When You Lose A Patient Quotes

To be, or not to be: that is the question: Whether 'tis nobler in the mind to suffer The slings and arrows of outrageous fortune, Or to take arms against a sea of troubles, And by opposing end them? To die: to sleep; No more; and by a sleep to say we end The heart-ache and the thousand natural shocks That flesh is heir to, 'tis a consummation Devoutly to be wish'd. To die, to sleep; To sleep: perchance to dream: ay, there's the rub; For in that sleep of death what dreams may come When we have shuffled off this mortal coil, Must give us pause: there's the respect That makes calamity of so long life; For who would bear the whips and scorns of time, The oppressor's wrong, the proud man's contumely, The pangs of despised love, the law's delay, The insolence of office and the spurns That patient merit of the unworthy takes, When he himself might his quietus make With a bare bodkin? who would fardels bear, To grunt and sweat under a weary life, But that the dread of something after death, The undiscover'd country from whose bourn No traveller returns, puzzles the will And makes us rather bear those ills we have Than fly to others that we know not of? Thus conscience does make cowards of us all; And thus the native hue of resolution Is sicklied o'er with the pale cast of thought, And enterprises of great pith and moment With this regard their currents turn awry, And lose the name of action.--Soft you now! The fair Ophelia! Nymph, in thy orisons Be all my sins remember'd!

Death comes for all of us. For us, for our patients: it is our fate as living, breathing, metabolizing organisms. Most lives are lived with passivity toward death -- it's something that happens to you and those around you. But Jeff and I had trained for years to actively engage with death, to grapple with it, like Jacob with the angel, and, in so doing, to confront the meaning of a life. We had assumed an onerous yoke, that of mortal responsibility. Our patients' lives and identities may be in our hands, yet death always wins. Even if you are perfect, the world isn't. The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients. You can't ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.

When you lose someone you love, it’s hard to imagine that you’ll ever feel better. That, one day, you’ll manage to be in a good mood simply because the weather is nice or the barista at the coffee shop on the corner remembered your order. But it does happen. If you’re patient and you work at it.

Don't close your door when someone walks away. Your wounds will heal and summer wind will dry your tears. Don't close your heart, surrender to the sea of silky rose petals and let the sun tickle you. Don't lose hope, life still believes in you. Darling, raindrops are nothing but diamonds tears from heaven and when your sky is cloudy, stars are painting sparkly scenery for you. Be patient.

I sought loneliness when I was young. You’ve seen me there: on my promontory, patient and unaware. But when I think of you, I want to be alone together. I want to strive against and for. I want to live in contact. I want to be a context for you, and you for me. I love you, and I love you, and I want to find out what that means together.

Falling in love is when you lose yourself slowly, piece by piece. Infatuation is when you lose yourself all at once. Love is like ivy. It wraps around you, chokes every part of you quietly. It is not patient, or kind, or gentle. It is needy, cunning, and suffocating.

There is so much I hope to teach you, little one. I hope that I may do so by example, but I feel the need to put the words to paper as well. It is a quirk of mine, one which I expect you will recognize and find amusing by the time you read this letter. Be strong. Be diligent. Be conscientious. There is never anything to be gained by taking the easy road. (Unless, of course, the road is an easy one to begin with. Roads sometimes are. If that should be the case, do not forge a new, more difficult one. Only martyrs go out looking for trouble.) Love your siblings. You have two already, and God willing, there will be more. Love them well, for they are your blood, and when you are unsure, or times are difficult, they will be the ones to stand by your side. Laugh. Laugh out loud, and laugh often. And when circumstances call for silence, turn your laugh into a smile. Don't settle. Know what you want and reach for it. And if you don't know what you want, be patient. The answers will come to you in time, and you may find that your heart s desire has been right under your nose all the while. And remember, always remember that you have a mother and a father who love each other and love you. I feel you growing restless. Your father is making strange gasping sounds and will surely lose his temper altogether if I do not move from my escritoire to my bed. Welcome to the world, little one. We are all so delighted to make your acquaintance.

Our patients’ lives and identities may be in our hands, yet death always wins. Even if you are perfect, the world isn’t. The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients. You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.

When you lose someone you love, it's hard to imagine that you'll ever feel better. That, one day, you'll manage to be in a good mood simply because the weather is nice or the barista at the coffee shop on the corner remembered your order. But it does happen. If you're patient and you work at it.

For you know that you can get nothing more out of this lifetime. When you have time, when you have had the time to rest and re-energize your soul, you are allowed to choose your re-entry back into the physical state. Those people who hesitate, who are not sure of their return here, they might lose the chance that was given them, a chance to fulfill what they must when they’re in physical state.” I

Even if you are perfect, the world isn’t. The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients. You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.

You lose when you take time to fall apart just when things are starting to unravel around you,” I tell him in an almost muted tone. “You can eventually have your moment of weakness; you just have to be patient.

Just like we need food and water, humans need each other. A brain study revealed that when placed in an MRI, a patient's reward center lit up when another person sat in the room. Neurons fire when talk to someone, think about someone, and they go haywire when we hold someone's hand. Our brains and bodies are actually programmed to seek each other out and connect. So then why do so many people prefer being alone? Why do we often run for the hills when we feel the slightest connection? Why we do we feel compelled to fight what we're hardwired to do? Maybe it's because when we find someone or something to hold on to, that feeling becomes like air. And we're terrified we're going to lose it. And trust me, you can get pretty good at the alone thing. But most things are better when they're shared with someone else.

Even worse than losing self-confidence, though, is reacting defensively. There are surgeons who will see faults everywhere except in themselves. They have no questions and no fears about their abilities. As a result, they learn nothing from their mistakes and know nothing of their limitations. As one surgeon told me, it is a rare but alarming thing to meet a surgeon without fear. “If you’re not a little afraid when you operate,” he said, “you’re bound to do a patient a grave disservice.

Acting on desire is more like a craft, a science, an art. It takes careful mindful practice. Be patient and quiet. Listen, observe, take notes. Figure out what you want, privately, and then choose to want it, publicly. Put your desire out in the open. I want to go swimming. I want to bake bread. I want to paint a picture. I want to build a chair. I want to write a book. You act and then you fail. Over and over. And it’s better to start failing when you’re young, when all you lose is an ice-cream cone or a basketball game or an afternoon of fun. When you’re older, the stakes are higher. If adults don’t know how to want, then they lose a love, a career, a life.

You have to learn when to care, son. His father’s voice. And when to let go. You’ll grow calluses. He never had. Storm him, he never had. It was why he’d never made a good surgeon. He couldn’t lose patients.

Freud was fascinated with depression and focused on the issue that we began with—why is it that most of us can have occasional terrible experiences, feel depressed, and then recover, while a few of us collapse into major depression (melancholia)? In his classic essay “Mourning and Melancholia” (1917), Freud began with what the two have in common. In both cases, he felt, there is the loss of a love object. (In Freudian terms, such an “object” is usually a person, but can also be a goal or an ideal.) In Freud’s formulation, in every loving relationship there is ambivalence, mixed feelings—elements of hatred as well as love. In the case of a small, reactive depression—mourning—you are able to deal with those mixed feelings in a healthy manner: you lose, you grieve, and then you recover. In the case of a major melancholic depression, you have become obsessed with the ambivalence—the simultaneity, the irreconcilable nature of the intense love alongside the intense hatred. Melancholia—a major depression—Freud theorized, is the internal conflict generated by this ambivalence. This can begin to explain the intensity of grief experienced in a major depression. If you are obsessed with the intensely mixed feelings, you grieve doubly after a loss—for your loss of the loved individual and for the loss of any chance now to ever resolve the difficulties. “If only I had said the things I needed to, if only we could have worked things out”—for all of time, you have lost the chance to purge yourself of the ambivalence. For the rest of your life, you will be reaching for the door to let you into a place of pure, unsullied love, and you can never reach that door. It also explains the intensity of the guilt often experienced in major depression. If you truly harbored intense anger toward the person along with love, in the aftermath of your loss there must be some facet of you that is celebrating, alongside the grieving. “He’s gone; that’s terrible but…thank god, I can finally live, I can finally grow up, no more of this or that.” Inevitably, a metaphorical instant later, there must come a paralyzing belief that you have become a horrible monster to feel any sense of relief or pleasure at a time like this. Incapacitating guilt. This theory also explains the tendency of major depressives in such circumstances to, oddly, begin to take on some of the traits of the lost loved/hated one—and not just any traits, but invariably the ones that the survivor found most irritating. Psychodynamically, this is wonderfully logical. By taking on a trait, you are being loyal to your lost, beloved opponent. By picking an irritating trait, you are still trying to convince the world you were right to be irritated—you see how you hate it when I do it; can you imagine what it was like to have to put up with that for years? And by picking a trait that, most of all, you find irritating, you are not only still trying to score points in your argument with the departed, but you are punishing yourself for arguing as well. Out of the Freudian school of thought has come one of the more apt descriptions of depression—“aggression turned inward.” Suddenly the loss of pleasure, the psychomotor retardation, the impulse to suicide all make sense. As do the elevated glucocorticoid levels. This does not describe someone too lethargic to function; it is more like the actual state of a patient in depression, exhausted from the most draining emotional conflict of his or her life—one going on entirely within. If that doesn’t count as psychologically stressful, I don’t know what does.

A KING WHO PLACED MIRRORS IN HIS PALACE There lived a king; his comeliness was such The world could not acclaim his charm too much. The world's wealth seemed a portion of his grace; It was a miracle to view his face. If he had rivals,then I know of none; The earth resounded with this paragon. When riding through his streets he did not fail To hide his features with a scarlet veil. Whoever scanned the veil would lose his head; Whoever spoke his name was left for dead, The tongue ripped from his mouth; whoever thrilled With passion for this king was quickly killed. A thousand for his love expired each day, And those who saw his face, in blank dismay Would rave and grieve and mourn their lives away- To die for love of that bewitching sight Was worth a hundred lives without his light. None could survive his absence patiently, None could endure this king's proximity- How strange it was that man could neither brook The presence nor the absence of his look! Since few could bear his sight, they were content To hear the king in sober argument, But while they listened they endure such pain As made them long to see their king again. The king commanded mirrors to be placed About the palace walls, and when he faced Their polished surfaces his image shone With mitigated splendour to the throne. If you would glimpse the beauty we revere Look in your heart-its image will appear. Make of your heart a looking-glass and see Reflected there the Friend's nobility; Your sovereign's glory will illuminate The palace where he reigns in proper state. Search for this king within your heart; His soul Reveals itself in atoms of the Whole. The multitude of forms that masquerade Throughout the world spring from the Simorgh's shade. If you catch sight of His magnificence It is His shadow that beguiles your glance; The Simorgh's shadow and Himself are one; Seek them together, twinned in unison. But you are lost in vague uncertainty... Pass beyond shadows to Reality. How can you reach the Simorgh's splendid court? First find its gateway, and the sun, long-sought, Erupts through clouds; when victory is won, Your sight knows nothing but the blinding sun.

serves as prevention. Gives physical healing in the body. No matter what name is given to any problem; it will be solved, when the Blood of Jesus is brought in. If you keep pleading the Blood of Jesus, no matter how terrible an infirmity is, it will disappear by the power in the Blood of Jesus. If your life is pure and you lay your hands on any sickness, pleading the Blood of Jesus, it will vanish. You might wonder if it is really as simple as that but that is the Power in the Blood of Jesus. The Power in pleading the Blood of Jesus is yet to be understood by Man. Some people criticise those pleading the Blood of Jesus. It is because they have not passed through the valley, so they cannot know what it means. Someone who has never been tortured by a terminal disease cannot know what it means to be threatened by death, so he or she cannot understand why a cancer patient is praying fervently for healing, or why the person is jubilating after he or she has been miraculously healed. The preachers, who discourage people from praying fire prayers or pleading the Blood of Jesus, do so, because they have not experienced such things. The Blood of Jesus cannot dry up; neither can it lose its power. Therefore you can plead it a million times, if you want to. The more you plead the Blood of Jesus, the more the chance of totally submerging the disease, in the pool of the Blood

You learn it when you become a doctor. Not in school—that isn’t where you learn, in any case—but when you lay your hands on people and presume to heal them. There are so many there, beyond your reach. So many you can never touch, so many whose essence you can’t find, so many who slip through your fingers. But you can’t think about them. The only thing you can do—the only thing—is to try for the one who’s in front of you. Act as though this one patient is the only person in the world—because to do otherwise is to lose that one, too. One at a time, that’s all you can do. And you learn not to despair over all the ones you can’t help, but only to do what you can.” She

I sought loneliness when I was young. You've seen me there: on my promontory, patient and unaware. But when I think of you, I want to be alone together. I want to strive against and for. I want to live in contact. I want to be a context for you, and you for me. I love you, and I love you, and I want to find out what that means together.

When you are tempted to lose patience with someone else, think how patient God has been with you all this time.

