It is Guardia for one month and the administrators sentence the Wracks to a month in obstetrics gynecology downtown.   After an unanticipated snafu of one half of a year, the Wracks finds himself in the center of Guadalajara in a government hospital, after a long bus ride with one transfer.  Built of stone and bricks like everything in Guad, the hospital is an open-air affair with rooms situated like huge stadiums cordoned off with a wall.   Naked women in gurneys’ line up in the room and the Wracks is told to stand behind the surgeon and do whatever he asks.   Unlike the states where women get their own room for anything, Mexico is a catholic country and women cannot be in a room with a man without an escort.  In gynecology here, a medico works with a nurse with the sole intention that the patient cannot declare violation because another woman is present.  And so, it goes.   The doctor swabs a woman’s fourchette and places it in saline for a wet mount, and another goes to Microbiology for a culture.  The doctor does the work and hands the swabs to the Wracks who puts them in a labeled tube and sets them in a test tube wrack.   A nurse stands aside and brings supplies and helps physically manage the patients.  After the ladies are done, Wracks is told to leave and sit outside with his blue Harrison’s book and read and wait for the next batch of patients.   This is assembly line medicine in Mexico and it works and is safe.  This edifice is a downtown government hospital and stands close to the government building for the city of Guadalajara.  No one else is around, the patients load from the back of the arena and the Wracks is there for insurance.

Occasionally a tall man walks by the Wracks and looks at him.   He is a slender six feet three, in a grey silk suit with a lanyard for a tie.   His shoes are black leather custom boot, sort of a cross between a tuxedo shoe and a western boot, affluent cowboy Mexican style.   What arouses the Wracks attention is the fact that this tall man has two European body guards, also in suits. that stand one on each side of him and from their looks and serious demeanor, they are all book and mean business.    This tall, elegant evidently rich man never says a word but he takes a Mexican flan desert in a plastic custard cup and with a wooden spoon, eats it in front of the Wracks and disposes the plastic in the nearest trash can.   Not daily but occasionally, he and his bodyguards walk up to the Wracks, show him the cup of Mexican flan which is one of the most delicious deserts the Wracks has ever enjoyed, eats it and then walks away.  His eyes are not brown but uncommonly grey and the Wracks feels the ominous vibrations whenever he appears.   Like a guardian angel, he looks at the Wracks, evaluates, eats his flan, signals to his bodyguards and leaves.   A nurse briefly sticks her body out of the stadium and wags her index finger from side to side as is the Mexican beware signal and whispers “LASARO”, and then she is gone.   The Guardia ensues, the Wracks assists in some birthing, then more gynecology and then he sits with his book, the physician tells him he can leave and he takes his double bus ride to his reduvid infested adobe room in plaza del sol.    Then as soon as it started, the Guardia ends and the Wracks is back at the clinical campus in respiratory medicine looking at x-rays of pulmonary tuberculosis, and discussing treatment options with the doctor doing his social service at the clinical campus. 

They say Lasaro Cardenas died a long time ago.  I have to disagree with that because people with a heavy vibe about them are not normal, they are exceptional and Lasaro had a pretty fair granddaughter that the Wracks never had enough money to date.   Maybe he was evaluating the Wracks for talking with his granddaughter.  It really does not matter anymore and it never has.  Great men do not die; they simply fade away unmercifully.   The Wracks is honored that such a spectacular historical figure would take some of his precious time to deal with him.   Time moves on and the Wracks never had time to attend his graduation because his residency starts in one week and he has to be in New York to secure lodging.  His oil rich friend who drove the Wracks around in his car eventually moved to Texas and practiced there and the next epic in the saga starts.   It has been a long time, and the Wracks is in his room with an energy efficient Qualcomm processor that lasts 16 hours.   He doesn’t like the Mac operating system and he wishes he did, because it lasts 16 hours or more on a charge.  A cup of coffee and a candy bar are subjects of mirth and happiness and the clock goes round and round eventually.   

