Surgery Operation Quotes

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

I didn't expect to recover from my second operation but since I did, I consider that I'm living on borrowed time. Every day that dawns is a gift to me and I take it in that way. I accept it gratefully without looking beyond it. I completely forget my physical suffering and all the unpleasantness of my present condition and I think only of the joy of seeing the sun rise once more and of being able to work a little bit, even under difficult conditions.

Whatever is deeply, essentially female--the life in a woman's expression, the feel of her flesh, the shape of her breasts, the transformations after childbirth of her skin--is being reclassified as ugly, and ugliness as disease. These qualities are about an intensification of female power, which explains why they are being recast as a diminution of power. At least a third of a woman's life is marked with aging; about a third of her body is made of fat. Both symbols are being transformed into operable condition--so that women will only feel healthy if we are two thirds of the women we could be. How can an "ideal" be about women if it is defined as how much of a female sexual characteristic does not exist on the woman's body, and how much of a female life does not show on her face?

The maturing of a woman who has continued to grow is a beautiful thing to behold. Or, if your ad revenue or your seven-figure salary or your privileged sexual status depend on it, it is an operable condition.

The operating is the easy part, you know,’ he said. ‘By my age you realize that the difficulties are all to do with the decision-making.

When push comes to shove we can afford to lose an arm or a leg, but I am operating on peoples thoughts and feelings... and if something goes wrong I can destroy that persons character... forever.

At least a third of a woman's life is marked with aging; about a third of her body is made of fat. Both symbols are being transformed into operable condition--so that women will only feel healthy if we are two thirds of the women we could be. How can an "ideal" be about women if it is defined as how much of a female sexual characteristic does not show on her body, and how much of a female life does not show on her face?

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?

When I tell a patient that I think I should do their operation under local anaesthetic they usually look a little shocked. In fact the brain cannot itself feel pain since pain is a phenomenon produced within the brain.

Psychological research has shown that the most reliable route to personal happiness is to make others happy. I have made many patients very happy with successful operations but there have been many terrible failures and most neurosurgeons’ lives are punctuated by periods of deep despair.

Some of my operations are great triumphs and tremendous. But they're only triumphs because there are also disasters

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.

Do you think we’ll ever go back to the way it was?” I ask Finn. He glances at me. “I don’t know,” he says thoughtfully. “When I used to talk to patients before surgery, they always asked if they’d be able to do everything they used to do before the operation. I mean, technically, the answer should be yes. But there’s always a scar. Even if it’s not right across your belly, it’s in your head somewhere—the brand-new knowledge that you weren’t invincible. I think that changes you for the long haul.

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.

While railing against the manufactured prerequisites of womanhood or manhood, we need to avoid manufacturing our own prerequisites. The non-operative journey and the objection to it illustrate just one area in which we need to open our thinking to other journeys while expecting that others respect our own. - Mercedes Allen

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.

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.

Recent experiments in neuroscience support the view that it is our physical brain, following the known laws of science, that determines our actions, and not some agency that exists outside those laws. For example, a study of patients undergoing awake brain surgery found that by electrically stimulating the appropriate regions of the brain, one could create in the patient the desire to move the hand, arm or foot, or to move the lips and talk. It is hard to imagine how free will can operate if our behaviour is determined by physical law, so it seems that we are no more than biological machines and that free will is just an illusion.

Anyone who claims that contraception and abortion are incompatible with the prevailing views of the Vatican should take a look at this book by Pope John XXI.

Minor surgery is an operation on someone else. You’ve heard that,

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.

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.

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.

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

For them, the last option was to have brain surgery, which involved removing parts of the skull and exposing the brain. (Since the brain has no pain sensors, a person can be conscious during this entire procedure, so Dr. Penfield used only a local anesthetic during the operation.)

What's going on? A soul? Did you say, a soul? What the hell! Next thing you know we'll have cholera again. What did I tell you? [He tossed the thin one on his horns.] I told you so... we should operate on all of them, on the imagination. Extirpate the imagination. Surgery's the only answer... nothing but surgery...

His most famous (and possibly apocryphal) mishap involved an operation during which he worked so rapidly that he took off three of his assistant's fingers and, while switching blades, slashed a spectator's coat. Both the assistant and the patient died later of gangrene, and the unfortunate bystander expired on the spot from fright. It is the only surgery in history said to have had a 300 percent fatality rate.

