Surgery Doctor Quotes

I don't know. I don't actually remember anything from before the surgery." His eyebrows rose, his blue eyes sucking in all the light of the room. "The cybernetic opetation?" "No, the sex change." The doctor's smile faltered. "I'm joking.

Fifty percent of all doctors graduate in the bottom half of their class - Hope your surgery went well!

Cognitive robotics can integrate information from pre-operation medical records with real-time operating metrics to guide and enhance the precision of physicians’ instruments. By processing data from genuine surgical experiences, they’re able to provide new and improved insights and techniques. These kinds of improvements can improve patient outcomes and boost trust in AI throughout the surgery. Robotics can lead to a 21% reduction in length of stay.

Pilots used to fly planes manually, but now they operate a dashboard with the help of computers. This has made flying safer and improved the industry. Healthcare can benefit from the same type of approach, with physicians practicing medicine with the help of data, dashboards, and AI. This will improve the quality of care they provide and make their jobs easier and more efficient

A-la-la-la-la, fine, I get it,” said Thorne, covering his ears. “Please, never say that word again.” Dr. Erland raised an eyebrow. “Cellular? Hematopoietic? Ganglion?” “That last one.” Thorne grimaced. “Bleh.” The doctor scowled. “Are you squeamish, Mr. Thorne?” “Eye stuff weirds me out. As does any surgery regarding the pelvic bone. You can knock me out for that part, right?” He lay back on the exam table. “Do it fast.

The boys could have been many things had they not been ruined by that place. Doctors who cured diseases or perform brain surgery, inventing shit that saves lives. Run for president. All those lost geniuses - sure not all of them were geniuses, Chickie Pete for example was not solving special relativity - but they had been denied even the simple pleasure of being ordinary. Hobbled and handicapped before the race even began, never figuring out how to be normal.

I hope she never needs heart surgery, because the doctor wouldn't be able to find it.

Most medical students go through a brief period when they develop all manner of imaginary illnesses – I myself had leukaemia for at least four days – until they learn, as a matter of self-preservation, that illnesses happen to patients, not to doctors.

If lawyers had followed the norm of no execution without trial, if doctors had accepted the rule of no surgery without consent, if businessmen had endorsed the prohibition of slavery, if bureaucrats had refused to handle paperwork involving murder, then the Nazi regime would have been much harder pressed to carry out the atrocities by which we remember it. Professions

Yes of course there's always someone worse off than you. But imagine you're in a doctor's surgery with a broken arm. The person next to you has two broken arms, the person next to him has two broken arms and a broken leg. This is all very well, but the point is that you have a broken arm and it hurts.

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

While all doctors treat diseases, neurosurgeons work in the crucible of identity: every operation on the brain is, by necessity, a manipulation of the substance of our selves, and every conversation with a patient undergoing brain surgery cannot help but confront this fact. In addition, to the patient and family, the brain surgery is usually the most dramatic event they have ever faced and, as such, has the impact of any major life event. At those critical junctures, the question is not simply whether to live or die but what kind of life is worth living. Would you trade your ability - or your mother's - to talk for a few extra months of mute life? The expansion of your visual blind spot in exchange for eliminating the small possibility of a fatal brain hemorrhage? Your right hand's function to stop seizures? How much neurologic suffering would you let your child endure before saying that death is preferable? Because the brain mediates our experience of the world, any neurosurgical problem forces a patient and family, ideally with a doctor as a guide, to answer this question: What makes life meaningful enough to go on living?

Healthy people, I have concluded, including myself, do not understand how everything changes once you have been diagnosed with a fatal illness. How you cling to hope, however false, however slight, and how reluctant most doctors are to deprive patients of that fragile beam of light in so much darkness. Indeed, many people develop what psychiatrists call ‘dissociation’ and a doctor can find himself talking to two people – they know that they are dying and yet still hope that they will live. I had noticed the same phenomenon with my mother during the last few days of her life. When faced by people who are dying you are no longer dealing with the rational consumers assumed by economic model-builders, if they ever existed in the first place.

The night before brain surgery, I thought about death. I searched out my larger values, and I asked myself, if I was going to die, did I want to do it fighting and clawing or in peaceful surrender? What sort of character did I hope to show? Was I content with myself and what I had done with my life so far? I decided that I was essentially a good person, although I could have been better--but at the same time I understood that the cancer didn't care. I asked myself what I believed. I had never prayed a lot. I hoped hard, I wished hard, but I didn't pray. I had developed a certain distrust of organized religion growing up, but I felt I had the capacity to be a spiritual person, and to hold some fervent beliefs. Quite simply, I believed I had a responsibility to be a good person, and that meant fair, honest, hardworking, and honorable. If I did that, if I was good to my family, true to my friends, if I gave back to my community or to some cause, if I wasn't a liar, a cheat, or a thief, then I believed that should be enough. At the end of the day, if there was indeed some Body or presence standing there to judge me, I hoped I would be judged on whether I had lived a true life, not on whether I believed in a certain book, or whether I'd been baptized. If there was indeed a God at the end of my days, I hoped he didn't say, 'But you were never a Christian, so you're going the other way from heaven.' If so, I was going to reply, 'You know what? You're right. Fine.' I believed, too, in the doctors and the medicine and the surgeries--I believed in that. I believed in them. A person like Dr. Einhorn [his oncologist], that's someone to believe in, I thought, a person with the mind to develop an experimental treatment 20 years ago that now could save my life. I believed in the hard currency of his intelligence and his research. Beyond that, I had no idea where to draw the line between spiritual belief and science. But I knew this much: I believed in belief, for its own shining sake. To believe in the face of utter hopelessness, every article of evidence to the contrary, to ignore apparent catastrophe--what other choice was there? We do it every day, I realized. We are so much stronger than we imagine, and belief is one of the most valiant and long-lived human characteristics. To believe, when all along we humans know that nothing can cure the briefness of this life, that there is no remedy for our basic mortality, that is a form of bravery. To continue believing in yourself, believing in the doctors, believing in the treatment, believing in whatever I chose to believe in, that was the most important thing, I decided. It had to be. Without belief, we would be left with nothing but an overwhelming doom, every single day. And it will beat you. I didn't fully see, until the cancer, how we fight every day against the creeping negatives of the world, how we struggle daily against the slow lapping of cynicism. Dispiritedness and disappointment, these were the real perils of life, not some sudden illness or cataclysmic millennium doomsday. I knew now why people fear cancer: because it is a slow and inevitable death, it is the very definition of cynicism and loss of spirit. So, I believed.

Is the practice of medicine a business or is it a vocation? Where does the balance lie between doing well and doing good?

But I then thought of how the value of my work as a doctor is measured solely in the value of other people's lives, and that included the people in front of me in the check-out queue.

