A very successful man once told the author that the key to success in business is-the ability to turn chicken shit into chicken salad.   The guru of nuclear physics also said-get a map of all the bagel shops in New York state.  This verbal utterance leads the reader to the photoelectric effect.  This effect which won Mr. Einstein the Nobel prize of physics in 1925.  In the photoelectric effect, light of varied wavelengths that impinge upon alkali and alkaline earth metals of sufficient wavelength and magnitude, cause an electron to leave the outer orbital and fall to a lower energy state liberating energy.   In essence, light shining upon a pure metallic element creates a current when the substrate is hooked up to a circuit.   The wavelength and the metal chosen, in a pair, create an endless battery.   For example, visible light and metallic lithium in a circuit produces electricity.  The electricity can be used to power electronic devices.  In this study, radioactive waste, notably cesium 137 and Strontium 90 which are strong gamma emitters produce gamma photons that can cause a photoelectric effect in an alkali metal, when in circuit, and this becomes a natural battery.   High level radioactive waste, emitters with a half-life 30 years, can power spacecraft and other applications with an almost endless array of electricity, suitable for deep space missions. 

Like Thomas Edison said- genius is one percent inspiration and 99 percent perspiration, the correct metals can be matched with the appropriate wavelengths that liberate electrons and mankind has a battery that does not need to be recharged and last thirty years.  Battery powered robots can pioneer new paths in scenarios where the common man cannot live.   This gift might lead humankind into places thought unknown and uninhabitable.  Just like anything good, it takes a lot of work.  Just do it.  Start working.

Battery technology is not just lithium in a colloidal gel that explodes when it is overcharged.  Battery technology is more and in front of everyone’s face on the periodic table.  We just have to try and never give up, and an angel might speak the secret of the universal wave equation into someone’s mind and the human race can move to a new planet once the sun burns out.  

The temperate forest is green and un- impenetrable and blends into huge mountains and hidden valleys.  The sea undulates in greens, blues, greys and browns and boiling whites and seems to move on endlessly.   The vast deserts and plains lead to cities and nowhere under a tumultuous sun.  With all this beauty that surrounds us, it might be time to play with lasers and high energy electrons.  It gets old getting drunk and smoking pot and dreams exist on an expansive event horizon into eternity.    Gee Whiz, what’s on YouTube tonight?

At eleven P.M the nursing night shift arrives.  The charge nurse enters through the main door and the four nurses sit in the nursing stations and discuss the seven patients in the ICU.  The charge nurse leaves and within the next fifteen minutes the night shift evaporates to a small kitchen at the front of the unit near the main door.  They lock the door and draw the shades.  The fluorescent tubes glow within and the smell of coffee permeates the ICU. Dr. Wracks is alone, and on call as a surgical resident at the Amityville general hospital.  The clock shows 12 A.M. and his orders are to cover the surgical floor, the obstetrics gynecology surgical unit and the pediatric oncology unit here.  No one is in the ICU except Dr. Wracks. Sit with the comatose patients and watch the heart monitors. Watch intently.  Adverse reactions evidence on the EKG.  The heart monitors display their green lines and a red-light pulse with each heartbeat for each patient on the verge of life or death. The respirators puff at inspiration and gasp at the expiration as a filmy foggy mist exits the respirator regulators.  Dr. Wracks orders are to survey the patients and report any neurological disturbances that might herald death such as decerebrate posturing and agonal respiration through the thoracic muscles.  Normal breathing is diaphragmatic and using the accessory muscles of respiration signals anoxia and a consequent cardiac arrest.  Decerebrate posturing happens when the brain does not receive blood any more. Then the patient curls unto themselves and dies. Alongside the most critical patients is a crash cart. The crash cart is a metal box full of syringes, needles of varying sizes and a myriad of heart drugs, mostly epinephrine. The lights are low and one fixture pulsates with a dying light.  Dr. Wracks has to note this and tell physical plant at first light.  Dr. Wracks never really felt at home at the ICU because everything, all parameters were taken away and placed in God’s hands. During the day Dr. Wracks would have to rush in and take an arterial blood gas of a respirator patient and bring it to the cigarette smoking technician locked within a little room down the hall with three machines and a coffee urn. He would take the blood, blow smoke at Dr. Wracks, say thanks and then close the door.  The rest was in God’s hands.  Tonight, the fifth pathway student is alone, as he is always alone and left with a thankless job.  Every man must know his limitations and his limitations are that this body requires much sleep that he has not gotten in six months. He is on call every third night and call begins at 11 P.M. He must visit all units at least once during the shift and catch what sleep he can.  Dr. Wracks never really sleeps because fate wakes him up before he enters REM sleep and he is never satisfied.  Most surgical patients require a sleeper medication and those pre-operation and post- operations are at risk for respiratory arrest if Dr. Wracks give too much.  The anesthesiologists caution him before to be prejudicial and withhold medication. The patients moan and look at Wracks with wide scared eyes and beg to be put to sleep.  Oxacepam does not work as the books state.  Dalmane is the only thing that works and 5 mg may not be enough and the patient begs for more; Dr. Wracks signs a requisition and give five more.  The nurse administers it in his presence.  Wracks leave and try to get more sleep. He is tired of smoking cigarettes and drinking coffee, especially at night because he becomes irritable and short tempered. he exits to my call room, close the door, and barricade it with furniture so no one can enter silently.  Sleep is always short and a nurse bangs on the hardwood door until Wracks emerges. Now is the second run through the hospital and the Wracks enters the ICU.  It must be two AM, and the lights are dim, and the respirators puff, the monitors skew and the red lights blink.  Sometimes He imagines a dying patient turns to me and smiles out of the corner of his eye. He turns around and they are asleep once again. The quiet deafens, the red lights blink and the respirators puff.  The nurses lock themselves in the kitchen. Another patient seems to open their eyes and beckon to the Wracks but when he turns around, they are asleep.  Once a human being is at deaths door, they ask everyone around them not to bring them back, and when there is an arrest, a surgeon moonlighting in the Emergency room appears and starts the procedures.  They inject epinephrine, calcium and more and use the shockers to start the heart beating again.  When the patient dies, they all seem to have a wan smile on their face because they know their will be no more, pain; anguish, despair, or disappointment and Dr. Wracks says a prayer and wish them God speed. Nothing is going on in the ICU tonight.  Dr. Wracks has not met God and he does not think he wants to.  The eerie glows and the shadows and the weird feeling that appears at night here are an effect of hopelessness and finality.  He exits the unit through the front door and wait in the hall for someone else to come out or enter.  No one does.  He is told to use the stairway at night.  The wracks do not know why. He does not want to know why.  Entering the pediatric Oncology section, he lingers as to make sure the poor children condemned to suffering are comfortable and not vomiting.  If they are, Dr. Wracks contacts the oncologist attending by hall phone and waits until they arrive. The kids are at rest and a single nurse sits in the station reading a book. She smiles at Dr. Wracks wave and walks by.  Back to the surgical ward on floor three Dr. wracks looks for a bag of tea and put a traveler boiler probe in the cup with it.  A tall man with a small black book enters the unit. He is greater then six feet and wears an expensive suit.  He looks at the book, then at the room number and enters a suite. Dr. Wracks follows him in.  He is sitting next to a surgical patient.  The Wracks walks over and examine his badge that he wears on his left lapel.  Everything seems to be in order.  He is a bonafide licensed member of the hospital. He looks at the wracks and gestures as he looks at my badge too. He does not know what he does but the credentials are in order.  Rocking the boat will get him trashed. He departs.  He enters his call room and barricade the door with furniture.  the watch says 3:30 A.M. He takes his pager and pulls the batteries out of it and set it on the bureau.   He hangs his smock on the door and crawls into a small bunk bed.  He pulls the covers over his head and says a prayer.  Now I lay me down to sleep……  Surgical rounds begin at seven A.M and dr. Wracks will be in surgery from eight A.M. to at least 2 P.M. non-stop.  he wonders if this is the life He really want and if he will make the cut. Sleep overtakes him again.  As he drifts off, he imagines he hear a hand trying to open the handle on the door. Then he is asleep.  The silence, the unduly silence pervades and detracts, the nurses hide, red lights blink, someone dies, someone lives, and in the quiet life begins again.  The ICU can wait, and the chief of staff who chose Dr. Wracks to command the ICU during his sabbatical is a fool.  