His most famous (and possibly apocryphal) mishap involved an operation during which he worked so rapidly that he took off three of his assistant’s fingers and, while switching blades, slashed a spectator’s coat. Both the assistant and the patient died later of gangrene, and the unfortunate bystander expired on the spot from fright. It is the only surgery in history said to have had a 300 percent fatality rate.

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

On the Soyuz, there’s simply not room to fly someone whose main contribution is expertise in a single area. The Russian rocket ship only carries three people, and between them they need to cover off a huge matrix of skills. Some are obvious: piloting the rocket, spacewalking, operating the robotic elements of the ISS like Canadarm2, being able to repair things that break on Station, conducting and monitoring the numerous scientific experiments on board. But since the crew is going to be away from civilization for many months, they also need to be able to do things like perform basic surgery and dentistry, program a computer and rewire an electrical panel, take professional-quality photographs and conduct a press conference—and get along harmoniously with colleagues, 24/7, in a confined space.

Veeva squirmed up and down the length of me, vibrating like a coin operated motel bed. When she stopped kissing my mouth, I said, "It sounds so great, Veeva. Just you and me with our brand new plastic surgery noses, running for our lives, hating each other’s guts... Both of us getting to look more and more like Michael Jackson every day.

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

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.

After three hours, I come back to the waiting room. It is a cosmetic surgery office, so a little like a hotel lobby, underheated and expensively decorated, with candy in little dishes, emerald-green plush chairs, and upscale fashion magazines artfully displayed against the wall. A young woman comes in, frantic to get a pimple "zapped" before she sees her family over the holidays. An older woman comes in with her daughter for a follow-up visit to a face-lift. She is wearing a scarf and dark glasses. The nurse examines her bruises right out in the waiting room. And you are in the operating room having your body and your gender legally altered. I feel like laughing, but I know it makes me sound like a lunatic.

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

Awareness creates another world - an already existing world where you were not aware of its existence! It is an operation of ‘mature cataract’ surgery!

It was now so much a part of him, that it could not have been torn from him without destroying him almost entirely: as they say in surgery, his love was no longer operable.

believe I already wrote in my notes that love was very similar to torture or surgery. But this idea can be developed in a most bitter way. Even if two lovers are very much in love and full of mutual desires, one of the two will always be calmer or less possessed than the other. The former is the operator or the executioner; the latter is the subject, the victim. Do you hear these sighs, preludes to a tragedy of dishonor, these groans, these cries, these gasps? Who hasn't uttered them, who has resisted extorting them? And what do you find to be the worst part of the torment applied by the careful torturers? The revolting sleepwalker eyes, the limbs with muscles that jump or stiffen as if they were galvanized; certainly, not even the most furious effects of intoxication, delirium or opium could provide such horrible and curious examples. And the human face, which Ovid believed to be made to reflect the stars, is now wearing an expression of crazy ferocity or slackening in some sort of death. Surely, I would think it a sacrilege if I used the word "ecstasy" for such decomposition.

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.

It’s like surgery. You can’t close the patient’s chest until you’ve found the wound and operated on it. The problem is the open chest, the wound is the challenge and the YES is the operation. You

Because I live in south Florida I store cans of black beans and gallons of water in my closet in preparation for hurricane season. I throw a hurricane party in January. You’re my only guest. We play Marco Polo in bed. The sheets are wet like the roof caved in. There’s a million of me in you. You try to count me as I taste the sweat on the back of your neck. I call you Sexy Sexy, and we do everything twice. After, still sweating, we drink Crystal Light out of plastic water bottles. We discuss the pros and cons of vasectomies. It’s not invasive you say. I wrap the bedsheet around my waist. Minor surgery you say. You slur the word surgery, like it’s a garnish on a dish you just prepared. I eat your hair until you agree to no longer talk about vasectomies. We agree to have children someday, and that they will be beautiful even if they’re not. As I watch your eyes grow heavy like soggy clothes, I tell you When I grow up I’m going to be a famous writer. When I’m famous I’ll sign autographs on Etch-A-Sketches. I’ll write poems about writing other poems, so other poets will get me. You open your eyes long enough to tell me that when you grow up, you’re going to be a steamboat operator. Your pores can never be too clean you say. I say I like your pores just fine. I say Your pores are tops. I kiss you with my whole mouth, and you fall asleep next to my molars. In the morning, we eat french toast with powdered sugar. I wear the sugar like a mustache. You wear earmuffs and pretend we’re in a silent movie. I mouth Olive juice, but I really do love you. This is an awesome hurricane party you say, but it comes out as a yell because you can’t gauge your own volume with the earmuffs on. You yell I want to make something cute with you. I say Let me kiss the insides of your arms. You have no idea what I just said, but you like the way I smile.

a study of patients undergoing awake brain surgery found that by electrically stimulating the appropriate regions of the brain, one could create in the patient the desire to move the hand, arm, or foot, or to move the lips and talk. It is hard to imagine how free will can operate if our behavior is determined by physical law, so it seems that we are no more than biological machines and that free will is just an illusion.

