Month: January 2017

Folks:

I registered some domains so long ago that the registrar is Network Solutions, which was somewhat expensive in the old days but now has cranked up their prices to crazy expensive. I might just give up the domain, which I’m not using: clickthrough.net. Back in the mid-1990s, it seemed like measuring clicks from one domain to another would be exciting (see the User Tracking chapter of Philip and Alex’s Guide, for example). But who is even aware of this now?

I can’t remember anyone ever inquiring to purchase this domain. That means it is worthless, right?

Can I park this worthless domain somewhere for $10? Or should I just let it expire?

Thanks in advance!

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Have you seen reports in the media of an ill-bred president whose sexual habits and choice of spouse excite gossip and disapproval? According to White Trash: The 400-Year Untold History of Class in America, we already had one: Andrew Jackson, from 1829-1837.

Given that his initial support in the 1824 campaign came from Alabama, Mississippi, North Carolina, and Tennessee, Jackson was derided for having cornered the cracker vote.

Jackson partisans were routinely chastised for their lack of taste and breeding.

The candidate’s private life came under equal scrutiny. His irregular marriage became scandalous fodder during the election of 1828. His intimate circle of Tennessee confidants scrambled to find some justification for the couple’s known adultery. John Overton, Jackson’s oldest and closest friend in Nashville, came up with the story of “accidental bigamy,” claiming that the couple had married in good conscience, thinking that Rachel’s divorce from her first husband had already been decreed. But the truth was something other. Rachel Donelson Robards had committed adultery, fleeing with her paramour Jackson to Spanish-held Natchez in 1790. They had done so not out of ignorance, and not on a lark, but in order to secure a divorce from her husband. Desertion was one of the few recognized causes of divorce.62 In the ever-expanding script detailing Jackson’s misdeeds, adultery was just one more example of his uncontrolled passions. Wife stealing belonged to the standard profile of the backwoods aggressor who refused to believe the law applied to him. In failing to respect international law, he had conquered Florida; in disregarding his wife’s first marriage contract, he simply took what he wanted. Jackson invaded the “sanctity of his neighbor’s matrimonial couch,” as the Ohio journalist Charles Hammond declared.63 All sorts of vicious names were used in demeaning Rachel Jackson. She was called an “American Jezebel,” “weak and vulgar,” and a “dirty black wench,” all of which pointed to her questionable backwoods upbringing. It was pro-Adams editor James G. Dana of Kentucky who luridly painted her as a whore. She could no more pass in polite company, he said with racist outrage, than a gentleman’s black mistress, even if the black wench wore a white mask. Her stain of impurity would never be tolerated among Washington’s better sort. Another unpoliced critic made a similar argument. Her crude conduct might belong in “every cabin beyond the mountains,” he wrote, but not in the President’s House.64 Even without the marriage scandal, Rachel Jackson had the look of a lower-class woman. One visitor to the Jacksons’ home in Tennessee thought she might be mistaken for an old washerwoman. Another described her as fat and her skin tanned, which may explain the “black wench” slur. Whiteness was a badge of class privilege denied to poor cracker gals who worked under the sun. Critics laughed at Mrs. Jackson’s backcountry pronunciation; they made fun of her favorite song, “Possum Up a Gum Tree.” She smoked a pipe. Alas, Rachel Jackson succumbed to heart disease shortly before she was meant to accompany her husband to Washington and take up her duties as First Lady.

President Jackson helped popularize the title phrase:

Though “white trash” appeared in print as early as 1821, the designation gained widespread popularity in the 1850s. The shift seemed evident in 1845 when a newspaper reported on Andrew Jackson’s funeral procession in Washington City. As the poor crowded along the street, it was neither crackers nor squatters lining up to see the last hurrah of Old Hickory. Instead, it was “poor white trash” who pushed the poor colored folk out of the way to get a glimpse of the fallen president.

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During my annual visit to the gym today I saw Jeff Sessions being grilled about his suitability for the job of Attorney General. I had never been previously aware of the guy and hadn’t seen him on TV before today so I don’t have an opinion as to his fitness for the job. My stupid political question for today is why would he want to switch from senator (making the law) to Attorney General (enforcing whatever laws the Senate happens to make).

Wikipedia says that he has been a senator for 20 years. Thus boredom is a potential explanation. But what else? What is so great about being Attorney General that a senator would want to quit?

[Also at the gym, I overheard a woman talking to her personal trainer about how she had recently ended a 35-year friendship with another woman. Why? It seems that the long-time friend had refused to support Hillary Clinton. “She just doesn’t see that Trump’s attitude will trickle down to everyone,” said the exerciser. I also met a guy with a remarkably lifelike portrait of a long-haired woman on his calf. It was at least as detailed as a Wall Street Journal hedcut. He’d gotten it before getting married down in Texas, 15 years earlier: “fortunately I still like my wife.” He moved up here just two months ago. Let’s hope that the difference in profitability for a plaintiff under Massachusetts family law compared to Texas family law doesn’t motivate his wife to make a trip down to the courthouse! (Papers referenced from the Causes of Divorce chapter show how changes in the prevailing law can make people more or less likely to sue for divorce.)]