The main aim of education should be to send children out into the world with a reasonably sized anthology in their heads so that, while seated on the lavatory, waiting in doctor's surgeries, on stationary trains or watching interviews with politicians, they have something interesting to think about.

Right, what's there possibly to worry about?" she said. "Just some surgery in the garage with a drunk doctor." Little miss," said Doc, pointing a finger at Cass. "I'm drinking. I'm not drunk. There's a difference." He took another sip from his cup. "But in another ten minutes or so, that might change, so you should stop stalling.

I hope she never needs heart surgery, because the doctors wouldn't be able to find it.

As the Koran says in Surah 5:32: whoever saves a life, it shall be as though he had saved the lives of all mankind.

Are you a doctor?” Li said. “I’m better than that. I’m a vet. Vets do everything: brain surgery, heart surgery, lab analysis, dislocations –

When I went on my first antidepressant it had the side effect of making me fixated on suicide (which is sort of the opposite of what you want). It’s a rare side effect so I switched to something else that did work. Lots of concerned friends and family felt that the first medication’s failure was a clear sign that drugs were not the answer; if they were I would have been fixed. Clearly I wasn’t as sick as I said I was if the medication didn’t work for me. And that sort of makes sense, because when you have cancer the doctor gives you the best medicine and if it doesn’t shrink the tumor immediately then that’s a pretty clear sign you were just faking it for attention. I mean, cancer is a serious, often fatal disease we’ve spent billions of dollars studying and treating so obviously a patient would never have to try multiple drugs, surgeries, radiation, etc., to find what will work specifically for them. And once the cancer sufferer is in remission they’re set for life because once they’ve learned how to not have cancer they should be good. And if they let themselves get cancer again they can just do whatever they did last time. Once you find the right cancer medication you’re pretty much immune from that disease forever. And if you get it again it’s probably just a reaction to too much gluten or not praying correctly. Righ

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

Few people outside medicine realize that what tortures doctors most is uncertainty, rather than the fact they often deal with people who are suffering or who are about to die. It is easy enough to let somebody die if one knows beyond doubt that they cannot be saved - if one is a decent doctor one will be sympathetic, but the situation is clear. This is life, and we all have to die sooner or later. It is when I do not know for certain whether I can help or not, or should help or not, that things become so difficult.

In medical school, doctors are taught to view the human body as a random mistake-ridden vessel that has to be forced into submission with surgery, antibiotics, antihypertensives, antihistamines, anti-inflammatories, and other medical interventions. The natural extension of this paradigm over the past 100 years has been for the medical profession to condition human beings not to trust anyone but certified medical doctors to fix these defective aberrations of creation.

I hate those TV shows where characters talk about one thing, such as their patient on the operation table (let's say they're a doctor), then you realize they're actually talking about actually talking about themselves. The patient's open-heart surgery is nothing compared to their own messed-up heart or whatever. It's selfish. And means they're not concentrating, which is medical negligence.

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

thoughts hidden there? If she can, what will she do? Call the cops? Send me to the nuthouse? Do I want her to? I just want to sleep. The whole point of not talking about it, of silencing the memory, is to make it go away. It won’t. I’ll need brain surgery to cut it out of my head. Maybe I should wait until David Petrakis is a doctor, let him do it.

Anxious and angry relatives are a burden all doctors must bear, but having been one myself was an important part of my medical education.

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

The boy's death turned me into a person marked by war: it was the Sarajevo equivalent of a campaign medal, although not one to wear with pride.

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

The fatal combination of indulgence without feeling disgusts me. Strange to be both greedy and dead. For myself, I prefer to hold my desires just out of reach of appetite, to keep myself honed and sharp. I want the keen edge of longing. it is so easy to be a brute and yet it has become rather fashionable. Is that the consequence of leaving your body to science? Of assuming that another pill, another drug, another car, another pocket-sized home-movie station, a DNA transfer, or the complete freedom of choice that five hundred TV channels must bring, will make everything all right? Will soothe the nagging pain in the heart that the latest laser scan refuses to diagnose? The doctor's surgery is full of men and women who do not know why they are unhappy. "Take this", says the Doctor, "you'll soon feel better." They do not feel better, because, little by little, they cease to feel at all.

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

I learned a long time ago in the outpatient clinic to make no distinction –as some condescending doctors still do –between ‘real’ or ‘psychological’ pain. All pain is produced in the brain, and the only way pain can vary, other than in its intensity, is how it is best treated, or more particularly in my clinic, whether surgery might help or not.

Tear people open when they pull out their gallbladder or remove their appendix? There’s really no other sort of surgery where the doctor prefers to just let you get torn apart rather than cut you, and I’m assuming that’s because gynecologists are just really lazy.

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

I was afraid they kept the hogs in a pen out behind the hospital. I've been prepared for surgery and the doctor says to an orderly, 'Leon, go out to the hog pen and get me a valve.

My readiness to admit to my fallibility is perhaps rather English, but I hope that the problems I describe will be familiar to doctors and patients everywhere.

Do I shock you? We are very playful here. It's a good tone for an operating theater. It is a theater, after all.

When a worker is injured at an IBP plant in Texas, he or she is immediately presented with a waiver. Signing the waiver means forever surrendering the right to sue IBP on any grounds. Workers who sign the waiver may receive medical care under IBP's Workplace Injury Settlement Program. Or they may not. Once workers sign, IBP and its company-approved doctors have control over the job-related medical treatment - for life. Under the program's terms, seeking treatment from an independent physician can be grounds for losing all medical benefits. Workers who refuse to sign the IBP waiver not only risk getting no medical care from the company, but also risk being fired on the spot...Injured workers almost always sign the waiver. The pressure to do so is immense. An IBP medical case manager will literally bring the waiver to a hospital emergency room in order to obtain an injured worker's signature. When Lonita Leal's right hand was mangled by a hamburger grinder at the IBP plant in Amarillo, a case manager talked her into signing the waiver with her left hand as she waited in the hospital for surgery. When Duane Mullin had both hands crushed in a hammer mill at the same plant, an IBP representative persuaded him to sign the waiver with a pen held in his mouth.

Hours before his death in 1955 from a ruptured abdominal aortic ayeurysm, Albert Einstein's doctors proposed trying a new and unproven surgery as a final option for extending his life. Einstein refused. "I have done my share," he said. "It is time to go. I will do it elegantly.

Sonny had a quintuple bypass in 2003, when he was fifty-six years old—the last thing he remembered before falling unconscious under the anesthesia was a doctor standing over him saying his mother’s cells were one of the most important things that had ever happened to medicine. Sonny woke up more than $125,000 in debt because he didn’t have health insurance to cover the surgery.

