh, many a time, sir,’ said Jagiello. ‘I know it well. I believe I could show you Hamlet’s grave from here.’ I was really wondering whether they had ten or thirteen inch mortars on the upper terrace,’ said Jack, ‘but I should be very happy to see Hamlet’s grave as well.’ Both ten and thirteen, sir. And if you go a little to the right from the farthest turret, there are some trees: and among those trees there is the grave. You can just make out the rocks.’ So there he lies,’ said jack, his telescope leveled. ‘Well, well: we must all come to it. But it was a capital piece, capital. I never laughed so much in my life.’ A capital piece indeed,’ said Stephen, ‘and I doubt I could have done much better myself. But, do you know, I have never in my own mind classed it among the comedies. Pray did you read it recently?’ I never read it at all,’ said Jack. ‘That is to say, not right through. No: I did something better than that—I acted in it. There, the upper terrace fires. I was a midshipman at the time.

As soon as she left, Cinder felt the air change. A sudden tension, a sudden stillness. She licked her parched lips. "Are you the king of Luna now?" Kai looked surprised at the question. "No. As Levana was never the true queen, she didn't have the legal power to appoint anyone as king consort. I am technically a widower, but I think I can get that little mishap annulled." "Little mishap?" For something she had risked her life to prevent multiple times, Cinder wasn't sure she could consider Kai's marriage a "little mishap". "A temporary mistake," he said, shoving away the surgeon's light so it was no longer blinding Cinder. "With all that was going on, we never even had time to consummate." Cinder coughed. "Unnecessary information." "Really? You weren't curious?" "I'd been trying not to think about it." "Well - think no more. I'm still thanking all the stars, one by one." Cinder would have laughed, except it hurt too much.

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

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

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.

He though continually about the apartment building, a Pandora’s Box whose thousand lids were one by one, inwardly opening. The dominant tenants of the high-rise, those who had adapted most successfully to life there, were not the unruly airline pilots and film technicians of the lower floors, nor the bad-tempered and aggressive wives of the tax specialists on the upper levels. Although at first sight these people appeared to provoke all the tension and hostility, the people really responsible were the quiet and self-contained residents, like the dental surgeons Steele and his wife.

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

For those who believe in an afterlife, must we suffer as we lie dying, if we are to earn our place in heaven? Must the soul undergo a painful birth if it is to survive the body’s death, and then ascend to heaven? Is it yet more magic and bargaining – if we suffer now, we will not suffer in the future? We will not go to hell or linger as unhappy ghosts? Is it cheating, to have a quick and easy death? But I do not believe in an afterlife – my concern is simply to achieve a good death. When the time comes, I want to get it over with. I do not want it to be some prolonged and unpleasant experience, presided over by terminal-care professionals, who derive their own sense of meaning and purpose from my suffering. The only meaning of death is how I live my life now and what I will have to look back upon as I lie dying.

Once a hunter met a lion near the hungry critter's lair, and the way that lion mauled him was decidedly unfair; but the hunter never whimpered when the surgeons, with their thread, sewed up forty-seven gashes in his mutilated head; and he showed the scars in triumph, and they gave him pleasant fame, and he always blessed the lion that had camped upon his frame. Once that hunter, absent minded, sat upon a hill of ants, and about a million bit him, and you should have seen him dance! And he used up lots of language of a deep magenta tint, and apostrophized the insects in a style unfit to print. And it's thus with worldly troubles; when the big ones come along, we serenely go to meet them, feeling valiant, bold and strong, but the weary little worries with their poisoned stings and smarts, put the lid upon our courage, make us gray, and break our hearts.

We desire that God would give us the death-stroke; but we long to die without pain; we would die to our own will by the power of the will itself; we want to lose all and still hold all. Ah! what agony, what distress, when God has brought us to the end of our strength! We faint like a patient under a painful surgical operation. But the comparison is nought, for the object of the surgeon is to give us life -- that of God to make us die.

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.

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

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

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

White Fang received the nursing. Judge Scott's suggestion of a trained nurse was indignantly clamoured down by the girls, who themselves undertook the task. And White Fang won out on the one chance in ten thousand denied him by the surgeon. The latter was not to be censured for his misjudgement. All his life he had tended and operated on the soft humans of civilization, who live sheltered lives and had descended out of many sheltered generations. Compared with White Fang, they were frail and flabby, and clutched life without any strength in their grip. White Fang had come straight from the Wild, where the weak perish early and shelter is vouchsafed to none. In neither his father nor his mother was there any weakness, nor in the generations before them. A constitution of iron and vitality of the Wild were White Fang's inheritance, and he clung to life, the whole of him and every part of him, in spirit and in flesh, with the tenacity that of old belonged to all creatures.

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.

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

Your hair grows by itself, your heart beats by itself, and your breath happens pretty much by itself. Your glands secrete the essences by themselves and you do not have voluntary control over these things, and so we say they happen spontaneously. So, when you go to bed and try to go to sleep you interfere with the spontaneous process of going to sleep. If you try to breathe real hard you will find you get balled-up in your breathing. So if you are to be human, you just have to trust yourself to go to sleep, to digest your food, and to have bowel movements. Of course if something goes seriously wrong and you need a surgeon that is another matter, but by and large the healthy human being does not from the start of life need surgical interference. One lets it happen by itself, and so with the whole picture that is fundamental to it. You have to let go and let it happen, because if you don’t then you are constantly going to be trying to do what happens easily only if you do not try. When you think a bit about what people really want to do with their time, and you ask what they do when they are not being pushed around or somebody is telling them what to do, you find they like to make rhythms. They listen to music and they dance or they sing, or perhaps they do something of a rhythmic nature like playing cards, bowling, or raising their elbows. Given the chance, everybody wants to spend their time swinging.

