Class Onc

Dr. Gull appears in class as a man of medium height and build with thick wavy black hair.  He dresses in a white physician’s smock, a white shirt and tie, black loafer shoes, and a Rolex watch.  He smokes Marlboro cigarettes incessantly. He does not seem of Latin descent.  His bright eyes search the surroundings through a thick grey wisp of tobacco smoke that slowly floats upwards and seems to linger everywhere; Dr. Gull holds the title of Chief of Oncology Services at the big U.  He likes to teach anyone who will listen, the Science of Tumor Immunology.  He will instruct a student if he or she has the IQ and prerequisites to enter the halls of the Health Sciences. In a small classroom in the School of Microbiology, Dr. Gull instructs medical residents, Graduate Students, visiting professors from other countries, and even Wracks.  

Good afternoon, Dr. Gull, says Wracks, I am enrolled in your course in Tumor Immunology.  I look forward to an exciting and enlightening quarter here while I work on an independent research project down the hall.   May I smoke also during the lecture?   I like Marlboro Red cigarettes also.

Sure, says Dr. Gull.   Most of my staff here and the residents at Woodland Bethlehem Hospital are also smokers.  We need the lift to get us through the day.  Go right ahead and light up but bring your ashtray.  Get seated, I have to start the lecture.

Mr. Simms also completed upper-division Immunology with Wracks and now sits next to Wracks in the lecture hall.  Dr. Gull starts writing on the chalkboard the first topic of the course.  Sir Burnet’s theory of Immune surveillance.  All the medical residents pull a cigarette out of their coat pockets and light up.  The room slowly fills up with smoke and Dr. Gull lectures through a thick haze of photochemical smog.

Does everyone have to smoke, says Mr. Simms.  Mr. Simms presents as a tall-boned Nordic-derived student at the Big U.  All the smoke makes me sick.  Will everyone put out their cigarettes? Wracks extinguishes his cigarette immediately.    Then the medical Residents of Pine Bethlehem blow heavy smoke clouds at Mr. Simms.  

Mr. Simms exclaims, if you do not stop smoking, I will drop the course and file a complaint against everyone.  

The residents continue to blow smoke toward Mr. Simms until he closes his notebook with a bang and storms out of the hall.   Dr. Gull tries to ignore the situation.  After time assures that Mr. Simms has left for good, everyone puts out their cigarettes as if inspired by unseen forces.   Dr. Gull turns to his audience and smiles.

Does everyone understand Sir Howard Burnett’s theory now that it is on the board?  

Everyone nods their heads in agreement and the instructor smoking cigarette in hand continues.

Forty-five minutes later the instructor concludes and assigns case studies and term papers to the students of his class.  Everyone leaves in a hurry because they all have work to do, families to go to, or a sweetheart somewhere. Everyone except the Wracks.  Wracks has his dinner at the student union and then a long bus ride home ending in a walk up a hill at night.  The wracks have no experiment scheduled now because his tissue-transplanted mice have to grow up.  Then their spleens and blood will be harvested and the statistical construct begin.  A wrack takes the elevator down to the first floor and emerges at the entrance to the school of medicine.  A huge black onyx building is in construction and the cranes hoist enormous steel girders into place as the sun sets in a reddish flame framed by grey petrochemical smog. Today wracks will enter the student cafeteria by an alternate route.  Walking underneath the suspended hallway connecting the health sciences with the biological sciences, Wracks takes the connecting road down to the front of campus past the big buildings that house the professional schools and clinics of the Big U.  Up the main promenade to the student store, in the front door and then take the elevator to the second floor.  Wracks exits the elevator, then walks left to the queue lines in front of the cafeteria.  The budget student menu does not draw the crowd expected for such a bargain and charity offering. Most of the students patronize the bars and go dancing downtown.  No other place on the west side delivers a full meal with all-you-can-drink coffee for one dollar and a quarter. Most of the student body eats instead at the designer restaurants and discotheques located in town about a stone’s throw from the animal house.  For the more affluent students, the best restaurants in the state are less than five miles away on the miracle mile.    At five o’clock on a weekday, only twenty people utilize the vast resources of the student cafeteria.  Adjoining the student cafeteria situates the varsity athletes’ dining room.  The privileged few awesome athletes that join the fabulous and famous football and basketball teams, eat steak and hamburgers to infinity, cooked in front of them on a huge gas-fired charcoal grill.  Wracks sit in front of Kirk’s Hall and smell the delicious odors emanating from the athlete’s dining room every day while enjoying a cigarette and a cup of coffee.   Then an occasional nap in the huge leather armchairs decorating the picture windows in the student hall happens.  Curled up in bliss, in uteri in a friendly place, with warm feet and toes, Wracks knaps in the world of opulence.    The moment occurs now and tonight at five, Wracks chooses the chicken pot pie on the student menu with all-you-can-eat crackers.   Wracks grabs one of the large porcelain cups provided for the coffee-drinking student body.   In his usual spot, facing the entrance line, with his back to the wall sits Dahlman.  Both of Dolmans’ Parents have accolades as tenured faculty members in the health sciences at the Big U.  Instead Dahlman trains to be a lawyer and his parents want him to attend a catholic school.   Tonight, Dahlman dines on a sumptuous roast beef sandwich with de jour dressing, a bag of potato chips, and a tall glass of brown tea.  Wracks slams his stew out of a large beige bowl into his mouth and sends the food to his stomach with shooters of hot coffee with excesses of half and half creamer.   Wracks eat the first of his three packages of Nabisco saltine crackers when the bowl licks clean.  