Bear in mind that since medications do not fix anything, they allow the underlying problem to continue uncorrected and actually accelerate. Meanwhile, new symptoms and new seemingly unrelated diseases are the inevitable consequence of this biochemical faux pas. Furthermore, drug side effects are the leading cause of death. NSAIDs as an example of only one group of medications, are fatally toxic to thousands of people each year by damaging joints, lungs, kidneys, eyes, hearts, and intestines. And they are covered by insurance. You and your doctor have been screwed into believing every symptom is a deficiency of some drug or surgery. You've been led to believe you have no control, when in truth you're the one who must take control. Unfortunately, the modus operandi in medicine is to find a drug to turn off the damaged part that is producing symptoms.

If lawyers had followed the norm of no execution without trial, if doctors had accepted the rule of no surgery without consent, if businessmen had endorsed the prohibition of slavery, if bureaucrats had refused to handle paperwork involving murder, then the Nazi regime would have been much harder pressed to carry out the atrocities by which we remember it.

Equally worrying, and far less recognized, medicine has been slow to confront the very changes that it has been responsible for—or to apply the knowledge we have about how to make old age better. Although the elderly population is growing rapidly, the number of certified geriatricians the medical profession has put in practice has actually fallen in the United States by 25 percent between 1996 and 2010. Applications to training programs in adult primary care medicine have plummeted, while fields like plastic surgery and radiology receive applications in record numbers. Partly, this has to do with money—incomes in geriatrics and adult primary care are among the lowest in medicine. And partly, whether we admit it or not, a lot of doctors don’t like taking care of the elderly.

Several years ago, researchers at the University of Minnesota identified 568 men and women over the age of seventy who were living independently but were at high risk of becoming disabled because of chronic health problems, recent illness, or cognitive changes. With their permission, the researchers randomly assigned half of them to see a team of geriatric nurses and doctors—a team dedicated to the art and science of managing old age. The others were asked to see their usual physician, who was notified of their high-risk status. Within eighteen months, 10 percent of the patients in both groups had died. But the patients who had seen a geriatrics team were a quarter less likely to become disabled and half as likely to develop depression. They were 40 percent less likely to require home health services. These were stunning results. If scientists came up with a device—call it an automatic defrailer—that wouldn’t extend your life but would slash the likelihood you’d end up in a nursing home or miserable with depression, we’d be clamoring for it. We wouldn’t care if doctors had to open up your chest and plug the thing into your heart. We’d have pink-ribbon campaigns to get one for every person over seventy-five. Congress would be holding hearings demanding to know why forty-year-olds couldn’t get them installed. Medical students would be jockeying to become defrailulation specialists, and Wall Street would be bidding up company stock prices. Instead, it was just geriatrics. The geriatric teams weren’t doing lung biopsies or back surgery or insertion of automatic defrailers. What they did was to simplify medications. They saw that arthritis was controlled. They made sure toenails were trimmed and meals were square. They looked for worrisome signs of isolation and had a social worker check that the patient’s home was safe. How do we reward this kind of work? Chad Boult, the geriatrician who was the lead investigator of the University of Minnesota study, can tell you. A few months after he published the results, demonstrating how much better people’s lives were with specialized geriatric care, the university closed the division of geriatrics.

Another, related issue is that longevity itself, and healthspan in particular, doesn’t really fit into the business model of our current healthcare system. There are few insurance reimbursement codes for most of the largely preventive interventions that I believe are necessary to extend lifespan and healthspan. Health insurance companies won’t pay a doctor very much to tell a patient to change the way he eats, or to monitor his blood glucose levels in order to help prevent him from developing type 2 diabetes. Yet insurance will pay for this same patient’s (very expensive) insulin after he has been diagnosed. Similarly, there’s no billing code for putting a patient on a comprehensive exercise program designed to maintain her muscle mass and sense of balance while building her resistance to injury. But if she falls and breaks her hip, then her surgery and physical therapy will be covered. Nearly all the money flows to treatment rather than prevention—and when I say “prevention,” I mean prevention of human suffering.

Good nutrition and vitamins do not directly cure disease, the body does. You provide the raw materials and the inborn wisdom of your body makes the repairs. Someday healthcare without megavitamin therapy will be seen as we today see childbirth without sanitation or surgery without anaesthetic.

Start on clavicle. Remove middle third. Control and divide subsc art and vein. Divide large nerve trunks around these as prox as poses. Then come onto chest wall immed anterior and divide Pec maj origin from remaining clav. Divide pec minor insertion and (very imp) divide origin and get deep to serrates anterior. Your hand sweeps behind scapula. Divide all muscles attached to scapula. Stop muscle bleeding with count suture. Easy! Good luck. Meirion

Are you always going to look this way, August? I mean, can't you get plastic surgery or something?" I smiled and pointed to my face. "Hello?" This is after plastic surgery. Jack clapped his hand over his forehead and started laughing hysterically. "Dude, you should sue your doctor!" he answered between giggles.

The health care establishment is structured to profit from chemical and surgical intervention. Diet still takes the back seat to drugs and surgery. One criticism that is constantly leveled at the dietary argument is that patients will not make such fundamental changes. One doctor charges that Dr. Esselstyn’s patients change their eating habits simply because of Esselstyn’s “zealous belief.”47 This criticism is not only wrong and insulting to patients; it is also self-fulfilling. If doctors do not believe that patients will change their diets, they will neglect to talk about diet, or will do it in an off-handed, disparaging way.

The problem is that doctors today often assume that something mysterious and unidentified has gone wrong with labor or that the woman's body is somehow "inadequate" - what I call the "woman's body as a lemon" assumption. For a variety of reasons, a lot of women have also come to believe that nature made a serious mistake with their bodies. This belief has become so strong in many that they give in to pharmaceutical or surgical treatments when patience and recognition of the normality and harmlessness of the situation would make for better health for them and their babies and less surgery and technological intervention in birth. Most women need encouragement and companionship more than they need drugs.

Even though we were supposed to have free medical care, the doctors expected us to pay them for the surgery. It sounds harsh, but the government gave them almost nothing, and bribery was the only way for them to survive. Somehow my parents persuaded the doctors to perform the operation if we supplied them with the anesthetic and antibiotics they needed.

You go in through the front door of the hospital and depending on how successful your treatment is determines whether you leave through the front door or in a box out of the back door.

Before operating on a patient's brain, I realized, I must first understand his mind: his identity, his values, what makes his life worth living, & what devastation makes it reasonable to let that life end. The cost of my dedication to succeed was high, & the ineluctable failures brought me nearly unbearable guilt. Those burdens are what make medicine holy & wholly impossible.

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.

the role of relationships in sustaining change seems absurdly obvious, and yet relationships are never designed into any of our solutions. Our health services are designed around the lone individual. The doctor sees the patient. In fact, at my local doctor’s surgery – ironically, in Peckham, close to the site of the great experiment – if I show up with another family member I am reprimanded and told to make another appointment.

