In Hebrew, ab means father or leader and ib has no definitive definition in Hebrew lore or the bible.  In Sanskrit, ib means elephant or big thing.   The current nomenclature of the new immunologic acting drugs end with a suffix of ib or ab.     The best illustration of how the immune system works is in Sir Harvey Burnetts book, “A theory of Immune Surveillance” In a nutshell the immune system is an intricate organ that eliminates foreign invaders from attacking the self and it has links to the coagulation system, the complement system, and the kallikrein system.  In boomer heavy lingo, the immune system is an immaculate organ that should not be interfered with in any way unless a clinician can augment its action.   Why then does Medicine use monoclonal antibodies to treat auto-immune conditions?   

To make monoclonal antibodies a patent protected animal is injected with the human antigen or tissue in question, and after an immune reaction ensues and perfects, the animal is sacrificed and the plasma fraction of its blood is passed in a special Sephadex column to remove pure antibodies.   Nowadays these antibodies are directed against the human immune system.  Idea becomes that the antibody will attack the cells causing the disease and the complement system. will eliminate the cells, hence no disease.   The monoclonal antibody produced usually attaches to the Fc portion of antibody in solution or attached to B and T cells and this action eliminates autoimmune disease.  In reality what happens, the monoclonal antibody attaches to B and T cells, destroying the functional immune system after complement kills the cells, and the patient or subject, deprived of a functioning immune system dies from a mold or bacterial infection.   If an infection doesn’t kill a patient, monocytes, Kupffer cells from the liver or hunter-killer cells without intrinsic antibody regulation proliferate forming granulomas, similar to a tuberculosis infection and the patient dies from obstruction of a viscus or a growing granuloma with Langham’s giant cells creating a stroke.

  Auto-immune phenomena usually appear after the thymus involutes after age 18.  The Thymus makes thymosin, a hormone that stimulates T-helper cells or T-tolerizing cells to augment antibody production to the appropriate antigen.  WHY NOT JUST GIVE THE PATIENTS INJECTIONS OF THYMOSIN?    Thymosin is a three amino acid peptide hormone that can be synthesized commercially.  Other immunomodulators that haven’t been studied are levamisole and Freund’s adjuvant.  The impetus of this communication is to state that auto-immune disease or conditions are not treated by destroying the immune system.  Back in prehistoric times, the professors in my lab studied Anti-T serum administration to destroy the T cell population thus hindering help or in the case of study low zone tolerance.  The professors would never disclose how they made anti-T serum because its effects on the immune system are catastrophic and so is ib and ab pharmaceuticals.  

Patents usually run in the pharmaceutical industry for 35 years and can be renewed once, allowing pharmaceutical companies to make billions of dollars feeding on the SSI health care fund.   Today is like the 1920’s when the FDA formed.   All medications that aid mankind benefit mostly, the people who hold stock in the companies that manufacture them.   All medications that survive the patent eliminate because they are now non-profitable.  A case in point is chronic heart disease that impinges on the auto-immune question tangentially.   Back in the 1800’s heart patients drank a dilute solution of opium when they experience angina, and chewed chewing tobacco for the nicotine to make their heart beat when it started slowing down too much.  The good old days are long gone with women in petticoats and little girls in pretty pig tails giggling at church.  Nowadays, heart patients undergo a barrage of invasive tests and take organic chemical prescriptions that cause cancer, and the government pays the enormous costs of secondary and tertiary care medicine in the elderly.  There is no room for the old and nicotine is a hazardous drug like cocaine, heroin and LSD, so go figure.  Tinsley Harrison, one of the unknown greats who devoted their lives to eliminating suffering in humankind said,

“Let us not forget the old just for the sake of the new”.   The new are patent rights that benefit no one but the wealthy and the old are the dreams of working man to make a life for themselves in our so-called classless democracy.  Let me iterate once and again that the immune system is nothing to be meddled with, only added to and the educated professionals to read Sir Harvey Burnett.      