Magnetic resonance imaging is the new technique for 21^St century medicine, The eighty percent when they come to the hospital for illness say- “I want an MRI to diagnose me because it is new.”    Do they know any better?   Are they inundated with pedantic diatribe by people whose only aim in life is to make money?   Are they serving humankind or annihilating it?   A long time ago, when the United States was one nation under God, a good history and physical combined with a chemistry panel could diagnose 99 percent of all maladies under the sun.   If an x-ray and or CAT scan was thrown in, this figure approaches one hundred percent, why do we, the eighty percent need or want an MRI.  Are they better?   Do they demonstrate occult processes not viewable otherwise?   Is this a low-cost economical technology that certainly will revolutionize medicine and improve the health status of the nation?    Let us the 80 percent look a little closer.

If a low-income person walks to the receiving side of an imaging center, they see a huge transformer with a myriad of wires hooked up to the power lines.  MRI uses a huge amount of electricity and this cost passes on to the public and is paid for by one third of the GNP of the United States.   What the dang is this newfangled thing they call MRI?   According to the ivory tower elitists, when a person passes under a magnetic field of awesome magnitude, the ions in the body align with the magnetic field.  When the power turns off, the ions realign to their former states emitting a signal.   Sensors pick up the signal and the result is processed by a computer to reveal an image and a radiologist can choose any color they want to display on their QLED computer screen.  The question is, Is the signal conglomerated by the computer processor real, or an artifact of no physiological significance?   Does this expensive representation relay information that is not available otherwise at on hundredth of the cost? MRI scanners cost millions of dollars to make, transport and install and the electricity costs all come from the GNP and the trillions of dollars that wage earning taxpayers pay.   I have a stark realization for all unfortunate souls reading these lines.

Lenz’s law of electromagnetism states:

The direction of an induced current is always such that it opposes the change in magnetic flux that produced it.

In other words, intense magnetic fields induce a current in your body that burns the DNA.   This fulgurating current destroys cellular DNA and induces cancer.    It is already known that people who work with high power lines have an increased incidence of leukemia and other malignancies and this is topping on the cake.  Magnetic fields induce a current like the plug in you living room that powers your computer and television set.   Just because someone is of the twenty percent and has a high IQ does not mean they are ethical.  Ethicality is what human medicine is all about and all states require licensure after a rigorous education to practice healing human beings.   Do doctors need to read anymore?   Are the intuitively exceptional and politically correct governing body exempt from national testing and subjective licensure?   A person, man or woman does not have to be a genius to practice medicine, they have to be ethical!    Isn’t this what civilization being all about?   Brother helps brother and shares the bounty so we by the grace of God can live together.  

Tinsley Harrison, one of the last vestiges of decency in the United States stated in his special edition of “Harrisons Internal Medicine”.   “Let us not discard the old just for the sake of the new” This is the preface of his special edition, and all the medical geniuses out there can go fuck themselves.   

A winter wonder land greets the imagination on Monday morning.  The snow is ten feet high.  How this much snowfall can occur in two days remains a mystery.  One of the residents who is a retired pitcher from a minor league team throws a packed snowball at Wracks head.  A good reaction time saves the day and a medical book takes the damage.  The blow stings the fingers exposed to the missile.  “Thanks for nothing,” Dr. W says.  “I like you,” says Dr. A.  He then proceeds to bean another helpless doctor in a white smock. “I love snowball fights,” he says.   The rest of the team hurries to the main building before Dr. A can pelt any more of us.  At the doorway is Dr. Lecter.  “Give me my key back,” he states with his hand outstretched like a beggar.  “I have it with me,” says Dr. Wracks.  “Here it is nice and warm from around my neck.”  Thank you he says.  Dr. Beck storms into the room and says. “You bastards left on Friday without finishing interviewing the in patients.”  “I am going to flunk the lot of you,” he promises.  “I was here,” says the Wracks.  “Shut up, I was not talking to you.”   “We had to get out before the storm,” said the rich Dr. who drives a Lincoln town car.   “Your first duty is toward the patients,” stammers Dr. Beck.  “You have not heard the last of this.”  Dr. Beck then spins on his heels and vanishes in a flash of anger.   “After taking role, go to your respective wards and interview your patients,” says Dr. Lecter.  Back in the lockup Dr. Lecter and Dr. R. go to interview Mr.  Shine. Shine sits in the padded cell in a hospital gown and underwear.  “Mr. Shine, a person cannot run around hurting people and get away with it.” Says Dr. Lecter.  “I have my reasons,” says Mr. Shine.  Mr. Shine appears to be a Caucasian of average height and build in his early forties.  Brown hair and a fair complexion do not reveal that his job in Viet Nam was to interrogate prisoners and cut them with a Kbar knife for information.  Wracks thinks, I pity the poor slob who gets in a knife fight with him. He has traumatic stress syndrome and when put under pressure has a breakdown and beats up everyone around him.  This could number up to ten people in an episode.  “Mr. Shine,” says Dr. Lecter, “I hear you stopped taking your medication”.   “The medicine makes me restless and makes my jaw stiff, “says Mr. shine.   “We will change the medicine to something else that does not make you restless.”  Says Dr. Lecter.  “However you must stay here until you are stable.”  “When you are stable, you can go home.” “I understand,” says Mr. shine. “Hello Mr.,” I Shine I am Dr. W.  “I remember you.” says Mr. Glitz. “Nice to meet you,” Dr. W. says.  “Today you will administer Psychological therapy to Mr. Heim.  He is a paranoid schizophrenic who used to be a financial genius. See what you can do with him.  “I will,” says Dr. W.  “But first you are to interview Mr. O.  Your rotation nears its end.” I will be in my office.”  Dr. Lecter turns and disappears into the corridor.  “Be sure to maintain distance. He regards proximity as an affront and will break your nose.”