So let me say what I mean, as well as I can. I sought loneliness when was young. You've seen me there: on my promontory, patient and unaware. But when I think of you, I want to be alone together. I want to strive against and for. I want to live in contact. I want to be a context for you, and you for me. I love you, and I love you, and I want to find out what that means together

And the Yak, they can afford to move so fucking slow, man, they’ll wait years and years. Give you a whole life, just so you’ll have more to lose when they come and take it away. Patient like a spider. Zen spiders.

deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients. You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.

Our patients' lives and identities may be in our hands, yet death always wins. Even if you are perfect, the world isn't. The secret is to know that the deck is stacked, that you will lose, that your hands or judgement will slip, and yet still struggle to win for your patients.

When you lose someone you love, it's hard to imagine that you'll ever feel better. That, one day, you'll manage to be in a good mood simply because the weather is nice or the barista at the coffee shop on the corner remembered your order. But it does happen. If you're patient and you work at it

When you lose someone you love, it’s hard to imagine that you’ll ever feel better. That, one day, you’ll manage to be in a good mood simply because the weather is nice or the barista at the coffee shop on the corner remembered your order. But it does happen. If you’re patient and you work at it.

As long as he retains externally the habits of a Christian he can still be made to think of himself as one who has adopted a few new friends and amusements but whose spiritual state is much the same...And while he thinks that, we do not have to contend with the explicit repentance of a definite, fully recognised, sin, but only with his vague, though uneasy, feeling that he hasn’t been doing very well lately. This dim uneasiness needs careful handling. If it gets too strong it may wake him up...if you suppress it entirely...we lose an element in the situation which can be turned to good account. If such a feeling is allowed to live, but not allowed to become irresistible and flower into real repentance, it has one invaluable tendency. It increases the patient’s reluctance to think about the Enemy. All humans at nearly all times have some such reluctance; but when thinking of Him involves facing and intensifying a whole vague cloud of half-conscious guilt, this reluctance is increased tenfold...In this state your patient will not omit, but he will increasingly dislike, his religious duties...He will want his prayers to be unreal, for he will dread nothing so much as effective contact with the Enemy.

However, questions arise. Are there people who aren't naive realists, or special situations in which naive realism disappears? My theory—the self-model theory of subjectivity—predicts that as soon as a conscious representation becomes opaque (that is, as soon as we experience it as a representation), we lose naive realism. Consciousness without naive realism does exist. This happens whenever, with the help of other, second-order representations, we become aware of the construction process—of all the ambiguities and dynamical stages preceding the stable state that emerges at the end. When the window is dirty or cracked, we immediately realize that conscious perception is only an interface, and we become aware of the medium itself. We doubt that our sensory organs are working properly. We doubt the existence of whatever it is we are seeing or feeling, and we realize that the medium itself is fallible. In short, if the book in your hands lost its transparency, you would experience it as a state of your mind rather than as an element of the outside world. You would immediately doubt its independent existence. It would be more like a book-thought than a book-perception. Precisely this happens in various situations—for example, In visual hallucinations during which the patient is aware of hallucinating, or in ordinary optical illusions when we suddenly become aware that we are not in immediate contact with reality. Normally, such experiences make us think something is wrong with our eyes. If you could consciously experience earlier processing stages of the representation of the book In your hands, the image would probably become unstable and ambiguous; it would start to breathe and move slightly. Its surface would become iridescent, shining in different colors at the same time. Immediately you would ask yourself whether this could be a dream, whether there was something wrong with your eyes, whether someone had mixed a potent hallucinogen into your drink. A segment of the wall of the Ego Tunnel would have lost its transparency, and the self-constructed nature of the overall flow of experience would dawn on you. In a nonconceptual and entirely nontheoretical way, you would suddenly gain a deeper understanding of the fact that this world, at this very moment, only appears to you.

When I was a young girl, I studied Greek in school. It's a beautiful language and ever so many good things were written in it. When you speak Greek, it feels like a little bird flapping its wings on your tongue as fast as it can. This is why I sometimes put Greek words into my stories, even though not so many people speak Ancient Greek anymore. Anything beautiful deserves to be shared round, and anything I love goes into my stories for safekeeping. The word I love is Arete. It has a simple meaning and a complicated meaning. The simple one is: excellence. But if that were all, we'd just use Excellence and I wouldn't bring it up until we got to E. Arete means your own excellence. Your very own. A personal excellence that belongs to no one else, one that comes out of all the things that make you special and different. Arete means whatever you are best at, no matter what that is. You might think the Greeks only meant things like fighting with bronze swords or debating philosophy, but they didn't. They meant whatever you're best at. What makes you feel like you're doing the rightest thing in the world. And that might be fighting with bronze swords and it might mean debating philosophy—but it also might mean building machines, or drawing pictures, or playing the guitar, or acting in Shakespeare plays, or writing books, or making a home for people who need one, or listening so hard and so well that people tell you the things they really need to say even if they didn't mean to, or running faster than anyone else, or teaching people patiently and boldly, or even making pillow forts or marching in parades or baking bread. It could be lending out just the right library book to just the right person at just the right moment. It could be standing up to the powerful even if you don't feel very powerful yourself, even if you're lost and as far away from home as you can get. It could be loving someone with the same care and thoroughness that a Wyvern takes with alphabetizing. It could be anything in the world. And it isn't easy to figure out what that is. It's even harder to get that good at it, because nothing, not even being yourself, comes without practice. But your arete goes with you everywhere, just waiting for you to pay attention to it. You can't lose it. You can only find it. And that's my favorite thing that starts with A.

That voice that talks badly to you is a demon voice. This very patient and determined demon shows up in your bedroom one day and refuses to leave. You are six or twelve or fifteen and you look in the mirror and you hear a voice so awful and mean that it takes your breath away. It tells you that you are fat and ugly and you don’t deserve love. And the scary part is the demon is your own voice. But it doesn’t sound like you. It sounds like a strangled and seductive version of you. Think Darth Vader or an angry Lauren Bacall. The good news is there are ways to make it stop talking. The bad news is it never goes away. If you are lucky, you can live a life where the demon is generally forgotten, relegated to a back shelf in a closet next to your old field hockey equipment. You may even have days or years when you think the demon is gone. But it is not. It is sitting very quietly, waiting for you. This motherfucker is patient. It says, “Take your time.” It says, “Go fall in love and exercise and surround yourself with people who make you feel beautiful.” It says, “Don’t worry, I’ll wait.” And then one day, you go through a breakup or you can’t lose your baby weight or you look at your reflection in a soup spoon and that slimy bugger is back. It moves its sour mouth up to your ear and reminds you that you are fat and ugly and don’t deserve love. This demon is some Stephen King from-the-sewer devil-level shit.

It’s no one’s fault really,” he continued. “A big city cannot afford to have its attention distracted from the important job of being a big city by such a tiny, unimportant item as your happiness or mine.” This came out of him easily, assuredly, and I was suddenly interested. On closer inspection there was something aesthetic and scholarly about him, something faintly professorial. He knew I was with him, listening, and his grey eyes were kind with offered friendliness. He continued: “Those tall buildings there are more than monuments to the industry, thought and effort which have made this a great city; they also occasionally serve as springboards to eternity for misfits who cannot cope with the city and their own loneliness in it.” He paused and said something about one of the ducks which was quite unintelligible to me. “A great city is a battlefield,” he continued. “You need to be a fighter to live in it, not exist, mark you, live. Anybody can exist, dragging his soul around behind him like a worn-out coat; but living is different. It can be hard, but it can also be fun; there’s so much going on all the time that’s new and exciting.” I could not, nor wished to, ignore his pleasant voice, but I was in no mood for his philosophising. “If you were a negro you’d find that even existing would provide more excitement than you’d care for.” He looked at me and suddenly laughed; a laugh abandoned and gay, a laugh rich and young and indescribably infectious. I laughed with him, although I failed to see anything funny in my remark. “I wondered how long it would be before you broke down and talked to me,” he said, when his amusement had quietened down. “Talking helps, you know; if you can talk with someone you’re not lonely any more, don’t you think?” As simple as that. Soon we were chatting away unreservedly, like old friends, and I had told him everything. “Teaching,” he said presently. “That’s the thing. Why not get a job as a teacher?” “That’s rather unlikely,” I replied. “I have had no training as a teacher.” “Oh, that’s not absolutely necessary. Your degrees would be considered in lieu of training, and I feel sure that with your experience and obvious ability you could do well.” “Look here, Sir, if these people would not let me near ordinary inanimate equipment about which I understand quite a bit, is it reasonable to expect them to entrust the education of their children to me?” “Why not? They need teachers desperately.” “It is said that they also need technicians desperately.” “Ah, but that’s different. I don’t suppose educational authorities can be bothered about the colour of people’s skins, and I do believe that in that respect the London County Council is rather outstanding. Anyway, there would be no need to mention it; let it wait until they see you at the interview.” “I’ve tried that method before. It didn’t work.” “Try it again, you’ve nothing to lose. I know for a fact that there are many vacancies for teachers in the East End of London.” “Why especially the East End of London?” “From all accounts it is rather a tough area, and most teachers prefer to seek jobs elsewhere.” “And you think it would be just right for a negro, I suppose.” The vicious bitterness was creeping back; the suspicion was not so easily forgotten. “Now, just a moment, young man.” He was wonderfully patient with me, much more so than I deserved. “Don’t ever underrate the people of the East End; from those very slums and alleyways are emerging many of the new breed of professional and scientific men and quite a few of our politicians. Be careful lest you be a worse snob than the rest of us. Was this the kind of spirit in which you sought the other jobs?

I hadn't told him the news yet, but in that same preternatural way he was always aware of what I was feeling or thinking, he could smell my lies a mile away. He was just giving me time to come to him. To tell him I'd be baking his bun for the next seven and a half months. ''I'm okay." Dex's chuckle filled my ears as he wrapped his arms around my chest from behind, his chin resting on the top of my head. "Just okay?" He was taunting me, I knew it. This man never did anything without a reason. And this reason had him resembling a mama bear. A really aggressive, possessive mama bear. Which said something because Dex was normally that way. I couldn't even sit around Mayhem without him or Sonny within ten feet. I leaned my head back against his chest and laughed. "Yeah, just okay." He made a humming noise deep in his throat. "Ritz," he drawled in that low voice that reached the darkest parts of my organs. "You're killin' me, honey." Oh boy. Did I want to officially break the news on the side of the road with chunks of puke possibly still on my face? Nah. So I went with the truth. "I have it all planned out in my head. I already ordered the cutest little toy motorcycle to tell you, so don't ruin it." A loud laugh burst out of his chest, so strong it rocked my body alongside his. I friggin' loved this guy. Every single time he laughed, I swear it multiplied. At this rate, I loved him more than my own life cubed, and then cubed again. "All right," he murmured between these low chuckles once he'd calmed down a bit. His fingers trailed over the skin of the back of my hand until he stopped at my ring finger and squeezed the slender bone. "I can be patient." That earned him a laugh from me. Patience? Dex? Even after more than three years, that would still never be a term I'd use to describe him. And it probably never would. He'd started to lose his shit during our layover when Trip had called for instructions on how to set the alarm at the new bar. "Dex, Ris, and Baby Locke, you done?" Sonny yelled, peeping out from over the top of the car door. "Are you friggin' kidding me?" I yelled back. Did everyone know? That slow, seductive smile crawled over his features. Brilliant and more affectionate than it was possible for me to handle, it sucked the breath out of me. When he palmed my cheeks and kissed each of my cheeks and nose and forehead, slowly like he was savoring the pecks and the contact, I ate it all up. Like always, and just like I always would. And he answered the way I knew he would every single time I asked him from them on, the way that told me he would never let me down. That he was an immovable object. That he'd always be there for me to battle the demons we could see and the invisible ones we couldn't. "Fuckin' love you, Iris," he breathed against my ear, an arm slinking around my lower back to press us together. "More than anything.

We had assumed an onerous yoke, that of mortal responsibility. Our patients’ lives and identities may be in our hands, yet death always wins. Even if you are perfect, the world isn’t. The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients. You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.

There are things that cannot wait. You have to rush and run and march if you must fight or take the best place in the market. You strain your nerves and are on the alert when you chase opportunities that are always on the wing. But there are ideals which do not play hide-and-seek with our life; they slowly grow from seed to flower, from flower to fruit; they require infinite space and heaven's light to mature, and the fruits that they produce can survive years of insult and neglect. The East with her ideals, in whose bosom are stored the ages of sunlight and silence of stars, can patiently wait till the West, hurrying after the expedient, loses breath and stops. Europe, while busily speeding to her engagements, disdainfully casts her glance from her carriage window at the reaper reaping his harvest in the field, and in her intoxication of speed cannot but think him as slow and ever receding backwards. But the speed comes to its end, the engagement loses its meaning and the hungry heart clamours for food, till at last she comes to the lowly reaper reaping his harvest in the sun. For if the office cannot wait, or the buying and selling, or the craving for excitement, love waits and beauty and the wisdom of suffering and the fruits of patient devotion and reverent meekness of simple faith. And thus shall wait the East till her time comes. I

It’s easier like that, isn’t it?” “What is?” “Never showing anyone who you really are.” He watches me calmly. Patiently. In the soft light of the apartment, his eyes are dark all around. Sometimes I hear a car running, but the traffic here is not nearly as loud as at my own apartment. “That way if something goes wrong, if someone rejects you, then it’s not about you, is it? When you’re yourself, that’s when you’re exposed. Vulnerable. But if you hold back . . . Losing a game’s always painful, but knowing that you haven’t played your best hand makes it bearable.