Knock on her door and ask her why

Offer a piece of apple pie

Wake up from another dream

I don’t know and I don’t care

Life is an elegant symphony

Life is an elegant symphony.

Dressed in a homemade blouse and short pants this morning, she begins her day cooking a weekend breakfast and her hair is washed, and combed and new today.

Man wants to see inside the human body for interest and to give medicine a way to classify disease.   X-rays enable doctors to look at the body based on atomic weight that is proportionate to density on the film.   X-rays are ionizing radiation that mutate the DNA and can cause cancer but the frequency of the assay and intensity of radiation needed to impact a film are almost negligible.  CAT scans use less energy and are thus safer but inordinately more expensive.   Now the medical fraternity have magnetism induced currents that can be elucidated by a sensor and digitized in a computer to produce a colored picture.  Rediculous new technology uses extreme amounts of current to produce a magnetic field powerful enough to induce a flip-flop current similar to the production of microwaves.   MRI uses magnets just like a microwave oven and the result is cooked flesh.   The brilliant medical fraternity produces invasive tests for the purpose of making a good-old American buck and benefits the low-income patient in no way except to debit the insurance company that pays for the expensive assay that reveals nothing that cannot be seen in a CAT scan.  All of this machination is to generate money that the professionals glean and live in exclusive gated communities in prosperous cities.  This author guesses that charlatan medicine for the working class is better than no medicine at all.

Getting some sun out in the yard, weeding and bringing in some tomatoes to make sauce for dinner, her grey eyes glimmer in the American native whisper.

We all look for technologies that are not invasive, not costly, and bring to the extremely well-educated physician more information to elaborate prompt diagnosis and classification.  The first item to ascertain is blue light.  Red light lasers do not project very far in the atmosphere.  They attenuate because the wavelength of the red light is equal to the bond length of water, hence the radiation from the source becomes absorbed and becomes radiant heat.  Blue light on the other hand is not absorbed by water, or by most lucent elements, so it projects and shows less attenuation proportional to the inverse square of the distance.   Light emitting diodes can produce blue light of sufficient intensity to use as assay media, so the physician can project blue light through tissue to demarcate structures within or about.  Blue light can project through breast tissue, neck tissue, testicular tissue, and leg tissue and a picture taken by a high resolution camara can show a map of any structure within or without.   Blue light can reveal masses and bone malformations caused by traumatic events or chemical insults and the technic is cheap, painless, and God-fearing.

Home from the store with candy, a smile and her bags as a day tripper.  Dinner is ready and night descends

Who has a temperature, the signs of infection are tumor, rubor and Calor.  Swelling redness and warmth indicate infection without a doubt no matter what the white count, ESR, or CRP say.  Maybe, elegant physicians should use temperature change to elucidate infection or catabolic environments secondary to intoxication. 

The Russians have the best thermal sensitive sensors available, maybe we should ask them for one with a please and thank you.   Plastic planes and cloaking technologies that defuse radar cannot obviate thermal emission from a warplane or ship.  Things can be seen a long way off because radiation only slowly attenuates unless acted upon by an outside force.  As scientists, socked away in a research lab, attached as an appendage to a medical school, they see that cancer produces cold lesions, and infections and autoimmune conditions produce warm lesions.

Putting a Russian thermal sensor over a purported sickness, when pixelated and digitized, produces a map or thermal radiation signature of the affected tissue.  Usually, cancers are well demarcated and infections more diffuse and generalized.   Auto-immune conditions are diffuse and unlocalized.   It is time to beg a commie for a thermal sensor to configure as a scanning device for the people of the nation.   The patient can go home with a picture of their conditions printed on a Hewlett-Packard inkjet printer with 1200 dpm resolution. Que bueno!