Benjamin Franklin said- One thing is inevitable, death and taxes.  Now, in the twenty-first century we have medical plans.  Human beings live a long time if they eat right and aren’t poisoned, and the only thing that curtails a lifespan is infectious disease.  Then came sulfa, penicillin and a myriad of fungal based antibiotics that help humankind extend their lifespan into the hundreds.  We should be in good stead, all of us, is this true.  The oldest of our kind who saw the nineteenth and twentieth century, before they died stipulated that life was of better quality in the nineteenth century than it is today, because of the rise of cancer and degenerative diseases.  In Cotrans’ Clinical Pathology, he extrapolates the rise of cancer on a graph on an exponential basis because everything, foodstuffs, pharmaceutical drugs and health food additives are laced with oil-based chemicals, courtesy of the organic chemists graduated by major universities.  What appears now are medical plans.

If a citizen of the United States, of the 80 percent, the wage earners who are the substance of the nation, the salt of the earth need medical care, their employers through the federal mandate of universal medical care,  and up to one half of the hourly wage earmarks to medical plans and if the citizens are lucky to be employed in a union affiliated segment, the employer matches this amount and designates it to a plan to be reimbursed to the employed if necessary.

These plans are corporations set up by the 20 percent to provide medical care to the wage earners.   The plans feed from government subsidies and as everyone knows, and is published and admonished, one third of the gross national products ends up being allocated to health care and its subsidies.  The plans exist by the staffing of administrators that make upwards of 100K a year and do nothing more than shuffle papers and deny wage earning folks’ medical care.  Of course, the plan is free, with free dentistry, opticians, gyms, perks and more that access by the given of a copayment in addition to any medicine incurred during the outing.  The main design of plans is to give the 20 percent easy jobs that earn 100k a year and keep them employed and happy in wealthy suburbs.  The type of professionals that serve in the plans are minimum and the administrators choose the cheapest professionals in the area that they can find.   Good medicine costs a lot of money!  If a patient needs a specialist, they often have to travel one hour or more by car to another area to get the advanced treatment they deserve, and the reason patients have to travel is that these specialists are the cheapest the plan can hire in an area.   Excellent physicians in town cost an arm and a leg. 

Presidents and politicians, every day elaborate how dedicated and humanitarian they are by supporting health care but health care plans offer minimal health care and are at their best supporting the 20 percent.  As already said, health care is an enormous burden and one third of the national budget goes to health care.  The medical care the working class gets is not worth a grain of salt, and they have to pay for it anyway, directly or indirectly. 

If a United States Citizen makes it to social security by paying a third of their income taxes into the health care system via SSI, they get social security income and hospital care as defined by part A.   To get access to an outside specialist, he and she must buy part B which permits them to pay twenty percent of the hundred percent debited to the health care system.  It is interesting to note that most people who need part B are wage earners with degenerative disease due to their occupations and they simply cannot afford the 20 percent! Then the administrators give us part C, and part D for drugs and Medigap which covers all the ancillary costs not provided by part A and B, which the 80 percent have to pay for.  The plans provided by corporate health care businesses are free too, but like all other plans the money earned by the plan ends up in the pockets of the administrators, not the poor and sick who need them the most.  The medical care the 80 percent get for one third of the national budget is not worth the paper it is written on.   Excellent medical physicians become millionaires and they deserve the money for what they do but the poor do not have access to them because they can not afford it. A career insurance man told me once to buy all the health insurance you can afford because the hospitals which are a profit center eat up every cent. 