How did the war go on the southern flank, asks Dahlman?

More of the same says Wracks.   I go to class, then study for an hour in between, then go to a lab, check on my animals, go back to afternoon class, and then show up here.  We go to the Research library after dinner, put in two to three hours of exam preparation, and then take the bus home.  What happens on the North campus?

The same, says Dahlman, I research law books and take notes then transcribe the data to three by five cards.   Only three by five cards can be admitted to a courtroom if he or she is not the defending or prosecuting attorney.  Then I come here.   In the morning, I sit for exams until lunch. 

Why are we doing this asks Wracks.

There is no other way, says Dahlman.  Academic achievement occurs as the only game in town.   Everything else gets old.   Let’s get going.   See you at the end. 

Spring starts to break at the big U.  The large trees bear buds and the winter ebbs and the entire leaves have blown away three months ago.  The quad sits deserted in the dark twilight and the Romanesque forums stand adamant in utter solitude.  Up the steps to the marbled halls of myriad classrooms, and through the café connecting the old building with the new to the lighted entrance promenade signaling the Buckminster fuller rendition of glass that houses the research library.  Up the central elevator to the fifth-floor rocket the two students. On the fifth floor, they separate because the line of sight of movement distracts attention while reading. A huge physics graduate student sits at a little desk next to the elevator and looks up to see if Wracks smokes.   Satisfied, he continues reading.  Sitting at his window to the opulent world Wracks surveys the beauty, organization, and technological majesty that money creates.   In this world of non-olfactory money, where source seems unimportant and effect paramount Wracks digs in at the end of the short winter and promises himself, that he will not fall asleep tonight. 

Let’s hit it!  Yells Dahlman at Wracks, we have only 12 minutes to catch the 8:55 bus. 

 Wracks throws his huge heavy books into his briefcase and jumps off to the run.  Trotting down the staircase, they bound through the glass frontal portal and lope across the North Campus Avenue.  Trotting down the hill they cross the entrance road and stand at the pole on the island where the RTD stops on Hill Street.  Just as they arrive a huge yellow bus without any passengers careens into view and stops suddenly without screeching its tires.  The door opens and both Wracks and Dahlman flash their monthly student passes at the bus driver.  The door closes and the huge yellow rectangle accelerates at magnum speed down the hill. 

One minute later we would have missed the bus, smiles Dahlman. At a jog, it takes eleven minutes to get to Hill Street and the bus was one minute early.    Ten seconds later we would have missed it.  It seems prudent to allocate at least fifteen minutes to transit to the Hill stop.  

I am tired says Wracks. I am glad today ends and tomorrow becomes Friday. 

On the undulating bus, Wracks falls asleep as usual clasping his heavy briefcase to his chest.  

Dahlman shouts this is my stop, see you tomorrow morning on the steps.