The bottom line is money, and America is green and 60 percent Irish.  Begosh and begora.   Now we the people have tests that are cheap, do not kill, do not cause a hospitalization, and the patients can take home the pictures and show their friends and family.   Please end the snake oil and sacred divination of modern-day Medicine and give us something we can really sink our teeth into.  Yes, the pictures can be 3-D rendered on craft paper if necessary, and used as contemporary art.  

For I am a Yankee doodle dandy, Yankee doodle dandy do, strike up the old brass band, salute the red, white and blue.   

From the perch, on the rocks, high above the Aegean Sea, the sea glimmers and sparkles from the refracted sunlight reflecting off the windblown waves.  He looks, and waits, and imagines, that Zeus will demonstrate his power.   The time elapses, then wanes, and he gets up and walks towards the city, and its people, and its power.   The intense sun bleaches his dark hair and he walks in a tunic, with a cape wrapped around his body to protect against the elements. Now she is here, and she appears and stands in the sun with the light illuminating her appearance.  The stands about six feet tall, because the maker wants her strong, her hair is raven black which is common amongst the people here, but her skin is alabaster white, like fresh crème and it accentuates her long thick hair that grows down to her waist. Her eyes are dark-blue grey.   She wears Phoenician cotton, woven into a beautiful tunic of white with blue stripes, in patterns, and a belt secures the fine cotton over her body so that it accentuates her curves rather than covering them and the cloth seems to cling to her body.  Her bosom is large but not too large, and her hips full but not matronly, like Artemis, meant for running and pursuit.   All in all, she is perfect, and to good for him to have.  Her name is justice, and she lives for only one thing, ethos.   When Justice speaks, her voice is commanding and almost hypnotic so that all that behold her must obey and they obey because they want to, not because they are forced to.  This is her gift from the maker.   Her hair is dark and skin white to personify that the law has good and bad aspects, and she is female because females are merciful in a world of men.   The law has evil and godly characteristics, and mortals are reminded that the human condition is not black or white but shades of grey and she is here to interpret and command.   And everyone is forced to do what she says.   She is perfect he thinks and too good for me.    The sun still shines in the Peloponnesian place, and he moves away so not to be entranced by her beauty.   She wears a mask sometimes, because no matter what people look like, they are all the makers children and equal under the law.   She holds a scale to remind mortals, that their works and ways will eventually be evaluated and judged.  He turns away and she waves, and he doesn’t think he sees her wink at him.

They are beautiful seas, the Aegean and Ionian, dancing in blue green color, full of fish and life and home to just and virtuous people, at least for the time being.  She is Justice, and Justice is perfect for all to witness and see

It is beautiful here, and the sun shines, and the sky is blue, gulls fly, and fish jump and it should never end.

He turns upward towards the heavens and exclaims in a loud voice, “Hail Zeus, what wizardry have you besought among mortal men” I AM THESEUS.       