     “Hello Mr. O. “says Dr. W. “Can I sit down?”  “Silence” Dr. W pulls up a chair in front of Mr. O.  Mr. O sits in the recreation room in the Pookipsie VA center.  He wears a long red dress and a string of pearls around his neck.  His dark black curly hair sets close on his head.  He wears a big grin on his face. “Mr. O, how are you doing today?  Do you like your medication?” “Silence”  “Would you like to relay any concerns to Dr. Lecter? I will see him presently.”  “Silence.”   “Before I go, is their any thoughts that you would like to share with me.”  “Yes, he says.”  “Can I have two cigarettes?”   “Sure,” says Dr. W.  As Dr. W. hands the cigarettes to Mr. O, he keeps the distance between Mr. O and himself to a maximum and pays particular attention to Mr. O.’s hands.   “Thank you.” Says Mr. O.  “Good day. “Says Dr. W.  Dr. R then looks for Mr. heim.  Mr. heim locates in his room.  He is not so sociable.  “Can I interview you in the consultation area,” says Dr. W.  “Yes,” says Mr. Heim Dr. W leads Mr. heim to the consultation area.  He decides to use Rogers’s sounding board implosion therapy.  Mr. Heim is a small man with dark black hair and not muscular and should be easy to dodge should he decide to strike.  Rogers sound board implosion therapy translates to mimicking what a patient says or does just as they do it and locate the mimicry temporally so the patient sees for themselves what behavior they manifest simultaneously when they exhibit it. Mr. heim sits down and starts telling Dr. R about the stock “Chock full of nuts.”  Dr. W mimics him.  Mr. heim finally discovers that Dr. W repeats what he says like a tape recorder and starts making animal noises.  Dr. W mimics the animal noises.  Finally Mr. Heim leaps up on to the table, pulls down his pants and exhibits himself.  “That is enough.” Says Dr. R.  “Pull your pants back up.”  Do you understand the content of your verbal discourses?  They make me angry too.” “Some of what you say has no basis in reality.”  Mr. heim sits back in his chair and thinks about it.  The revelation becomes so awesome to his psyche that he sits their dumbfounded.  “Thank you for the interview. I must leave now. ´” Dr. W gets up from his chair and with his eyes still on the patient fluidly exits the consultation room. Mr. heim sits their dumbfounded.  Dr. R moves on in his rounds. 

     Unless a person stirs the muck and becomes intrepid, nothing really happens in a Chronic Psychiatric facility.  The patients come and take their medication and sit like dazed animals in house until the Psychiatrist dischargers them.  Some patients stay forever.  Some patients return periodically as they lose the ability to cope with the environment.  Mental illness stigmatizes human beings. Mental illness is a self-fulfilling prophecy in the sense that if a person can not be trained in a new line of work they become slaves to the system and permanent part time inmates.  The urgency with mental illness remains to try to get the person back to reality in the workplace as soon as possible.  This maneuver becomes inordinately expensive.  Money has been and is the power to drive reeducation of a person with a shattered existence.  Without money to send a person back to school, to retain competent health advisors and physicians who monitor the chronic medication and to house mental patients, mental illness penalizes  human beings and converts them to useless appendages of society who die alone, unhappy.  Most people can not afford the cure.   The cure comes from money, honesty and the undying care from health science personnel.   “Time for my plus three dinner,” thinks Dr. W