What man needs is a radical change of nature, what Professor H. M. Gwatkin called ‘a change from self to unself’. We cannot do this for ourselves any more than patients needing surgery can perform their own operations.

Surgical Talk As we look at the insides of humans, We find the inside of ourselves And each other. What lies beneath us? What do we believe About the world and our place in it? We cut down layer upon layer And dissect the inner life.

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 operation?” “No, the sex change.” The doctor’s smile faltered. “I’m joking.

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.

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.

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

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.

When I learned my mom was going to die of cancer at the age of forty-five, I felt the same way. I didn’t even believe in God, but I still felt that he owed me something. I had the gall to think How dare he? I couldn’t help myself. I’m a selfish brute. I wanted what I wanted and I expected it to be given to me by a God in whom I had no faith. Because mercy had always more or less been granted me, I assumed it always would be. But it wasn’t. It wasn’t granted to my friend whose eighteen-year-old daughter was killed by a drunk driver either. Nor was it granted to my other friend who learned her baby is going to die of a genetic disorder in the not-distant future. Nor was it granted to my former student whose mother was murdered by her father before he killed himself. It was not granted to all those people who were in the wrong place at the wrong time when they came up against the wrong virus or military operation or famine or carcinogenic or genetic mutation or natural disaster or maniac. Countless people have been devastated for reasons that cannot be explained or justified in spiritual terms. To do as you are doing in asking If there were a God, why would he let my little girl have to have possibly life-threatening surgery?— understandable as that question is—creates a false hierarchy of the blessed and the damned. To use our individual good or bad luck as a litmus test to determine whether or not God exists constructs an illogical dichotomy that reduces our capacity for true compassion. It implies a pious quid pro quo that defies history, reality, ethics, and reason. It fails to acknowledge that the other half of rising—the very half that makes rising necessary— is having first been nailed to the cross. That

After hearing much from his patients about alleged faith-healing, a Minnesota physician named William Nolen spent a year and a half trying to track down the most striking cases. Was there clear medical evidence that the disease was really present before the ‘cure’? If so, had the disease actually disappeared after the cure, or did we just have the healer’s or the patient’s say-so? He uncovered many cases of fraud, including the first exposure in America of ‘psychic surgery’. But he found not one instance of cure of any serious organic (non-psychogenic) disease. There were no cases where gallstones or rheumatoid arthritis, say, were cured, much less cancer or cardiovascular disease. When a child’s spleen is ruptured, Nolen noted, perform a simple surgical operation and the child is completely better. But take that child to a faith-healer and she’s dead in a day.

Although Liston was renowned for his success stories—such as the removal of a forty-five-pound scrotal tumor in four minutes; prior to the operation, the poor patient had been forced to carry his scrotum around in a wheelbarrow—he also developed a reputation for the flamboyancy of his surgical failures. For instance, his joy at amputating a patient’s leg at the thigh in less than three minutes was hindered greatly when he realized he had also inadvertently sawed off the patient’s testicles. And perhaps, most famously, another leg amputation performed in less than three minutes had the unfortunate result of killing three people: the patient (who survived the surgery but died of gangrene several days later); his young assistant (whose fingers he accidentally sawed off during surgery and who would also later succumb to gangrene); and “a distinguished surgical spectator” whose coattails Liston also slashed. The man, who found himself surrounded by geysers of blood, was so convinced that the knife had pierced his vitals that he immediately “dropped dead from fright.” It was later described as “the only operation in history with a 300 percent mortality [rate].

The sex act is emotionally the richest and the most imaginatively charged event in our lives, comparable only to the embrace of our children as a source of affection and mystery. But no kinaesthetic language has yet been devised to describe it in detail, and without one we are in the position of an unqualified observer viewing an operation for brain surgery. Ballet, gymnastics, American football and judo are furnished with elaborate kinaesthetic languages, but it's still easier to describe the tango or the cockpit take-off procedures for a 747 than to recount in detail an act of love.