Of the many 'firsts' with which I have been involved at the Texas Heart Institute —including the first successful human heart transplant in the United States and the first total artificial heart transplant in the world—the achievement that may have the greatest impact on health care did not occur in the operating room or in the research laboratory. It happened on a piece of paper... when we created the first-ever packaged pricing plan for cardiovascular surgical procedures.

Amazing!" said Mr. McSwiney. "You've got a permanently fixed larynx," he told Owen. "I've rarely seen such a thing," he said. "Your voice box is never in repose - your Adam's apple sits up there in the position of a permanent scream. I could try giving you some exercises, but you might want to see a throat doctor; you might have to have surgery." "I DON'T WANT TO HAVE SURGERY, I DON'T NEED ANY EXERCISES," said Owen Meany. "IF GOD GAVE ME THIS VOICE, HE HAD A REASON," Owen said.

In fact, other than factory farms, hospitals and doctors’ offices are the primary breeding ground of superbugs. A simple injection or a minor surgery can now, fairly routinely, lead to months in the hospital, or loss of limb, or loss of life.

New Rule: Now that liberals have taken back the word "liberal," they also have to take back the word "elite." By now you've heard the constant right-wing attacks on the "elite media," and the "liberal elite." Who may or may not be part of the "Washington elite." A subset of the "East Coast elite." Which is overly influenced by the "Hollywood elite." So basically, unless you're a shit-kicker from Kansas, you're with the terrorists. If you played a drinking game where you did a shot every time Rush Limbaugh attacked someone for being "elite," you'd be almost as wasted as Rush Limbaugh. I don't get it: In other fields--outside of government--elite is a good thing, like an elite fighting force. Tiger Woods is an elite golfer. If I need brain surgery, I'd like an elite doctor. But in politics, elite is bad--the elite aren't down-to-earth and accessible like you and me and President Shit-for-Brains. Which is fine, except that whenever there's a Bush administration scandal, it always traces back to some incompetent political hack appointment, and you think to yourself, "Where are they getting these screwups from?" Well, now we know: from Pat Robertson. I'm not kidding. Take Monica Goodling, who before she resigned last week because she's smack in the middle of the U.S. attorneys scandal, was the third-ranking official in the Justice Department of the United States. She's thirty-three, and though she never even worked as a prosecutor, was tasked with overseeing the job performance of all ninety-three U.S. attorneys. How do you get to the top that fast? Harvard? Princeton? No, Goodling did her undergraduate work at Messiah College--you know, home of the "Fighting Christies"--and then went on to attend Pat Robertson's law school. Yes, Pat Robertson, the man who said the presence of gay people at Disney World would cause "earthquakes, tornadoes, and possibly a meteor," has a law school. And what kid wouldn't want to attend? It's three years, and you have to read only one book. U.S. News & World Report, which does the definitive ranking of colleges, lists Regent as a tier-four school, which is the lowest score it gives. It's not a hard school to get into. You have to renounce Satan and draw a pirate on a matchbook. This is for the people who couldn't get into the University of Phoenix. Now, would you care to guess how many graduates of this televangelist diploma mill work in the Bush administration? On hundred fifty. And you wonder why things are so messed up? We're talking about a top Justice Department official who went to a college founded by a TV host. Would you send your daughter to Maury Povich U? And if you did, would you expect her to get a job at the White House? In two hundred years, we've gone from "we the people" to "up with people." From the best and brightest to dumb and dumber. And where better to find people dumb enough to believe in George Bush than Pat Robertson's law school? The problem here in America isn't that the country is being run by elites. It's that it's being run by a bunch of hayseeds. And by the way, the lawyer Monica Goodling hired to keep her ass out of jail went to a real law school.

While all doctors treat diseases, neurosurgeons work in the crucible of identity: every operation on the brain is, by necessity, a manipulation of the substance of our selves, and every conversation with a patient undergoing brain surgery cannot help but confront this fact.

A rain of pebbles from overhead makes me glance up in time to see Ruthann step onto the lip of the cliff, another fifteen feet above me. Her body is wrapped tight in a pure white robe. "Ruthann!" I shout, my voice caroming off the rock walls, an obscenity. She looks down at me. Across the distance our eyes meet. "Ruthann, don't," I whisper, but she shakes her head. I'm sorry. In that half-second, I think about Wilma and Derek and me, all the people who do not want to beleft behind, who think we know what is best for her. I think about the doctors and the medicines Ruthann lied about taking. I think about how I could talk her down from that ledge like I have talked down a dozen potential suicide victims. Yet the right thing to do, here, is subjective. Ruthann's family, who wants her alive, will not be the one to lose hair from drugs, to have surgery to remove her breast, to die by degrees. It is easy to say that Ruthann should come down from that cliff, unless you are Ruthann. I know better than anyone what it feels like to have someone else make choices for you, when you deserve to be making them yourself. I look at Ruthann, and very slowly, I not. She smiles at me, and so I am her witness -- as she unwraps the wedding robe from her narrow shoulders and holds is across her back like the wide wings of a hawk. As she steps off the edge of the cliff and rises to the Spirit World. As the owls bear her body to the broken ground.

A scream starts in my gut—I can feel the cut, smell the dirt, leaves in my hair. I don’t remember passing out. David says I hit my head on the edge of the table on my way down. The nurse calls my mom because I need stitches. The doctor stares into the back of my eyes with a bright light. Can she read the thoughts hidden there? If she can, what will she do? Call the cops? Send me to the nuthouse? Do I want her to? I just want to sleep. The whole point of not talking about it, of silencing the memory, is to make it go away. It won’t. I’ll need brain surgery to cut it out of my head.

Were there many sick people in Europe that you recall? Any notable outbreaks in your province?" "I don't know. I don't actually remember anything before the surgery." His eyebrows rose, his blue eyes sucking in all the light of the room. "The cybernetic operation?" "No, the sex change." The doctor's smile faltered. "I'm joking.

He walked across the room and flicked a switch. A spotlight turned on, illuminating a laminated poster of a woman on his wall. He took a crayon from his pocket and began drawing on it. I could see smudges from past demonstrations. [. . .] His dashed lines crisscrossed the woman's chest as if he were planning a military maneuver on undulating terrain.