What the 80 percent get for their hard work, dedication, and perseverance is mal-diagnosis, physicians refusing to treat active disease and unnecessary surgery.  The plans pay for NMR, PET, diagnostic dye studies and biopsies, which for the most part are unnecessary modalities that help the patient very little but rack up billions of dollars for hospital and health maintenance corporations.  Most disease can be diagnosed by comprehensive blood chemistry, clinical appearance and an x-ray.   Most of the questions in the national board of clinical internists an eight-hour exam, revolve off of a single diagnostic x-ray.  Let this author make it clear that excellent physicians deserve to roll around in Cadillacs and Mercedes-Benz luxury coupes, but most physicians don’t.    

My grandfather told me that if you are not part of the solution, you are part of the problem so keep your mouth shut.   William Shakespeare capitulated that the pen is mightier than the sword so takes it for what it is worth.  The people who are this nation, the workers that maintain the infrastructure, and the veterans that give up their lives for the country deserve the best medical care that the government can provide.   The twenty percent should pay out of pocket.   Organ transplants last at best five years so is a transplant and ancillary health care worth millions of dollars debited to the federal government?

The cure is excellent accounting.    All people have the right of seeing the closest physician of their choosing and changing if necessary.  They don’t want a plan that sends them to a quack who makes his or her money and then farms these patients to a specialist one hour away.   The government does not need the private infrastructure to manage health care.   Each physician should handle their own billing or not get paid.  Lastly and not least.  Working people deserve to use the best physicians and the government should reimburse adequately for their services.  This matter is open to the physicians and the medical administrators of the government who are in their employ.   We the people of the United States…………promote the general welfare and secure the blessings of liberty for OURSELVES and our posterity.  Good medicine is not a business; it is a service under God.  

“Wracks we want you to come in at night at the ER because that is when the action happens.  Be sure to be here Friday or Saturday night on the Graveyard.  Every week we have a gunshot or a bludgeoning event.  We need the extra hands to tie sutures,” said Dr. Saber. “I will be here,” said the Wracks

“We have a stat on a fight victim coming in,” said the dispatcher.  “Wracks, bring him in and work him up. Then call me.” Said Dr. Saber.  The Paramedics brought the patient into the double doors of the ER.  The ER had double electric doors in case a murderer wanted to finalize an act not perfected.  We could lock them out.  The patient was of average height and average build Caucasian male.  He wore sweats and had no obvious odors diagnostic of metabolic conditions.  Upon neurological exam, I find the pupils fixed and dilated. The breathing is intermittent but not agonal.  There is no obvious bleeding from the nose, eyes or ear canals upon fundoscopic observation.  The patient is unconscious and does not respond to pain from needle prick or skin pull.  “Dr. Saber, I think we have a subarachnoid hemorrhage with antecedents of trauma to the face. “  Dr. Saber runs to console, grabs the phone and calls upstairs.  “Wait with him!” Dr. Saber commands.

They say it in hushed tones. N-surg.  It happens in the penthouse.  A nurse brings Wracks the key and puts it in his hands.  They want you upstairs.  Don’t forget to put the key in the basket when you enter.  The Wracks goes blindly unwitting to what is going to befall.  The elevator goes up and up, and the door opens.

     “Dr. Saber said you have good hands,” said the brain surgeon. “I want you to assist me in neurosurgery tonight.”  “I will teach you how.”   The patient was already upstairs.   The brain surgeon is a smallish man impeccably dressed in a suit and tie. His hair is wavy and reddish and has a curl to it and his eyes are gun metal gray just like his brother.  He gestures to me and says, scrub in and I will meet you at the stadium. Don’t stop and get anything to eat. The Wracks enters the surgical suite and the anesthesiologist has a water filled blanket on the patient, his head is scrubbed and affixed by metal hold fasts.  

“I will teach you brain surgery,” said the brain surgeon.  “First, the conditions.”   “Cool your patient to 90 degrees Fahrenheit with a water blanket.  This will slow the heart and make the neurons less irritable.”  “Then infuse urea to establish hyper osmotic equilibrium to prevent brain swelling. The urea extravasates in four hours.  Switch to mannitol post operative.  Now infuse solumedrol to prevent inflammation. There is an immediate naturistic effect and a long-term hormonal effect. When the patient is readied by the anesthesiologist then we will begin.  Anesthesiology must be light or the patient will stop breathing.  The patient will be conscious.  No matter what the patient says keep going. Learn to focus and block out everything but the job at hand.”

   The patients head was shaved and the brain surgeon looked at the x-rays.  Visualize in your mind where the lesion is from the x-rays.  Take the x-rays here before surgery.  Do not rely on anyone.  Do not let anyone but licensed surgeons into the room.”  “Now we will unearth the calvarium.” Said the brain surgeon. 

     The bone saw whirs at a high frightening screech.  The saw is a small stainless steel orb that glints under the klieg lights and comes from a sterilized package.   “Hold open the operating theatre for me,” he said.  “Do not let go.”  “The patient might move!”  The saw whirred with a horrible whine and the frequency dulled as the blade cut the bone.  Smoke arose from the cut and I started to vomit.  “Dr. Saber said you were good.”   “Are you good?”  “I am good.” says the Wracks and his senses came back.  He pulled of the top of the patient’s skull and snipped the tentorial ligaments with a small scissors.  “This is the durra mater and underneath the subarachnoid membrane. “  Under the durra mater, a skin like membrane stretched over the top of the brain was a mass of congealed blood.  The patient started to speak in a childish voice a language I could not discern. “Do not listen,” he said.  The brain then starts to swell like a loaf of bread rising in an oven.  It pushed out two inches high.   “This is a bad one,” said the brain surgeon.  “We will have to do a total lobectomy.”     “I Want you to hold the suck and turn the fulgurate on when I tell you to.”  The Wracks holds the suck stable.  The surgeon literally sucks brain matter through a stylet into a huge plastic receptacle.  The osterized brain matter is bright pink like Jell-O.   The neurons are a light grey and the supporting structure of glial cells and myelin is alabaster white.  The brain surgeon hit a capillary and the blood spurts two feet high like a small geyser.  He clips it with the forceps and says “burn it.” The Wracks presses the trigger of the fulgurates.  The smell of burnt brain permeates the whole operating area.  The Wracks starts to black out.  “I am going Doctor,” says the Wracks The brain surgeon commands, “Hold the suck.”   “I am going Dr,” says the Wracks.   The brain surgeon commands “Hold the suck.”   The Wracks slowly starts to come back. Slowly, surely the Wracks comes back to consciousness.  “Now we can continue.” He said.  Small hemorrhages would occur as he aspirated brain tissue.  The Wracks holds the suck and triggers the burner as he commands “Our father who art in heaven.”  And they continued.  “Hallowed be thy name.”  And they continue.  “Thy kingdom come. Thy will be done.”   “There” said the brain surgeon.   “The bleeding and swelling have stopped and the patient still breathes.”  He put the top of the skull back on the patient and secured it with staples.  Then he sutured the scalp back into place.   The clock says two A.M and I am spent.  “You can go now.” Said the brain surgeon.  “I am done here.”