Sherri Solvig had had cancer, lymphatic cancer, but due to valiant efforts by her doctors she had gone into remission. However, encoded in the memory-tapes of her brain was the datum that patients with lymphoma who go into remission usually eventually lose their remission. They aren’t cured; the ailment has somehow mysteriously passed from a palpable state into a sort of metaphysical state, a limbo. It is there but it is not there. So despite her current good health, Sherri (her mind told her) contained a ticking clock, and when the clock chimed she would die. Nothing could be done about it, except the frantic promotion of a second remission. But even if a second remission were obtained, that remission, too, by the same logic, the same inexorable process, would end. Time had Sherri in its absolute power. Time contained one outcome for her: terminal cancer. This is how her mind had factored the situation out; it had come to this conclusion, and no matter how good she felt or what she had going for her in her life, this fact remained a constant. A cancer patient in remission, then, represents a stepped-up case of the status of all humans; eventually you are going to die.

My ideal man," Malak said ponderingly. "I'm not sure what that means. I don't want the ideal. I want complexity. I want passion. I want imperfection. "My ideal man is not ideal. But," she said, leaning forward, "I'll tell you about him." "I want him to have lunch at home. I want him to help me with my own mind. I want him to be bookish, wise, cunning, and exemplary. I want him to be a good storyteller, and always on my side." "Yes, I want him to be near me. A good conversationalist, proud, not afraid of the lofty heights." "I want him to be a singer, one who knows and loves a good song, can play an instrument, the oud or the ney, and preferably both. I want him to be a good mourner, know how to attend to the pain of others, a consoler who could assuage the grief I have for all those I loved and befriended and who are no longer here. I want him to be a healer, an expert in all that troubles me. I want him to be a fire that annihilates all danger that lies ahead and behind me and that which I have, somehow, without his help, found a way to avoid. I want him to be faithful---" "Incapable of deception. I want him to be constant__" "Constant in his love and in his prayers and, when those prayers are not answered, I want him to change reality with his own hands. I want him to be my lord-" "For all the world to see. I want him to make me proud, to make vanish old and fresh longings, new and unremembered regrets. I want him to be vigilant-" "To protect me from sorrows even once their great heights have passed. I want him to know how to deal with the past. I want him to be occasionally gripped by fear-" "The fear of losing me. I want him to be patient, to help me to endure the injustices visited upon the houses of those I love. But I also want him to be impatient-" "To lose all reason and hurry off, forgetting his shoes and hat, and ride-" "His horse flanked by wings of angry dust, galloping, if need be, all night to find the traitorous, to change my fortunes and avenge me." "And then I want him to return to me, to prosper by my side. I want to take him to the clearest stream, one only I know the way to, and there quench his thirst. I want him to look at me sometimes as if he does not know who I am. But I want to be forever recognized by him, come what may, to point me out in a crowd when, after the passage, we are reunited." "I want him to see me when I cannot see myself.

Death comes for all of us. For us, for our patients: it is our fate as living, breathing, metabolizing organisms. Most lives are lived with passivity toward death—it's something that happens to you and those around you...Our patients' lives and identities may be in our hands, yet death always wins. Even if you are perfect, the world isn't. The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients. You can't ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving

1. Choose to love each other even in those moments when you struggle to like each other. Love is a commitment, not a feeling. 2. Always answer the phone when your husband/wife is calling and, when possible, try to keep your phone off when you’re together with your spouse. 3. Make time together a priority. Budget for a consistent date night. Time is the currency of relationships, so consistently invest time in your marriage. 4. Surround yourself with friends who will strengthen your marriage, and remove yourself from people who may tempt you to compromise your character. 5. Make laughter the soundtrack of your marriage. Share moments of joy, and even in the hard times find reasons to laugh. 6. In every argument, remember that there won’t be a winner and a loser. You are partners in everything, so you’ll either win together or lose together. Work together to find a solution. 7. Remember that a strong marriage rarely has two strong people at the same time. It’s usually a husband and wife taking turns being strong for each other in the moments when the other feels weak. 8. Prioritize what happens in the bedroom. It takes more than sex to build a strong marriage, but it’s nearly impossible to build a strong marriage without it. 9. Remember that marriage isn’t 50–50; divorce is 50–50. Marriage has to be 100–100. It’s not splitting everything in half but both partners giving everything they’ve got. 10. Give your best to each other, not your leftovers after you’ve given your best to everyone else. 11. Learn from other people, but don’t feel the need to compare your life or your marriage to anyone else’s. God’s plan for your life is masterfully unique. 12. Don’t put your marriage on hold while you’re raising your kids, or else you’ll end up with an empty nest and an empty marriage. 13. Never keep secrets from each other. Secrecy is the enemy of intimacy. 14. Never lie to each other. Lies break trust, and trust is the foundation of a strong marriage. 15. When you’ve made a mistake, admit it and humbly seek forgiveness. You should be quick to say, “I was wrong. I’m sorry. Please forgive me.” 16. When your husband/wife breaks your trust, give them your forgiveness instantly, which will promote healing and create the opportunity for trust to be rebuilt. You should be quick to say, “I love you. I forgive you. Let’s move forward.” 17. Be patient with each other. Your spouse is always more important than your schedule. 18. Model the kind of marriage that will make your sons want to grow up to be good husbands and your daughters want to grow up to be good wives. 19. Be your spouse’s biggest encourager, not his/her biggest critic. Be the one who wipes away your spouse’s tears, not the one who causes them. 20. Never talk badly about your spouse to other people or vent about them online. Protect your spouse at all times and in all places. 21. Always wear your wedding ring. It will remind you that you’re always connected to your spouse, and it will remind the rest of the world that you’re off limits. 22. Connect with a community of faith. A good church can make a world of difference in your marriage and family. 23. Pray together. Every marriage is stronger with God in the middle of it. 24. When you have to choose between saying nothing or saying something mean to your spouse, say nothing every time. 25. Never consider divorce as an option. Remember that a perfect marriage is just two imperfect people who refuse to give up on each other. FINAL

Obviously, in those situations, we lose the sale. But we’re not trying to maximize each and every transaction. Instead, we’re trying to build a lifelong relationship with each customer, one phone call at a time. A lot of people may think it’s strange that an Internet company is so focused on the telephone, when only about 5 percent of our sales happen through the telephone. In fact, most of our phone calls don’t even result in sales. But what we’ve found is that on average, every customer contacts us at least once sometime during his or her lifetime, and we just need to make sure that we use that opportunity to create a lasting memory. The majority of phone calls don’t result in an immediate order. Sometimes a customer may be calling because it’s her first time returning an item, and she just wants a little help stepping through the process. Other times, a customer may call because there’s a wedding coming up this weekend and he wants a little fashion advice. And sometimes, we get customers who call simply because they’re a little lonely and want someone to talk to. I’m reminded of a time when I was in Santa Monica, California, a few years ago at a Skechers sales conference. After a long night of bar-hopping, a small group of us headed up to someone’s hotel room to order some food. My friend from Skechers tried to order a pepperoni pizza from the room-service menu, but was disappointed to learn that the hotel we were staying at did not deliver hot food after 11:00 PM. We had missed the deadline by several hours. In our inebriated state, a few of us cajoled her into calling Zappos to try to order a pizza. She took us up on our dare, turned on the speakerphone, and explained to the (very) patient Zappos rep that she was staying in a Santa Monica hotel and really craving a pepperoni pizza, that room service was no longer delivering hot food, and that she wanted to know if there was anything Zappos could do to help. The Zappos rep was initially a bit confused by the request, but she quickly recovered and put us on hold. She returned two minutes later, listing the five closest places in the Santa Monica area that were still open and delivering pizzas at that time. Now, truth be told, I was a little hesitant to include this story because I don’t actually want everyone who reads this book to start calling Zappos and ordering pizza. But I just think it’s a fun story to illustrate the power of not having scripts in your call center and empowering your employees to do what’s right for your brand, no matter how unusual or bizarre the situation. As for my friend from Skechers? After that phone call, she’s now a customer for life. Top 10 Ways to Instill Customer Service into Your Company   1. Make customer service a priority for the whole company, not just a department. A customer service attitude needs to come from the top.   2. Make WOW a verb that is part of your company’s everyday vocabulary.   3. Empower and trust your customer service reps. Trust that they want to provide great service… because they actually do. Escalations to a supervisor should be rare.   4. Realize that it’s okay to fire customers who are insatiable or abuse your employees.   5. Don’t measure call times, don’t force employees to upsell, and don’t use scripts.   6. Don’t hide your 1-800 number. It’s a message not just to your customers, but to your employees as well.   7. View each call as an investment in building a customer service brand, not as an expense you’re seeking to minimize.   8. Have the entire company celebrate great service. Tell stories of WOW experiences to everyone in the company.   9. Find and hire people who are already passionate about customer service. 10. Give great service to everyone: customers, employees, and vendors.

Some researchers, such as psychologist Jean Twenge, say this new world where compliments are better than sex and pizza, in which the self-enhancing bias has been unchained and allowed to gorge unfettered, has led to a new normal in which the positive illusions of several generations have now mutated into full-blown narcissism. In her book The Narcissism Epidemic, Twenge says her research shows that since the mid-1980s, clinically defined narcissism rates in the United States have increased in the population at the same rate as obesity. She used the same test used by psychiatrists to test for narcissism in patients and found that, in 2006, one in four U.S. college students tested positive. That’s real narcissism, the kind that leads to diagnoses of personality disorders. In her estimation, this is a dangerous trend, and it shows signs of acceleration. Narcissistic overconfidence crosses a line, says Twenge, and taints those things improved by a skosh of confidence. Over that line, you become less concerned with the well-being of others, more materialistic, and obsessed with status in addition to losing all the restraint normally preventing you from tragically overestimating your ability to manage or even survive risky situations. In her book, Twenge connects this trend to the housing market crash of the mid-2000s and the stark increase in reality programming during that same decade. According to Twenge, the drive to be famous for nothing went from being strange to predictable thanks to a generation or two of people raised by parents who artificially boosted self-esteem to ’roidtastic levels and then released them into a culture filled with new technologies that emerged right when those people needed them most to prop up their self-enhancement biases. By the time Twenge’s research was published, reality programming had spent twenty years perfecting itself, and the modern stars of those shows represent a tiny portion of the population who not only want to be on those shows, but who also know what they are getting into and still want to participate. Producers with the experience to know who will provide the best television entertainment to millions then cull that small group. The result is a new generation of celebrities with positive illusions so robust and potent that the narcissistic overconfidence of the modern American teenager by comparison is now much easier to see as normal.

Appendix 1 Seven Points and Fifty-Nine Slogans for Generating Compassion and Resilience POINT ONE Resolve to Begin 1. Train in the preliminaries. POINT TWO Train in Empathy and Compassion: Absolute Compassion 2. See everything as a dream. 3. Examine the nature of awareness. 4. Don’t get stuck on peace. 5. Rest in the openness of mind. 6. In Postmeditation be a child of illusion. POINT TWO Train in Empathy and Compassion: Relative Compassion 7. Practice sending and receiving alternately on the breath. 8. Begin sending and receiving practice with yourself. 9. Turn things around (Three objects, three poisons, three virtues). 10. Always train with the slogans. POINT THREE Transform Bad Circumstances into the Path 11. Turn all mishaps into the path. 12. Drive all blames into one. 13. Be grateful to everyone. 14. See confusion as Buddha and practice emptiness. 15. Do good, avoid evil, appreciate your lunacy, pray for help. 16. Whatever you meet is the path. POINT FOUR Make Practice Your Whole Life 17. Cultivate a serious attitude (Practice the five strengths). 18. Practice for death as well as for life. POINT FIVE Assess and Extend 19. There’s only one point. 20. Trust your own eyes. 21. Maintain joy (and don’t lose your sense of humor). 22. Practice when you’re distracted. POINT SIX The Discipline of Relationship 23. Come back to basics. 24. Don’t be a phony. 25. Don’t talk about faults. 26. Don’t figure others out. 27. Work with your biggest problems first. 28. Abandon hope. 29. Don’t poison yourself. 30. Don’t be so predictable. 31. Don’t malign others. 32. Don’t wait in ambush. 33. Don’t make everything so painful. 34. Don’t unload on everyone. 35. Don’t go so fast. 36. Don’t be tricky. 37. Don’t make gods into demons. 38. Don’t rejoice at others’ pain. POINT SEVEN Living with Ease in a Crazy World 39. Keep a single intention. 40. Correct all wrongs with one intention. 41. Begin at the beginning, end at the end. 42. Be patient either way. 43. Observe, even if it costs you everything. 44. Train in three difficulties. 45. Take on the three causes. 46. Don’t lose track. 47. Keep the three inseparable. 48. Train wholeheartedly, openly, and constantly. 49. Stay close to your resentment. 50. Don’t be swayed by circumstances. 51. This time get it right! 52. Don’t misinterpret. 53. Don’t vacillate. 54. Be wholehearted. 55. Examine and analyze. 56. Don’t wallow. 57. Don’t be jealous. 58. Don’t be frivolous. 59. Don’t expect applause.