In addition, to the patient and family, the brain surgery is usually the most dramatic event they have ever faced and, as such, has the impact of any major life event. At those critical junctures, the question is not simply whether to live or die but what kind of life is worth living. Would you trade your ability—or your mother's—to talk for a few extra months of mute life? [...] How much neurologic suffering would you let your child endure before saying that death is preferable? Because the brain mediates our experience of the world, any neurosurgical problem forces a patient and family, ideally with a doctor as a guide, to answer this question: What makes life meaningful enough to go on living?

lawyers had followed the norm of no execution without trial, if doctors had accepted the rule of no surgery without consent, if businessmen had endorsed the prohibition of slavery, if bureaucrats had refused to handle paperwork involving murder, then the Nazi regime would have been much harder pressed to carry out the atrocities by which we remember it.

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

I could have a room to myself, with a carpet and with my own loo – details that are very important to patients but not to NHS administrators and architects. Nor, I am afraid to say, do many doctors care about these things, until they become patients and come to understand that patients in NHS hospitals rarely get peace, rest or quiet and never a good night’s sleep. I

[My mother] related a childhood anecdote about one of her sisters who had an appendix operation and afterwards had been given a beautiful purse by another sister. My mother was fourteen at the time. Oh, how she yearned to have an exquisitely beaded purse like her sister's, but she dared not open her mouth. So guess what? She feigned a pain in her side and went the whole way with her story. Her family took her to several doctors. They were unable to produce a diagnosis and so opted for exploratory surgery. It had been a bold gamble on my mother's part, but it worked--she was given an identical little purse! When she received the coveted purse, my mother was elated despite being in physical agony from the surgery. Two nurses came in and one stuck a thermometer in her mouth. My mother said, 'Ummm, ummm,' to show the purse to the second nurse, who answered, 'Oh, for me? Why, thank you!' and took the purse! My mother was at a loss, and never figured out how to say, 'I didn't mean to give it to you. Please return it to me.' Her story poignantly reveals how painful it can be when people don't openly acknowledge their needs.

The Mongols made culture portable. It was not enough to merely exchange goods, because whole systems of knowledge had to also be transported in order to use many of the new products. Drugs, for example, were not profitable items of trade unless there was adequate knowledge of how to use them. Toward this objective, the Mongol court imported Persian and Arab doctors into China, and they exported Chinese doctors to the Middle East. Every form of knowledge carried new possibilities for merchandising. It became apparent that the Chinese operated with a superior knowledge of pharmacology and of unusual forms of treatment such as acupuncture, the insertion of needles at key points in the body, and moxibustion, the application of fire or heat to similar areas. Muslims doctors, however, possessed a much more sophisticated knowledge of surgery, but, based on their dissection of executed criminals, the Chinese had a detailed knowledge of internal organs and the circulatory system. To encourage a fuller exchange of medical knowledge, the Mongols created hospitals and training centers in China using doctors from India and the Middle East as well as Chinese healers.

Why do foreigners always ask about clothing?” one woman doctor asked. “Why does it matter so much what we wear? Of all the issues in the world, is that really so important?” Another said: “You think we’re victims, because we cover our hair and wear modest clothing. But we think that it’s Western women who are repressed, because they have to show their bodies—even go through surgery to change their bodies—to please men.

If I walk out of my office today and get hit by a drunk driver, that will not be my fault. But it will be my responsibility to deal with the outcome. I am the one who has to go to the doctor and get surgery. I am the one who will have to go to the physical therapist. I am the one who will have to grieve. And I will be the one who has to work through the anger and do the forgiving. Those things are all my responsibility, even though I did not choose to get hit by a drunk driver. Unsafe people do not do that hard work. They stay angry, stuck, and bitter, sometimes for life. When they feel upset, they see others as the cause, and others as the ones who have to do all the changing. When they are abused, they hold on to it with a vengeance and spew hatred for the rest of their lives. When they are hurt, they wear it like a badge. And worst of all, when they are wrong, they blame it on others. Denial is the active process that someone uses to avoid responsibility. It is different from being unaware of sin. When we are unaware, we do not know about our sin. Denial is more active than that. It is a style and an agenda, and it can be very aggressive when truth comes close. People with a style of denial and blaming are definitely on the list of unsafe people to avoid.

Alan Scheflin reports on some of the children who received stereotaxic surgery in the sixties and seventies. He lists several doctors who performed such surgery on children because they suffered from behavioral problems such as "wandering." One young boy would sneak away from his home and crawl underneath an automobile in order to smell the oil. Two groups were as young as two and four years old when surgery took place for "violent behavior.

We are healthy, we think, if we do not feel any pain or too much pain, and if we are strong enough to do our work. If we become unhealthy, then we go to a doctor who we hope will “cure” us and restore us to health. By health, in other words, we mean merely the absence of disease. Our health professionals are interested almost exclusively in preventing disease (mainly by destroying germs) and in curing disease (mainly by surgery and by destroying germs). But the concept of health is rooted in the concept of wholeness. To be healthy is to be whole. The word health belongs to a family of words, a listing of which will suggest how far the consideration of health must carry us: heal, whole, wholesome, hale, hallow, holy. And so it is possible to give a definition to health that is positive and far more elaborate than that given to it by most medical doctors and the officers of public health.

Humans are organisms, subject to physical laws, including, alas, the one that says entropy always increases. Diseases are molecules misbehaving; the basic requirement of life is metabolism, and death its cessation. While all doctors treat diseases, neurosurgeons work in the crucible of identity: every operation on the brain is, by necessity, a manipulation of the substance of our selves, and every conversation with a patient undergoing brain surgery cannot help but confront this fact. In addition, to the patient and family, the brain surgery is usually the most dramatic event they have ever faced and, as such, has the impact of any major life event. At those critical junctures, the question is not simply whether to live or die but what kind of life is worth living. Would you trade your ability—or your mother’s—to talk for a few extra months of mute life? The expansion of your visual blind spot in exchange for eliminating the small possibility of a fatal brain hemorrhage? Your right hand’s function to stop seizures? How much neurologic suffering would you let your child endure before saying that death is preferable? “Because the brain mediates our experience of the world, any neurosurgical problem forces a patient and family, ideally with a doctor as a guide, to answer this question: What makes life meaningful enough to go on living?

Expertise is the mantra of modern medicine. In the early twentieth century, you needed only a high school diploma and a one-year medical degree to practice medicine. By the century’s end, all doctors had to have a college degree, a four-year medical degree, and an additional three to seven years of residency training in an individual field of practice—pediatrics, surgery, neurology, or the like. In recent years, though, even this level of preparation has not been enough for the new complexity of medicine.

Darwin is associated, in the popular imagination, with bloody zero-sum competition, with Tennyson’s “nature, red in tooth and claw”—with the motto “survival of the fittest.” But this wasn’t actually his phrase. It was coined by a philosopher and sociologist named Herbert Spencer and his fellow “social Darwinists,” who were promoters of white and upper-class supremacy. For Darwin, says Keltner, “survival of the kindest” would have been a better moniker. Darwin was a gentle and melancholic soul, a doting husband and adoring father of ten, deeply in love with nature from earliest childhood. His father had wanted him to be a doctor, but when at age sixteen he witnessed his first surgery, performed in those days without anesthesia, he was so horrified that for the rest of his life he couldn’t stand the sight of blood. He retreated to the woodlands and studied beetles instead. Later, he described his encounter with a Brazilian forest as “a chaos of delight, out of which a world of future & more quiet pleasure will arise.