      The elevator from the top slowly descends to moral reality and the Wracks walks back into the ER.   “Did he make it?” said Dr. Saber “He made it.” Says the Wracks.  “Good “said Dr. Saber.  “We have a gunshot wound to the abdomen in room 3 and I want you to wait there until the police arrive.”   “o.K.,” says the Wracks.

      They said the patient was alive on a respirator until he was transferred to another hospital.  The Wracks lost track of him.  Some say he died some say he slipped away.  Some say the event never happened.  He might be a billionaire of a dot com.   The Wracks never saw the brain surgeon again. He flies around the United States and operates on peoples’ heads. He looks like an inbred Englishman.  Instead, he does brain surgery with an African American who hated to do colostomies.   There was always action in the south, in the city, downtown, late at night during the summer externships at the citadel with a pretty name of a clinic when the Wracks was a medical student.

“Where were you,” said Dr. Saber.   We need suturing for a head wound in room two.  The Wracks went back to work for nothing in the days before the darkness during youth when achieving was so important and nothing else mattered.  He has to pay to learn the craft in a closed shop populated by eccentrics., If they don’t invite you to apply, don’t even bother and waste your life.  

At eleven o’clock A.M. Dr. Wracks is preparing to go to the cafeteria to eat.  The charge nurse for the surgical unit runs directly at him and says “There is a large aneurysm to be resected in the main surgical theatre. Dr. P and Dr. W want you there now.” Tell them to find someone else to assist them,” says Dr. R.   “They want you now,” says the charge nurse. “Go and scrub in, Now!”  “I have to check a bandage and then eat,” says the Wracks.   The Charge nurse points at the door and says “NOW!”   Dr. Wracks slouches to the hallway ramparts, turn right and key in the code at the surgical unit door and enter.  “Grab a cup of coffee and some donuts,” says Dr. W.  “We may be in there all afternoon.”    dress in a new green and then scrub in.  “Where did you learn to wash your hands like that,” says Dr. Weir.  “In Mexico,” says Dr. Wracks.   “And I got a “C” in surgery operating on dogs.”  “You will do,” he adds.

      The patient is a huge obese lady who is out cold under anesthesia.  We rope her to the table.  Dr. Pan is there with a knife.  “Watch me rip her open,” he says.    He takes the stainless steel knife that glints from autoclave clean, starts at the belly and jerks it up to her rib cage.  Blood spurts everywhere.  “I will clamp the bleeders, you tie them off,” says Dr. W.   We learned to tie knots fast at the Guad.   He clamps, Wracks ties, he takes off the clamps and Wracks ties the next. “We will be in next,” says Dr. P.  He takes all the used hemostat clamps and throws them in the corner eight feet away.”   “We have to count them all before we close,” says Dr. W.   Dr. W. takes a scalpel and cuts the peritoneal membrane and the viscera bulge out of the wound.  They are a beautiful pink on white.  He then sticks his hands into her abdomen and pulls out all of her guts and sets them on her chest on top of a cotton gauze towel.   He puts another towel on top of her bowels and says to Dr. Wracks. “You have to hold them on her chest.  If you let them go, she dies.”    Dr. Wracks starts sweating and he holds and looks inside her body cavity.  Dr. P is clamping off her aorta top and bottoms one large underneath her kidney and two other on the other two femoral arteries.  The aneurysm loots like a huge asymmetrical sac, reddish purple from coagulated blood about eight centimeters in diameter.   “It is ready to burst,” says Dr. P and he goes and gets the polyester pants that will replace the artery.  He holds them up and plays with them like a little rag doll.  Dr. W says, “Is everyone ready?”  By now the whole surgical staff and medical student were watching from afar.  Some of them began to faint and were pulled outside by their friends.  The big fat woman who was dead because her heart had to stop to resect the aneurysm rolled on the table like a huge beached whale.  Dr. P said “Now.”  Dr. W maneuvered to the other side of the table next to Dr. Wracks.  Dr. P took a scalpel and in one motion delivered the aorta with aneurysm to a waiting steel bedpan held by Dr. W.  A charge nurse stepped in and took the bedpan.  I held her guts on top of her chest.  Dr. P put the polyester pants in place and started to sew.  Dr. W. took the top end and started to sew.  When they were done the polyester pants were in place with three clamps remaining.  “Second guess me Dr. W.” said Dr. P.  “It looks good,” says Dr. W.  “Let’s let her rip”.  Dr. P was the chief surgical resident in his fifth year.  He won the by over Dr. W by subjective advantage.  They were both equally good but Dr. W gets all the amputations.   Dr. P slowly, slowly. Slowly took the clamps off the aorta and threw them as far away from the table as he could.  I held her viscera on her chest.   “Start her heart,” Dr. W said to the anesthesiologist.  He injected epinephrine in her subclavian port and shocked her.  He shocked her again and the monitor came alive.  Sine wave and red blinking dot online. She is alive.  The graft inflated like a balloon and it held.  “Lets wait,” said Dr. W.  “I want to see.” The graft held and pulsed slowly. “Let go of her guts,” said Dr. W.  The Wracks muscles were frozen into tetanic spasm and as he came back into consciousness, he let them go and stepped away from the table.  Dr. P stuffed the intestines back into her body cavity and closed the peritoneum with polylysine blue strand. Dr. Ware tied and cut the knots.  Dr. P said “thank you everyone.” And left.  Dr. W. said “Here is the stapler, “you staple her up.”  “I have to do an amputation.” So, Dr. Wracks staples with a large stainless-steel stapler.  A second-year resident held the skin together for me as he stapled.  I asked, “Why staples?”  The resident said, “In case we need to rip her open again, we can pop them quickly.”  The Wracks staples.  The anesthesiologist and the internist wheel her into recovery. They say, “You can go eat dinner now.”   He has to eat dinner because tonight was a call night every third day.  He will have to be up late.  Cigarettes lose their taste.  Coffee gives everyone who drinks a lot of it an ulcer.  What keeps someone going is sheer will, perseverance and faith.  After dinner Dr. Wracks will sleep an hour and then walk my rounds through the hospital till, they tell him they do not need him until tomorrow.  By then it will be tomorrow anyway and the cycle begins anew and he wonders if he is really cut out to be a surgeon.  Dr. Wracks needs too much sleep.  Every man must know his limitations and without knowing these a man is vulnerable to life and in life is birth, death and a new beginning.  Dr. Wracks goes to the locker and scrubs out.  Someone has stolen the earpieces from his stethoscope. He wraps tape around the pipe. Stick them in a pocket and walk towards the cafeteria.  The moon is full outside.  Spring is in the air.  The snow has melted and the air is delicious, but the Wracks is inside doing what needs to be done because it has to be done and he really wonders why. There must be a better way.  The Wracks thinks about how he is going to sabotage his pager because they always bust him at dinner to do a blood gas.  They say I have good hands.  I would rather have a good heart.  The African American cook looks at Dr. Wracks with a smile in the cafeteria. “The same,” he says.  Chicken fricassee with broccoli and a scoop of mashed potatoes. Then coffee and a cigarette.   He does not know why she smiles at me. At this point he does not care.  Dr. Wracks is on call tonight in the ICU.