Wracks waves goodbye and Dahlman exits.   Two miles later on the hill of Moonrise Avenue, Wracks becomes the last passenger to leave the bus.   From here the bus travels to the ocean, turns around, and then goes back up moonrise to nightclub land.  He crosses the street in the darkness and walks across the gas station turf.   Up past the drug store, liquor store, and convenience market, Wracks heads up the long Quiz way and then up the hill to Bacon Way.   The night still chills and the wind blows offshore so the waves cannot be heard echoing up the canyon and the stars twinkle because the smog blows out to sea on nights like this.  The beautiful night lives and wracks cannot be enjoyed because the day as it lives tires the disciplined who must sleep to replenish the mind that drives them mercilessly.  Punkin wags his tail while sleeping on his cushion in the family room. He is the only one welcoming Wracks and wracks strips off his shoe’s pants and shirt, dives into bed, and falls asleep immediately after pounding the alarm clock that rests next to his bed.  Tomorrow is a new day

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She’s got the curves

Curves that move when she moves

Curves that move from the gloom inside my room

To bewildered to know just what to do

Entranced by the curves that make up you

I start singing she’s got the curves

Youth is wasted on the young, and a woman’s figure starts to falter around age forty.  A personal physician prescribes Premarin for women to maintain their female habitus.   Let us look closer to see what the doctor is giving her.  Premarin or conjugated estrogen is an estrogen molecule with an ethinyl substituent at carbon 21.  The addend is a triple bonded sp1 hybridization that adds or eliminates in the appropriate environment.  This added makes Premarin less susceptible to degradation or conjugation by hepatic enzymes.  In addition, the triple bond adds to the DNA initiator site in a 60S Svedberg system and won’t let go.   In a mammalian transcription system, this means DNA replication rather than being induced and finite becomes constitutive.  In the cancer zoo at the Big U, monkeys develop huge fluctuant carcinomas when maintained on mega doses of Premarin.  Why then do physicians prescribe Premarin?

Physicians prescribe oral Premarin because the liver has trouble breaking the molecule down for elimination.  This means easy and convenient dosing and the woman maintains secondary sexual characteristics, or so it seems.

Expert organic chemist makes a lot of money, adding here, subtracting there, or causing gross elimination to unsubstituted nuclei.  Current birth control pills use chemically modified androgens as a pregestational agent because androgens are excreted in great quantity from horse urine.  If it makes money it goes, and the nation has an economy based on the acceptance of substances offered by the AMA. 

The main action of estrogen is sodium ion influx into cells.  This is why a fertile woman feels soft, silky, and supple.  In addition, the DNA replication induced by the steroid drug causes the proliferation of cells that are sensitive to estrogens and estrogen-like substances like the uterus and breast.  This is why women who chronically ingest birth control pills for inane reasons have large breasts.   If a woman wants to grow large breasts, they just have to get on birth control.  The main function of estrogen is to stimulate the growth of the epithelia in the uterus so it can maintain a fetus in a pregnancy.  Progesterone which is 21 hydroxy steroid caps off the proliferation by maintaining the uterine stroma and the fetus can develop. The main difference between estrogen and progesterone is the cyclization of the benzene group in the per phenanthrene molecule. When the estrogen feeds back into the ovarian operon, steroid production ceases, and a woman cycles.  If a pregnancy happens, and they do very often, the corpus luteum of the developing syncytial cytotrophoblast begins producing estrogen to maintain the placenta and the baby grows.

What is the solution?   The solution is to give estrogen by injection which few people except insulin diabetics can tolerate.  There might exist another solution in the plant world.  Hearsay and old wife’s tales stipulate that an estrogen-like substance occurs in eggplant.    A woman who desires curves can juice or cook eggplant daily in direct relation to her cycle.   The world seeks a botanist to come up with a suitable estrogen-containing plant that can be extracted, concentrated, and purified for mature women in middle age and beyond.  The world is waiting, there is a lot of work to be done.  Consult old Indian herbalist guides and inquire from doctors practicing traditional Chinese medicine about what avenues to pursue.  Hope springs eternal and she has the curves. 

Upton Sinclair and “The Jungle” existed one hundred years ago.  Now in the twenty-first century, the pharmaceutical giants mandate the health status of the working class in the United States.  The drugs they produce hopefully extend life, and in most cases, they do, except for delayed toxic effects.  It used to be that all pharmacological agents useful to mankind, were cultivated, harvested extracted, and purified into oral forms for the betterment of society and the nation as a whole.   Aspirin which comes from the bark of a tree, and derives from the culture exudate of common molds, and cannabinol which derives from cannabis sativa, in addition to others form the mainstay of agents used to promote health and rescue working human beings from the ravages of infectious disease.   Before antibiotics, waves of plague and pestilence swept nations and destroyed our intelligent beautiful children.  People who live in today’s world do not realize that antibiotics are the only factor that helps them live past 40 years of age and that disease used to take our most loved children.  

