Good morning, Dr. Wracks, how was your breakfast asks Dr. Lector.

Fine says Dr. Wracks, but they only let you have one cup of coffee. They say you will get fat.

Get used to it Says Dr. Lector.   I have a new arrival I want you to work up.  He is very important.

His family is the richest family in New York State and they want him here for evaluation.  Be careful what you say.  The council want to know if the condition is a psychosis, a neurosis or medical, and how to deal with it.   He is a financial genius.   Do you think you can handle it?

I will do my best says Dr, Wracks.

He will be in the interview room at 11 o’clock.  Be sure to look your best. 

It is interview time and Dr. Wracks has gone back to his cell, shaved and brushed his teeth and put on a tie.  His white clinician coat will do.  He precedes to the interview room.  Inside waits the patient.  He sits in a chair, and he is of average height with hair thinning in the calvarium and occipital regions, skin tone normal, slight freckling which might be due to hereditary factors and no odor, mannerisms or automatism.  Dr. Wracks introduces himself.  Good morning Mr. home, I am Dr. Wracks, a fifth pathway intern, sent here to interview you.  How are you today?

His eyes open wide and he says, Buy chock full of nuts.  

Dr. Wracks asks again, what is chock full of nuts?

Dimba, dimba, do says Mr., home

Is Chock full of nuts a stock, an equity or a possession

La la, ga ga, goo says Mr. Home

At this point the interrogator decides that this patient is compos mentis and decides to use Carl Rogers sounding board technique.   The Sounding board technique is designed to elucidate whether the patient is psychotic or not and to elucidate transference which will induce remission if successful.

Yakka yakka bop, says Mr. Home

Yakka yakka bop, says Dr, Wracks

Diddly de diddly does, says Mr. Home

Diddly de diddly does says Dr, Wracks

Bam bam bop says Mr. Ho

Bam bam bop says Dr. Wracker

At this point Mr. Home jumps up on the table and pulls down his pants exposing himself.

Dr. Wracks says.  Now you hear what you are saying.   Do you understand now why you are here

Mr. home pulls up his pants and sits back in his chair and is silent.

Dr. Lector and the council will place you on medication if you so desire to stabilize your condition.  Our interview is concluded.  Do you understand, Mr. Home

Mr. Home nods his head sullenly

Thank you very much for your time, and I hope to see you in the future.  Have an excellent day Mr. Home.  Dr. Wracks stands up, backsteps his way to the door and exits the interview room.  The door shuts and locks with a loud click.

Dr. Wracks adds to his notes.  There exists a possible hebephrenic condition not thought to be psychosis.  These mannerisms exist as possible reaction formation to an aversive situation.  A full blood workup indicates with attention to SGOT and BUN.   Screen for sympathomimetic addiction as people of high intelligence resort to substance abuse to maintain performance levels. The pupils are normal size and reactive to light.  The Patient is cognizant and responds to question and reacts to answer.

Dr. Wracks finishes the report and deposits it in Dr. Lectors office slot.

What ever happened to Mr. Home acts Dr. Wracks

He is better and his family requests he be requisitioned to more favorable and opulent surroundings.  Thank you very much Dr. Wracks.  Good Work says Dr. Lector.  Enjoy the rest of your day.

It is very spartan here at the VA.   Dr. Wracks sits in his cell with his light and his Harrisons principle of Internal Medicine and tries to read.  The Milky Way bar he bought from the prison concessionaire tastes really good and later he might visit the patient canteen and get a Styrofoam cup of rot gut coffee.  It is snowing outside in March and the administration suggests all unnecessary personnel go home before they are snowed in.  Dr. Wracks has no place to go and his cell is his room and the weekend will be long and this VA in upstate has long dark tunnels that connect the units which he will manage this weekend.

How where and when does man build a nuclear reactor that is safe and minimally impacts the community?

The answer is simple, not simplistic, and derives from common sense and good old Yankee ingenuity.

A reactor must be built in a place where an eventual meltdown will not cause a horrendous calamity. Safe places exist.  Because the most long-lived reactors in the world sit near a great body of water, so must water-cooled nuclear reactors reside. Evidence is the San Onofre nuclear reservation.   In a meltdown, huge quantities of water cool the core and bring the reaction back to equilibrium.  In the United States, safe places are on the seashores of coastal states and abutting the Great Lakes area where the lakes hold millions of gallons of extremely cold water benefiting only the Erie Canal and Niagara Falls. 

A reactor can also be built in a remote area where a meltdown has no direct effect on local populations.  In sparsely populated states in the northern forty’s longitude, a meltdown has little consequence and the energy produced by reactors can feed into a grid to serve populated cities and heavy product factories. 