A scan showed that a benign brain tumor was pressing on her right frontal lobe. In terms of operative risk, it was the best kind of tumor to have, and the best place to have it; surgery would almost certainly eliminate her seizures. The alternative was a lifetime on toxic antiseizure medications.

he’s not real I can take his space. As I get into bed beside him, the strongman vanishes. I pick up my diary and record him: was there, isn’t any more. This happened in early July, 2010. I had surgery on the first of the month, and was scheduled to stay in hospital for about nine days. The last thing the surgeon said to me, on the afternoon of the procedure: ‘For you, this is a big thing, but remember, to us it is routine.’ The operation was to relieve a stricture in my bowel, before it closed completely and created an emergency. But though we had used the latest scans in preparation, neither

EVERY WEDNESDAY, I teach an introductory fiction workshop at Harvard University, and on the first day of class I pass out a bullet-pointed list of things the students should try hard to avoid. Don’t start a story with an alarm clock going off. Don’t end a story with the whole shebang having been a suicide note. Don’t use flashy dialogue tags like intoned or queried or, God forbid, ejaculated. Twelve unbearably gifted students are sitting around the table, and they appreciate having such perimeters established. With each variable the list isolates, their imaginations soar higher. They smile and nod. The mood in the room is congenial, almost festive with learning. I feel like a very effective teacher; I can practically hear my course-evaluation scores hitting the roof. Then, when the students reach the last point on the list, the mood shifts. Some of them squint at the words as if their vision has gone blurry; others ask their neighbors for clarification. The neighbor will shake her head, looking pale and dejected, as if the last point confirms that she should have opted for that aseptic-surgery class where you operate on a fetal pig. The last point is: Don’t Write What You Know. The idea panics them for two reasons. First, like all writers, the students have been encouraged, explicitly or implicitly, for as long as they can remember, to write what they know, so the prospect of abandoning that approach now is disorienting. Second, they know an awful lot. In recent workshops, my students have included Iraq War veterans, professional athletes, a minister, a circus clown, a woman with a pet miniature elephant, and gobs of certified geniuses. They are endlessly interesting people, their lives brimming with uniquely compelling experiences, and too often they believe those experiences are what equip them to be writers. Encouraging them not to write what they know sounds as wrongheaded as a football coach telling a quarterback with a bazooka of a right arm to ride the bench. For them, the advice is confusing and heartbreaking, maybe even insulting. For me, it’s the difference between fiction that matters only to those who know the author and fiction that, well, matters.

By the way, don’t thank me for saving you, thank the lifeguards. If it was up to me, I would’ve just carried you off to the building by the boardwalk that said SURGERY. I’m sorry, but there’s a big difference between a family doctor treating you for the sniffles, and a guy who actually owns and knows how to use an operating table.

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.

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

Nineteenth-century operating “theaters” had more to do with medical instruction than with saving patients’ lives. If you could, you stayed out of them at all cost. For one thing, you were being operated on without anesthesia. (The first operations under ether didn’t take place until 1846.) Surgical patients in the late 1700s and early 1800s could feel every cut, stitch, and probing finger. They were often blindfolded—this may have been optional, not unlike the firing squad hood—and invariably bound to the operating table to keep them from writhing and flinching or, quite possibly, leaping from the table and fleeing into the street. (Perhaps owing to the presence of an audience, patients underwent surgery with most of their clothes on.)

[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.

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

Though we feel that we can choose what we do, our understanding of the molecular basis of biology shows that biological processes are governed by the laws of physics and chemistry and therefore are as determined as the orbits of the planets. Recent experiments in neuroscience support the view that it is our physical brain, following the known laws of science, that determines our actions, and not some agency that exists outside those laws. For example, a study of patients undergoing awake brain surgery found that by electrically stimulating the appropriate regions of the brain, one could create in the patient the desire to move the hand, arm, or foot, or to move the lips and talk. It is hard to imagine how free will can operate if our behavior is determined by physical law, so it seems that we are no more than biological machines and that free will is just an illusion.

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?

In the novel Janus Equation, writer G. Spruill explored one of the harrowing problems with time travel. In this tale a brilliant mathematician whose goal is to discover the secret of time travel meets a strange, beautiful woman, and they become lovers, although he knows nothing about her past. He becomes intrigued about finding out her true identity. Eventually he discovers that she once had plastic surgery to change her features. And that she had a sex change operation. Finally, he discovers that “she” is actually a time traveler from the future, and that “she” is actually himself, but from the future. This means that he made love to himself. And one is left wondering, what would have happened if they had had a child? And if this child went back into the past, to grow up to become the mathematician at the beginning of the story, then is it possible to be your own mother and father and son and daughter?