It possibly came into being after the civil war and then president Ulysees Grant. The need arises for clandestine yet forceful intervention into reality to preserve the existence of the democratic nation.  

The psychologists call for a person, not sadistic, not unduly violent or aligned with fringe political groups.  He or she must feel an undying affection for their country no matter where it leads them.    He or she might be burdened by guilt, guilt that impinges upon consciousness about a crime committed that cannot be righted by any action, no matter how violent or money endowed that became in their early existence.  Now they are empowered by righteousness and a sense to avenge their evil transgression.  They are now and they exist in a mortal mind, in a high place that might die very soon.  They are not real and they will never be.

They are not paid because a paycheck is part of an account that ends up on a computer system. Where they go is a bag of unmarked bills, enough to get them through an assignment and all the necessary gear to carry out the imperative.  A key arrives in a manilla envelope to a home where he or she leads a common non-descript existence.   They could be accountants or insurance men or real estate agents, or maybe even a salesperson, and they have a family with children.  In the manilla envelope, the key has a tag with an address and a date and the person wherever they live, calls in sick, or whatever and then leaves an goes to an unknown location in a circuitous route immediately.  At the destination, usually a motel or a pay-share, they find a cache of bills, and any necessary ordinance they require to carry out their mission.  Instructions are written, on disposable paper and surely, they flush down a toilet.   The list is only to be read once and then destroyed.   He or she then carries out a shooting, or a robbery, or a hacking at a server, or an impersonation at an important place to carry out a distraction for an event that is about to occur.   

After the agent complies with the written order signed by an authority, they destroy everything and take the quickest way home without attracting attention.    He or she then take a shower and go back to a humdrum existence.   The mode of transportation is the key, and they do not exist and they never happened.  They get to keep anything and everything they can steal on the way too and from and use the infrastructure provided to commit crimes.   They are not on the books, and they do not exist, the memory of them resides in the mind of the person that sent them, who configured them, and that person has to ultimately die.   

Take some time to go to Arlington, and kneel at the tomb, and say a prayer, and then leave forever.  Without these men and women, the bad guys ultimately win and without them our great nation would not exist.  Under God we trust, and our nation is delivered by them for another day.   Ask for the luck of the Irish, and Gods speed, and remember the Lord helps people that help themselves.   