     On the last day of the rotation, Dr. Beck approaches Dr. Wracks.  He asks, “What did you do to Mr. Heim.”  “Rogers sounding board reverberation therapy,” says Dr. R. “Sounding board therapy becomes efficacious when used with a high functioning schizophrenic who can learn from his behavior what works or not.”  “What ever you did cured him,” says Dr. Beck. “He is going home tomorrow.” “I guess I am really lucky,” says Dr. W.  “Thank you for the rotation.  I learned much about Psychiatry.”  “After you finish your fifth pathway, come back here if you want a job,” says Dr. Beck.  “Thank you very much, I will certainly keep your offer in mind.” says Dr. W.    

     In life luck is everything.  Beginners luck is even better.  Chalk one up for the gipper.  Victory is sweet

The train in Pookipsie looks like the train in Harry Potter’s “The sorcerers Stone.”  The train rambles slowly downstate and eventually ends up at Grand Central Station.  On the train sits Dr. W, in a suit and tie, with his bag of medical books bound for Amityville and the surgical rotation about to begin the next day.  The scenery in the country side after a late winter storm swims by slowly.  White juxtaposed on evergreen, separated by skeletons of ash and birch. Connote the scene.  Dr. W reads from one of his books and occasionally looks up to view the panorama.  The train rocks and sways, slows and lurches and rumbles with a knocking vibration heard and felt at the same time.  He will probably do simple stuff like wound suture and suture removal.  This will give him time to review for the California board Examination.  The train rumbled on and darkness slowly permeated the scene and the interior lights of the train card turned on.  The seats were comfortable enough and the comfort is the day drawing to an end.  Dr. W thinks he is on easy street.  Just a little cutting and tying in surgery and checking outpatient bandages, thinks Dr. R.  Amityville hospital is about to administer a surprise to Dr. R like he has never been surprised in his life. The hospital staff will also throw in the ICU as a bonus prize. Before he left, Dr. Lecter floated into view, long jet-black hair in a white smock.  When you get your license, stop by.   By the way my name is Hannibal.    “Tis folly to be wise when ignorance is bliss,” muses Dr. W.  “Amen.”  “…..and so it goes.”

     On the bulletin board in the staff area is a notice. The notice reads, “All residents and fifth pathway students report to Dr. Beck’s office at 0700 today.”   The whole gang of Doctors crowd into Dr. Beck’s small room with a huge brown desk.  Dr. Beck reports, “Everyone must leave the complex by 1500 today or stay here the weekend. A huge winter storm will drop at least eight feet of snow tonight and leaving otherwise will be impossible and dangerous.  Make all preparations for evacuation now.  The clinic will resume on Monday or Tuesday when the snow blowers clear the roads.  Any Questions?”

“What if you have no place to go?”  asks Dr. Wracks.   Dr. Beck says, “Anyone staying will assume the duties of the regular staff and remain in general quarters.  The cafeteria will be open at a reduced level on standard meal times.” 

      Working in a Psychiatric hospital is boring. As long as a person integrates protocol into a mindless act, the rigmarole gets boring. Open the doors and make sure they are closed as a person exits.  Genius experts evaluate each patient individually and place them on appropriate medication.  What a clinical Psychiatrist does is watch for side effects of a particular medication and administer antidote or note overt change.  Any dramatic change of a patient’s behavior in any way indicates failure to take the medication or evolution of florid psychoses mandating a change in pharmacotherapy.  Most patients after evaluation and medication do not change very much and the evaluation of these patients becomes automatic and quick.  The main exceptions are split personality, catatonic schizophrenia and undifferentiated Schizophrenia.  A clinical physician treats all patients with these conditions gingerly, as stress precipitates psychoses with a violent outcome. Once a patient becomes violent he or she must be restrained, paralyzed with medication, and if no remission ensues ultimately terminated. To be a clinical Psychiatrist a physician must be highly intelligent to memorize the pharmacology of the medications and recognize symptoms, the side effects of the medications and the antidotes or remedies for treatment failure.  A clinical Psychiatrist must be religious because mental patients in a high percentage are doomed to a precarious existence for life.  Once a patient confines to a mental hospital, he or she most likely returns periodically until they die in an abbreviated and shortened life span. To realize most of your patients will die in a filthy or sordid way sobers even the most optimistic of human beings.