One day, after school, around 2:30 at Valley High, Wrak pulls the chains from a red Suzuki 250 motocross bike set up for street. He puts the chains in his back pack.  A tall person walks towards him from the Parking lot. The person has dark curly hair, sports a Hawaiian shirt, beige corduroy walking shorts and plastic flip flop zories.   The people in these parts call plastic sandals zories because Zorba wears zories and has a pair.  The person waves the classic star trek salute to Wrak and says, “Hello, my name is Lu, want to party this weekend?”   Wrak says, “Are you from around here?”  “I go to Sunni high school on the west side and am visiting a friend here in town.  I have all the stuff necessary to party and I need a shotgun. Are you in?”  “What you got?” inquires Wrak.  Lu points to a brand new Volkswagen Westphalia minivan.  “I even have curtains on all the windows,” says Lu.  “The back seat folds out into a bed big enough for four people. It gets good gas mileage and even has a water tank in case of thirst, but I try to keep the water tank full of Vodka.”  ”Are you joking,” asks Wrak?   “Can I see?”   “Sure,” says the minivan is two tones with a light blue bottom and white top.  All the windows have cute sliding curtains done in beige cotton print.  “Look inside,” says Lu.  The side door slides open with a low metallic groan.  Inside is a huge bed fitted with turquoise vinyl   foam cushions one foot thick.  A small wet bar constructed of stainless steel sits opposite the bed on the driver’s side.  Next to the door is a small closet.  Indian style curtains with beads separate the drivers compartment from the bedroom so that a person can drive and another sleep in back in total privacy. “I have the big 1800 engine.” Says Lu.  “It will do 80 miles an hour and 65 miles an hour up hill.  “How much did this cost,” asks Wrak?   “Six thousand dollars,” says Lu, “six thousand.”  The van is totally custom with an electrical outlet and running water.”  “Unbelievable,” exclaims Wrak.  “If I am in town on Friday, I will stop by and pick you up with some girls.”  “Are you in?”  Whispers Lu “I’m in” says Wrak.  Lu walks slowly to his van door, gets in, starts the engine and drives off slowly.  Wrak waves goodbye and kick starts his motorcycle to ride home.  Friday is three days away.  The sun sets early in tranquil hills because the mountains near the ocean shield the sun during its descent.  The sunsets on the beach are magnificent on a daily basis especially in the spring and summer.  The huge orange supernova orb descends minutely surrounded by   red, yellow and purple strata and Wrak never gets tired viewing them and today is a school day with homework to do, family to visit and dinner to eat before going to bed and early to rise to make a young man healthy, wealthy and wise. The little dog curls up on his cushion and lies on his side and runs and whines as he sleeps like he is chasing rabbits.  Then when you go to see, punkin has gone outside, nowhere to be seen.

     “Be sure you brush your teeth,” says Lu.  Girls do not like grungy teeth.  He is in the classic Hawaiian surfer wardrobe as usual.  My father looks at Lu, Lu looks at my father, and my father looks back at Lu.  My grandmother peeks out from the behind the hall door with one eye and then she is gone. “Let’s go partying,” yells Wrak. “Yes.”  “Party we shall.”  Shotgun in the Van with seatbelts and down Bacon Way past Mellowman’s’s Lane to Market Street and then on Moonrise Blvd. the van hums with tuned exhaust headers and a glass pack muffler.  Lu pulls a gas mask from underneath his seat.  “What is that?” asks Wrak. This is an oxygen mask from a B-17 with a meerschaum pipe secured to its end.  “What do you smoke in it?” asks Wrak.  “Weed,” says Lu, “and Lots of it.” From behind the seat, Lu pulls a 30 gallon black trash bag into the drivers compartment.  The bag is full of something.  The something is Mexican commercial green marijuana, about, two pounds worth.  Lu stuffs some Mexican grass into the meerschaum pipe, secures the gas mask to his head and hands Wrak a Bick Lighter.  “Light me up,” says Lu.  “The police cannot see me smoke anything while I drive,” says Lu.  “I can smoke pot on the freeway.”  Wrak takes the Bick lighter and flames the pipe bowl.  Lu puffs hard inside the mask and smoke jettisons out the side ports like a fire breathing dragon.  The whole cockpit fills with smoke.  “I will smoke a cigarette,” says Wrak.  Lu pulls down his mask and says, “Rag weed.”  I don’t smoke rag weed, only the best.” “The police cannot believe I smoke weed through a B-17 oxygen mask.  They never pull me over.”  He pulls over to a street off the Sunset Boulevard in tranquil hills and stops in front of a residential address.  He honks twice.  Two girls run out from the front door of a house set in lush bushes.  They have light brown hair rendered blond by the sun or peroxide.  Lu says, “This is Joanie and Jennie.  Jennie says she wants to meet you because she likes your surfing. 