Grey was here.” He hadn’t known, that was obvious from the way his eyes widened. “You lie.” Rose chuckled. “I saw him. I spoke to him. He said he came to see me. And then he ran out of here as though the hounds of hell were nipping at his heels.” Archer shook his head, an expression of disbelief on his face. “They tend to do that when Hades freezes over.” Then he offered her a grin. “He braved being seen in public just to come here and see you?” “He was watching from a balcony. I wouldn’t have known he was here if the fortune teller hadn’t told me.” His brows shot up. “And there’s a story for another time. Look, Lady Rose, I know he’s frustrating as all get-out, but you cannot expect Grey to change years of behavior in a week. You have to be patient-like waves lapping at a stone.” That was so very easily said. He wasn’t the one being pressured to find a husband. He wasn’t the one who felt as though everything she wanted was just out of reach. “You know, I suddenly find myself very interested in Lady Monteforte’s literary tastes. Shall I make the introductions?” “I will hang your puppy if you do not.” Rose grinned. He truly was the most charming of rascals. “How very fortunate for me then, that I do not own a puppy.” “For shame. Every young lady should have a puppy.” Rose made the introductions, and Archer wasted no time in asking Lady Monteforte if she cared to dance. For a moment it seemed the lady might decline, but then Rose offered to stay with Jacqueline and Archer offered the widow his arm. She hesitated before taking it. Interesting. Rose had never seen a woman react so coolly to Archer’s charm before. The Kane men were obviously losing their touch.

I wished I could have told Jeff what I had come to understand about life, and our chosen way of life, if only to hear his wise, clever counsel. Death comes for all of us. For us, for our patients: it is our fate as living, breathing, metabolizing organisms. Most lives are lived with passivity toward death—it’s something that happens to you and those around you. But Jeff and I had trained for years to actively engage with death, to grapple with it, like Jacob with the angel, and, in so doing, to confront the meaning of a life. We had assumed an onerous yoke, that of mortal responsibility. Our patients’ lives and identities may be in our hands, yet death always wins. Even if you are perfect, the world isn’t. The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients.

question that our system can produce positive results when focused on the right problem. U.S. hospitals today are filled with some of the world’s most dedicated, intelligent, and hardworking professionals. But they are operating in a system that has lost its way, one that now makes money when patients are sick and loses money when they are healthy. The modern medical system has systematically, overwhelmingly, and unequivocally let us down in preventing and reversing chronic disease. In fact, if you pull out deaths from the top eight infectious diseases (which were decreased by antibiotics) from historical data, life expectancy rates haven’t improved much in the past 120 years—despite, of course, the fact that health care is the largest and fastest-growing industry in the United States—with the vast majority of health care dollars going to chronic disease care.

What the fuck was that about?” Vaughn said, standing over me. “I pissed him off.” Dark blue eyes flicking to the restroom, Vaughn reached back and scratched at his shoulder. “All I know is when Judd came back from Texas, he was all hollowed out. Like a ghost, I guess. This morning before his bitch fit, he looked alive again. Whatever you said or did, can’t be that big a deal compared to the shit mood he’s been in lately.” Glancing at the restroom, I wanted to go back to before I said the words. My honesty ruined our happy morning. “You can’t take it personally,” Vaughn added when I just stared at the restroom. “You know how moody Judd is. Always crying and bitching about something. A freaking drama queen.” Grinning, I looked up at him. “Thank you.” “Men like us aren’t used to pretty girls looking at them like you look at Judd. He’s not sure what to do with you and you’re just gonna have to be patient while he figures shit out.” “Okay,” I said, studied him. Whereas Judd hid a deep sorrow and iced heart behind his walls, I sensed Vaughn concealed a barely contained rage. He smiled easily enough, but it was a ruse. Just like Judd who acted like the world didn’t touch him, Vaughn faked his exterior to avoid showing anything to the world. “Why do they call you Outlaw?” I asked. Vaughn sighed. “Because it’s better than calling me dead man walking.” “I don’t understand.” “You don’t need to, darlin. The drama queen returns.” When Judd appeared next to me, his expression was unreadable while kissing me softly. When he pulled away, his gaze flickered to Vaughn. “Thanks.” “You are so premenstrual sometimes.” Grinning, Judd sat down across from me then glanced at Vaughn. “Fuck off.” Vaughn leaned his hip against the side of the booth and sized me up. “What is it about the Smith sisters that makes otherwise strong men lose their balls?” “I have no idea and I’m out of sisters, so I guess you’re out of luck.” “Thank the Lord too. I like my balls attached.

He concluded the speech with an irritated motion of his hands. Unfortunately, Evie had been conditioned by too many encounters with Uncle Peregrine to discern between angry gestures and the beginnings of a physical attack. She flinched instinctively, her own arms flying up to shield her head. When the expected pain of a blow did not come, she let out a breath and tentatively lowered her arms to find Sebastian staring at her with blank astonishment. Then his face went dark. “Evie,” he said, his voice containing a bladelike ferocity that frightened her. “Did you think I was about to…Christ. Someone hit you. Someone hit you in the past—who the hell was it?” He reached for her suddenly—too suddenly—and she stumbled backward, coming up hard against the wall. Sebastian went very still. “Goddamn,” he whispered. Appearing to struggle with some powerful emotion, he stared at her intently. After a long moment, he spoke softly. “I would never strike a woman. I would never harm you. You know that, don’t you?” Transfixed by the light, glittering eyes that held hers with such intensity, Evie couldn’t move or make a sound. She started as he approached her slowly. “It’s all right,” he murmured. “Let me come to you. It’s all right. Easy.” One of his arms slid around her, while he used his free hand to smooth her hair, and then she was breathing, sighing, as relief flowed through her. Sebastian brought her closer against him, his mouth brushing her temple. “Who was it?” he asked. “M-my uncle,” she managed to say. The motion of his hand on her back paused as he heard her stammer. “Maybrick?” he asked patiently. “No, th-the other one.” “Stubbins.” “Yes.” Evie closed her eyes in pleasure as his other arm slid around her. Clasped against Sebastian’s hard chest, with her cheek tucked against his shoulder, she inhaled the scent of clean male skin, and the subtle touch of sandalwood cologne. “How often?” she heard him ask. “More than once?” “I…i-it’s not important now.” “How often, Evie?” Realizing that he was going to persist until she answered, Evie muttered, “Not t-terribly often, but…sometimes when I displeased him, or Aunt Fl-Florence, he would lose his temper. The l-last time I tr-tried to run away, he blackened my eye and spl-split my lip.” “Did he?” Sebastian was silent for a long moment, and then he spoke with chilling softness. “I’m going to tear him limb from limb.” “I don’t want that,” Evie said earnestly. “I-I just want to be safe from him. From all of them.” Sebastian drew his head back to look down into her flushed face. “You are safe,” he said in a low voice. He lifted one of his hands to her face, caressing the plane of her cheekbone, letting his fingertip follow the trail of pale golden freckles across the bridge of her nose. As her lashes fluttered downward, he stroked the slender arcs of her brows, and cradled the side of her face in his palm. “Evie,” he murmured. “I swear on my life, you will never feel pain from my hands. I may prove a devil of a husband in every other regard…but I wouldn’t hurt you that way. You must believe that.

She is waiting for me when I step outside of school at the end of the day, her sturdy frame standing by the passenger door of my papaw's small truck, waving. Yes,waving-ildly, with both arms in the air,and catching herself on the door when she loses her balance. Mortified,I attempt a nonchalant wave to the other girls on my squad. Practice actually went well today.I like the girls and I'm on top of all the pyraminds, which is cool. What is not cool is my grandmother shouting my name and motioning at me like an escaped mental patient who has taken a day job landing planes.I sprint over to their truck, which is parked diagonally across to handicapped spots, as quickly as I can. "I'm here, gosh! Stop yelling," I say. "Comee here, baby," she says, and before I know it, she's pressing me against her massive bosom in a bear hug, slapping my back and cooing into my ear. "You're Mamaw's baby, ain't ya? Yes, Mamaw's sure happy to see you." There is no escape.Because I am too short and scrawny and no match for her brute grandchild-love strength, I wait it out.

Lanius helps patients who have experienced trauma in their youth to be aware of their feelings again—often for the first time (we’ll read more about that in Chapter Seven). “Many of them have never felt positive emotions—they have a complete inability to experience positive feelings, and when they do feel something positive, they’re immediately flooded with negative emotions,” she says. This is borne out by a study that found that kids who lost a parent early in life didn’t necessarily have more negative moods than other people did—they simply had fewer positive moods. Investigators showed study participants forty mood words. People who lost a parent early in life experienced the negative words as negative, but, according to brain-wave measurements, they also experienced the positive words they saw (“loving, warm-hearted, affectionate, pleased, happy, enthusiastic”) as negative. Other research shows that kids who lost a parent at an early age later experience low self-esteem, loneliness, isolation, and an inability to express feelings—even seventy-one years after losing their parent.

Looking back on getting fired from Apple in 1985, Steve Jobs said, “It was awful-tasting medicine, but I guess the patient needed it. Sometimes life hits you in the head with a brick. Don’t lose faith. I’m convinced that the only thing that kept me going was that I loved what I did.” I saw that to do exceptionally well you have to push your limits and that, if you push your limits, you will crash and it will hurt a lot. You will think you have failed—but that won’t be true unless you give up. Believe it or not, your pain will fade and you will have many other opportunities ahead of you, though you might not see them at the time. The most important thing you can do is to gather the lessons these failures provide and gain humility and radical open-mindedness in order to increase your chances of success. Then you press on. My final lesson was perhaps the most important one, because it has applied again and again throughout my life. At first, it seemed to me that I faced an all-or-nothing choice: I could either take on a lot of risk in pursuit of high returns (and occasionally find myself ruined) or I could lower my risk and settle for lower returns. But I needed to have both low risk and high returns, and by setting out on a mission to discover how I could, I learned to go slowly when faced with the choice between two things that you need that are seemingly at odds. That way you can figure out how to have as much of both as possible. There is almost always a good path that you just haven’t discovered yet, so look for it until you find it rather than settle for the choice that is then apparent to you. As difficult as this was, I eventually found a way to have my cake and eat it too. I call it the “Holy Grail of Investing,” and it’s the secret behind Bridgewater’s success.

Quote from "The Dish Keepers of Honest House" ....TO TWIST THE COLD is easy when its only water you want. Tapping of the toothbrush echoes into Ella's mind like footsteps clacking a cobbled street on a bitter, dry, cold morning. Her mind pushes through sleep her body craves. It catches her head falling into a warm, soft pillow. "Go back to bed," she tells herself. "You're still asleep," Ella mumbles, pushes the blanket off, and sits up. The urgency to move persuades her to keep routines. Water from the faucet runs through paste foam like a miniature waterfall. Ella rubs sleep-deprieved eyes, then the bridge of her nose and glances into the sink. Ella's eyes astutely fixate for one, brief millisecond. Water becomes the burgundy of soldiers exiting the drain. Her mouth drops in shock. The flow turns green. It is like the bubbling fungus of flockless, fishless, stagnating ponds. Within the iridescent glimmer of her thinking -- like a brain losing blood flow, Ella's focus is the flickering flashing of gray, white dust, coal-black shadows and crows lifting from the ground. A half minute or two trails off before her mind returns to reality. Ella grasps a toothbrush between thumb and index finger. She rests the outer palm against the sink's edge, breathes in and then exhales. Tension in the brow subsides, and her chest and shoulders drop; she sighs. Ella stares at pasty foam. It exits the drain as if in a race to clear the sink of negativity -- of all germs, slimy spit, the burgundy of imagined soldiers and oppressive plaque. GRASPING THE SILKY STRAND between her fingers, Ella tucks, pulls and slides the floss gently through her teeth. Her breath is an inch or so of the mirror. Inspections leave her demeanor more alert. Clouding steam of the image tugs her conscience. She gazes into silver glass. Bits of hair loosen from the bun piled at her head's posterior. What transforms is what she imagines. The mirror becomes a window. The window possesses her Soul and Spirit. These two become concerned -- much like they did when dishonest housekeepers disrupted Ella's world in another story. Before her is a glorious bird -- shining-dark-as-coal, shimmering in hues of purple-black and black-greens. It is likened unto The Raven in Edgar Allan Poe's most famous poem of 1845. Instead of interrupting a cold December night with tapping on a chamber door, it rests its claws in the decorative, carved handle of a backrest on a stiff dining chair. It projects an air of humor and concern. It moves its head to and fro while seeking a clearer understanding. Ella studies the bird. It is surrounded in lofty bends and stretches of leafless, acorn-less, nearly lifeless, oak trees. Like fingers and arms these branches reach below. [Perhaps they are reaching for us? Rest assured; if they had designs on us, I would be someplace else, writing about something more pleasant and less frightening. Of course, you would be asleep.] Balanced in the branches is a chair. It is from Ella's childhood home. The chair sways. Ella imagines modern-day pilgrims of a distant shore. Each step is as if Mother Nature will position them upright like dolls, blown from the stability of their plastic, flat, toe-less feet. These pilgrims take fate by the hand. LIFTING A TOWEL and patting her mouth and hands, Ella pulls the towel through the rack. She walks to the bedroom, sits and picks up the newspaper. Thumbing through pages that leave fingertips black, she reads headlines: "Former Dentist Guilty of Health Care Fraud." She flips the page, pinches the tip of her nose and brushes the edge of her chin -- smearing both with ink. In the middle fold directly affront her eyes is another headline: "Dentist Punished for Misconduct." She turns the page. There is yet another: "Dentist guilty of urinating in surgery sink and using contaminated dental instruments on patients." This world contains those who are simply insane! Every profession has those who stray from goals....

