Food, Drink or Drug Related – Page 5 – education and deconstruction.com

Genius on the Edge – Bonus Post

This blogger skimmed “Genius on the Edge” by Gerald Imber, MD, published in 2010. This long book describes the career of Dr. William Halsted.

Halsted was born in 1852 in New York City. There was still much ignorance about medicine in his generation. Fatal diseases, such as malaria, yellow fever and tuberculosis were rampant. He developed a passion for medicine at Yale University. The most prominent doctors of his age included Pasteur, Lister, Morse, Hunter, Wells, Koch, Morton, Young and Warren. They spurred progress in sanitation, anaesthesia, and the collection of new information and techniques for treating patients.

In the 1870’s, Columbia College, Physicians and Surgeons didn’t require undergraduate degrees for entry because it was seeking revenue from student tuition. The three-year program was all lectures– no labs, no interaction with patients. In the 1870’s, during Halsted’s internship at Bellevue Hospital, many personnel didn’t wash their hands before operating, and smoked.

In late 1884, Halsted started using cocaine as a local anaesthetic in dentistry. He displayed, “…hyperactivity, rambling speech, inattention, and suspended decision-making ability.” Medical students and their teachers started using cocaine as a pick-me-up. They became addicted. “The drug was readily available in Europe, through Merck, and there was no stigma associated with its purchase.” In late 1886, Halsted went to work at Johns Hopkins Pathological– the “Bell Labs” of medicine. He went to Baltimore because his addiction had wrecked his career in New York. He substituted morphine for cocaine.

It is unclear how much better Halsted could have performed were it not for his addiction. He did have a brilliant career, but there were bouts of irresponsibility, socially and teaching-wise. He missed classes, started surgery at 10am instead of 8 after a while, failed to show up for meetings, and retreated to his country home for almost half the year. One positive side effect of his addiction was that Halsted delegated complete patient care to residents when he had morphine withdrawal symptoms. So the residents got a golden opportunity they would not have had otherwise, to learn their craft.

Side Note (There’s nothing new under the sun.): “As a group, they [nurses] felt themselves underpaid and overworked.” The Training School taught them to cook and clean. They were required to wear brown Oxford shoes.

Halsted experimented on dogs on and off for a couple of years, between months-long stints in drug rehab. He began seeing human patients for surgery in early 1889. He pioneered the medical-school residency program. He instituted the training of surgeons to train other surgeons. Three other doctors at Johns Hopkins who wrought major change in medicine in the U.S. were William Osler, William Welch, and Howard Kelly. Halsted specialized in surgery for breast cancer and inguinal hernia.

Johns Hopkins wanted to remain on the cutting edge of medicine by opening a medical school but it needed money to do so. Female heirs of prominent, wealthy families raised the money and placed conditions on the school’s opening, requiring gender equality. After much controversy, it opened in the fall of 1893.

Read the book to learn how medicine in America changed through the years of the late 19th into the 20th century, and how, according to this book, Johns Hopkins led the way.

Behind the Gates of Gomorrah

The Book of the Week is “Behind the Gates of Gomorrah” by Stephen Seager, published in 2014. This book describes the personal experience of a psychiatrist working with violent criminals in a state mental hospital in California. He was the only medical doctor on his unit. The rest of the workers who treated the patients were psychologists and nurses. Some of the patients were faking mental illness because they would rather have been there than in prison. All the patients had taken human lives; some in gruesome ways.

Almost every week, there were emergencies with sirens blaring, usually due to patients’ poor impulse control. The patients would engage in physical fighting with eyeglass stems or other sharp weapons they fashioned themselves, just like in prison. But they hurt hospital employees too, even killed a few through the years. The employees were unarmed (unlike prison guards). The patients fought for their legal rights (like obtaining eyeglasses, which they would accidentally-on-purpose damage so as to get a new source of weapons). According to the book, on the author’s first day at work, he had to have ten stitches in his scalp when he was caught in the middle of a patients’ fight.

There was a tendency on the part of the employees to rationalize their bonding with the patients. It seemed to this blogger that the employees were showing signs of “Stockholm syndrome.” In some ways, the employees were actually captives.