It is too expensive to culture, harvest, and purify drugs so the pharmaceutical giants create drugs cheaply by forming them in steaming pots.  The miracle of organic chemistry that gives us polymer pistols and plastic fighter jets also gifts mankind with a plethora of prescription-only drugs.  These drugs, if they work, if used chronically, evoke cancer of the pancreas, cancer of the liver, leukemias, and lymphomas.  The bulk of this paper serves to enumerate illustrations of what the American Medical Society prescribes for the working class to save their lives and yes, to save a buck.  Administrators put the bulk of the National budget for health care into their own pockets and prescribe carcinogens for the public so they die after they retire.   A retired worker does not create income, and if they die inauspiciously, the corporation and the government do not have to pay them a pension. 

If a person lives long enough, they eventually develop diabetes.  The medical society depends on these phenomena for their livelihood.   Metformin, which is a mainstay of diabetes type two, makes a patient acidotic and induces a fatal heart arrhythmia.   Sulfonylureas, the other agent used to treat high blood sugar, causes leukemia after chronic use.  Insulin, which President Biden promises to keep cheap, is only indicated in unstable ketotic diabetics and if needed can be delivered in a protamine zinc or neutral protein Hagedorn preparation delivered at most once a day.  Current medical dogma has diabetics walking around with insulin infusion pumps delivering normal insulin continuously.  Many years ago, the only indication for regular insulin was diabetes ketoacidosis or hyperosmotic glucose crisis and now people run around like robots with large pumps stapled to their abdomen.  Please lord up above, tell me, am I missing something?

If a person lives long enough, due to metal accumulation and eating a lifespan of beef, their blood pressure rises continuously by about 10 mm Hg per decade of life after fifty years of age.  There exists no satisfactory treatment for high blood pressure.  The agents that  highly intelligent, religious, and altruistic doctors prescribe all induce cancer of the pancreas after ten years of chronic use.   The only treatment for high blood pressure is to get drunk and smoke pot and yes, stop eating top sirloin strip steaks.  I will reveal how the pharmaceutical giants produce such incredible incomes.  A third of the National budget subsidizes the making of carcinogens and pays administrators working in plans who carry out such a nefarious schema.  

An organic chemist makes drugs by boiling organic precursors in pressure cookers bought at Walmart. 

A biochemist takes an x-ray microscopic picture of an enzyme the scientists want to inhibit, that they think causes disease.  With this picture, the chemists delineate the size of the enzyme’s active site and build organic molecules in a pressure cooker.   To make a large ring structure, a chemist utilizes a precursor molecule then adds carbons to it and then nitrate derivatives to form a cyclic structure.  Each nitrogen a chemist adds to form a ring structure has a pair of unbonded electrons in a sp2 hybridized configuration.  This makes the ring structure a nucleophile and the ligand bonds to the DNA and destroys it.  The more nitrogen, a chemical has in its structure is directly proportional to its carcinogenic potential.  To make Minipress, a potent antihypertensive agent, a cook puts chemical waste in a pressure cooker, urinates into it, and cooks the mixture for an hour.  When filtered, the person has pure Minipress.   

Long aliphatic chains on a molecule are also potent carcinogens, as taught by a tall dark-haired man, former chief at the big U.  These are phrased as aliphatic carcinogens and exemplified as Benz-aminopyrine. 

Anti-hypertensive agents with long tails are marginally effective and at most decrease the blood pressure after chronic use at most 5 mm Hg. This author knows and measures.  They are not even marginally effective.  They have super names like cardiolol and others.  The drug causes cancer by wrapping the long tail around the phosphate backbone of DNA, rendering it incapable of replicating and the cell becomes cancerous.  The new agent for diabetes, a polypeptide structure has long aliphatic tails bound to the molecule to increase the rate of diffusion and this agent also may be a direct-acting carcinogen. 

In Mexico, high blood pressure patients turn blue from ingesting hydrochlorothiazide, also known as Hydrodiuril, and they all commit suicide when told they have cancer of the pancreas.  The list goes on and on.  The PDR is so verbose it is hard to decipher intent,  and the subsections are written by chemists with a law degree.  

This author does not have an answer for this hubris.  “if you are not part of the solution, you are part of the problem”.   This author is not a soothsayer or mediator.   It says in the good book that Dios puts on earth everything mankind needs to help themselves.   They just have to find it, grow it, harvest and purify it.    Life is a lot of hard work for everyone except the fortunate few.  I guess a chemist can add a ring structure here or there if they belong to a church.  I will stand my ground and I won’t back down.