The US traded its manufacturing sector’s health for its entertainment industry, hoping that Police Academy sequels could take the place of the rustbelt. The US bet wrong. But like a losing gambler who keeps on doubling down, the US doesn’t know when to quit. It keeps meeting with its entertainment giants, asking how US foreign and domestic policy can preserve its business-model. Criminalize 70 million American file-sharers? Check. Turn the world’s copyright laws upside down? Check. Cream the IT industry by criminalizing attempted infringement? Check. It’ll never work. It can never work. There will always be an entertainment industry, but not one based on excluding access to published digital works. Once it’s in the world, it’ll be copied. This is why I give away digital copies of my books and make money on the printed editions: I’m not going to stop people from copying the electronic editions, so I might as well treat them as an enticement to buy the printed objects. But there is an information economy. You don’t even need a computer to participate. My barber, an avowed technophobe who rebuilds antique motorcycles and doesn’t own a PC, benefited from the information economy when I found him by googling for barbershops in my neighborhood. Teachers benefit from the information economy when they share lesson plans with their colleagues around the world by email. Doctors benefit from the information economy when they move their patient files to efficient digital formats. Insurance companies benefit from the information economy through better access to fresh data used in the preparation of actuarial tables. Marinas benefit from the information economy when office-slaves look up the weekend’s weather online and decide to skip out on Friday for a weekend’s sailing. Families of migrant workers benefit from the information economy when their sons and daughters wire cash home from a convenience store Western Union terminal. This stuff generates wealth for those who practice it. It enriches the country and improves our lives. And it can peacefully co-exist with movies, music and microcode, but not if Hollywood gets to call the shots. Where IT managers are expected to police their networks and systems for unauthorized copying – no matter what that does to productivity – they cannot co-exist. Where our operating systems are rendered inoperable by “copy protection,” they cannot co-exist. Where our educational institutions are turned into conscript enforcers for the record industry, they cannot co-exist. The information economy is all around us. The countries that embrace it will emerge as global economic superpowers. The countries that stubbornly hold to the simplistic idea that the information economy is about selling information will end up at the bottom of the pile. What country do you want to live in?

Children’s minds are cast in much the same mold as our own. Sternness and severity of manner chill them and set them back. It shuts up their hearts, and you will weary yourself to find the door. But let them see that you have an affectionate feeling towards them and that you really desire to make them happy and do them good, so that if you punish them, they know it is intended for their well-being. As they see that you, like the pelican, would give your heart’s blood to nourish their souls, they will soon be submitted and devoted to you.[2] But they must be wooed with kindness, if their attention is ever to be won. And surely, reason itself might teach us this lesson. Children are weak and tender creatures, and they need patient and considerate treatment. We must handle them delicately, like frail machines, for fear that by rough fingering we do more harm than good. They are like young plants and need gentle watering – often, and only a little at a time. We must not expect all things at once. We must remember what children are and teach them as they are able to bear. Their minds are like a lump of metal – not to be forged and made useful all at once but only by a succession of little blows. Their understanding is like narrow-necked vessels: we must pour in the wine of knowledge gradually, or much of it will be spilled and lost. Precept upon precept; line upon line, line upon line; here a little, and there a little must be our rule (Isaiah 28:10). The whetstone does its work slowly, but frequent rubbing will bring the scythe to a fine edge. Truly, patience is needed in training a child, but without it, nothing can be done. Nothing will compensate for the absence of this tenderness and love. A minister may speak the truth as it is in Jesus – clearly, forcibly, and unanswerably; but if he does not speak it in love, few souls will be won. Likewise, you must set before your children their duty – command, threaten, punish, and reason – but if affection is lacking in your treatment, your labor will be all in vain. Love is one grand secret of successful training. Anger and harshness may frighten, but they will not persuade the child that you are right. If he often sees you lose your temper, you will soon cease to have his respect. A father who speaks to his son as Saul did to Jonathan when his anger was kindled against him and he called him the son of the perverse rebellious woman (1 Samuel 20:30), can’t expect to retain his influence over that son’s mind. Try hard to maintain your child’s affections. It is a dangerous thing to make your children afraid of you. Anything is almost better than reserve and insecurity between your child and you, but hesitancy will result from fear. Fear puts an end to openness; fear leads to secrecy; fear sows the seed of much hypocrisy and leads to many lies. There is a mine of truth in the apostle’s words to the Colossians: Fathers, do not exasperate your children, so that they will not lose heart (Colossians 3:21). Be sure not to overlook the advice this verse contains.

Chapter One Vivek Ranadivé “IT WAS REALLY RANDOM. I MEAN, MY FATHER HAD NEVER PLAYED BASKETBALL BEFORE.” 1. When Vivek Ranadivé decided to coach his daughter Anjali’s basketball team, he settled on two principles. The first was that he would never raise his voice. This was National Junior Basketball—the Little League of basketball. The team was made up mostly of twelve-year-olds, and twelve-year-olds, he knew from experience, did not respond well to shouting. He would conduct business on the basketball court, he decided, the same way he conducted business at his software firm. He would speak calmly and softly, and he would persuade the girls of the wisdom of his approach with appeals to reason and common sense. The second principle was more important. Ranadivé was puzzled by the way Americans play basketball. He is from Mumbai. He grew up with cricket and soccer. He would never forget the first time he saw a basketball game. He thought it was mindless. Team A would score and then immediately retreat to its own end of the court. Team B would pass the ball in from the sidelines and dribble it into Team A’s end, where Team A was patiently waiting. Then the process would reverse itself. A regulation basketball court is ninety-four feet long. Most of the time, a team would defend only about twenty-four feet of that, conceding the other seventy feet. Occasionally teams played a full-court press—that is, they contested their opponent’s attempt to advance the ball up the court. But they did it for only a few minutes at a time. It was as if there were a kind of conspiracy in the basketball world about the way the game ought to be played, Ranadivé thought, and that conspiracy had the effect of widening the gap between good teams and weak teams. Good teams, after all, had players who were tall and could dribble and shoot well; they could crisply execute their carefully prepared plays in their opponent’s end. Why, then, did weak teams play in a way that made it easy for good teams to do the very things that they were so good at? Ranadivé looked at his girls. Morgan and Julia were serious basketball players. But Nicky, Angela, Dani, Holly, Annika, and his own daughter, Anjali, had never played the game before. They weren’t all that tall. They couldn’t shoot. They weren’t particularly adept at dribbling. They were not the sort who played pickup games at the playground every evening. Ranadivé lives in Menlo Park, in the heart of California’s Silicon Valley. His team was made up of, as Ranadivé put it, “little blond girls.” These were the daughters of nerds and computer programmers. They worked on science projects and read long and complicated books and dreamed about growing up to be marine biologists. Ranadivé knew that if they played the conventional way—if they let their opponents dribble the ball up the court without opposition—they would almost certainly lose to the girls for whom basketball was a passion. Ranadivé had come to America as a seventeen-year-old with fifty dollars in his pocket. He was not one to accept losing easily. His second principle, then, was that his team would play a real full-court press—every game, all the time. The team ended up at the national championships. “It was really random,” Anjali Ranadivé said. “I mean, my father had never played basketball before.” 2. Suppose you were to total up all the wars over the past two hundred years that occurred between very large and very small countries. Let’s say that one side has to be at least ten times larger in population and armed might

I can’t remember a specific time when the comments and the name-calling started, but one evening in November it all got much worse,’ she said. ‘My brother Tobias and me were doing our homework at the dining room table like we always did.’ ‘You’ve got a brother?’ She hesitated before nodding. ‘Papa was working late at the clinic in a friend’s back room – it was against the law for Jews to work as doctors. Mama was making supper in the kitchen, and I remember her cursing because she’d just burned her hand on the griddle. Tobias and me couldn’t stop laughing because Mama never swore.’ The memory of it made her mouth twitch in an almost-smile. Then someone banged on our front door. It was late – too late for social calling. Mama told us not to answer it. Everyone knew someone who’d had a knock on the door like that.’ ‘Who was it?’ ‘The police, usually. Sometimes Hitler’s soldiers. It was never for a good reason, and it never ended happily. We all dreaded it happening to us. So, Mama turned the lights out and put her hand over the dog’s nose.’ Esther, glancing sideways at me, explained: ‘We had a sausage dog called Gerta who barked at everything. ‘The knocking went on and they started shouting through the letter box, saying they’d burn the house down if we didn’t answer the door. Mama told us to hide under the table and went to speak to them. They wanted Papa. They said he’d been treating non-Jewish patients at the clinic and it had to stop. Mama told them he wasn’t here but they didn’t believe her and came in anyway. There were four of them in Nazi uniform, stomping through our house in their filthy great boots. Finding us hiding under the table, they decided to take Tobias as a substitute for Papa. ‘When your husband hands himself in, we’ll release the boy,’ was what they said. ‘It was cold outside – a freezing Austrian winter’s night – but they wouldn’t let Tobias fetch his coat. As soon as they laid hands on him, Mama started screaming. She let go of Gerta and grabbed Tobias – we both did – pulling on his arms, yelling that they couldn’t take him, that he’d done nothing wrong. Gerta was barking. I saw one of the men swing his boot at ther. She went flying across the room, hitting the mantelpiece. It was awful. She didn’t bark after that.’ It took a moment for the horror of what she was saying to sink in. ‘Don’t tell me any more if you don’t want to,’ I said gently. She stared straight ahead like she hadn’t heard me. ‘They took my brother anyway. He was ten years old. ‘We ran into the street after them, and it was chaos – like the end of the world or something. The whole town was fully of Nazi uniforms. There were broken windows, burning houses, people sobbing in the gutter. The synagogue at the end of our street was on fire. I was terrified. So terrified I couldn’t move. But Mum kept running. Shouting and yelling and running after my brother. I didn’t see what happened but I heard the gunshot.’ She stopped. Rubbed her face in her hands. ‘Afterwards they gave it a very pretty name: Kristallnacht – meaning “the night of broken glass”. But it was the night I lost my mother and my brother. I was sent away soon after as part of the Kindertransport, though Papa never got used to losing us all at once. Nor did I. That’s why he came to find me. He always promised he’d try.’ Anything I might’ve said stayed stuck in my throat. There weren’t words for it, not really. So I put my arm through Esther’s and we sat, gazing out to sea, two old enemies who were, at last, friends. She was right – it was her story to tell. And I could think of plenty who might benefit from hearing it.

He concluded the speech with an irritated motion of his hands. Unfortunately, Evie had been conditioned by too many encounters with Uncle Peregrine to discern between angry gestures and the beginnings of a physical attack. She flinched instinctively, her own arms flying up to shield her head. When the expected pain of a blow did not come, she let out a breath and tentatively lowered her arms to find Sebastian staring at her with blank astonishment. Then his face went dark. "Evie," he said, his voice containing a bladelike ferocity that frightened her. "Did you think I was about to... Christ. Someone hit you. Someone hit you in the past---who the hell was it?" He reached for her suddenly---too suddenly---and she stumbled backward, coming up hard against the wall. Sebastian went very still. "Goddamn," he whispered. Appearing to struggle with some powerful emotion, he stared at her intently. After a long moment, he spoke softly. "I would never strike a woman. I would never harm you. You know that, don't you?" Transfixed by the light, glittering eyes that held hers with such intensity, Evie couldn't move or make a sound. She started as he approached her slowly. "It's all right," he murmured. "Let me come to you. It's all right. Easy." One of his arms slid around her, while he used his free hand to smooth her hair, and then she was breathing, sighing, as relief flowed through her. Sebastian brought her closer against him, his mouth brushing her temple. "Who was it?" he asked. "M-my uncle," she managed to say. The motion of his hand on her back paused as he heard her stammer. "Maybrick?" he asked patiently. "No, th-the other one." "Stubbins." "Yes." Evie closed her eyes in pleasure as his other arm slid around her. Clasped against Sebastian's hard chest, with her cheek tucked against his shoulder, she inhaled the scent of clean male skin, and the subtle touch of sandalwood cologne. "How often?" she heard him ask. "More than once?" "I... i-it's not important now." "How often, Evie?" Realizing that he was going to persist until she answered, Evie muttered, "Not t-terribly often, but... sometimes when I displeased him, or Aunt Fl-Florence, he would lose his temper. The l-last time I tr-tried to run away, he blackened my eye and spl-split my lip." "Did he?" Sebastian was silent for a long moment, and then he spoke with chilling softness. "I'm going to tear him limb from limb." "I don't want that," Evie said earnestly. "I-I just want to be safe from him. From all of them." Sebastian drew his head back to look down into her flushed face. "You are safe," he said in a low voice. He lifted one of his hands to her face, caressing the plane of her cheekbone, letting his fingertip follow the trail of pale golden freckles across the bridge of her nose. As her lashes fluttered downward, he stroked the slender arcs of her brows, and cradled the side of her face with his palm. "Evie," he murmured. "I swear on my life, you will never feel pain from my hands. I may prove a devil of a husband in every other regard... but I wouldn't hurt you that way. You must believe that." The delicate nerves of her skin drank in sensations thirstily... his touch, the erotic waft of his breath against her lips. Evie was afraid to open her eyes, or to do anything that might interrupt the moment. "Yes," she managed to whisper. "Yes... I---" There was the sweet shock of a probing kiss against her lips... another... She opened to him with a slight gasp. His mouth was hot silk and tender fire, invading her with gently questing pressure. His fingertips traced over her face, tenderly adjusting the angle between them.