Read the book to learn the answer to the question: “If lots of people are mentally ill, and the great majority are not violent, who then should we be worried about?” [the ones who go on shooting sprees] Here’s a hint: It’s not those who have autism, OCD, depression or the “foil-hat-wearing, babbling street schizophrenic.”

Siberia Bound

The Book of the Week is “Siberia Bound” by Alexander Blakely, published in 2002. This is the personal account of a recent college graduate who decided life in the United States was too easy.

In the early 1990’s, the author moved to Novosibirsk, Siberia to see, with a business partner, whether he, fluent in Russian, could help a region of the former Soviet Union make the transition from Communism to capitalism. He and his partner borrowed money to buy cocoa beans and sold them to chocolate factories on credit.

Blakely wrote about Siberian culture. One amusing passage told of the detergent brand “Barf” imported from Iran. “Things got dirty all the time: In summer, it was dust and car exhaust. In winter, it was coal soot and body odor trapped by layers of insulation.” The relationship between Blakely’s business partner’s wife and her mother-in-law was less than friendly. This was partly because the wife spoiled her young daughter, and the mother-in-law was strict with her– the opposite behavior of mothers and grandmothers in American culture.

Sadly, the moral of the author’s story became “Be careful what you wish for.” He realized that the major cultural, political and economic changes taking place in his community meant that Siberians had become like Americans. They started riding in cars instead of walking. They ate fatty foods for lunch and the men stopped exercising. The women started going to aerobics classes at the gym.

Blakely thought that bringing capitalism to them would be a good thing. However, they soon developed an insatiable appetite for consumer goods. Once they were made of aware of their severe deprivation by the media and increased their connections with the rest of the world, they became depressed. Previously, they had been happy due to their ignorance of how materially poor they were.

Read the book to learn of the sea changes taking place at the author’s business, which sold not just chocolate, but surgical gloves, potatoes and other products; and the formerly Communist community, over the next four years.

Sirio

The Book of the Week is “Sirio, The Story of My Life and Le Cirque” by Sirio Maccioni and Peter Elliot, published in 2004.

Sirio, born in spring 1932, came from a poor family in the resort city of Montecatini in Tuscany. His immediate family members could read, unlike most other people his family knew. His father had been a multi-lingual concierge who worked long hours at a hotel. His uncles worked long hours on the farm. Since he was orphaned at an early age, and was short on education, he felt his career options were limited. He therefore fell into the role of waiter at a hotel restaurant. In the 1930’s, waiters were required to dress elegantly, be multilingual and actually prepare food in front of diners at the table.

In the 1950’s, Sirio was receiving training the traditional French way as a hotel chef. But he was part of a trend later labeled “nouvelle cuisine”– meaning preparing food creatively– putting a regional, personal touch on the food. “…And they [the chefs] refused to treat people badly… Paris was still ruled by the hotel mentality.”

The French had an elitist system whereby the trainees slaved away long hours and were bullied unmercifully so only the most dedicated ones survived. If they were courageous, they started their own restaurants and repeated the cycle with their underlings. As was common for aspiring chefs of his generation, Sirio paid his dues in a few different European cities. In the 1960’s, he basically played the role of greeter at an upscale hotel restaurant in New York. He was skillful at this job, given his diplomatic temperament with the rich and famous diners.

Sirio has these words of wisdom for the reader: “There’s a saying, ‘The customer is always right.’ Not true. Not always. The customer always gets what he wants. Very different. All I do is try to understand what they want.” and “You know, if you talk to a real man, not a phony, they tell you where and how they learn things… So many chefs I know just pretend to know things… Many times in the kitchen they don’t want to learn anything at all, especially not from an owner…”

Read the book to learn how Sirio finally got to run a restaurant of his own; of the chefs he employed (including his falling-out with Daniel Boulud who behaved unprofessionally at the end); his adventures in the business; and how Sirio’s co-author gets a bit full of Sirio when he boldly proclaims, “By 1981 Le Cirque was the most famous restaurant in the world.”

