You're Love in the Time of Cholera!
by Gabriel Garcia Marquez
Like Odysseus in a work of Homer, you demonstrate undying loyalty by
sleeping with as many people as you possibly can. But in your heart you never give
consent! This creates a strange quandary of what love really means to you. On the
one hand, you've loved the same person your whole life, but on the other, your actions
barely speak to this fact. Whatever you do, stick to bottled water. The other stuff
could get you killed.
Take the Book Quiz
at the Blue Pyramid.
You're Infinite Jest!
by David Foster Wallace
While you1 consider yourself2 to be clever,
there are those3 who think you're just full of yourself or, perhaps worse,
playing a joke4 on everyone around you, and yet you are pretty sure that
you really are that brilliant after all, since people would hardly take the time to
get to know you5 if they didn't care very deeply about what you had to
say to them, to wit, about their lives, their hopes, their dreams, their fears, their
drug habits, and of course what videos6 they prefer to watch, since,
after all, your impressive vocabulary and tendency to go on and on7 makes
you seem superior, able to educate them, and really drive a sense of something
ineffable into their measly little skulls while you are not above making a cheap
gag or really going after anyone or anything or telling them about incredible
futures involving tennis, geopolitics, and
1Meaning you personally, not someone like you or your own
personal daddy, for example.
2As well as you can see yourself, which, frankly, may not be that well.
3Though we wouldn't deign to be so peripatetic as to name them here, mind.
4Jokes, though not common in Victorian England, were known to originate
sometime in ancient history, perhaps as early as the time of Babylon, or even before.
It is thought that the history of the joke plays an integral role in the mindset of
the characters depicted here, though you may disagree at this point, in which case I
am facing quite the dilemma in relaying this narrative, no?
5It is rather time consuming, after all.
6Ha!
7and on and on and on...
Take the Book Quiz II
at the Blue Pyramid.
You're The Metamorphosis!
by Franz Kafka
Though you think you're in the midst of a dream, the fact of the
matter is that your life has become a nightmare. The nightmare at first seems
horrific to you, but you are slowly able to adjust to the facts of the matter
and settle down and make do with what you've been given. There are those that
would say you're pointless and absurd, but you're really just trying to
demonstrate that people can (and do) adapt to anything, no matter how absurd
it is. Not that this will really inspire them to change, because they probably
don't understand.
Take the Book Quiz II
at the Blue Pyramid.
8 comments:
https://books.google.com/books?id=iTMkDwAAQBAJ&lpg=PT72&dq=Rahu%20in%20Ardra%20is%20rule%20by%20Rahu%20itself%20and%20Ketu%20in%20Mula%20is%20ruled%20by%20Ketu&pg=PT72#v=onepage&q=Rahu%20in%20Ardra%20is%20rule%20by%20Rahu%20itself%20and%20Ketu%20in%20Mula%20is%20ruled%20by%20Ketu&f=false
Yes, I will put Exercise 84, with the snowy lawn and Cercis. I will do it.
https://onedrive.live.com/?authkey=%21AK-_Ln5sxFBg_30&cid=F55F42B98D0538C0&id=F55F42B98D0538C0%211868&parId=root&o=OneUp
I had a patient today, a cryptanalyst from the Pentagon, who was treated as a drug addict at the VA because she had been in a devastating car accident that resulted in the loss of all of her front teeth and a high spinal cord injury with late-onset (several weeks) spinal shock. They accused her of faking it, requiring help to walk and urinary catheterization because she was drug-seeking. How terrible.
https://www.archives-pmr.org/article/S0003-9993(00)19201-9/pdf
"The atrophy of the SPNs in the acute stage of SCI in humans
may contribute to the condition of ‘‘spinal shock’’ observed
immediately after the SCI in animals45-47 and humans.4,48-50
After acute SCI there is a flaccid paralysis, with urinary bladder
atonia, paralytic bowel, and sympathetic underactivity resulting
in low systemic arterial pressure. Besides the immediate
depression of autonomic functions resulting from a loss of
important excitatory input from the brain stem,36 the atrophy of
SPNs likely contributes to the initial sympathetic atonia.
With time after SCI, sustained excitatory responses develop
that manifest as autonomic dysreflexia.2,12,51 Autonomic dysreflexia
is generally seen during the subacute and chronic stages
of human SCI, becoming obvious within the first few months
after cord injury in individuals with cervical or high to
midthoracic cord injury.2,52-55 By the later stage of SCI, other
mechanisms may contribute to impaired cardiovascular control.
For example, in animals after SCI, dorsal root afferents have
been shown to sprout56 and spinal neurons that initially lose
synaptic inputs appear to have them replaced with synapses
from a different source.57 Therefore, new inappropriate afferent
inputs from different afferent sources could contribute to the
later autonomic dysreflexia after SCI in humans"
While I am vacationing, I am not sure if I will have consistent connectivity on the island, but I will work on Exercise 90 to upload here.
Exercise 90:
https://drive.google.com/file/d/1No3QAuK_y8HHA83fPAQNW70i6tmRo5Qs/view?usp=sharing
Hyperglycemia with cardiogenic shock. Remember now, cardiogenic shock is unresponsive to fluid resuscitation, and the sustained, elevated blood sugar in a diabetic is due to the acute stress response of catecholamines related to decompensation.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9580099/
https://www.amjmed.com/article/S0002-9343(18)30225-0/fulltext
Novices miss things because they do not know. Decades-experienced clinicians miss things because they are complacent, and read the signs right in front of them with biases. No one was hurt in this case, the dobutamine was initiated (late), but I will always remember this case. New-onset heart failure post-MI (LVEF 10-15%) with uncontrolled diabetes. It did not help that his significant other was feeding and watering him constantly in helping the only way she knew how.
This patient I mentioned in September 2023 was implanted with a Heartmate III lvad. He just went home with the battery pack that weighs more than him.
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