I’m first up, love,” Arion says as he starts invading my space again. “I thought the only thing holding you back was your fear. Clearly the fear is absent if you’re willing to turn yourself over to the very darkest part of me. It’s amazing you’re in one piece, so clearly you played submissive very well, Violet. It’s because you were ready for me to save you and overcame your fear of me. Now we can be together.” When I say nothing and simply stare at him like he’s forever losing his mind more and more when we speak, he frowns like he’s genuinely perplexed. “Arion, no matter what you did, I couldn’t have endured another second of those cries. And you were at Abby’s mercy while in that state. You ripped my throat out and told me to put on some healing potion so you could sit down and watch the fight.” Apparently, I guess right, because his pupils widen marginally. “I held your hand when you finished,” he says like he’s defending himself. “So you could watch the fight.” “Vance was focused. It’s been ages since he focused. Thing of beauty while it happens,” he says as if that’s important information. I gesture between us. “That’s sort of the problem. I feel like the conduit for your feelings for them because you have heterosexual body parts with a homosexual mentality. I’m not sure I’m okay with simply being a conduit,” I carefully explain, causing his eyes to widen a little more, as several muffled sounds of amusement spring from somewhere else in the room. “I’m sorry, love, but you’ve really lost me,” Arion says very seriously, brow crinkling. “You want this to be a thing between you and me, even though Idun is returning, because you want them back. It looks like you’re getting that without me, so we can be friends,” I suggest, completely rambling. I don’t think I’m explaining this very well, since they’re all muffling laughter down the hall. Even Vance makes a choked sound of amusement. Or they’re just really immature about these things… That’s definitely possible. Arion scrubs a hand over his face, as someone struggles to cover a surprise laugh with a cough. “I’m so sorry. I shouldn’t be having this conversation right now. It’s inappropriate to do with an audience,” I babble. “But you’re really intense. And I’ve just survived an apocalyptic wolf storm with your mostly naked beta, whose threads are still in my bra because one set of clothes ended up being enough.” The look of frustrated confusion on his face doubles. “I could use a small break before we discuss curses, some really confusing relationship statuses, and the somewhat terrifying woman you’ve all loved rising very soon. And those wolves stole my oranges, so I need to go back and get all of them.” “I’ve already returned them to your cellar,” Emit says from somewhere behind Arion. “Then I need to go start using them while they’re useable,” I say as I quickly disentangle myself from Arion and attempt to escape. “I’ll return the shirt.” “Keep it,” he says quietly from behind me, as I finally take in the other three all standing somewhat close together, smirking at me. “I’ll drive you home,” Damien says with a slow grin. “I’m not talking to you, and if you’re a smart man, you’ll figure out why,” I state firmly. “Only when you figure it out will we discuss it.” “I’ll take you—” “I don’t want to talk to you right now, because I need to get my cool back,” I tell Emit, whose eyes immediately flick away, as his jaw tics. He’s had multiple opportunities to explain to me why he told Damien I was a monster, and yet didn’t even bother telling me what I was. All this time, I’ve been patiently waiting, refusing to get too angry. Now…I’m getting sort of freaking angry, because he still hasn’t said one word about it. “Guess that just leaves me,” Vance says as he puts his hand at the small of my back and starts guiding me out.

To my Charley on his wedding day – I know you think these notes are silly. I have watched you scrunch your face over the years when I give them to you. But understand that sometimes I want to tell you something and I want to get it just right. Putting it down on paper helps me do that. I wish I had been a better writer. I wish I had gone to college. If I had, I think I would have studied English and maybe my vocabulary would have improved. So many times I feel I am using the same words over and over, like a woman wearing the same dress every day. So boring! What I want to say to you, Charley, is you are marrying a wonderful girl. I think of Catherine in many ways like I think of Roberta. Like a daughter. She is sweet and patient. You should be the same with her, Charley. Here is what you are going to find out about marriage: you have to work at it together. And you have to love three things. You have to love 1) Each other 2) Your children (When you have some! Hint! Hint!) 3) Your marriage What I mean by the last one is, there may be times that you fight, and sometimes you and Catherine won’t even like each other. But those are the times you have to love your marriage. It’s like a third party. Look at your wedding photos. Look at any memories you’ve made. And if you believe in those memories, they will pull you back together. I’m very proud of you today, Charley. I am putting this in your tuxedo pocket because I know how you lose things. I love you every day. Mom

Helpful Tips For Getting The Nutrition You Need Your interest in nutrition means that you are probably already a label reader as you traverse the supermarket aisles. You also hear about food and nutrition on the evening news. The knowledge you acquire about nutrition for optimal health can truly be life-changing. These tips will help you in your efforts to get the health and energy-giving nutrients that you need. Remember that portions are extremely important. To make sure you are eating the correct portion sizes, fill up your plate with the healthiest foods first and then the least healthy. It also helps to eat the foods on your plate in the same order. Carefully inspect food labels to determine the nutrition facts. Just because something says that it has reduced fat doesn't mean that it is full of healthy ingredients. Avoid highly processed foods when losing weight. Any label that is trustworthy is a label that has ingredients which are common and that people know what they are. Avoid buying foods with a lot of artificial ingredients listed on their label. Take some ideas from other countries when evaluating your nutrition. For centuries, other cultures have incorporated unusual and inventive ingredients that can be very good for you. Taking the time to research some of these ideas and finding the ingredients, can definitely add some spice to a potentially boring menu. Treatment Wheatgrass shoots may not be rated #1 in taste, but they contain many nutrients and vitamins that are great for your nutrition. Incorporate more wheatgrass in your diet to get healthy. It is a great way to detoxify your body and rebuild your bloodstream. In fact, it is a great treatment for anyone with blood disorders. Sugary drinks like apple juice contain a large amount of sugar. People who are trying to lose weight should avoid fruit drinks because they are deceptively filled with carbohydrates. Oranges, apples, and peaches all contain very high levels of sugar which in turn provides a ton of calories. Hospitals are often known to use fruit juice as a treatment for severely malnourished patients, due to its caloric value. These are just a few ideas that can get you going in the right direction or that can give you some new ways to get the nutrients that you need. Don't expect instant results - this is a long-term process. Ignoring the advice is like running a motor without ever changing the oil. Sure, you won't see any effects for a long time, but little by little the motor is sustaining irreversible damage. Don't let that happen to your body!

In 1999, a bunch of researchers published a study of about 1,600 adults examined in order to come up with equations to estimate kidney function. Just plug in the patient’s creatinine, age (because adults tend to lose muscle mass as we get older), and gender (because men tend to have more muscle mass than women), and voila!—an estimate of kidney function. Most laboratories can do this for us now. A rising creatinine level in the blood means the kidneys are not able to pee creatinine out as well as they used to, so the person’s estimated kidney function is lower. But wait—if the patient is Black, the study determined that you have to multiply by 1.2 to get a more accurate estimate. This finding was attributed to Blacks in the study having higher muscle mass than Whites and, therefore, higher amounts of creatinine in their bodies. Laboratories report the eGFR, and just below it, the eGFR if Black. Of course one of the problems with generalizations is that they aren’t always true. In medicine, in particular, they make us lazy and we often accept them without question—especially when they are in line with our underlying assumptions and beliefs. Like the belief that Black and African are inherently different from White and European at a DNA level, a belief that dates back to the days when American researchers were measuring Black-White differences in skull size to prove Black inferiority and justify slavery. But I wonder how often health-care providers make the mental adjustment that the “race adjustment” is really a proxy for muscle mass rather than just focusing on the race of the person in front of them when they are assessing lab results. I wonder if the person in front of them were a White male bodybuilder how many would tell him the race-adjusted estimate of kidney function, or a skinny Black woman the non-race-adjusted estimate. Then too I wonder how many health-care practitioners realize that equations derived from the original study of 1,600 people only included about 200 Blacks—and no American Samoans, no Hispanics, no Asians. These groups have very different body frames, but all are simply “not Black” in our equations. The implication, then, is that only Black people are different. This shortcut has the potential for a significant negative impact on Black patients who happen to not have a high muscle mass. Patients like Book of Eli. When the non-race-adjusted eGFR is 20 (when a person can be placed on the waiting list), the race-adjusted value is closer to 25. Just as the difference between eGFRs of 20 and 10 can be several years for many patients, so can the difference between 25 and 20. Years of accruing time on the kidney transplant waiting list when thirteen people on the waiting list die every day waiting for a kidney.

There is so much I hope to teach you, little one. I hope that I may do so by example, but I feel the need to put the words to paper as well. It is a quirk of mine, one which I expect you will recognize and find amusing by the time you read this letter. Be strong. Be diligent. Be conscientious. There is never anything to be gained by taking the easy road. (Unless, of course, the road is an easy one to begin with. Roads sometimes are. If that should be the case, do not forge a new, more difficult one. Only martyrs go out looking for trouble.) Love your siblings. You have two already, and God willing, there will be more. Love them well, for they are your blood, and when you are unsure, or times are difficult, they will be the ones to stand by your side. Laugh. Laugh out loud, and laugh often. And when circumstances call for silence, turn your laugh into a smile. Don’t settle. Know what you want and reach for it. And if you don’t know what you want, be patient. The answers will come to you in time, and you may find that your heart’s desire has been right under your nose all the while. And remember, always remember that you have a mother and a father who love each other and love you. I feel you growing restless. Your father is making strange gasping sounds and will surely lose his temper altogether if I do not move from my escritoire to my bed. Welcome to the world, little one. We are all so delighted to make your acquaintance.

Fifteen years ago, Israeli scientists published a study in which engineers observed patient care in ICUs for twenty-four-hour stretches. They found that the average patient required 178 individual actions per day, ranging from administering a drug to suctioning the lungs, and every one of them posed risks. Remarkably, the nurses and doctors were observed to make an error in just 1 percent of these actions—but that still amounted to an average of two errors a day with every patient. Intensive care succeeds only when we hold the odds of doing harm low enough for the odds of doing good to prevail. This is hard. There are dangers simply in lying unconscious in bed for a few days. Muscles atrophy. Bones lose mass. Pressure ulcers form. Veins begin to clot. You have to stretch and exercise patients’ flaccid limbs daily to avoid contractures; you have to give subcutaneous injections of blood thinners at least twice a day, turn patients in bed every few hours, bathe them and change their sheets without knocking out a tube or a line, brush their teeth twice a day to avoid pneumonia from bacterial buildup in their mouths. Add a ventilator, dialysis, and the care of open wounds, and the difficulties only accumulate.

You okay, Ruthie?" Oh, just throwing up in my mouth. "Did she just give you her number?" He chuckles. "Indeed. She insisted I write down her contact information so I can send her a message." Isn't that cute. "Lucky you." Kazex's smile fades as he studies me. "You sure you're all right? You look troubled." I hate seeing the happiness fade from his face. I hate that I'm the big party pooper for the day. It just makes how I'm feeling worse. I'm the problem, not Kazex. He doesn't owe me anything. "I ate something that disagreed with me. Tell the others I'm going back to the ship, all right?" A look of concern crosses his face. "I'll come with you⁠—" I put a hand up, silencing him. He's going to be kind and friendly and patient like he always is, and I'll just lose it even more. "I don't need you." When he flinches, I feel like a monster. God, I'm just making this worse by the moment. "I'm going back alone. You find the others. I'll see you back home.

Our patients' lives and identities may be in our hands, yet death always wins. Even if you are perfect, the world isn't. The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients. You can't ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.