         Most young doctors come from rich families.  Only rich families can afford the lengthy and expensive medical education.  By 1400, all the residents and fifth pathway interns are on the train out of Pookipsie or hook up into carpools to take them downstate. These people will have a tremendous weekend because New York City never sleeps.  A bar, a nightclub or restaurant remains open 24/7 somewhere in the city, usually on the upper-class side.  All it takes is mountains of non-olfactory money spent in a casual and frivolous way.  Money remains the rate limiting factor in a Gibb’s free energy equation.  Probably if Dr. Wracks had money he would float on a surfboard somewhere in the sun. Dr. W makes his rounds and heads to the cafeteria for the one plus one plus one meal.  “It’s so you do not get fat,” she says.  Dr. Lecter finds him there.  “Why aren’t you gone,” Questions Dr. Lecter.  “I have no where else to go.” says Dr. W.  “I did not have anywhere to go either,” says Dr. Lecter.  Here is the master key to all the wards.  This key opens everything, anywhere on the complex.   I want you to do morning rounds in our ward and again at 2300 hours before you turn in.  We have a new patient from a wealthy family.  He was a Viet Nam Veteran and forced to kill people with his bare hands.  He was one of the last out at Da Nang.  He has become violent   and lies in a strait jacket in the padded holding cell.  Pay particular attention to him.  Remember; do not let chronic schizophrenics get between you and the door.  I live close by and will remain in touch. Wear the key on your neck and sleep with it.  If it is lost, all the locks in the whole veteran’s complex have to be changed.” “Goodnight,” he says as he walks off into the long corridor.

     The Pookipsie Veterans Hospital is a huge apparition set in a park like arcade. The buildings link by means of catacomb tunnels with locked doors at each end.  Large fluorescent lights hang in the long, cold, grey, concrete tunnels and sound echoes eerily and reverberates into nothingness.  The environment is kind of like a Lon Chaney Frankenstein movie.  It must be here where Lon got the settings for the movie.  The Wracks walks alone here late at night in the tunnel leading to Ward 4.  He sings and says words to see the ramifications of the reverberations. “Spooky,” Dr. W. says to himself.  “Real spooky.”

When Dr. W.I arrive at Ward 4, everything is mundane. Drugs medicate the patients and they are asleep.  The nurse, who looks overworked, stressed and tired, beckons to me from behind the glass blast shield.  Dr. W waves back.  Dr. W moves to the restraining cells and removes the shield from the glass porthole.  As Dr. Looks into the cell Mr. shine looks him back eye to eye in the glass.  Only one inch of hardwood door separates the two faces.  Mr. Glitz looks more frightened then mean.  He must be frightened because he knows that payment is expected for his violent behavior. He stands in a strait jacket in hospital bed clothes.  Dr. W. introduces himself.  “I am Dr. W.  I will check on you periodically this weekend.  Do not be alarmed, nothing changed.  Dr. Lecter will see you Monday morning.  Get some sleep, it is late.”  Dr. W. then looks into the room of the catatonic schizophrenic.  Mr. M sits in his chair, wrapped in his usual sheets facing away from me.  Dr. R looks away down the hall and looks back in through the porthole.  Mr. M does not sit in the chair; he moved out of view.  Dr. W.  instinctively checks the door to make sure it is locked.  In ten milliseconds, Mr. M. senses the Wracks appearance and moves out of view.  He could be juxtaposed behind the door if it is opened.  Dr. W does not open the door and walks on.  “Make a mental note,” Dr. W

 says to himself. “Mr. M can feel me.” Dr. W.  leaves Ward 4 and enters the tunnels.  He walks alone through the tunnels. He makes sure the doors lock behind him. He enters the Residents lodging and his cubicle.  Dr. W. hangs his white smock on the door. Dr W. heats water with his tourist prong and makes instant coffee. Dr. W.  makes sure the key is around his neck.  He adds powdered creamer to the coffee.  Dr. W.  lights a cigarette, opens his books and reads until sleep overtakes him.