God, If You’re Not Up There, I’m F*cked

The Book of the Week is “God, If You’re Not Up There, I’m F*cked” by Darrell Hammond, published in 2011. This ebook is the autobiography of a professional entertainer who recounts how he has dealt with his serious psychological problems.

As a versatile impressionist of celebrities, Hammond made appearances on the TV show “Saturday Night Live” for about a decade and a half, starting in 1995. He describes the show’s people thusly: “…an incredible staff of Emmy winners– hair, make-up, costumes, writers, producers.”

Hammond grew up in Melbourne, Florida, and moved to the Hell’s Kitchen section of New York City as an adult. He erroneously writes that the Javits Center is at Forty-Second Street– an easy error to make for even clear-headed New Yorkers, as the city has so many famous points of interest; keeping their locations straight is a tough job.

However, from his twenties to his fifties, the author was often drunk, high, cutting himself, and/or trying to escape uncomfortable feelings in other ways that resulted in his taking various medications (some self-prescribed), numerous emergency room visits and psychiatric hospital stays. This was because, in his childhood, Hammond experienced extreme psychological and physical abuse at the hands of his mother, and was witness to the violent behavior of his father, a veteran of two wars. Hammond concisely states that he was plagued by alcoholism and trauma– a progressively fatal combination.

Hammond naively went from one psychiatrist to the next, each one misdiagnosing the cause of his behavior by labeling it as schizophrenia, bipolar disorder, etc. This way, they could write prescriptions for anti-psychotic drugs for him. They were afraid he would commit suicide on their watch, so it was safer for them to minimize his ability to harm himself.

Read the book to learn of: how Hammond beat the odds despite his problems; what happened when he finally found a competent doctor; the three kinds of bipolar disorder; and intimate details of the culture of Saturday Night Live.

Island Practice

The Book of the Week is “Island Practice” by Pam Belluck, published in 2012. This ebook discusses in detail, the life of a doctor who has been practicing general medicine and surgery on Nantucket for decades. He is a colorful character: having no qualms about cursing when providing psychotherapy (without a license); making house calls and treating patients at his own house; allowing patients to pay their bills through bartering; not charging indigent patients at all; treating animals as well; maintaining an extensive collection of operative firearms; occasionally allowing a needy person to live with him, his wife and three kids; and engaging in other offbeat pursuits.

Nantucket, a less-than-fifty-square-mile island in Massachusetts, is a socially isolated summer vacation destination for many wealthy celebrities. However, its year-round residents also need medical care, frequently for three serious tick-borne diseases, on which Dr. Lepore is an expert. When a patient has a life-threatening condition that requires immediate treatment, the doctor has them airlifted by helicopter to a hospital in the Boston area. In times of severe weather when aircraft are not flying, he must try to save the patient himself, by doing a Caesarian section or sewing up a hole in a duodenum in a case of pancreatitis.

The author portrays Dr. Lepore as similar to the fictional TV character Dr. Gregory House in that he is often diagnosing “zebras” (rare medical conditions) rather than “horses” (common ailments) through his intuition and then heroically curing the patient while bucking hospital rules.

Read the book to learn of the doctor’s highly irregular approach to practicing medicine, the difficulties and controversies he and his family have faced through the years, and the precarious future that medical professionals like him face, with the introduction of Obamacare.

As an aside, it appeared that this book’s thesis, stated toward the end, is that Obamacare would force doctors such as Lepore out of business. This blogger thinks that that will not occur. The wealthy will always seek out the best medical care, and pay such doctors under the table if necessary, to obtain it. They will find the loopholes in national healthcare to avoid a bad HMO. They would gladly pay the fine for not signing up for Obamacare because the fine will never be sufficiently high to be a deterrent for making their own private arrangements for medical treatment. A major argument some people– not just the wealthy– have against national healthcare– is that it is unfair to make the healthy people pay the high medical bills of the people who knowingly engage in risky, self-destructive behaviors (smoking; poor eating habits, lack of exercise) that result in preventable medical conditions or that exacerbate certain conditions (cancer, obesity, diabetes, etc.) that require expensive medical care. [By the way, this blogger’s medical bills were $0 last year and have been $0 so far this year (this includes out-of-pocket expenses)– for you curious readers.]