Migraine, like my patient Sarah had, also correlates closely to poor metabolic health. In the ENT otology clinic, we often saw this condition and had limited success in treating it. Sufferers of this debilitating neurological disease—about 12 percent of people in the United States—tend to have higher insulin levels and insulin resistance. A comprehensive review of fifty-six research articles identified links between migraine and poor metabolic health, pointing out that “migraine sufferers tend to have impaired insulin sensitivity.” The review supports the “neuro-energetic” theory of migraine. Additionally, evidence suggests that micronutrient deficiencies in key mitochondrial cofactors may also be a contributing factor of migraine. Research has suggested that migraines could be treated by restoring levels of vitamins B and D, magnesium, CoQ10, alpha lipoic acid, and L-carnitine. Vitamin B12, for instance, is involved in the electron transport chain responsible for the final steps of ATP generation in the mitochondria, and studies have indicated that high doses of B12 can help prevent migraine. These micronutrients usually have fewer side effects than other drugs used to treat migraines, making them a promising option for relief, which can be obtained through a diet rich in these micronutrients, or supplementation. Having high markers of oxidative stress, a key Bad Energy feature, is associated with a significantly higher risk of migraine in women, with some studies suggesting that migraine attacks are a symptomatic response to increased levels of oxidative stress. Less painful and more common tension-type headaches are also linked to high variability (excess peaks and crashes) in blood sugar. Hearing Loss The same story of metabolic ignorance in the ENT department unfolded for auditory problems and hearing loss, one of the most common issues presented to our ENT clinic. We’d typically tell our patients that their auditory decline was inevitable, due to aging and loud concerts in their youth, and we would suggest interventions like hearing aids. Yet insulin resistance is a little-known link to hearing problems. If you have insulin resistance, you are more likely to lose hearing as you age because of poor energy production in the delicate hearing cells and blockage of the small blood vessels that supply the inner ear. One study showed that insulin resistance is associated with age-related hearing loss, even when controlling for weight and age. The likely mechanism for this is that the auditory system requires high energy utilization for its complex signal processing. In the case of insulin resistance, glucose metabolism is disturbed, leading to decreased energy generation. The impact of Bad Energy on hearing is not subtle: A study showed that the prevalence of high-frequency hearing impairment among subjects with elevated fasting glucose levels was 42 percent compared to 24 percent in those with normal fasting glucose. Moreover, insulin resistance is associated with high-frequency mild hearing impairment in the male population under seventy years of age, even before the onset of diabetes. These papers suggest that assessing early metabolic function and levels of insulin resistance is essential in the ENT clinic and counseling individuals on the potential warning signs is paramount.

NATURE MORTE You are given two things today, one is an angry nail in your side; Changing what you are able to sense is the second thing you are gifted. Nature is always a referred existence, writes Emerson, never a presence. Who knows where the time goes, sings Sandy Denny. Who can bear to hear it? One reaches the moment when one loses words—in the pastoral, in the cosmic? Think about the scars on the planets, & how patient those stars seem to be. I am painting the natural landscape with my eyes closed today. It is like writing A poem with all the cross-outs left in; an expression like never thought I’d see the day. Nature that begins with unknowable & ends with more monotonous hills. Today, I want to be the country-fried philosophe or a Hudson River School painting. When this life is over, describe to me how its concave & convex forms are & are not. We live amid surfaces, writes Emerson, & the true art of life is to skate well on them.

Lord, I take great comfort in knowing You hear my prayers. Your Word tells me You listen and are never so far away that You cannot hear when I call. Help me to be patient to wait for Your answers, to not lose heart, and to never fear that You have not heard. Help me to trust You enough every day of my life to pray for all that concerns me.

No one wants to go into a nursing home. My patients fear it; families often feel terrible guilt when the time comes: it is thought of as an abandonment. Nursing homes are where we place our bad outcomes, our frail, our no-longer-independents. They are places people go to wait safely to die. The old doubly incontinents. You might have stood up to Stalin, you might still read Tolstoy, but if you're losing it from both the front and back and you're not a two-year-old, you're going to be hidden away. "Don't know the nursing homes, they do a pretty good job," a geriatrician said to me. And most of the time they perform their function: as a holding bay for old people. Most of the time.

To help you along the way, our patients shared these catchphrases they used that inspired or motivated them when they were feeling down or defeated. Use one of theirs or come up with some of your own. • Only I have the power to let myself down.17 • I don’t have unlimited time to flail around in the universe. • I don’t really want to give up ever . . . if I give up, what else do I have? • Reality is better than the fiction in my head. • I’d rather feel the uncomfortable sensations for a while (by not giving in to the false messages) and have my sanity. • What am I doing today to improve my life? • These thoughts and sensations are not real—do not give in to them. • Do not feed the monster. • Remember what it is like to give in—you lose time, energy, and relationships. • With respect to deceptive brain messages, it’s not what you think or feel, it’s what you do that counts.18 • These deceptive brain messages have no power—they are false. EXERCISE: Write down what you will say to inspire and motivate you to keep going when you feel like giving up or believe the deceptive brain messages are true:

Surrendering the Pen to God   Cheryl’s Journal (June 18, 1994) Cheryl’s prayer: There must be a reason, Lord, that You want me alone. You must be shaping me for something. I’ll be honest. I’m sick of it, but as I always say, You know best. I know it will be special when You, my Lord, finally bless me with marriage and a family. My future is in Your hands. Lord, I don’t know where it’s headed, but I’d like for You to use me for Your sake and glory. God’s reply: Trust in Me. Take it day by day. Trust that I know what I’m doing. Be patient. Place your security in Me, not in others. Know who you are, firmly grounded in Me first. Then you are free to share your life with someone else. It’s a gift. I am the Creator of love. I don’t always work in ways expected. Stay open. Receive from Me what I have for you. Cheryl’s prayer: It’s not worth accepting a gift from You, God, if I lose You and me in that gift. God’s reply: Your desire is a natural desire. Yet, like everything else, it must fall into place by My timing, not yours.

It’s easy to lose perspective when you have little kids. One of the hardest things about this season in your life is that you don’t see many results of your training. Even though you try to teach kindness, your kids still fight. Although you pray for patience, you lose yours. You sing “Jesus loves me” until you are blue in the face, yet you wonder if it’s really sinking in. This is a season of input and training, and you are not likely to see the results of this training for years. That’s hard because we really need to see tangible fruit of our labor. We live in an instant society. We expect instant results in so many other areas of our lives and then we don’t experience it in raising our kids. We need to recognize that looking for immediate results is an unrealistic expectation. We have to remember that God is patient. He is not in a hurry. He is not surprised by our mistakes. He knows and loves each one of our children even more than we do. And he has chosen the exact children in the exact birth order with the exact personalities for our family. He has given us our kids not merely so that we can raise them but also in order that they might be used by him to grow us up into the men and women he has created us to be. He will use our children in our lives. He is at work in our family even if we can’t see it right now, even when we feel like a bad parent, even when we fear we have messed up our child forever! We have to remember that there is no mess that God cannot redeem. He is not condemning us. Instead he is delighting in us! He is patiently working through us and in us. And as he does he will gently lead us.

retreat in order to charge with greater strength, and to kill the enemy with one fatal blow! This teaches you to withdraw frequently into yourself. Recall your insignificance, your inability to accomplish anything. You will then place great confidence in the almighty power of God, so that you will be able, through His grace, to attack and conquer the passions that oppose you. Here you must implore: “My Lord, My God! Jesus! Mary! Do not abandon your soldier! Do not permit me to be conquered by this temptation!” Whenever the enemy gives you a breathing spell, call up your understanding to reinforce your will. Strengthen it with motives that will raise its courage and give it new life for the fight. For example, if you are unjustly accused or harmed in some other way, and, in desperation, are tempted to lose all patience, try to check yourself by reflecting on these points: 1. Consider whether you might not deserve the unpleasantness you are undergoing, and whether you have not brought it upon yourself. If you are in any way to blame, it is proper that you patiently endure the agony of the wound which you yourself have occasioned. 2. However, if you are not guilty on this score, glance back at some past offenses for which divine justice has not yet inflicted a punishment, and for which you have not sufficiently expiated by a voluntary penance. When you see that God, in His infinite mercy, instead of a long punishment in purgatory, or even an eternal one in hell, has decreed but an easy and momentary one in this life, accept it, not merely with resignation, but with joyous thanksgiving.

My ideal man," Malak said ponderingly. "I'm not sure what that means. I don't want the ideal. I want complexity. I want passion. I want imperfection. My ideal man is not ideal. But," she said, leaning forward, "I'll tell you about him." "I want him to have lunch at home. I want him to help me with my own mind. I want him to be bookish, wise, cunning, and exemplary. I want him to be a good storyteller, and always on my side." "Yes, I want him to be near me. A good conversationalist, proud, not afraid of the lofty heights." "I want him to be a singer, one who knows and loves a good song, can play an instrument, the oud or the ney, and preferably both. I want him to be a good mourner, know how to attend to the pain of others, a consoler who could assuage the grief I have for all those I loved and befriended and who are no longer here. I want him to be a healer, an expert in all that troubles me. I want him to be a fire that annihilates all danger that lies ahead and behind me and that which I have, somehow, without his help, found a way to avoid. I want him to be faithful---" "Incapable of deception. I want him to be constant__" "Constant in his love and in his prayers and, when those prayers are not answered, I want him to change reality with his own hands. I want him to be my lord-" "For all the world to see. I want him to make me proud, to make vanish old and fresh longings, new and unremembered regrets. I want him to be vigilant_" "To protect me from sorrows even once their great heights have passed. I want him to know how to deal with the past. I want him to be occasionally gripped by fear-" "The fear of losing me. I want him to be patient, to help me to endure the injustices visited upon the houses of those I love. But I also want him to be impatient_" "To lose all reason and hurry off, forgetting his shoes and hat, and ride-" "His horse flanked by wings of angry dust, galloping, if need be, all night to find the traitorous, to change my fortunes and avenge me." "And then I want him to return to me, to prosper by my side. I want to take him to the clearest stream, one only I know the way to, and there quench his thirst. I want him to look at me sometimes as if he does not know who I am. But I want to be forever recognized by him, come what may, to point me out in a crowd when, after the passage, we are reunited." "I want him to see me when I cannot see myself.

Got Milk? For the record, you shouldn’t. I am not advocating for training your gut to handle lactose. We learned about the effect of animal protein and saturated fat on the gut in Chapter 2—less SCFA-producing bacteria, more inflammatory bacteria, increased TMAO production, increased intestinal permeability, and increases in bacterial endotoxin. As we’ve done in the past, when we examine the whole food rather than a sum of its parts, we find that dairy products have been associated with prostate cancer and Parkinson’s disease. Also the link to bone health turns out to be a myth—a prospective study of ninety-six thousand people over twenty-two years showed that milk consumption during teenage years did not protect against hip fracture later in life. In fact, men who drank more milk as a teenager actually had increased risk of hip fracture in the study. In a study of women in Sweden, high milk intake was associated with increased risk of bone fracture, heart disease, cancer, and premature death. One of the first things I do with my patients who have gas, bloating, or diarrhea is to eliminate dairy. You would not believe how many of them are cured just by doing this. Sorry, but milk doesn’t do a body good. The irony is that lactose, which has been vilified through the years as evil, is probably the most redeeming thing about dairy because lactose is actually a prebiotic and can have a beneficial effect on the gut microbiota.

We shouldn’t be walking away from a conversation in a rage; we should regulate ourselves. Repair the ruptures. Reconnect and grow. When you walk away, everybody loses. We all need to get better at listening, regulating, reflecting. This requires the capacity to forgive, to be patient. Mature human interactions involve efforts to understand people who are different from you.

To past generations, You grew up in a time of tall trees and flowers. Stumbled through the dark, blameless and carefree. When you were at fault, you answered only to yourself. The pain you’ve caused others—now inconsequential—because no one was watching. You belong to a world of forgotten transgressions. Our generation blooms in the era of eyes and judgment. Where our mistakes are timestamped; our broken hearts livestreamed. But does this give you a right to throw stones at us? Self-growth is a long and winding road, and the ground we are treading is unlike any other. Please be patient with us. Be kind. Understand that we must lose our way, over and over, before we can find the best version of ourselves.