“Well Dr. Wrak, you have completed twenty weeks of surgery and Dr. Ony has passed you,” says Dr. Q.  Dr. Q is the chief of internal medicine at Amityville hospital and oversees the fifth pathway program offered by New Amsterdam College.   Dr. Q stands slightly taller than average, has a slight build, olive colored skin, thin hair, but bright eyes.  His teeth show that braces were too expensive for his family in his youth and now as a rich medical doctor, he still has not corrected the poor bite which stands out when he smiles.  “I think that it is time for a vacation for you.  What elective rotation would you like for six weeks?” inquires Dr. Q.   “I would like radiology because there is no call in Radiology,” says Dr. Wrak.  “Don’t you like call,” explores Dr. Q.  “Not when it is every third day and I have to do surgery in the middle of the night,” says Dr. Wrak. “You will like the Radiology vacation,” says Dr. Q. “Dr. Pine will be instructing you.” “He is an extremely busy man.  Do not speak as you sit in the reading room and Dr. Pine will instruct you.”  “Not a word!”  insists Dr. Q.  “Not a word!”  “I promise,” says Dr. Wrak, “When do I begin?” “As soon as you leave this room.” Says Dr. Q.  “Dr. Pine is a pioneer in balloon angioplasty and will let you assist him if he likes you.”  “They read at ten AM and Four PM.” “Be there.’  “Thank you Dr. Q.” says Dr. Wrak.  As Dr. Wrak walks out of the room he hears again in the hall “Not a word Dr. Wrak.”   “Yes sir,” says Dr. Wrak as he enters the stairway and walks down from the second story at Amityville hospital into the stairwell.  Radiology lives on the first floor next to admissions.   The sign says, “Radiology, Patients enter here.”  Down the hall a smaller sign says, “Doctors only.”  Wrak chooses to enter there.  The cryptographer at the desk next to the door says, “Dr. Wrak you are late.  They are reading now.  Enter the room and take a chair in the back if one is available.  If not stand in back until they finish reading.”  “Thank you,” says Dr. Wrak.  The reading room lies to the right behind a sturdy oak door.  Inside the lights shroud a huge wall of white fluorescent reading screens with cloth pins at the top of each screen to hold the transparent X-ray films.  Comfortable padded chairs sit behind the screen plush with padding. Dr. Pine sits with three residents looking at films.  The room is dark and a red light provides enough illumination to enable a person to walk safely.  Dr. Wrak decides to stand in back.  “Good morning Dr. Wrak,” says Dr. Pine and he resumes reading films.   “This one is an intusception. Notice the fluid level above the obstruction. Phone third floor now.”   He flicks the film off the wall and places it back into a manila envelope.  A resident grabs the envelope, stands up and leaves without speaking a word.  Dr. Wrak takes his seat.  “This film is reactivation tuberculosis.  Notice the cavitation in the right lung apex on an anterior posterior.”  He puts the film back in an envelope, hands it to a resident and the resident leaves like the first one.  “Dr. Wrak, remember tuberculosis prefers the right lung because the main stem bronchus juts at a right angle.  The left stem bronchus exits at forty five degrees.  Above all be systematic in your analysis.” Says Dr. Pine.  Dr. Wrak nods his head once.   Dr. pine shoots through ten more films, looking at a film, writing an interpretation, and throwing the film back into a manila envelope.  He does this quickly and the clothes pins holding the transparencies on the wall make a snapping noise with the speed and ferocity of the actions.  “I am done.” Exclaims Dr. Pine.  “Do you want to assist in a procedure, he inquires.”  Dr. Wrak nods his head once.  “Get a radiology badge from the front office and meet me in surgery in thirty minutes.” Says Dr. Pine.  Dr. Wrak nods his head once.   The cryptographer in the front office opens a large manila folder as Dr. Wrak enters the office.  Inside the folder are bunch of radiology badges like prizes in a cracker jack box.   She wears her hair short, has glasses and a professional looking blouse buttoned up.  “Here is your badge. Do not lose it.”  She writes the number of the badge on a ledger and asks Dr. Wrak to sign it.”  “Thank you very much,” says Dr. Wrak.  “Take the badge home with you too,” She insists.

     “This patient has a stenosis in the left femoral artery at the level of the inferior olecranon process proximal to the popliteal space.” Says Dr. Pine.  “You are going to hold her leg still as I advance the cannula from her femoral triangle down to the obstruction.”  We will take films periodically as the balloon stylus descends.  The films will reveal progress.  Hold her leg still with both hands because if I pierce the arterial intima, an aneurysm will develop and the procedure will fail.  Dr. Wrak holds the patients leg and Dr. Pine inserts the cannula in the arterial stent created by a general surgeon moments before.  The X-ray gun hums.  A picture appears on the screen.  “Pixels,” says Dr. Pine.  “It is the new technology.”  He advances the cannula further.  The x-ray machine hums.  He advances the cannula as Dr. Wrak holds the patients leg.  The x-ray machine hums with a buzz and another picture appears on the screen above the table.  “We are almost there,” says Dr. Pine.  “When we get to the obstruction, hold the leg extremely still and I will inflate the balloon. At this point we will take films at the rate of one per five seconds to monitor the progress of the balloon inflating.”  The x-ray machine buzzes and a picture appears on the screen.  Dr. Pine squeezes a bulb furiously.  The x-ray machine buzzes and another picture appears on the screen.  The closed artery is being expanded.  The x-ray machine buzzes three more times and then Dr. Pine exclaims, “the dilation is successful.”  He deflates the balloon and slowly withdraws the catheter from the artery like an angler pulling in a fish.  The catheter appears to be three or more feet long. “Bring the patient back to recovery.” Says Dr. Pine The anesthesiologist leaves with the patient, dragging her IV pole beside him.  “Thank you Dr. Wrak.”  Says Dr. Pine. “See you at four.”  Dr. Wrak nods his head once.  As Dr. Pine walks out the surgical suite door he says casually as he exits, “The procedure only lasts for six months then the artery re-occludes.  I do them anyway.”

   “Dr. zel wants you to assist him in a lower GI barium swallow,” says the cryptographer. “Enter the room down the hall. You do not have to scrub.  The procedure will take about an hour.  You will rejoin the radiologists at four PM after lunch.  “What a morning,” thinks Dr. Wrak.  “Another surgical procedure.  I thought Radiology would be my vacation!”   Dr. Zel stands at medium height with large owl like spectacles and wavy dark brown hair.  He wears a pressed shirt and tie underneath the hospital smock.  “Take off your hospital smock and put on this lead suit says Dr. Zel.  Dr. Wrak complies. He puts his smock on the desk outside the radiology suite.  Dr. Wrak looks like the alien invader from Earth versus flying saucers. Dr. Wrak feels ill at ease.  The patient wheels in and the radiology orderly runs out.  Dr. Wrak helps Dr. Zel position the patient on a movable table and fastens the patient down.  “When I invert the patient hold them so they do not fall off the table. Assist the patient whenever possible, “teaches Dr. Zel.  Dr. Wrak helps Dr. Zel by moving the table into various positions as Dr. Zel takes pictures with an x-ray gun. About a half hour into the procedure something strange happens.  On the wall behind the screen a metal plate falls off the wall and a blue glowing flame appears in a steel box like a reactor core melting down.  The flame is intensely blue and Dr. Wrak cannot bear to look at it.  The room starts to smell like a lightning flash during a thunderstorm.  Dr. Wrak moves behind the lead glass screen and gesticulates to Dr. Zel about the huge blue flame in the metal box on the wall.  Dr. Zel smiles and says, “I have to finish the procedure,”  “You can go.” Dr. Wrak pounds on the glass and jumps up and down.  “It’s Ok” says Dr. Zel “the procedure is nearly over, you can go.”  Dr. Wrak nods his head in prayer and implores Dr. Zel to leave.  “It’s OK,” says Dr. Zel.  Dr. Wrak exits the room from behind the leaded glass and throws off the radiation suit.  He grabs his smock and proceeds to the cafeteria.  “Finally time to sit around and eat,” thinks Dr. Wrak.  “Where are you,” inquires a resident. “I am in Radiology now,” says Dr. Wrak.  “If you want to help in surgery, just stop by says a fourth year surgical resident. “I most certainly will,” says Dr. Wrak and he begins to eat the chicken fricassee with broccoli, mashed potatoes and gravy, chocolate milk and a cup of coffee with free refills to residents only.