KF: This is sounding like it’s something akin to a cure; is that the case? TCC: Yes. The problem in this area of medicine is that traditional doctors are so focused on the use of targeted therapies (chemo, surgery, radiation) that they refuse to even acknowledge the use of therapies like nutrition and are loath to even do proper research in this area. So, in spite of the considerable evidence—theoretical and practical—to support a beneficial nutritional effect, every effort will be made to discredit it. It’s a self-serving motive.

When Barlinnie’s Prison doctor, Dr Danson, came to see Dingus, he turned in disgust at the state Dingus was left to lie in. Doctor Danson refused to treat him as he knew Dingus’s injuries were life threatening, he told the top warden that Dingus would need to be rushed to Glasgow Royal Infirmary for emergency surgery. The screws in the seg block refused to listen to the doctor, they pushed and manhandled their own doctor out of Dingus’s cell and threatened him with a severe beating if he made anything public about Dingus’s injuries.

Lots of concerned friends and family felt that the first medication’s failure was a clear sign that drugs were not the answer; if they were I would have been fixed. Clearly I wasn’t as sick as I said I was if the medication didn’t work for me. And that sort of makes sense, because when you have cancer the doctor gives you the best medicine and if it doesn’t shrink the tumor immediately then that’s a pretty clear sign you were just faking it for attention. I mean, cancer is a serious, often fatal disease we’ve spent billions of dollars studying and treating so obviously a patient would never have to try multiple drugs, surgeries, radiation, etc., to find what will work specifically for them. And once the cancer sufferer is in remission they’re set for life because once they’ve learned how to not have cancer they should be good. And if they let themselves get cancer again they can just do whatever they did last time. Once you find the right cancer medication you’re pretty much immune from that disease forever. And if you get it again it’s probably just a reaction to too much gluten or not praying correctly. Right?

I don’t like to use this word,” he said, “because I’m a man of science and I don’t believe in it. But what happened to your mother today was a miracle. I never say that, because I hate it when people say it, but I don’t have any other way to explain this.” The bullet that hit my mother in the butt, he said, was a through-and-through. It went in, came out, and didn’t do any real damage. The other bullet went through the back of her head, entering below the skull at the top of her neck. It missed the spinal cord by a hair, missed the medulla oblongata, and traveled through her head just underneath the brain, missing every major vein, artery, and nerve. With the trajectory the bullet was on, it was headed straight for her left eye socket and would have blown out her eye, but at the last second it slowed down, hit her cheekbone instead, shattered her cheekbone, ricocheted off, and came out through her left nostril. On the gurney in the emergency room, the blood had made the wound look much worse than it was. The bullet took off only a tiny flap of skin on the side of her nostril, and it came out clean, with no bullet fragments left inside. She didn’t even need surgery. They stopped the bleeding, stitched her up in back, stitched her up in front, and let her heal. “There was nothing we can do, because there’s nothing we need to do,” the doctor

Therapeutic fasting accelerates the healing process and allows the body to recover from serious disease in a dramatically short period of time. In my practice I have seen fasting eliminate lupus and arthritis, remove chronic skin conditions such as psoriasis and eczema, heal the digestive tract in patients with ulcerative colitis and Crohn’s disease, and quickly eliminate cardiovascular diseases such as high blood pressure and angina. In these cases the recoveries were permanent: fasting enabled longtime disease sufferers to unchain themselves from their multiple toxic drugs and even eliminate the need for surgery, which was recommended to some of them as their only solution.

Of course, the cadavers, in life, donated themselves freely to this fate, and the language surrounding the bodies in front of us soon changed to reflect that fact. We were instructed to no longer call them “cadavers”; “donors” was the preferred term. And yes, the transgressive element of dissection had certainly decreased from the bad old days. (Students no longer had to bring their own bodies, for starters, as they did in the nineteenth century. And medical schools had discontinued their support of the practice of robbing graves to procure cadavers—that looting itself a vast improvement over murder, a means once common enough to warrant its own verb: burke, which the OED defines as “to kill secretly by suffocation or strangulation, or for the purpose of selling the victim’s body for dissection.”) Yet the best-informed people—doctors—almost never donated their bodies. How informed were the donors, then? As one anatomy professor put it to me, “You wouldn’t tell a patient the gory details of a surgery if that would make them not consent.” Even if donors were informed enough—and they might well have been, notwithstanding one anatomy professor’s hedging—it wasn’t so much the thought of being dissected that galled. It was the thought of your mother, your father, your grandparents being hacked to pieces by wisecracking twenty-two-year-old medical students. Every time I read the pre-lab and saw a term like “bone saw,” I wondered if this would be the session in which I finally vomited. Yet I was rarely troubled in lab, even when I found that the “bone saw” in question was nothing more than a common, rusty wood saw. The closest I ever came to vomiting was nowhere near the lab but on a visit to my grandmother’s grave in New York, on the twentieth anniversary of her death. I found myself doubled over, almost crying, and apologizing—not to my cadaver but to my cadaver’s grandchildren. In the midst of our lab, in fact, a son requested his mother’s half-dissected body back. Yes, she had consented, but he couldn’t live with that. I knew I’d do the same. (The remains were returned.) In