Heart disease is the Jeffrey Dahmer of modern ailments. It kills more than 25 percent of us. That’s one person in the United States dying of it every 37 seconds. Expanding fitness just a bit—the equivalent of a person improving their max running speed from five to six miles an hour—reduces the risk of heart disease by 30 percent, according to the American Heart Association. Next is cancer. It kills 22.8 percent of us. The most fit people face a 45 percent lower risk of dying from the disease, according to a study in the Annals of Oncology. Then we have accidents. They take 6.8 percent of us. If a person is in a serious car accident, being in shape drops their chances of dying by 80 percent, according to a study in the Emergency Medical Journal. If the docs have to operate—regardless of whether it’s an emergency or a planned surgery—fitter people also face fewer surgical complications and recover faster than unfit people, say scientists in Brazil.

Get a microscope and some spit. Put the spit on a glass slide and put it under the microscope lens. Now look through the eyepiece. You’ll notice, if you look closely, that you can’t see anything, because you have no idea how to operate a microscope. But while you’re looking, billions of germs, left on the eyepiece by the previous microscope user, will swarm into your eyeball—which to them is a regular Club Med—and start reproducing like crazy via wild bacterial sex. You’ll probably need surgery.

always be. The new normal. “Do you think we’ll ever go back to the way it was?” I ask Finn. He glances at me. “I don’t know,” he says thoughtfully. “When I used to talk to patients before surgery, they always asked if they’d be able to do everything they used to do before the operation. I mean, technically, the answer should be yes. But there’s always a scar. Even if it’s not right across your belly, it’s in your head somewhere—the brand-new knowledge that you weren’t invincible. I think that changes you for the long haul.

Liston’s speed was both a gift and a curse. Once, he accidentally sliced off a patient’s testicle along with the leg he was amputating. His most famous (and possibly apocryphal) mishap involved an operation during which he worked so rapidly that he took off three of his assistant’s fingers and, while switching blades, slashed a spectator’s coat. Both the assistant and the patient died later of gangrene, and the unfortunate bystander expired on the spot from fright. It is the only surgery in history said to have had a 300 percent fatality rate.

If the body is no longer a site of otherness but of identification, then we have urgently to become reconciled with it, repair it, perfect it, turn it into an ideal object. Everyone treats their bodies the way men treat women in projective identification: they invest them as a fetish, making an autistic cult of them, subjecting them to a quasi-incestuous manipulation. And it is the body's resemblance to its model which becomes a source of eroticism and 'white' seduction -- in the sense that it effects a kind of white magic of identity, as opposed to the black magic of otherness. This is how it is with body-building: you get into your body as you would into a suit of nerve and muscle. The body is not muscular, but muscled. It is the same with the brain and with social relations or exchanges: body-building, brainstorming, word-processing. Madonna is the ideal specimen of this, our muscled Immaculate Conception, our muscular angel who delivers us from the weaknesses of the body (pity the poor shade of Marilyn!). The sheath of muscles is the equivalent of character armour. In the past, women merely wrapped themselves in their image and their finery -- Freud speaks of those people who live with a kind of inner mirror, in a fleshly, happy self-reference. That narcissistic ideal is past and gone; body-building has wiped it out and replaced it with a gymnastic Ego-Ideal -- cold, hard, stressed, artificial self-reference. The construction of a double, of a physical and mental identity shell. Thus, in `body simulation', where you can animate your body remotely at any moment, the phantasy of being present in more than one body becomes an operational reality. An extension of the human being. And not a metaphorical or poetic extension, as in Pessoa's heteronyms, but quite simply a technical one.

to love Grace unconditionally—to be blind to her condition. Bonnie had already reached that point. In fact, as she realized that our culture would not affect Grace in the same way as other girls, she began to see the advantage of having a daughter with Down syndrome. On the day of her surgery, Bonnie could not bear to be the one to hand her over to the medical staff. As I held Grace in the early morning hours prior to her surgery and then eventually walked down the hall to the operating room with her, my heart swelled with emotion. I was falling in love. Suddenly, I couldn’t imagine losing my baby girl.

Price Pritchett, author of The Quantum Leap Strategy, emphasizes that what often looks like failure is actually a work in progress: “Everything looks like a failure in the middle. You can’t bake a cake without getting the kitchen messy. Halfway through surgery it looks like there’s been a murder in the operating room.” If you measure your body fat after a week of work and there’s no change, you haven’t failed; you’ve simply produced a result. As long as you have a goal and you’re taking efficient daily action, then whatever result you produce is “performance feedback.” It may not be the result you want, but it’s still valuable feedback. You’ve learned one way that doesn’t work.