       Both girls have hot pants on without nylon stockings, and halter tops set off by tan bikini lines.  They have purses with chain straps.  “Don’t you feel cold,” says Wrak.  “Not at all,” says Jennie, “Not at all.”  “Wrak, get out of shotgun and go sit in back with Jennie.”  “Joanie wants to sit with me.”  Wrak opens the side door, gets out and then unlocks the side door and lets Jennie in.  Wrak and Jennie sit together.  She feels very warm to the touch.  “Would you like a drink,” says Jennie.  “Sure,” says Wrak.  Underneath the wet bar is a refrigerator, Lu says, “Jennie, there is a quart of beefeater gin underneath the sink, break it out, we are partying.”   Jennie obtains a plastic glass from the refrigerator and pours some beer into the glass and hands the cup to Wrak. “Drink all of it,” she says.  “Sure,” says Wrak,” ” I love Coors beer.”  Wrak drinks the cup down in one gulp and burps. “Pardon me,” says Wrak.  “That was really good.” “Here,” says Jennie. “Drink another.”  “I love beer.” Says Wrak.  Night moves in to tranquil hills and Death wood and happy hills.  Wrak never could remember where the party was that night, only that it was fun.  The party location exists somewhere in between the lines.

         The best parties have a live band and a keg of free bear, or three kegs of free beer, or four kegs of free beer and a smoking room.  This party has it all.  Wrak feels high and Jennie asks him to dance.  Wrak starts doing the twist like Chubby checkers and then the swim like Goldie Hahn.   Somehow a strange force throws him on the ground and he becomes the first break dancer in southern California, spinning and sliding on his back.  Jennie squeals with delight.  The night has just begun and the band plays “Gimme shelter,” and “Brown sugar”   and more.  A ton of pretty girls in scanty clothes appeared and now everyone is dancing.  The girls dance. The guys dance.  Kool is here. HP is here with the Doctor’s daughter and night moves into night.  “Let’s sit awhile,” says Wrak.  “Let’s go back to Lu’s Van and listen to the radio,” says Jennie “I left the door open.”  “All right,” says Wrak, “Let’s go.”

“It is more comfortable back here,” says Jennie.  “Why are you closing the curtains,” inquires Wrak.  “So we can have some privacy,” says Jennie.  “Want some more beer,”  “Sure, “says Wrak.  Wrak drinks beer. Wrak drinks beer because the world is incredibly high and colors and textures vivid and exciting. Wrak hopes the beer will cut the buzz that somehow permeates his being.  “I turned on the radio,” says Jennie. “You have a radical bottom turn.”  “What shall we talk about?”

   The door pulls open with ferocity and Lu pulls Wrak off Jennie.  “Get off her you idiot.”  “I was wondering where you two were.”  “I have to get the girls back home by 11:30!  “I don’t know what came over me.” Says Wrak.  Jennie closes the door and composes herself. Lu and Joanie get in the front and start the car.  Wrak and Jennie lean on each other.  Wrak is back on earth and the van hum’s down the highway from Happy Hills to Tranquil Hills to the beginning of rationality and reality.  “See you later girls,” says Lu.  “Bye Wrakie, let’s go party again,” says Jennie.  Wrak waves good bye.  Jennie turns around, puckers her lips and gives the air a slow long kiss, and then they are gone.  “Use the one day delay,” says Lu, “The one day delay.”  “What is the one day delay.” Says Wrak.  “Date them once and do not touch them, the next date they are all over you.”  “I understand,” says Wrak. 

The custom Westphalia sputters off into the night.  Lu has to visit a friend at Saint Elsewhere.  The night is dark and long and quiet and the porch lights on bacon way glimmer sadly and emphatically.  The quiet permeates the seaside atmosphere, and in the quiet broods something unearthly living on the house on the corner.  Wrak opens the front door with his Schlage key.  Grandma stands at the door with punkin sitting next to her standing there.  “You are home,” she says, “thank God.”  Punkin wags his tail and yips with a high note.  “It is fun dancing grandma,” says Wrak.  “It is late, go to bed,” she says. The door is locked and the house of Wrak closes up for the night, tonight and all are home and accounted for and Saturday is today when the sun comes up, Almost like slaughterhouse five.  