   “ Good morning Ms. Kleb,” says Dr. Wrak.  “Dr. Wrak, you radiation badge is red and you must see the head of Radiology immediately.”  Dr. Wrak examines the radiation badge clipped to his left breast pocket and by Jove, the badge turned from ivory white to a bloody crimson red.  The chief of radiology is an older man with white hair and looks like either the God Thor or Loki the evil elf.  Dr. Wrak hands him his badge.  “Where have you been?” inquires the chief.  “Just a few procedures,” says Dr. Wrak.  ” I left my badge outside a procedure yesterday because I was wearing a lead radiation suit head to toe.  Somehow the badge got exposed to radiation.  The Chief says, “When a badge turns red , the event signifies a lethal dose of radiation.  You do not look sick.  If I report this badge, you cannot continue your residency until you complete medical treatment. I am going to throw it away and issue you a new badge as if this event did not ever happen.  I will alter the books.  Here is your new badge.  You can go back to the wards. If you feel sick in any way, come back and see me.”  “I will,” says Dr. Wrak.  “Good luck,” says the chief. 

     This is how radiology is. Even amongst educated elite, the world is a tooth and nail fight for wealth and supremacy.  All rivals and competitors face instant elimination on a daily basis and interact with  the forces of evil constantly.  Dr. Wrak hopes he was not exposed to high energy ionizing radiation.  Lots of radiation destroys the immune system.  Today is a new day and more films are to be read and more procedures done with x-ray guns pointed nearby.  Dr. Wrak finished the book on Clinical Radiology in one night and now knows what to expect and what to do in the hospital.  The future of Medicine lies in imagery because viewing things in situ, de facto, in surgery portends morbidity, mortality and worse for the patient and the staff.  Dr. Wrak runs with the new technology of Radiology and feels proud to be part of the new wave.  With the new wave comes great danger and in danger heroes are made. Some things must be done and not talked about.  Reading x-ray films expertly requires high intelligence, a background of medicine and the ability to visualize anatomic detail in the  mind as a doctor  correlates the information with the imagery presented on the film. Hope springs eternal even for the damned.

     “Dr. Wrak, are you finished with Radiology yet,” inquires Dr. Q from across the hall.  “We need you back on the ward.”  “I am still on vacation Dr. Q,  Still on vacation. Nice to see you. Two weeks to go.” 

Dr. Wrak did not know what was in store for him or he would have left six weeks ago.

Crystals are formed from metals and other substances that develop an intrinsic geometric shape and native bond length and angle.   Glass and plastics are not crystals, rather, they are amorphous solids.  Crystals occur in nature or they can be man-made.  Crystals have a lattice and geometric structure, which in some ways identifies their physical and chemical properties.

They like crystals and are attracted to them as their glitter draws them closer.

Each crystal has a characteristic bond distance, the length between adjacent atoms that forms an ionic rather than a covalent bond.  The length of this interatomic bond is the nature of this discussion.

Diamonds, rubies, emeralds, and garnets fascinate and attract them even more. They are a subject of interest and demonstrate worth and intrinsic beauty.

When the energy of a single frequency focuses on a crystal, the crystal bond will absorb the energy and reradiate the energy as a wave function in a lower quantum level.  This feature is called lasing.  Any even multiplicand of the wave function coincident with the crystal bond length is absorbed and then emitted or lased.   The reemitted energy is typical of a crystal bond angle and should not be confused with Albert Einstein’s photoelectric effect of 1925.  The reemitted light is coherent and of a single wavelength and demonstrates the intrinsic physical quantities of the initiator crystal in question.   In the photoelectric effect, light raises the quantum level of an outer or bonding electron which then falls to the native level and emits a photon.  When the energy is of sufficient magnitude and optical quality to be harmonic with the bond length of the intrinsic crystal, it reradiates as another form of energy that may be light, maybe heat, or even the weak force of gravity.  Again, this depends on the atomic weight and purity of the crystal as heavier metals demonstrate shorter bond lengths that determine the reradiation profile of that native crystal.     

What can we use as the initiator of the energy cascade?  Are they who want the beauty inherent to crystals willing to part with their property?

Does it take neutron radiation in a thermonuclear reaction to make the bonds lase?   After all a neutron has wavelike properties and a frequency and wavelength associated with it.  Can a high-intensity laser designed from a ramped-up photoelectric effect have enough power, E=h*nu to cause the bonds in a crystal to lase?  Will the re-emitted spectra have demonstratable qualities and quantities that enable scientists to use these forces productively?  Is the re-emitted light in the electromagnetic spectrum or really gravity, or time-space continuity?  Are the Di lithium crystals seen in the movie Star Trek a reality or a macabre fantasy of Gene Barry?

They adorn themselves with crystals because they are beautiful just as they are and they show them off unbelieving and unassuming of the true nature of the spectacle that lies within.

What is the energy necessary for crystal lase?  Can mankind create the necessary initiation energy and fabricate the necessary crystal for scientific use?  Is this re-radiated energy of sufficient character to harness and produce?  Will the nature of this energy continue to surprise as it surprises the other throughout history?   I don’t know because matter and energy are interconvertible and related to gravity and space-time.  The form function is merely an interpretation of the universal wave equation.  They wear them and they are as beautiful and desirable as they are.    Can I have my personal crystal and bring it home and infuse it with pi mesons to see what will happen?   Can it happen to us all?    Can a crystal make it happen and bring us to the next star: Alpha Centauri?     Is it silicon, carbon, titanium, or even nickel?   It all takes birth in a dream and when it is time the maker will surely fill us in with a hint and a smile. 