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

you’re dead set on creating explosions that a crematory operator would hear and would definitely be freaked out by, don’t leave unpopped popcorn in your body. Instead, try leaving a pacemaker in your body. (Note: I one-thousand-percent do not recommend doing this. I’m making a joke. See, I can make jokes too, Tim.) A pacemaker helps living people control their heartbeat, speeding up the heart if needed, slowing the heart down if needed. It’s a cute lil’ thing, the size of a small cookie, that is basically a battery, generator, and some wires implanted (through surgery) into the body. It can save your life if your heart is misfiring. But if a pacemaker is not removed from a dead body before the cremation, it can turn into a tiny bomb.

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.

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

Another common practice, the reps told us, was to take fancy meals to the entire doctor’s office (one of the perks of being a nurse or receptionist, I suppose). One doctor’s office even required alternating days of steak and lobster for lunch if the reps wanted access to the doctors. Even more shocking, we found out that physicians sometimes called the reps into the examination room (as an “expert”) to directly inform patients about the way certain drugs work. Hearing stories from the reps who sold medical devices was even more disturbing. We learned that it’s common practice for device reps to peddle their medical devices in the operating room in real time and while a surgery is under way. Janet and I were surprised at how well the pharmaceutical reps understood classic psychological persuasion strategies and how they employed them in a sophisticated and intuitive manner.

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

operative risk, it was the best kind of tumor to have, and the best place to have it; surgery would almost certainly eliminate her seizures. The alternative was a lifetime on toxic antiseizure medications. But I could see that the idea of brain surgery terrified her, more than most. She was lonesome and in a strange place, having been swept out of the familiar hubbub of a shopping mall and into the alien beeps and alarms and antiseptic smells of an ICU. She would likely refuse surgery if I launched into a detached spiel detailing all the risks and possible complications. I could do so, document her refusal in the chart, consider my duty discharged, and move on to the next task. Instead, with her permission, I gathered her family with her, and together we calmly talked through the options. As we talked, I could see the enormousness of the choice she faced dwindle into a difficult but understandable decision. I had met her in a space where she was a person, instead of a problem to be solved. She chose surgery.

In 2013 a study published in the Journal of Patient Safety8 put the number of premature deaths associated with preventable harm at more than 400,000 per year. (Categories of avoidable harm include misdiagnosis, dispensing the wrong drugs, injuring the patient during surgery, operating on the wrong part of the body, improper transfusions, falls, burns, pressure ulcers, and postoperative complications.) Testifying to a Senate hearing in the summer of 2014, Peter J. Pronovost, MD, professor at the Johns Hopkins University School of Medicine and one of the most respected clinicians in the world, pointed out that this is the equivalent of two jumbo jets falling out of the sky every twenty-four hours. “What these numbers say is that every day, a 747, two of them are crashing. Every two months, 9/11 is occurring,” he said. “We would not tolerate that degree of preventable harm in any other forum.”9 These figures place preventable medical error in hospitals as the third biggest killer in the United States—behind only heart disease and cancer.

I told her that what the family wanted would be entirely determined by what she said to them. If she said ‘we can operate and remove the damaged brain and he may just survive’ they were bound to say that we should operate. If, instead, she said ‘If we operate there is no realistic chance of his getting back to an independent life. He will be left profoundly disabled. Would he want to survive like that?’ the family would probably give an entirely different answer. What she was really asking them with the first question was ‘Do you love him enough to look after him when he is disabled?’ and by saying this she was not giving them any choice. In cases like this we often end up operating because it’s easier than being honest and it means that we can avoid a painful conversation. You might think the operation has been a success because the patient leaves the hospital alive but if you saw them years later – as I often do – you would realize that the result of the operation was a human disaster. The room was silent for a while. ‘The decision has been made to operate,’ the registrar said stiffly.