Well says Q, the head of the ICU is back from sabbatical, you are free to rotate.   Surgery wants your back, they say you have good hands.   Surgery residency is six days a week with every three days on call, why can’t I work in the outpatient clinic and hand out ampicillin like everyone else says Dr. Wracks.  You passed the boards didn’t you says Q, now you have to work.  I have an alternative autistic choice paradigm says Q, how would you like to spend a couple weeks in the CCU, it is on the same floor, just doors down from the ICU.  It is the same thing, just a Shepard looking over the flocks says Q seriously.   OK says Dr. Wracks, I thought passing the boards would get me my shingle, and it doesn’t.  When do I start.  Right now, says Q, this is my realm and they are already waiting for you.  Tally ho.   

The situation of the ICU is nearly the same as the CCU except the heart monitors are bigger and all the patients are hooked up with electrodes like a Frankenstein movie.   The nurses sit in a nest behind closed doors until they are needed, and the light is fluorescent, buzzing and bright and all the patients are sedated almost to a coma. Physicians like prescribing benzodiazepines.   It is part of the heart thing I guess, says Dr. Wracks.   A cardiologist sits at the bedside of a patient and watches the heart monitor for fifteen minutes at a time.  The sine wave gives the status of the heart patient almost to a T.   If the patients have color, they are surviving, if they don’t a physician must intently evaluate the monitor.  The most important aspect of the EKG is the p wave and time till the QRS or heart contraction.   If the p wave disappears occasionally, the heart doesn’t beat and there exists Mobitz type one phenomena.  If this occurs a problem exists because the sinoatrial node pacemaker is not functioning correctly, and an infarct may exist or there is an electrolyte imbalance.  An adrenergic agent like epinephrine or methamphetamine may correct the anomaly, and if not, cardioversion might be necessary.  Fortunately, this condition does not occur frequently and is most often caused by an overdosage of beta blockers.   This is the main reason why beta blockers should not be used.  If the sinoatrial node depolarizes but the latency time before QRS contraction increases slowly over time a Mobitz type two phenomena exists and this occurs most commonly with an overdosage of Ouabain or other cardiac glycosides.  Cardiac glycosides like Lanoxin while increasing the force of contraction, (inotropism) and rate of contraction (chronotropism), are extremely toxic so their use is indicated for the dying patients of congestive failure so they can get their estate together (6 months).   QRS phenomena usually indicate massive infarct and the prognosis is unfavorable, See the work of Sokolov for details.

For the most of the patients that survive the infarct which for them evidences with T wave inversion, disappearance, or S-T wave anomalies.  It is a good idea to check the monitor a couple of times every shift because a S-T wave depression signifies a developing subendocardial infarct and immediate necessary intervention.

The main drugs of the heart patient are beta blockers, adrenergic agents, cardiac glycosides and ganglionic blockers, all of which are toxic and must be titrated accordingly by body weight.  Beta blockers and procainamide induce cancer, particularly cancer of the pancreas and should not be used.  Morphine is the drug of the dying and the ancient told Dr. Wracks, “it is the angel of the elderly”.  Morphine should be used in excess but the prescription hand delivered by the pharmacist, and signed for,  must be injected by the attending, usually 10mg subcutaneously, because if left to the nursing staff, they will mainline half of it before injecting the patient.  This must be kept in mind.  Bretylium used to be used as a ganglionic blocker for Purkinje system anomalies but are now treated with calcium channel blockers like verapamil, but the slow onset of action and inhibition of the slow C channel is often non-efficacious.  Nicotine, now anathema has an immediate onset of action, short duration of action (two hours) and immediate elimination by the kidneys.  Other drugs exist but it has been fifty years and in the Wracks estimation, all heart patients should be maintained on morphine and nicotine, with injections of Benzedrine if necessary.    It seems overly simplistic and supercilious, but heart patients should be morphine addicts and vape nicotine to survive and shoot Benzedrine if their autonomic pacemaker fails.  Morphine is the angel and it decreases preload to the heart, is histaminic to increase vasodilation, and is negative bathmytropic to eliminate ventricular tachycardia. 