cause of cavities, even more damaging than sugar consumption, bad diet, or poor hygiene. (This belief had been echoed by other dentists for a hundred years, and was endorsed by Catlin too.) Burhenne also found that mouthbreathing was both a cause of and a contributor to snoring and sleep apnea. He recommended his patients tape their mouths shut at night. “The health benefits of nose breathing are undeniable,” he told me. One of the many benefits is that the sinuses release a huge boost of nitric oxide, a molecule that plays an essential role in increasing circulation and delivering oxygen into cells. Immune function, weight, circulation, mood, and sexual function can all be heavily influenced by the amount of nitric oxide in the body. (The popular erectile dysfunction drug sildenafil, known by the commercial name Viagra, works by releasing nitric oxide into the bloodstream, which opens the capillaries in the genitals and elsewhere.) Nasal breathing alone can boost nitric oxide sixfold, which is one of the reasons we can absorb about 18 percent more oxygen than by just breathing through the mouth. Mouth taping, Burhenne said, helped a five-year-old patient of his overcome ADHD, a condition directly attributed to breathing difficulties during sleep. It helped Burhenne and his wife cure their own snoring and breathing problems. Hundreds of other patients reported similar benefits. The whole thing seemed a little sketchy until Ann Kearney, a doctor of speech-language pathology at the Stanford Voice and Swallowing Center, told me the same. Kearney helped rehabilitate patients who had swallowing and breathing disorders. She swore by mouth taping. Kearney herself had spent years as a mouthbreather due to chronic congestion. She visited an ear, nose, and throat specialist and discovered that her nasal cavities were blocked with tissue. The specialist advised that the only way to open her nose was through surgery or medications. She tried mouth taping instead. “The first night, I lasted five minutes before I ripped it off,” she told me. On the second night, she was able to tolerate the tape for ten minutes. A couple of days later, she slept through the night. Within six weeks, her nose opened up. “It’s a classic example of use it or lose it,” Kearney said. To prove her claim, she examined the noses of 50 patients who had undergone laryngectomies, a procedure in which a breathing hole is cut into the throat. Within two months to two years, every patient was suffering from complete nasal obstruction. Like other parts of the body, the nasal cavity responds to whatever inputs it receives. When the nose is denied regular use, it will atrophy. This is what happened to Kearney and many of her patients, and to so much of the general population. Snoring and sleep apnea often follow.

The evaluation of the merits of medical treatments for madness has always been a calculation made by doctors and, to a certain extent, by society as a whole. Does the treatment provide a method for managing disturbed people? That is the usual bottom line. The patient’s subjective response to the treatment—does it help the patient feel better or think more clearly?—simply doesn’t count in that evaluation. The “mad,” in fact, are dismissed as unreliable witnesses. How can a person crazy in mind possibly appreciate whether a treatment—be it Rush’s gyrator, a wet pack, gastrointestinal surgery, metrazol convulsive therapy, electroshock, or a neuroleptic—has helped? Yet to the person so treated, the subjective experience is everything.

If you were to assume that many experts use their information to your detriment, you’d be right. Experts depend on the fact that you don’t have the information they do. Or that you are so befuddled by the complexity of their operation that you wouldn’t know what to do with the information if you had it. Or that you are so in awe of their expertise that you wouldn’t dare challenge them. If your doctor suggests that you have angioplasty — even though some current research suggests that angioplasty often does little to prevent heart attacks — you aren’t likely to think that the doctor is using his informational advantage to make a few thousand dollars for himself or his buddy. But as David Hillis, an interventional cardiologist at the University of Texas Southwestern Medical Center in Dallas, explained to the New York Times, a doctor may have the same economic incentives as a car salesman or a funeral director or a mutual fund manager: “If you’re an invasive cardiologist and Joe Smith, the local internist, is sending you patients, and if you tell them they don’t need the procedure, pretty soon Joe Smith doesn’t send patients anymore.” Armed with information, experts can exert a gigantic, if unspoken, leverage: fear. Fear that your children will find you dead on the bathroom floor of a heart attack if you do not have angioplasty surgery. Fear that a cheap casket will expose your grandmother to a terrible underground fate. Fear that a $25,000 car will crumple like a toy in an accident, whereas a $50,000 car will wrap your loved ones in a cocoon of impregnable steel.

Next week I start fifth grade. Since I’ve never been to a real school before, I am pretty much totally and completely petrified. People think I haven’t gone to school because of the way I look, but it’s not that. It’s because of all the surgeries I’ve had. Twenty-seven since I was born. The bigger ones happened before I was even four years old, so I don’t remember those. But I’ve had two or three surgeries every year since then (some big, some small), and because I’m little for my age, and I have some other medical mysteries that doctors never really figured out, I used to get sick a lot. That’s why my parents decided it was better if I didn’t go to school. I’m much stronger now, though. The last surgery I had was eight months ago, and I probably won’t have to have any more for another couple of years.

It is necessary to make this point in answer to the `iatrogenic' theory that the unveiling of repressed memories in MPD sufferers, paranoids and schizophrenics can be created in analysis; a fabrication of the doctor—patient relationship. According to Dr Ross, this theory, a sort of psychiatric ping-pong 'has never been stated in print in a complete and clearly argued way'. My case endorses Dr Ross's assertions. My memories were coming back to me in fragments and flashbacks long before I began therapy. Indications of that abuse, ritual or otherwise, can be found in my medical records and in notebooks and poems dating back before Adele Armstrong and Jo Lewin entered my life. There have been a number of cases in recent years where the police have charged groups of people with subjecting children to so-called satanic or ritual abuse in paedophile rings. Few cases result in a conviction. But that is not proof that the abuse didn't take place, and the police must have been very certain of the evidence to have brought the cases to court in the first place. The abuse happens. I know it happens. Girls in psychiatric units don't always talk to the shrinks, but they need to talk and they talk to each other. As a child I had been taken to see Dr Bradshaw on countless occasions; it was in his surgery that Billy had first discovered Lego. As I was growing up, I also saw Dr Robinson, the marathon runner. Now that I was living back at home, he was again my GP. When Mother bravely told him I was undergoing treatment for MPD/DID as a result of childhood sexual abuse, he buried his head in hands and wept. (Alice refers to her constant infections as a child, which were never recognised as caused by sexual abuse)

And he was introduced to Loki, the family’s hairless cat. “The kids wanted another pet,” Becky explained as Felix stared in horror at the creature beside him. “But with Polly’s allergies . . .” “You are lying to me. You borrowed this creature from a zoo to play a prank on me. This isn’t even really a cat, is it? This is some sort of rat and opossum hybrid. This is a lifelike Japanese robot that can dance to disco music.” “Funny. They’re called sphinx cats. Come on, feel her skin. Like peach fuzz, right? Isn’t she sweet? Give her a good rub. She’s very affectionate.” “Ah-ha, yes, isn’t that just . . . er, what is coating my hands?” “It’s . . . it’s like a body wax. I should’ve bathed her before you came. The hairless cats, they ooze this waxy stuff to protect their skin. ’Cause they don’t have hair. To protect them. So the waxy ooze helps. You see.” Felix stared at her for several seconds, his hands held up like a doctor about to perform surgery. “I’m going to wash my hands now. And I’m going to try very hard not to run out of this house screaming.

Our frog lies on her back. Waiting for a prince to come and princessify her with a smooth? I stand over her with my knife. Ms. Keen's voice fades to a mosquito whine. My throat closes off. It is hard to breathe. I put out my and to steady myself against the table. David pins her froggy hands to the dissection tray. He spreads her froggy legs and pins her froggy feet. I have to slice open her belly. She doesn't say a word. She is already dead. A scream starts in my gut - I can feel the cut, smell the dirt, leaves in my hair. I don't remember passing out. David says I hit my head on the edge of the table on my way down. The nurse calls my mom because I need stitches. The doctor stares into the back of my eyes with a bright light. Can she read the thoughts hidden there? If she can, what will she do? Call the cops? Send me to the nuthouse? Do I want her to? I just want to sleep. The whole point of not talking about it, of silencing the memory, is to make it go away. It won't. I'll need brain surgery to cut it out of my head. Maybe I should wait until David Petrakis is a doctor, let him do it.