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

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

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

to an AirPort Express in his hospital room, announcing his surgery. He assured them that the type of pancreatic cancer he had “represents about 1% of the total cases of pancreatic cancer diagnosed each year, and can be cured by surgical removal if diagnosed in time (mine was).” He said he would not require chemotherapy or radiation treatment, and he planned to return to work in September. “While I’m out, I’ve asked Tim Cook to be responsible for Apple’s day to day operations, so we shouldn’t miss a beat. I’m sure I’ll be calling some of you way too much in August, and I look forward to seeing you in September.” One side effect of the operation would become a problem for Jobs because of his obsessive diets and the weird routines of purging and fasting that he had practiced since he was a teenager. Because the pancreas provides the enzymes that allow the stomach to digest food and absorb nutrients, removing part of the organ makes it hard to get enough protein. Patients are advised to make sure that they eat frequent meals and maintain a nutritious diet, with a wide variety of meat and fish proteins as well as full-fat milk products. Jobs had never done this, and he never would.

So certain were experts that neonates felt no pain that through the mid-1980s major surgeries on newborn babies were sometimes performed without anesthesia. These included major cardiovascular procedures requiring prying open rib cages, puncturing lungs, and tying off major arteries. Though provided with no pharmacologic agents to blunt the pain that cracking ribs or cutting through the sternum might have induced, babies were given powerful agents to induce paralysis—ensuring an immobile (and undoubtedly terrified) patient on whom to operate. Jill Lawson’s remarkable story of her premature son, Jeffrey, and his unanesthetized heart surgery provides a heartbreaking account of such a procedure. After Jeffrey’s death in 1985, Lawson’s campaign to educate the medical profession about the need to treat pain in the young literally changed the field. And likely led to improved awareness of pain in animals, too. bA technique called clicker training pairs a metallic tick-tock! with a food treat every time the animal performs a desired behavior. Eventually the animal comes to associate the sound of the clicker with the feel-good neurochemical rewards of the food. When the treat is discontinued, the animal will continue doing the behavior, because

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

The realization that there were electrical pathways connecting the brain to the body wasn’t systematically analyzed until the 1930s, when Dr. Wilder Penfield began working with epilepsy patients, who often suffered from debilitating convulsions and seizures that were potentially life-threatening. For them, the last option was to have brain surgery, which involved removing parts of the skull and exposing the brain. (Since the brain has no pain sensors, a person can be conscious during this entire procedure, so Dr. Penfield used only a local anesthetic during the operation.) Dr. Penfield noticed that when he stimulated certain parts of the cortex with an electrode, different parts of the body would respond. He suddenly realized that he could draw a rough one-to-one correspondence between specific regions of the cortex and the human body. His drawings were so accurate that they are still used today in almost unaltered form. They had an immediate impact on both the scientific community and the general public. In one diagram, you could see which region of the brain roughly controlled which function, and how important each function was. For example, because our hands and mouth are so vital for survival, a considerable amount of brain power is devoted to controlling them, while the sensors in our back hardly register at all. Furthermore, Penfield found that by stimulating parts of the temporal lobe, his patients suddenly relived long-forgotten memories in a crystal-clear fashion. He was shocked when a patient, in the middle of brain surgery, suddenly blurted out, “It was like … standing in the doorway at [my] high school.… I heard my mother talking on the phone, telling my aunt to come over that night.” Penfield realized that he was tapping into memories buried deep inside the brain. When he published his results in 1951, they created another transformation in our understanding of the brain.

Society would have much to gain from decriminalization. On the immediate practical level, we would feel safer in our homes and on our streets and much less concerned about the danger of our cars being burgled. In cities like Vancouver such crimes are often committed for the sake of obtaining drug money. More significantly perhaps, by exorcising this menacing devil of our own creation, we would automatically give up a lot of unnecessary fear. We could all breathe more freely. Many addicts could work at productive jobs if the imperative of seeking illegal drugs did not keep them constantly on the street. It’s interesting to learn that before the War on Drugs mentality took hold in the early twentieth century, a prominent individual such as Dr. William Stewart Halsted, a pioneer of modern surgical practice, was an opiate addict for over forty years. During those decades he did stellar and innovative work at Johns Hopkins University, where he was one of the four founding physicians. He was the first, for example, to insist that members of his surgical team wear rubber gloves — a major advance in eradicating post-operative infections. Throughout his career, however, he never got by with less than 180 milligrams of morphine a day. “On this,” said his colleague, the world-renowned Canadian physician Sir William Osler, “he could do his work comfortably and maintain his excellent vigor.” As noted at the Common Sense for Drug Policy website: Halsted’s story is revealing not only because it shows that with a morphine addiction the proper maintenance dose can be productive. It also illustrates the incredible power of the drug in question. Here was a man with almost unlimited resources — moral, physical, financial, medical — who tried everything he could think of and he was hooked until the day he died. Today we would send a man like that to prison. Instead he became the father of modern surgery.

