The History of Man: (1) Beginnings

"Man, it would seem, has descended from arboreal apes. They lived a happy life in tropical forests, eating coconuts when they were hungry, and throwing them at each other when they were not. They were perpetually occupied in gymnastics, and acquired an agility which to us is truly astonishing. But after some millions of years of this arboreal paradise, their numbers increased to the point where the supply of coconuts was no longer adequate. The population problem set in, and was dealt with in two different ways: those who lived in the middle of the forest learned to throw coconuts with such accuracy as to disable adversaries, whose consequent death relieved the pressure of population, but those who lived on the edge of the forest found another method: they looked out over the fields and discovered that they yielded delicious fruits of venous kinds quite as pleasant as coconuts, and gradually they came down from the trees and spent more and more time in the open on the ground . . . they soon discovered that if you live on the ground it is easy to pick up stones, which are more effective missiles than coconuts." - Sir Bertrand Russell

Barista Not Actually Flirting with You, VII (?)

Maintenant, a song by Rupa
[translated from french]

once again you find yourself here
face to face, next to me
tell me what do you see
when you look at me? look at me
here at the edge of a breath
here at the edge of a dream
you don’t know what to say, what to do
expectation on your lips
but i come like the wind
and i come like the spring
open your mouth and place my name inside
let it lie there on your tongue
i come like the sun
making the blue deeper
open up your door for me
love does not like to wait
but you say “not now”
you don’t have the time
what do you think
that life will come again?
no, too bad for you!
close your eyes and kiss me
the moment presents us with the present
the moment is now

Why the Brain Drain Matters

A sign at the entrance of the University Teaching Hospital in Lasaka, Zambia, after a series of confrontations between angry patients and over-stretched nurses and doctors:

"Kindly take note that members of the staff at UTH work under very strenuous and demanding conditions due to the increase in the disease burden and critical shortages of man power. It may take a bit of time...Assaulting any member of staff is a criminal offence." (Lancet)

alternative titles to this post
(1) I Motherfucking Swear That I Am Not Just Pissing Away My Life by Going to Medical School but Finding Every Spare Moment I Can to Sit in a Library Corner to Read John Rawls
(2) Stop Asking Me About my Thesis Topic
(3) What the Bloody Fuck Am I Supposed To Do About the World's Suffering
and
(4) Please, Please Assure Me That My Life Has Meaning.

Cheers.

Sacred Garment

It started as a soft ache. As most anxieties do.

Twinges in my forearm. Reaching into my hand. Deep rumbles, a twisting, a dissatisfaction, something awry.

The first dissected forearm musculature i saw belonged to a cat, in a high school anatomy class. I didn't even want that class; the physics class was too full. And there were the glistening pearly forearms of some mangy stray cat, stripped of its fur, and skin. Some company had drained this creature, ran through its vessels colored latex in bright primary colors.

The class was easy. I had a good memory then. I made a cartoon illustration of the four classes of biological macromolecules. Biochemistry would seduce me later. First it was the forearms. Every crouching cat, its powerful pounce, lay in these muscles, dense, sinewy and...glistening. Beautiful. Something about the ligaments, the connective tissue, they were luminescent, like opal ropes. Maybe because you can see the motion, the potential in this dead and pickled flesh.

"There is a vitality, a life-force, an energy, a quickening."

In the human anatomy lab, it was the hands that frightened us. The rest was unrecognizable, a tangle of burning smells and discolored meat. I brought a friend once, late night, to the lab. He was already well into his third year, he hadn't been in the lab in so long. He shuddered. "I felt the sudden urge to hold the motherfucker's hand." We solemnly stared at this human form, torso ripped open, ribs sawed, intestines lumped tiredly to the side, its leg sawed off above the knee. The heart was sitting in a pan nearby. It was once an old man and the cap of its head had been removed and there, an empty cavern behind a monstrous face, a joke of a face, a halloween mask that made no sense. The arm was dissected to the wrist, muscles peeled away and dangling. At the wrist the skin began again and there it was...a man's hand. Yellowed, but with fingernails, they lay at ease, like that of a fellow snoozing. A wife could recognize it. Did the man have grandchildren? Did he hold them? Was he a surgeon, a plumber, a trumpeteer? Did he use it to sign the consent form, to be there with us, with me, my scalpel still dripping formaldehyde?

The pain, my pain is soft and increasing. And the fear...how will I type? How will i play capoeira, open jars, write my notes, chop garlic, shake my fist angrily? Tens of thousands of dollars, spent on my education. I thought it all in my head, a good reason to wear a helmet, get insurance on the thing. And i see here, even in this world of ideas, my hands. I needs dem.

"The instrument by which life is lived"

Once, a great teacher, "one of dance's most beloved ogres" who was "aristocratic and fearsome, severe and blunt (but he was always right) taught this: "Without structure, you could have a million ideas, yet they wouldn't come to life. Become concerned with the making of rules and the breaking of rules...to be aware of space, time, energy, and shape."

"The body says what words cannot."

and. "Movement never lies."

I Cannot Feel Much Sorrow

It only takes a year to start draining empathy from future physicians, according to a study of medical students in the March issue of Academic Medicine.

Researchers measured vicarious empathy, defined as a person's vicarious emotional response to perceived emotional experiences of others. Students reported their agreement or disagreement on a nine-point scale in response to statements such as "I cannot feel much sorrow for those who are responsible for their own misery."

Medical student empathy for patients begins to drop during the first year of medical school. The decline was likely due to a year of stress and anxiety linked to the students' competitiveness and desire to overachieve on exams, said Dr. Newton, associate dean of undergraduate medical education at the Arkansas medical school. Scores decreased again after the third year in school, when students finished their first year of clinical rotations.

Jerome Groopman, MD, author of How Doctors Think and chief of experimental medicine at Beth Israel Deaconess Medical Center in Boston, said it is clear physicians become worn down by time pressures, work load and the diminishing sense of autonomy in the health care system.

"The public tells us they want physicians who are good diagnosticians and also caring people," Dr. Frankel said. "We start with students who are very caring but have no diagnostic skills and end up with physicians with great diagnostics skill but who don't care."

(Myrle Croasdale, AMNews)

Overheard

"Um, Dave? You are using too many literary allusions in your casual speech and people are complaining."

"It was six stories of dirt held together by 100 years of paint."

"Oh you like animals, do you? Well, would you like to see the rat's ass that I give?"

"Oooooh, I get it. I inform people against their will."

Intestinal Worm

A 60-year-old woman presented to the outpatient clinic with vague abdominal discomfort that had developed over the previous several weeks. There was no abdominal tenderness. Colonoscopy demonstrated a worm, which moved (video). The worm had a smooth, cream-colored surface and was 20 cm in length. It was removed with an endoscopic snare and identified as Ascaris lumbricoides. Typically, complications from A. lumbricoides are associated with mechanical obstruction, such as migration of a worm into the biliary tree or the development of a high worm burden in the intestinal lumen. In this case, the abdominal discomfort resolved after the worm was removed. At a 2-month follow-up visit, the patient remained healthy. (NEJM)