It’s not for the weak or faint of heart. It will take a toll on you. Your body will hurt. Your soul will ache. Your family life will suffer. No one will understand what you do or why you do it, but you do it. You will work nights. You will work weekends. Holidays. You will bathe the elderly, the weak. You will clean their body, their bodily fluids. You will have to know every medication, what it does, when to stop it, when to give it, and how to get it into people. You will have to know how to interpret blood tests, when the doctor must know. You will have thirty seconds to start an IV, how to hook up an EKG machine. You will need to know how to interpret tracing or when you should give or take away oxygen. You will experience joy, grief, and sorrow in a day, sometimes within the same hour. You are the glue between the patient, the family, the doctor. It’s you who will keep everyone happy, as comfortable as possible. Code blue. Trauma evaluation. Labor. Delivery. Surgery. Babies. Postpartum. Psychology. These and more will all need to be learned. And when you think you know everything, you don’t. You’re just starting. I was asked to write this essay on why

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

I've just been certified as a shaman, or sha-woman, if you please," Dr. Tuttle said. "You can hop up on the table if you prefer not to stand. You look worse for wear. Is that the expression?" I leaned carefully against the bookshelf. "What do you use the massage table for?" I heard myself ask. "Mystical recalibrations, mostly. I use copper dowels to locate lugubriations in the subtle body field. It's an ancient form of healing—locating and then surgically removing cancerous energies." "I see." "And by surgery I mean metaphysical. Like magnet sucking. I can show you the magnet machine if you're interested. Small enough to fit in a handbag. Costs a pretty penny, although it's very useful. Very. Not so much for insomniacs, but for compulsive gamblers and Peeping Toms—adrenaline junkies, in other words. New York City is full of those types, so I foresee myself getting busier this year. But don't worry. I'm not abandoning my psychiatric clients. There are only a few of you anyway. Hence my new certification. Costly, but worth it. Sit on it," she insisted, so I did, grappling with the edge of the cool pleather of the massage table to hoist myself up. My legs swung like a kid's at the doctor's.

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

Rennie looked again and his hand attached itself to his arm, which was part of him. He wasn’t very far away. She fell in love with him because he was the first thing she saw after her life had been saved. This was the only explanation she could think of. She wished, later, when she was no longer feeling dizzy but was sitting up, trying to ignore the little sucking tubes that were coming out of her and the constant ache, that it had been a potted begonia or a stuffed rabbit, some safe bedside object. Jake sent her roses but by then it was too late. I imprinted on him, she thought; like a duckling, like a baby chick. She knew about imprinting; once, when she was hard up for cash, she’d done a profile for Owl Magazine of a man who believed geese should be used as safe and loyal substitute for watchdogs. It was best to be there yourself when the goslings came out of the eggs, he said. Then they’d follow you to the ends of the earth. Rennie had smirked because that man seemed to think that being followed to the ends of the earth by a flock of adoring geese was both desirable and romantic, but she’d written it all down in his own words. Now she was behaving like a goose, and the whole thing put her on foul temper. It was inappropriate to have fallen in love with Daniel, who had no distinguishing features that Rennie could see. She hardly even knew what he looked like, since, during the examinations before the operation, she hadn’t bothered to look at him. One did not look at doctors; they were functionaries, they were what your mother one hoped you would marry, they were fifties, they were passe. It wasn’t only inappropriate, it was ridiculous. It was expected. Falling in love with your doctor was something middle-aged married women did, women in soaps, women in nurse novels and sex-and-scalpel epics with titles like Surgery and nurse with big tits and doctors who looked like Dr. Kildare on the covers. It was the sort of thing Toronto Life did stories about, soft-core gossip masquerading as hard-nosed research expose. Rennie could not stand being guilty of such a banality.

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

He ran long at the White House, and arrived late to his next meeting with Hillary Clinton, Jake Sullivan and Frank Ruggiero—their first major strategy session on Taliban talks after the secret meeting with A-Rod. She was waiting in her outer office, a spacious room paneled in white and gilt wood, with tasseled blue and pink curtains and an array of colorfully upholstered chairs and couches. In my time reporting to her later, I only ever saw Clinton take the couch, with guests of honor in the large chair kitty-corner to her. She’d left it open for him that day. “He came rushing in. . . . ” Clinton later said. “And, you know, he was saying ‘oh I’m so sorry, I’m so sorry.’ ” He sat down heavily and shrugged off his coat, rattling off a litany of his latest meetings, including his stop-in at the White House. “That was typical Richard. It was, like, ‘I’m doing a million things and I’m trying to keep all the balls in the air,’ ” she remembered. As he was talking, a “scarlet red” flush went up his face, according to Clinton. He pressed his hands over his eyes, his chest heaving. “Richard, what’s the matter?” Clinton asked. “Something horrible is happening,” he said. A few minutes later, Holbrooke was in an ambulance, strapped to a gurney, headed to nearby George Washington University Hospital, where Clinton had told her own internist to prepare the emergency room. In his typically brash style, he’d demanded that the ambulance take him to the more distant Sibley Memorial Hospital. Clinton overruled him. One of our deputies on the SRAP team, Dan Feldman, rode with him and held his hand. Feldman didn’t have his BlackBerry, so he scrawled notes on a State Department expense form for a dinner at Meiwah Restaurant as Holbrooke dictated messages and a doctor assessed him. The notes are a nonlinear stream of Holbrooke’s indomitable personality, slashed through with medical realities. “Call Eric in Axelrod’s office,” the first read. Nearby: “aortic dissection—type A . . . operation risk @ > 50 percent”—that would be chance of death. A series of messages for people in his life, again interrupted by his deteriorating condition: “S”—Secretary Clinton—“why always together for medical crises?” (The year before, he’d been with Clinton when she fell to the concrete floor of the State Department garage, fracturing her elbow.) “Kids—how much love them + stepkids” . . . “best staff ever” . . . “don’t let him die here” . . . “vascular surgery” . . . “no flow, no feeling legs” . . . “clot” . . . and then, again: “don’t let him die here want to die at home w/ his fam.” The seriousness of the situation fully dawning on him, Holbrooke turned to job succession: “Tell Frank”—Ruggiero—“he’s acting.” And finally: “I love so many people . . . I have a lot left to do . . . my career in public service is over.” Holbrooke cracked wise until they put him under for surgery. “Get me anything you need,” he demanded. “A pig’s heart. Dan’s heart.