The reality of meltdowns is that the core forms a superheated magma and sinks deep into the earth.   Intervention by man serves no purpose and the core remnants can be fenced off until radiation follows the logarithmic law of extinction.

Reactor shielding

Most current nuclear reactors are poorly shielded because of man’s inhumanity to man.   To shield a nuclear reactor, water serves to moderate small particles like quarks and bosons. Steel stops fast neutrons and eventually becomes radioactive, this is why old reactors are decommissioned.  The next shielding layer stops the most important aspect of nuclear radiation danger.  Bromstrellung is a German word for radiation secondary to the deceleration of basic particles like protons, neutrons, and electrons.  Bromstrellung registers in the gamma and x-ray region of ionizing radiation.  To create bromstrellung, an alkaline earth crystalloid like steel enters a higher energy level after absorbing a particle and then radiates a gamma photon.  This is the bremsstrahlung   Impacting particles generate gamma rays.    A secondary shield of high-mass number elements like lead or other heavy metals turns the bromstrellung into infrared radiation also known as heat utilizing the photoelectric effect.  In addendum, to shield a nuclear reactor emanating fast neutrons, gamma rays, heat, and light, three shields become necessary.  The first is an ionic shield that can be made from water.  The second is a braking radiation shield to be made from steel; the third is a gamma shield that fabricates from the use of any of the heavy metals in the periodic table of elements. This coupled with a calculation of radiation-safe distance employing a Geiger counter forms the parameters and specifics of the shape and size of the containing vessel. When dealing with radiation, length is safe and duration minimized

Breeder reactors

Breeder reactors are thorium breeders or uranium breeders.  Thorium breeds are safer because the core does not go critical as fast as a uranium breeder fired by plutonium.   The birth of uranium 235 or plutonium 239 using thorium or uranium breeders respectively occurs at a logarithmic rate.  The product must be removed concerning a logarithmic calculation based on breeding mass and size of the fissioning bed.   The math is simple; people are complex and amiss to err and behavior change. 

The rate of breeding is directly proportional to the rate of radiation emitting from a core.  New material is added as the product is born and the reactor is safe and fashionable.  In the event of a meltdown, non-reacted raw material pulls from the core and the reactor comes to rest.  Thank God for AI and robots to help us.

Reactor design

A circle of concentric rods seems the safest and most logical picture of a reactor core.  The rods suspend through a chain or wire just as a guillotine blade hangs over the head of a criminal.  If the core overheats, moderator rods can be inserted or the raw material can drop out of the core into a concrete tomb.  The reactor sits safely away from supervising staff and controls occur by action of chains, wires, and levers pulled or guided from a remote location by robots.  Distance is lifesaving

Radioactive waste

Radioactive waste equals strontium ninety, and cesium 137 along with radioactive water.  Strontium 90 mainly emits alpha particles with a half-life of five thousand years and cesium 137 emits gamma rays with a half-life of 120 days.  In the future, man will collect radioactive waste as the positive byproduct of a nuclear reactor and use the waste as a source of heat or a source of electrons forming batteries by the device of the photoelectric effect turning gamma into electron movement in a wire.  Currently, the best way to store radioactive waste is to drop it into a chasm that empties into the center of the earth.

Fission or Fusion Oh My!

Fission reactors tend to overheat and go critical.   Fusion reactors burn at full throttle and can die in an instant.   Fission reactors produce large amounts of gamma-generating waste and fusion reactors generate helium which when it accumulates is one of the most toxic elements to biological life forms. The choice will be made by the next generation.  I, for one, choose fission because fission reactors do not go out, they refuse to die. I exclude fusion because of the generation of huge amounts of helium.  In my mind, fusion reactors will only serve as power for military vehicles because they require less shielding.  However, I am just a dreamer with my hands in my hair and the imagination is a canvas of beauty and optimism.  Others will choose.

Where is everyone, asks Dr. Wracks.   I saw them at breakfast in the cafeteria

They are in the outpatient venue says Dr. Lector.   They have enough to do.

Don’t you think it is dangerous, just you and me in a lockup with twenty-five patients?

There is plenty of staff, and the nurses sit behind bulletproof windows. Says Dr. Lector

I don’t mean them says Dr. Wracks, I mean you and me.