Have you ever played with a hoop before?” “Rolled a hoop? Of course! My daddy and I used to do it in Memphis.” “Have you ever rolled a hoop up a hill?” Felicia nodded. “There was a big hill not too far from where I lived.” “What happened if you started up the hill with the hoop and then quit pushing it?” Felicia looked at her with something akin to pity. “You can’t quit pushing the hoop when you’re going uphill, Miss Abby.” “Really? Why not?” “Because if you do,” Felicia said patiently, “it will start to roll back downhill.” Abby let Felicia’s response hang in the air, recognizing the moment the girl understood her point. “That’s what you mean by not taking things for granted,” she exclaimed. “You can’t ever stop fighting for what you want.” She stared into the fire, deep in thought. “Is that true for everyone or just for women?” “The principle is true for everyone,” Abby responded, “but it is truer for women because there are so many people that want to see us fail.” “That’s not right!” Felicia cried. “Right or not, that is the way it is,” Abby said. “It’s hard for me as a woman, and it’s going to be harder for you as a black woman. There are many times you are going to be very tired. You’re going to want to quit fighting and take a seat, but you can’t…” “…Because I will go downhill and lose what I worked so hard for.” Silence

Ginny told me that, like Dr. Wisner's patients, her problem was not so much that she had an urge to kill her grandchildren, but rather a fear that she might somehow lose control of her senses. She put it this way: "The fear is not that in my current state I could do these things, but that I might slip into a state where I could do it. Right now, when I am thinking about it, I know it won't happen. But still it festers, it festers and lingers, and it keeps beating on you and beating on - like it's the villain, the enemy, the monster, the demon - it's a faceless devil." With my encouragement, Ginny told her husband about the thoughts. She was relieved that his reaction was "he just couldn't even believe what he was hearing - he knew I'd never do these things, they were just bad thoughts." When I asked Ginny why she thought he has so much faith in her, she replied, "Because he sees me with people daily. He said he fell in love with me because I am kind. For example, he reminded me of a time when we were together in a cabin, and I noticed a bee trapped behind a screen and I told him I didn't want the bee to die, so he spent the first hour of our first weekend together undoing the screen to free the bee. He asked me, does that sound like someone who would kill her grandchildren? He also reminded me that I am soft and warm and very loving, and he would never worry about me doing the awful things I was thinking of." Needless to say, Ginny was relieved by her husband's reaction, since she had feared he would think she was crazy.

The individual will eventually lose even the right to make decisions about his own life. When patients report suicidal thoughts, therapists are under pressure to proceed to collocation; suicide is not allowed under any circumstances. However, if the government approves, you can get permission for euthanasia for reason of mental suffering. In other words, from now on, the government determines when you are allowed to die.

BerylHealth got lucky when its employees stepped up to the plate to help the organization expunge a cancer rather than simply getting sick of it and leaving—something that happens all too often in organizations. And losing great people because we as leaders are afraid or ignorant of the behaviors of those few bad apples is something an organization simply cannot afford—especially these days, when it is hard to find and keep great people. Once we have found superstars, we don’t want to lose them.

Remarkably, doctors tend to trivialize the suffering of patients with panic attacks—and somatization in general. When it becomes clear that the patient is not having a heart attack—it’s “only” a panic attack—many doctors lose interest or, worse, blame the patient for wasting their time. (I did this myself many times before I learned better.) These dismissive attitudes and behaviors have deep roots in the medical profession: They go to the core of what medicine is for. For many doctors, the purpose of medicine is to cure disease. For these “curing” doctors, if you don’t have a definable disease—panic attacks are not a disease—then you’ve come to the wrong place. But, for other doctors, the purpose of medicine is the same today as it has been for centuries: to relieve human suffering—sometimes by curing disease (when we can) but always by empathizing with, understanding, and trying to comfort the sufferer. Doctors

If you could learn entire languages in a week, draw perfect pictures without thinking about it, and make complex calculations in your head in seconds, would you be willing to trade that for the ability to comfortably walk into a coffee shop and shake a stranger’s hand? My thoughts went racing to modern comic mythology such as X-Men: The Last Stand, in which mutants are presented with a drug that could make them normal by robbing them of their powers. Would purine treatment in autistic savants be the same sort of thing? I had to know, so I asked Dr. Naviaux, “Will savants lose their mutant powers if we cure them? “Treating an autistic savant with a purine inhibitor should not change his or her extraordinary abilities at all,” he said. The hyperconnected islands of neurons that were formed when an autism patient was young would still be there. The powers that the islands grant would still be available, but they would no longer be the only neural connections available. “In younger patients in particular, new connections, longer ones, stand a good chance of forming once the danger response is shut down by a purine blocker,” says Dr. Naviaux. The result? A superhuman mind without the burden of autism. Wow.

When a red wolf loses its fur to mange, its coat grows back in as a creamy beige because pigment -producing cells are destroyed when the skin becomes highly inflamed. She looks resolute in her misery, or perhaps it is simply the endurance of a wild animal that knows the pattern of survival. “We’ve got to get rid of these bugs,” Ryan says, upset about the flies hovering near her sores. In that instant, I admire the responsibility he feels for taking care of the red wolves. It is one thing to administer routine vaccines and medical injections but quite another to want to remove flies from his patient’s wounds. I gaze at the wolf’s lean body, curled into a ball in the hot metal box. My eye catches something pink near her tail, then something dark moves. “She’s so scared of us, she’s pooping,” I blurt out. “That’s what they do when they’re scared,” Ryan says. He slowly lowers the lid on her box so that it would not clatter and further rattle her. She now has her privacy back, even if it is a hot, metallic, fly-filled hell. She has the whole fifty-by-fifty-foot pen to roam around, and yet this two-by-three-foot box is where she chooses to be. I begin to get a glimpse of how hard it must be to spend your career conserving an animal that doesn’t lose an ounce of affection on you, an animal that you are responsible for keeping fed, whole, and healthy while it makes it abundantly clear through its body language that it would rather be anywhere else on earth than near you. “They are scared to death of people,” Ryan says as we exit the pen. “As scared as some people are of being face-to-face with a wolf, you can pretty much guarantee that they are more scared of you.

Wilderness leaders need to understand that there are varying normal responses to a crisis. Until there is time to regroup, behaviors may seem unusual when, in truth, they should be expected. Some behaviors that may emerge in the face of a crisis include: 1. Regression. Many grown people revert to an earlier stage of development. The theory is that, since their parents used to care for them as children, someone else may care for them now if they behave in a childlike manner. In particular, tantrums used to be very effective. Tantrum-like or very dependent behavior is not unusual. 2. Depression. Closing into one’s inner world is another common response to crisis. This is where some people find the sources of strength to cope with an emergency. This is characterized as a shutdown effect: fetal positioning, slumped shoulders, downcast eyes, arms crossed over the chest, and unwillingness or difficulty in communicating. 3. Aggression. Some people lash out, physically or emotionally, at threats, including the vague threat of an emergency. High adrenaline levels may intensify the response, and so may the feelings of frustration, anger, and fear that commonly surround unexpected circumstances. This response is characterized by explosive body language, including swinging fists and jumping up and down. What one should do about the various behaviors that surface during a crisis depends somewhat on the individual circumstances. As a general rule, open communication, acknowledgement of the emotional impact of the event, and a healthy dose of patience and tolerance can go far during resolution of the situation. Some basic procedures to consider in crisis management might include the following: 1. Engage the patient in a calm, rational discussion. You can start the patient down the trail that leads through the crisis. 2. Identify the specific concerns about which the patient is stressed. You both need to be talking about the same problems. 3. Provide realistic and optimistic feedback. You can help the patient return to objective thinking. 4. Involve the patient in solving the problem. You can help the patient and/or the patient can help you choose and implement a plan of action. Someone who completely loses control needs time to settle down to become an asset to the situation. Breaking through to someone who has lost control can be a challenge. Try repetitive persistence, a technique developed for telephone interrogation by emergency services dispatchers. Remain calm, but firm. Choose a positive statement that includes the person’s name, such as, “Todd, we can help once you calm down.” (An example of a negative statement would be, “Todd, we can’t help unless you settle down.”) Persistently repeat the statement with the same words in the same tone of voice. The irresistible force (you) will eventually overwhelm the immovable object (the out-of-control person). Surprisingly few repetitions are usually needed to get through to the patient, as long as the tone of voice remains calm. Letting frustration or other emotions creep into the tone of voice, or changing the message, can ruin the entire effort. Over time, the overwhelming responses that generated the reaction may occasionally resurface. This is normal. Without being judgmental or impatient, regain control through repetitive persistence. A crisis may bring out a humorous side (sometimes appropriately, sometimes not) among the group. When you wish to release the intensity surrounding a situation or crisis, appropriate laughter is one of the best methods. It should also be noted that many people cope just fine with emergency situations and unexpected circumstances. They are a source of strength and an example of model behavior for the others.

Chapatis will soon become EXTINCT A renowned cardiologist explains how eliminating wheat can IMPROVE your health. Cardiologist William Davis, MD, started his career repairing damaged hearts through angioplasty and bypass surgeries. “That’s what I was trained to do, and at first, that’s what I wanted to do,” he explains. But when his own mother died of a heart attack in 1995, despite receiving the best cardiac care, he was forced to face nagging concerns about his profession. "I’d fix a patient’s heart, only to see him come back with the same problems. It was just a band-aid, with no effort to identify the cause of the disease.” So he moved his practice toward highly uncharted medical territory prevention and spent the next 15 years examining the causes of heart disease in his patients. The resulting discoveries are revealed in "Wheat Belly", his New York Times best-selling book, which attributes many of our physical problems, including heart disease, diabetes and obesity, to our consumption of wheat. Eliminating wheat can “transform our lives.” What is a “Wheat Belly”? Wheat raises your blood sugar dramatically. In fact, two slices of wheat bread raise your blood sugar more than a Snickers bar. "When my patients give up wheat, weight loss was substantial, especially from the abdomen. People can lose several inches in the first month." You make connections between wheat and a host of other health problems. Eighty percent of my patients had diabetes or pre-diabetes. I knew that wheat spiked blood sugar more than almost anything else, so I said, “Let’s remove wheat from your diet and see what happens to your blood sugar.” They’d come back 3 to 6 months later, and their blood sugar would be dramatically reduced. But they also had all these other reactions: “I removed wheat and I lost 38 pounds.” Or, “my asthma got so much better, I threw away two of my inhalers.” Or “the migraine headaches I’ve had every day for 20 years stopped within three days.” “My acid reflux is now gone.” “My IBS is better, my ulcerative colitis, my rheumatoid arthritis, my mood, my sleep . . .” and so on, and so on". When you look at the makeup of wheat, Amylopectin A, a chemical unique to wheat, is an incredible trigger of small LDL particles in the blood – the number one cause of heart disease. When wheat is removed from the diet, these small LDL levels plummet by 80 and 90 percent. Wheat contains high levels of Gliadin, a protein that actually stimulates appetite. Eating wheat increases the average person’s calorie intake by 400 calories a day. Gliadin also has opiate-like properties which makes it "addictive". Food scientists have known this for almost 20 years. Is eating a wheat-free diet the same as a gluten-free diet? Gluten is just one component of wheat. If we took the gluten out of it, wheat will still be bad since it will still have the Gliadin and the Amylopectin A, as well as several other undesirable components. Gluten-free products are made with 4 basic ingredients: corn starch, rice starch, tapioca starch or potato starch. And those 4 dried, powdered starches are some of the foods that raise blood sugar even higher. I encourage people to return to REAL food: Fruits Vegetables and nuts and seeds, Unpasteurized cheese , Eggs and meats Wheat really changed in the 70s and 80s due to a series of techniques used to increase yield, including hybridization. It was bred to be shorter and sturdier and also to have more Gliadin, (a potent appetite stimulant) The wheat we eat today is not the wheat that was eaten 100 years ago. If you stop eating breads/pasta/chapatis every day, and start eating chicken, eggs, salads and vegetables you still lose weight as these products don’t raise blood sugar as high as wheat, and it also doesn’t have the Amylopectin A or the Gliadin that stimulates appetite. You won’t have the same increase in calorie intake that wheat causes.

Tina is sitting at a table waiting for me. Her hands are folded and she’s sitting with perfect posture, like she’s an advertisement for some kind of ergonomic chair. I stop. Her eyes dart up to mine and then look away. I come to stand by her. “Hi, you.” We haven’t talked—or texted—since our brief exchange on Saturday night. And that’s okay. I can be patient. I don’t pretend to understand her, but I understand this: Like me, she’s caught. She wants to be responsible. She doesn’t like losing control—even as little as we did together. And I don’t want her terrified. I want her naked. I want her beneath me. And when she’s there, I want her to be sure.

Many studies have shown that children who are able to postpone gratification are more successful in life. This really doesn’t require a study to realize. Look around you and you will see that people who succeed are people who patiently persist in achieving their goals. They do not throw in the towel when they don’t get what they want right away. They don’t lose touch with or deny their wants and wishes just because life doesn’t give them what they want when they want it. They bounce back from life’s setbacks with renewed energy and enthusiasm.

If you point out a “truth,” for want of a better word, to patients before they’re able to hear or admit it, they lose trust in the therapist; their defences take over, and they improve only superficially. Overinterpreting to the client is the sign of a new or insecure therapist. A therapist can lead patients to the door of understanding, but they shouldn’t drag them in. Their patients will enter when they’re ready.

Hearing Loss The same story of metabolic ignorance in the ENT department unfolded for auditory problems and hearing loss, one of the most common issues presented to our ENT clinic. We’d typically tell our patients that their auditory decline was inevitable, due to aging and loud concerts in their youth, and we would suggest interventions like hearing aids. Yet insulin resistance is a little-known link to hearing problems. If you have insulin resistance, you are more likely to lose hearing as you age because of poor energy production in the delicate hearing cells and blockage of the small blood vessels that supply the inner ear. One study showed that insulin resistance is associated with age-related hearing loss, even when controlling for weight and age. The likely mechanism for this is that the auditory system requires high energy utilization for its complex signal processing. In the case of insulin resistance, glucose metabolism is disturbed, leading to decreased energy generation.