Dr. Wracks sits in front of the monitors and makes notes on the patient chart. The older doctor in a walker comes into the unit and speaks with the nurses. He is making sure the staff does not kill Dr. Wracks.   Dr. Wracks waves hi.,    Thanks to the immediate intervention in triage by the emergency room staff, the CCU is not an exciting place to work and the cardiologists are extremely meticulous and demand compliance because failure of one iota results in death and a malpractice suit.  The next assignment for Dr. Wracks is in pediatrics, screaming kids, vaccinations and liquid ampicillin bottles, but as a bonus Dr. Wracks is placed in Pediatric Oncology and surgical ophthalmic trauma.  

On a south swell the waves move into the point and give a long ride.  The girls are in the briefest bikinis, designed by a talk show host, and the wind at two pm calms down and the waves increase with the upcoming tide.  A beautiful place and a beautiful time in a peaceful era that the Wracks will never know.  Now we have YouTube and the information superhighway and memories can be stored on a flash drive. Memories that will not occur, and the world turns and time goes on.  And so, it goes.  

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.

The heat waves rise from the steam radiators inside the Veterans Administration graduate student housing. Revelry and reverie occur at 6 AM and the public showers lie too far away.  The Wracks settles for a sponge bath, a shave and then a tooth brushing.  The white smock covers the clearance clothes no one sees anyway.  In line at the cafeteria with patients in bedclothes and ragged edges for the sumptuous military repast.  One egg, one piece of toast, a pat of butter, a cup of coffee, and a glass of chocolate milk for desert exists as the morning fare. “Can I have another egg?” asks the Wracks?   The food server looks at him and she says, “No, it will make you fat.”   The Wracks moves on with the other residents in the cafeteria at a bunk table in a large hangar room converted to restaurant. Everyone smokes.  A patient dressed in a bathrobe and jeans comes over to Dr. Wracks and begs for a cigarette.  He gives   him two. He lights one up in front of Wracks, smiles, sticks the other over his ear on the side of his head, blows a smoke ring and moves on.  We meet today in the main observation area at seven hundred hours.

       Schizophrenics do not seem so bad.  For the most part they look the same as normal people, smile and wave to the Doctors as we come in.  There are exceptions.  The exceptions have private suites for everyone’s safety.   Dr. Lecter introduces me to a Viet Nam Veteran who is cross dresser and sits immobile for prolonged periods of time.  He is the one that broke Dr. Sheldon’s nose.  This patient is an afro American on the gaunt side.  He wears a long evening gown with a pearl necklace and earrings.   His hair is cut short Marine style.  Mr. O, this is Dr. W and he will be interviewing you today.  Should I have an absence, he will be the one interfacing with you. 

    “Hello Mr. O.   My name is Dr. W. How are you today?”

Silence

“Mr. O, be at liberty to tell me if your medication is correct and you feel well each day.  Should you desire more or less, let me know.  If your jaw clenches tight, let me know.  If you can not sit still, let me know.”

Silence

Mr. O smiles at me and says “I like you.  I hear you have good hands.”  Dr. W says, “thank you for the compliment.  If you have anything else to say or want me to write in my notes please speak now.”

Silence

“Good day Mr. O, I will see you tomorrow around the same time.”

“Bring me some cigarettes,” he says. “I like Marlboro too.”  “I will not forget,” says Dr. W.  Dr. W slowly, slowly, slowly rises from the interview chair and moves backwards keeping an eye on the patient at all times without maintaining direct eye contact. 