Lab work takes a lot of time and detracts from your studies.   Wracks brings his lunch in a brown bag to the lab and Dr. Goodlife tells him he cannot eat it here.

We use a lot of radioactive chromium to label white cells and poisoning with radioactive chromium induces red cell leukemia.  You have to find somewhere else to eat.

The Wracks moves down to the medical center cafeteria on the main floor and has his lunch with the medical students.

You can’t eat here says one of the students, you are not in the medical school.   Find somewhere else to have your lunch.

I will says the Wracks.

He wanders around the medical center and finds a room behind closed doors, inside is a huge glass dome and chairs above an operating room.  He takes a seat and has his baloney and American cheese on wonder bread sandwich and an apple for dessert.  Below him, a tall surgeon is doing laparoscopic surgery on patients.  The primitive laparoscope is a long surgical steel tube and the surgeon inserts the probe in the umbilicus, moves around, and looks into the viewport on the scope as he views the internal organs.  This is the first attempt at laparoscopic surgery.   The Wracks finishes his lunch puts the brown bag in a surgical waste refuge basket leaves and goes back to the lab.  He likes the solitude of the retreat and returns a couple of times and the surgeon notices him chewing on an apple and waves.

Dr. Good Life wants to talk to you says one of the Japanese medical techs who handles the radiologic assays his lab undertakes. 

I hear you are having lunch in the dome area says Dr. Good Life.   You left an apple core on the rim of the dome and the surgical residents want you to stop going to their personal area.

There is never anyone there when I go says the Wracks and I didn’t put my apple core on the view dome.

Yes, you did, says Dr. Goodlife and one of the surgical residents found it.

I guess I have to take my lunch in another area says the wracks.  He leaves Dr. Goodlife’s office

I can’t figure out how I left my Apple core on the viewport thinks the Wracks.  I put my trash in the closest surgical waste receptacle.  Errors of judgment are the way criminals are caught in a crime.  It is just a matter of time before they make an error and I guess this is how it happened.  My fault thinks the Wracks.   I must be more careful. 

The Wracks chooses the steps in the delivery area in the medical center to have his lunch.  Located in front on the side with a parking area where the Wracks arrive at night to do their experiments in the School of Microbiology at the Medical Center.  Time moves on, summer approaches, the summer quarter starts, his term is done and he turns in his keys to the research area to his preceptor.  This is the end of the line at the big U.  The wracks gather his laboratory notes, his statistical analysis, and methodology schema and turn them into Dr. Goodlife.  

The year of work consisted of the analysis of a one-gravity sedimentation apparatus for white cells and neoplastic stem cells.   Testing reveals that big cells fall faster through a column than small cells because the buoyant density of small cells slows their descent through the column apparatus.   His column consists of fetal calf albumen in various concentration steps over two hours of fall time.  He counts cell aliquots at regular intervals establishes a normal bell curve and uses trypan blue to statin the aliquots for histological analysis.   Cancer cells are larger and fall quicker through a gradient column and can be stained with trypan blue or fluorescein.    The result of this work is now a science called flow cytometry.   

The Wracks no longer attends the big U.   His peers harass him sexually.   He attends the extension school at the Big U and takes graduate classes like Psychopharmacology and Public Health.  He is interested in psychopharmacology because the wealthy like to take LSD and other mentally active congeners. 

Time moves on and the seasons do not change in southern California the Wracks does not take the yellow bus to the big U anymore and his grandmother is going to pay for his education in Mexico. 

Eating lunch alone on the steps next to Overguard where the busses run is relaxing and the time is over and the world turns, the night convenes and the stars shine beautifully in the night full of hope and promise. 

I am not cut out for this thinks Dr. Wracks.  I must be smart enough or I wouldn’t be here.

Stop daydreaming says Dr. Clancy, there is a presentation at two on thyroid surgery in the surgeons’ lounge by Dr. Canta.  Go there now.  They will have some bagels to eat

All the surgical residents except the two lead residents are in the lounge for the presentation.  Dr. Wracks grabs two bagels while they are still there.  They go fast.   Dr. Canta is a medium-height man with freckles and greyish-brown hair with huge horn-rimmed spectacles.  He wears a doctor’s smock over his suit and he is at the blackboard, with some chalk, and he begins.  He is an endocrine surgeon.   The thyroid is a wondrous organ that maintains homeostasis in the human being.  People with thyroid disease have heart problems and sugar problems.  Thyroid hormone maintains the body’s metabolism, regulates the heart rate, rhythm, and contractility, and augments metabolism.  People with thyroid disease also are cold and hairless.  A magnificent organ, the thyroid has four arteries that feed the organ, superior and inferior, and this demarcates the thyroid as an extremely important organ.  