Remember what I said about inappropriate comments, says Dr. Lector.   If you are sick, they can sense it.  Just don’t say anything or make noises and you will be OK.  Stay close to the doors.  You can see it in their faces before they turn.  Be smart.  I have a new admission I want you to work up. Says Dr. Lector.  He is from a wealthy family, and he became a marine and went to Vietnam.    He is one of the few survivors of the Tet Offensive and his superiors don’t know how he survived. He is back in the States now and got into a bit of trouble.  It seems someone gave his sister a venereal infection so he broke into their house in broad daylight and beat them all into unconsciousness, all five of them.   The perpetrator he beat into the ICU with a phone book. He is on a respirator.   He says he did not want to hurt his hands.   His lawyers have commended him into my care until the judiciary decides what to do with him.  He is five feet eight inches tall but he can move very quickly.   Follow me, I will show him to you.  He is in a padded cell.

Dr. Wracks and Dr. Lector move to the holding area of the building.  On a large oak door is a port hole with a door on it.  Dr. Lector opens the port and behind wire bars, a leering face with widely dilated grey eyes stares at the two outside.  

Mr. Carl, it is Dr. Lector.   I have a resident from the general hospital here to evaluate you.  Will you accept his care?   The patient nods his head slightly.   He will see you in the interview room after lunch.  His name is Dr. Wracks.   He will see you in two hours, and he slowly closes the porthole.

What else do you have on him asks Dr. Wracks, so I can be prepared.

He is maintained on 100mg of Thorazine twice a day, with 100 mg of Benadryl to sedate and prevent an extrapyramidal reaction.  He is a middle-aged nourished male with good conduct issued by the military.   His lawyers want to learn whether the attack was provoked and if there is an underlying drug addiction.  If you think there is an underlying physical or metabolic condition please transcribe it to your notes.   On the front lines in Vietnam, often the soldiers would mainline heroin to desensitize themselves from the constant shelling and explosions.  Please note any physical manifestations of addiction.   This man is a decorated soldier.  Put your file in my office and I will peruse it this afternoon and contact his attorney.  Have a good day Dr. Wracks.

Dr. Lector gravitates away and disappears.   He is never around but always appears when needed.

The interview room is well-lit and white, and Mr. Carl sits in a foldout chair, at a foldout desk, facing the door.  Good afternoon, Mr. Carl says Dr. Wracks.   I am an internist doing an internship here at the Veterans’ Administration for eight weeks.   May I interview you?   Yes, says Mr. Carl.     Is the facility giving you adequate care here at the Veterans facility?   Yes, Says Mr. Carl.  The medication you are now receiving is sedating and this means that any anger you still harbor will be abolished and soon eliminated.   How is the medication working for you?  Fine says Mr. Carl, except it makes me slur my words.   That is to be expected says Dr. Wracks.  The medication will make you less angry.   Do you feel like running around or having to walk around, this is called akathisia, and this is a common reaction to the medication.  No, I am fine.   Time passes by with ominous silence.   His pupils are dilatated but not fixed, and he is not salivating, shaking, or exhibiting autonomic mannerisms.  He dresses in denim jeans, sneakers, and a linen, buttoned, plaid shirt, in earth tones.  He is not talkative.   Would you like a cigarette, asks Dr. Wracks.   I don’t smoke says Mr. Carl.   If you have any questions or any other problems, ring the charge nurse and she will call me.   I will be checking in on you.    Wracks turns to the door and a muscular attendant opens the door for him.  Wracks edges out back first keeping his eyes on the patient.  The door closes and then locks.

In his evaluation, Dr. Wracks writes: that the subject is a well-nourished male in mid-life.   He is of average height and build.   He sports brown hair, and grey eyes, and seems of European descent.  Pupils are dilated, sclera not erythematous or injected, and there is no evidence of intravenous drug abuse.  A urine methamphetamine assay ordered.   Order head x-ray, frontal, lateral, and Townes view.    Standard blood profile indicated.   Will monitor for medication side effects.   Acyl phenothiazines are anticholinergic and sedating, and this patient does not manifest overt sedation or drowsiness.  Evaluate for sympathomimetic drug abuse and occult intracerebral neoplasm by the neurologist.  Suggest continued holding and evaluation until stable. The district attorney should be comfortable with these results.  The only psychiatric mannerism noticed by the evaluator is that the subject remains perfectly still but not catatonic.  Continue patient care. 

Dr. Wracks is done for today until afternoon rounds.   He is to sit with the incarcerated schizophrenics and observe their behavior.   He is to inform the pharmacist staff If extrapyramidal side effects manifest in any of the patients or if there is a violent acting out.  Then he will go to dinner and sit in his little room with a bed, a table, and a chair and sleep until tomorrow if it comes.  It is today’s world, one day at a time.

A storm blows into upstate and snow covers the facility with ten feet of snow.   More is on the way, and the radiators are hot, and steam blows out the vent holes in a whisper, night overtakes and the Wracks end the day with a prayer.