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

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

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I lost my first patient on a Tuesday. She was an eighty-two-year-old woman, small and trim, the healthiest person on the general surgery service, where I spent a month as an intern. (At her autopsy, the pathologist would be shocked to learn her age: “She has the organs of a fifty-year-old!”) She had been admitted for constipation from a mild bowel obstruction. After six days of hoping her bowels would untangle themselves, we did a minor operation to help sort things out. Around eight P.M. Monday night, I stopped by to check on her, and she was alert, doing fine. As we talked, I pulled from my pocket my list of the day’s work and crossed off the last item (post-op check, Mrs. Harvey). It was time to go home and get some rest. Sometime after midnight, the phone rang. The patient was crashing. With the complacency of bureaucratic work suddenly torn away, I sat up in bed and spat out orders: “One liter bolus of LR, EKG, chest X-ray, stat—I’m on my way in.” I called my chief, and she told me to add labs and to call her back when I had a better sense of things. I sped to the hospital and found Mrs. Harvey struggling for air, her heart racing, her blood pressure collapsing. She wasn’t getting better no matter what I did; and as I was the only general surgery intern on call, my pager was buzzing relentlessly, with calls I could dispense with (patients needing sleep medication) and ones I couldn’t (a rupturing aortic aneurysm in the ER). I was drowning, out of my depth, pulled in a thousand directions, and Mrs. Harvey was still not improving. I arranged a transfer to the ICU, where we blasted her with drugs and fluids to keep her from dying, and I spent the next few hours running between my patient threatening to die in the ER and my patient actively dying in the ICU. By 5:45 A.M., the patient in the ER was on his way to the OR, and Mrs. Harvey was relatively stable. She’d needed twelve liters of fluid, two units of blood, a ventilator, and three different pressors to stay alive. When I finally left the hospital, at five P.M. on Tuesday evening, Mrs. Harvey wasn’t getting better—or worse. At seven P.M., the phone rang: Mrs. Harvey had coded, and the ICU team was attempting CPR. I raced back to the hospital, and once again, she pulled through. Barely. This time, instead of going home, I grabbed dinner near the hospital, just in case. At eight P.M., my phone rang: Mrs. Harvey had died. I went home to sleep.

I’m still in the big Jacuzzi tub when the power flickers--once, twice--and then goes out, leaving me in total darkness, chin deep in lukewarm water. I don’t know why, but it all hits me then--Nan’s surgery tomorrow, shooting that moccasin, this stupid, never-ending storm. I start to cry, deep, gulping sobs. I know it seems childish, but I want my daddy. What if things get worse? What if the house starts to flood? Or the roof blows off? As much as I hate to admit it, I’m scared. Really scared. A knock on the bathroom door startles me. “Jemma? You okay in there?” “I’m fine,” I call out, my voice thick. My cheeks burn with shame at being caught crying in the dark like a two-year-old. “Do you want a candle or something? Maybe a hurricane lamp?” “No, I’m…” I start to say “fine” again, but a ragged sob tears from my throat instead. “It’s going to be okay, Jem. We’ll get through this.” I sink lower into the water, wanting to disappear completely. Why can’t he just go away and let me have my little meltdown in private? Why, after all these years of being a jerk, does he have to suddenly be so nice? “I got both dogs dried off,” he continues conversationally, as if I’m not in here crying my eyes out. “They’re in the kitchen eating their supper. I think Beau’s pretty worked up.” I continue to bawl like a baby. I know he can hear me, that he’s right outside the door, listening. Still, it takes me a good five minutes to get it all out of my system. Once the tears have slowed, I reach for my washcloth and lay it across my eyes, hoping it’ll reduce the puffiness. A minute or two later, I drag it away and wring it out before laying it over the edge of the tub. It’s still dark inside the bathroom, though I can see a flicker of light coming from beneath the door. Ryder must have a flashlight, or maybe one of the battery-operated lanterns I scattered around the house, just in case. I wonder how long he’s going to stand three, waiting for me. The lights flick off, and I think maybe he’s finally left me in peace. But then I hear a muffled thump, and I know he’s still out there, probably sitting with his back against the door. “Hey, Jem?” he says. “You saved my life, you know--out there by the barn. Most people couldn’t have made that shot.” I squeeze my eyes shut, but tears leak through anyway. I hadn’t wanted to kill that stupid snake, but if it had bitten Ryder and we hadn’t been able to make it to the hospital in time… I let the thought trail off, not wanting to examine it further. “Thank you,” he says softly. “I owe you one.

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.

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