To remove the thyroid Dr. Canta states, we must ligate the four arteries before extirpation and remove it from under the cricoid cartilage.    the patient must take the T4 hormone for the rest of their lives.  Be aware that the internal carotids are near the organ and feed it directly through tributaries, so we must be delicate to not sever them when we remove the organ.  Dr. Wracks eats his second bagel and nods his head.  Dr. Canta looks at him. 

Tonight, he is not on call so Dr. Wracks walks to his attic room in town to get needed rest and listen to the radio.  He locks the attic door and sleep overtakes him.

After rounds in the early AM, Dr. Wracks is sipping coffee in the cafeteria with a bun.  One of the lead residents tells him to get to surgery because he is on the board for an early procedure with Dr. Canta.

Dr. Wracks is late and all the donuts are gone, and he takes a quick slurp of Styrofoam container coffee in the waiting area and then walks to the board.  On the board is written in black marks a lot ink, “Baloney”, 

and he moves to the surgical sinks and scrubs in.   Walking backward into room four, Dr. Canta is waiting for him.   Hold the trocar while I incise, says Dr. Canta, tie off as I enter, the Beauvy makes too much smoke for this procedure.  Lifting the cricoid cartilage, the thyroid is revealed.   It is white and pink and perfused with blood that is not yellow, atrophied, and wasted as described in medical textbooks. 

Hashimoto’s Thyroiditis says Dr. Canta Look closer.

Dr. Canta cuts the inferior left thyroid artery and with his fingers directing the flow, he squirts bright, hot blood in Dr. Wrack’s face until his entire mask and surgical hat are covered.   He then clamps the artery and Dr. Wracks ties the vessel.   He looks up at Dr. Wracks.   Three more to go.

After cutting three more arteries and Dr. Wracks tying them off, he delicately excises the thyroid with a light green scalpel, desiccates the tissue, and then removes the organ.   A nurse appears and the thyroid goes into a surgical stainless steel pathology bucket.  The surgeon then closes, no one without a license in surgery can sew fascia or peritoneum or do amputations. 

The surgeon leaves and Dr. Wracks accompanies the patient to the waiting area the patient’s trachea tube is removed and Dr.  Wracks sits there covered in blood.   Thyroid surgery is extremely bloody. When the patient breathes normally and the vitals are stable Dr. Wracks runs to the locker room to wash off his face.  He discards his surgical gear into the contaminated discard bin and washes his face and head with cephadyl three times.  Lunch time is passed and Dr. Wracks skulks to the library to hide.  No one ever will find him there except his only friend.  Back on the surgical floor, one of the chief residents asks him if he wrote “Baloney” on the surgical board.  Dr. Wracks denies it.   I thought I saw Dr. Cuban do it says Dr. White but I am not sure.  When Dr. Wracks sees Dr. Cuban, he bows his head and makes the sign of the cross.  Is he the next to go thinks Dr. Wracks?   But it isn’t. 

Dr. Canta moves around the surgical floor like a phantom silhouette.   He carries a fresh scalpel in his hand raised to face level to strike.  His face and grey eyes glare in a leer.   When people see him, they start to run.   A scalpel is extremely sharp and can cut through nearly anything.  Dr. Wracks again makes the sign of the cross.  Dr. Cuban was not the next to go.  Dr. Wracks looks out the window on the observation floor at the world in New York in its beautiful summer.  Immense green punctuated with verdant thunderstorms as sudden squalls move into the area and the huge skyscrapers loom in the distance.  Life is really beautiful for the lucky few thinks Dr. Wracks.  If I go back to the surgical floor, they will have me taking blood gas from the ICU.  My mother wanted me to be a doctor.  It’s time to get back to work thinks Dr. Wracks

Another patient is coming in with abdominal pain says the charge nurse.  Dr. Ix wants you to work him up and do a guaiac after a rectal exam.  He is in the emergency room now, Go meet him.  The day moves on into the afternoon and eventually, there will be a “Light in August”.    And so it goes, et mas.