“What do you think about Mr. O?’ says Dr. Lecter.  “Undifferentiated, with catatonia and lack of affect.”  “That is what I think too.” Smiles Dr. Lecter.  “Now I want you to meet Mr. M.  Mr. M. is a chronic patient with catatonic schizophrenia.  He rarely moves in the presence of anyone.  The reason he is a chronic patient is because he likes to hang from the ceiling and fall on people.  He is a violent offender.  In his presence, move slowly and never ever take your eye off his body until you lock the ward door with your key.  Back away from him and never let him get between you and the door. When the lock clicks on the door, then you can turn away.”   Mr. M. sits in a chair, alone in a room covered with white bed sheets.  One arm hangs down low and the other is wrapped around his neck.  He does not move.  Like a statue, he sits there and does not move.  His breathing is imperceptible and his eyes never blink.   “How are you Mr. M.,” says Dr. Lecter.  Silence.   “If there is anything, I can do for your please let me know.” Says Dr. Lecter.  Silence.  “We are leaving now.  See you tomorrow.”  Silence.  We both back away to the door and Dr. Lecter takes the key hanging on his neck while the Wracks view the patient and opens the door.  As we slip outside the Wracks hears, “Goodbye.” From Mr. M.  When the door lock clicks he looks into the room from the observation window above the door handle.  Mr. M. has moved.  Both of his arms lay at his sides as if in preparation for a leap.  The chair has moved a quarter of a circle towards us.   All this happened in ten milliseconds of time.   “Let me remind you to never let him get between you and the door.”  The wracks nods and say, “I understand.”   “Let me now introduce you to a football player who occasionally becomes violent. He is a famous defensive lineman.  When he gets mad he picks up whoever angers him and throws them through a window like a softball.  Do not make him mad.  The reason he is here now is because he threw his wife and her family out a three story window into the street. I maintain him on an indoleamine alkaloid antipsychotic agent called Moban.  Use this drug for violent patients.  Moban works well.”  Mr. G. is a large afro American about six four or six five in height and extremely muscular.  He is famous for tackling fast running backs and hurting them.  “Hello Mr. G. how is you today?”  Mr. G says, “Fine, I like my Moban.  When can I go home?”  “When you are stable, we will send you home Mr. G.” says Dr. Lecter.   “I hope that is soon,” says Mr. G.  He pulls a cigarette from a package on his front pocket, lights it, takes a long inhale, blows it out and says. “See you later.”  He then walks towards the television set and watches the broadcast standing while smoking his cigarette.  “Interview your patients every day, write notes and advise me if a change occurs.”   “Do not change their medication without asking me.”  Says Dr. Lecter.   “See you tomorrow. I have to meet some private patients in my in town office says Dr. Lecter.  He walks off seamlessly and disappears into his office as the door clicks shut. We have missed lunch so the wracks go back to my room and review his notes and read again the notes Dr. Lecter presented to the group. He will see my comrades at six in the dinner line.  We all are dispersed in the many wards and places around the Veterans facility. Dr. Wracks locks himself into my little room and smokes.  I do not want to miss dinner.  Winter still exists outside and the cold seeps in through the cracks in the insulation.  The steam radiator radiates heat and a light mist escape from the relief valve on top of the unit.  Dr. Wracks has learned to quick dry shoes and underwear on the steam radiators. he pulls the reading lamp close to his face to illuminate the pages of my notes, his notes and medical texts.  Time goes by quickly and it is time to get the one plus one plus one dinner.  Main course plus a vegetable plus a starch and cool aid from the huge beverage coolers.   Food tastes good and tastes even better when a person is hungry.  Tomorrow will occur soon enough. He does not want to provoke it.  Now at night in Pookipsie, upstate, ensconced on the road to a career and maybe a new beginning, Dr. R sits by himself with his reading light and cigarettes.

Remember says Dr. Lecter, Proscribe your anti-Psychotic agents with side effects opposite to the patient’s overt behavior, not their diagnosis. If a patient gets violent administer 100mg of Benadryl I.M.   See you tomorrow.