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.

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

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

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.

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

Now sensitiveness to the state of mind of the public is a difficult thing to achieve or maintain. Any man can tell you with more or less accuracy and clearness his own reactions on any particular issue. But few men have the time or the interest or the training to develop a sense of what other persons think or feel about the same issue. In his own profession the skilled practitioner is sensitive and understanding. lhe lawyer can tell what argument will appeal to court or jury. “The salesman can tell what points to stress to his prospective buyers. The politician can tell what to emphasize to his audience, but the ability to estimate group reactions on a large scale over a wide geographic and psychological area is a specialized ability which must be developed with the same painstaking self-criticism and with the same dependence on experience that are required for the development of the clinical sense in the doctor or the surgeon. The significant revolution of modern times is not industrial or economic or political, but the revolution which is taking place in the art of creating consent among the governed. Within the life of the new generation now in control of affairs, persuasion has become a self-conscious art and a regular organ of popular government. None of us begins to understand the consequences, but it is no daring prophecy to say that the knowledge of how to create consent will alter every political premise. Under the impact of propaganda, not necessarily in the sinister meaning of the world alone, the only constants of our thinking have become variables. It is no longer possible, for example, to believe in the cardinal dogma of democracy that the knowledge needed for the management of human affairs comes up spontaneously from the human heart. Where we act on that theory we expose ourselves to self-deception and to farms of persuasion that we cannot verify. It has been demonstrated that we cannot rely upon intuition, conscience or the accidents of casual opinion if we are to deal with the world beyond our reach.

The rise of loneliness as a health hazard tracks with the entrenchment of values and practices that supersede any notion of "individual choices." The dynamics include reduced social programs, less available "common" spaces such as public libraries, cuts in services for the vulnerable and the elderly, stress, poverty, and the inexorable monopolization of economic life that shreds local communities. By way of illustration, let's take a familiar scenario: Walmart or some other megastore decides to open one of its facilities in a municipality. Developers are happy, politicians welcome the new investment, and consumers are pleased at finding a wide variety of goods at lower prices. But what are the social impacts? Locally owned and operated small businesses cannot compete with the marketing behemoth and must close. People lose their jobs or must find new work for lower pay. Neighborhoods are stripped of the familiar hardware store, pharmacy, butcher, baker, candlestick maker. People no longer walk to their local establishment, where they meet and greet one another and familiar merchants they have known, but drive, each isolated in their car, to a windowless, aesthetically bereft warehouse, miles away from home. They might not even leave home at all — why bother, when you can order online? No wonder international surveys show a rise in loneliness. The percentage of Americans identifying themselves as lonely has doubled from 20 to 40 percent since the 1980s, the New York Times reported in 2016. Alarmed by the health ravages, Britain has even found it necessary to appoint a minister of loneliness. Describing the systemic founts of loneliness, the U.S. surgeon general Vivek Murthy wrote: "Our twenty-first-century world demands that we focus on pursuits that seem to be in constant competition for our time, attention, energy, and commitment. Many of these pursuits are themselves competitions. We compete for jobs and status. We compete over possessions, money, and reputations. We strive to stay afloat and to get ahead. Meanwhile, the relationships we prize often get neglected in the chase." It is easy to miss the point that what Dr. Murthy calls "our twenty-first-century world" is no abstract entity, but the concrete manifestation of a particular socioeconomic system, a distinct worldview, and a way of life.

On the next floor below are the abdominal and spine cases, head wounds and double amputations. On the right side of the wing are the jaw wounds, wounds in the joints, wounds in the kidneys, wounds in the testicles, wounds in the intestines. Here a man realizes for the first time in how many places a man can get hit. Two fellows die of tetanus. Their skin turns pale, their limbs stiffen, at last only their eyes live—stubbornly. Many of the wounded have their shattered limbs hanging free in the air from a gallows; underneath the wound a basin is placed into which drips the pus. Every two or three hours the vessel is emptied. Other men lie in stretching bandages with heavy weights hanging from the end of the bed. I see intestine wounds that are constantly full of excreta. The surgeon’s clerk shows me X-ray photographs of completely smashed hipbones, knees and shoulders. A man cannot realize that above such shattered bodies there are still human faces in which life goes its daily round. And this is only one hospital, one single station; there are hundreds of thousands in Germany, hundreds of thousands in France, hundreds of thousands in Russia. How senseless is everything that can ever be written, done, or thought, when such things are possible. It must be all lies and of no account when the culture of a thousand years could not prevent this stream of blood being poured out, these torture-chambers in their hundreds of thousands. A hospital alone shows what war is. I am young, I am twenty years old; yet I know nothing of life but despair, death, fear, and fatuous superficiality cast over an abyss of sorrow. I see how peoples are set against one another, and in silence, unknowingly, foolishly, obediently, innocently slay one another. I see that the keenest brains of the world invent weapons and words to make it yet more refined and enduring. And all men of my age, here and over there, throughout the whole world see these things; all my generation is experiencing these things with me. What would our fathers do if we suddenly stood up and came before them and proffered our account? What do they expect of us if a time ever comes when the war is over? Through the years our business has been killing;—it was our first calling in life. Our knowledge of life is limited to death. What will happen afterwards? And what shall come out of us?

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