Back in the sixteenth century in Europe, the wealthy aristocracy wondered why citizens would get sick and die in the prime of their lives.   They prayed to find out why women died in childbirth and children were born deaf and what is tuberculosis, and a thing called cowpox.   The landed gentry with their money, and their power, and their influence commissioned scientists and general practitioners to elucidate the cause of disease.  These people began dissecting human cadavers to elucidate the causation of disease.   The disease is categorized by the color of the pus, the size of an organ (hypertrophy or hypotrophy), and its weight.   These parameters were the only ones available to the scientists at the time.   Pathologists still do the same thing and autopsies are hopelessly outdated by laboratory science and Microbiology discoveries.   Now scientists have machines that categorize sickness by genomic abnormalities but they do not tell the uneducated public that the mutations they discover might lie on the intergene DNA.   Most genes that code protein are well spaced out by spacer DNA.  This security through obscurity obfuscates horrible chemicals that destroy the DNA.  Most mutations occur in the spacer DNA if they occurred in the genes, they would not function correctly.

About one-half century ago, God’s gift to medicine decided after a half-century of practice that disease is either infectious or due to poisoning.   In other words, if a physician rules out infectious disease with a battery of laboratory tests, that patient has been poisoned.   Poisoning can be acute or chronic depending on the dose level and duration of poisoning.   Various poisons affect different organs in different ways and certain poisons affect different organs differently.  Poisons can be organic in nature, petroleum-based, or inorganic salts of various elements.  If a student looks at the periodic table of the elements, and looks at it again, at the groups and classes of elements with different electron levels, he or she discerns differences in chemical action.  The transition metals have electron configurations of plus two to plus six and can mimic to some extent, the natural ions sodium (+1) and potassium (+1) which constitute the major inorganic elements in the body.  The heavy earth metals like lead, arsenic, and more have an electron configuration of +2, this is why they are absorbed by the body.  Lead and arsenic resemble calcium (+2) which constitutes the major element of bone and muscle including the heart.  Any chemical element on the periodic table that ionizes, has the capability of causing disease if it accumulates in appreciable concentrations.  Scientists can look at the table and decide what element he or she is going to use as a poison. Even halogens that form a Negative one valence can uptake like protein which has a negative one valence in situ. 

The stage sets for American medicine in the twenty-first century.  American medicines’ preeminence happened because of laboratory science, and if the laboratory is not available, Chinese medicine functions better at diagnosis and treatment.    The tools for emergency room physicians are now high-pressure gas-liquid chromatography and mass spectrometry.   HPLC is ideal for enumerating organic toxins in the body.   Turn to the last chapter of the text (Current diagnosis and treatment) and look at the variety of common household poisons that affect humankind and can be brought to light for us all to see.   HPLC can bring a diagnosis, and treatment might be to be doused with hexane until the organic object passes out in the urine. Older people who sit in bars drink hard liquor not only to get intoxicated but also to initiate the elimination of organic toxins in their urine.  Ethanol solubilizes organic toxins. Do we need to be hospitalized and get intravenous infusions of grain alcohol?   Common poisons not in the text include atropine, strychnine, ibogaine, and more.  Further work in the field and pharmacy will eventually create modalities for the elimination of organic toxic entities. 

The real concern for emergency room physicians is inorganic ions.  Certain ionic species share predilection for certain organs and accumulate in these organs causing acute intoxication or poisonings of lesser amount and longer duration: chronic disease.   Pathologists will spend a decade removing organs from cadavers that died of chronic degenerative diseases and burning them with mass spectrometry until they understand what elements in the periodic table exhibit toxic properties and organ predilection.  The function of discovery is an easy task.  More arduous is elaborating on what chelating agents are most efficacious for removing inorganic ions from the body.   For example, what most internists regard as actinic keratosis in the elderly is merely chronic arsenic poisoning that if it continues, causes skin cancer.  Lead seems to accumulate most in the kidney and then the brain, hence renal failure and senile dementia.    Transuranic elements cause psychological derangement before chronic disease.  Does anybody remember when Psychiatrists had to be board-certified in internal medicine before practicing psychiatry?   Many Psychiatric maladies are merely chronic afflictions due to the accumulation of inorganic ions.   Is it true uranium ions cause manic-depressive illness?    The real work to be done is discovering novel chelating agents that remove metal from the body.  BAL removes everything.  EDTA removes lead and arsenic, deferoxamine removes iron and other transition elements.  Succimer which is a four-carbon moiety resembles oxaloacetate in the TCA cycle and causes sickness and weakness and although it is an over-the-counter agent, it is to be avoided because it is toxic and doesn’t work too well.   The sky is the limit, and drug companies have a lot of growing harvesting, and extracting to find new and more efficacious chelating agents.  Pathologists will be burning tissue by mass spectrometry to give the working public a handle on what is ailing them.   Then we have to find a cure.   Like the gift to medicine said, “disease is either an infection or a poisoning” and he was too old to do anything about it when he made this conclusion and discovery.   Now the ball is in our courts and there is a lot of work to do.  It is a lot of work!

Yo no soy marinero

Ni desperado alquileres

Pero yo bebo tequila

Entonces sangria

Hasta que yo tranquila

Yo soy capitan

Yo soy capitan

Tal vez la bamba

Da me la bamba

Presta la bamba

Queria la bamba

Porque o sea

Porgue o sea

Yo no soy marinero

Ni desperado alquilero

Pero yo baila

En mis calcitones

Abraza con miga

Besa mi ligera

Porque yo pedia

Desfruta ti cercita

Porgue o sea

Porgue o sea

La la la la

Es la bamba

Nada se importa

Excepto tu y yo

Es la única

Es la bamba

Pide el señor para la bamba

Por gue o sea

Por gue o sea

La la la

La bamba