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From our anonymous insider…

Sonographers and clinicians demonstrated echocardiography. The ultrasound radiologist said, “This will be the moment everyone is captivated by ultrasound.” She was not wrong as we gazed at our hearts in action. Echos are a fantastic way to noninvasively get a snapshot of the heart. My classmates loved using the “color doppler” feature to visualize the blood flow in and out of the different heart chambers. Due to Doppler effect, blood flowing towards the transducer compresses the sound waves and thus reflects sound at a higher frequency; blood flowing away from the transducer stretches the sound waves and thus reflects at a lower frequency.

Lectures continued on cardiac output and numerous regulatory mechanisms of the cardiovascular system. Cardiac output is governed by metabolic demands of the body. I was fascinated by the principle of “peripheral vessel capacitance”. Arterioles (small arteries) conduct rather than store blood. Arteriole smooth muscle tone determines the resistance of these rigid tubes by changing the diameter. Venules (small veins) are slack by comparison due to high levels of elastic fibers and the low amount of smooth muscle in their walls. Arterioles and venules behave as a combination of resistors and capacitors for blood. Venules collectively are a massive reservoir of blood. A sudden increase in cardiac output and increased blood pressure can be handled by charging the venule reservoir rather than by returning venous blood to the heart. In the event of a hemorrhage, the vessels will discharge to maintain arterial blood pressure. Smooth muscle contraction of the arteries increases resistance and thus decreases flow, whereas smooth muscle contraction of the venous system leads to a decrease in capacitance and increased flow. It seems to me most blood pressure research and pharmacological intervention is focused on manipulating arterial muscle tone. I wonder how venous tone may be dysregulated in pathologies such as hypertension? (see “How changes in venous capacitance modulate cardiac output”, Tyberg 2002)

The patient case involved a late-50s male who suffered a heart attack. “Jack” was also a type 1 diabetic diagnosed at an early age. He lost his financial industry job in 2009, along with his insurance, then had a heart attack a month later. During his week in the hospital, physicians put him into a medically-induced coma, which the patient said saved his brain function (because an awake brain would place a greater demand on the injured heart?). He recovered well and is back to work in a “less-stressful” job. The enormous bill was paid in full by a charitable organization associated with the hospital.

Due to his chronic condition, type 1 diabetes, he deals with nearly a dozen specialists, including an internist, rheumatologist, cardiologist and endocrinologist. He prioritises his cardiologist’s’ recommendation over treating his joint pain from type 1 diabetes after his rhematologist recommended he switch to a drug which his cardiologist vehemently opposed putting him on. Jack complains that he does not know how his heart is doing now. He lives with perpetual uncertainty. He knows he should lose 15-20 pounds. The cardiologist said the tests that might shed light on the heart’s condition are not economically justified. When Jack mentioned his concern, the cardiologist said, “the question for patients after the first heart attack is not if, it is when, the next heart attack will be.”

A quirky neurosurgeon presented his research interests to the class. He opened with, “Fracking will save neurosurgery!” He explained that neurosurgery involves an astronomically expensive procedure that, even when successful, frequently results in disabled individuals who cannot support themselves. “If a bomb went off at the neurosurgery conference, public health would not be affected. Only rich economies can support such a field.” His research dream is to find a neurosurgery procedure that has an actual economic benefit. This lecture was a good reminder that a country’s GDP is not a great measure of a country’s wealth; if everyone gets diabetes the GDP will go up from increased health care spending, but the average American will certainly not be better off.

Next, an ENT specialist described her interest in hearing loss. The ear is a masterful mechanical device that focuses sound waves and transmits it to a circular fluid drum called the cochlea. Sound energy hitting the ear vibrates the fluid inside the cochlea. Specialized nerve cells innervate the cochlea bearing tiny hair projections into the fluid that deform at pre-set frequencies. These nerve cells send this signal this information to create the sense of sound. Medicine now has the ability to implant artificial cochleas. Our ENT lecturer was trying to determine at what age these prosthetics should be implanted to get the best hearing outcome. She presented a case in which one sibling got an implant at age 3 and is now more or less normal while the sibling who also lost hearing at age 2 but didn’t get the implant until age 6 is struggling with both hearing and speech. She is able to surgically implant these devices without having done the grueling general surgery residency and also treats adults, thus breaking what we were told are the rules for choosing a specialty: (1) to cut or not to cut, and (2) do I like kids?

Statistics for the week… Study: 15 hours. Sleep: 7 hours/night; Fun: 1 night. Example fun: Double date with 24-year old classmate and his wife who is studying to become a physician’s assistant, followed by drinks at the new taco/tequila bar.

The Whole Book: http://tinyurl.com/MedicalSchool2020

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White Trash: The 400-Year Untold History of Class in America by Nancy Isenberg is brilliantly-titled to capture the Zeitgeist of the recent election. The author teaches “U.S. Women’s History” at Louisiana State University and the book is an interesting window into contemporary American academic thinking.

Some background:

British colonists promoted a dual agenda: one involved reducing poverty back in England, and the other called for transporting the idle and unproductive to the New World. After settlement, colonial outposts exploited their unfree laborers (indentured servants, slaves, and children) and saw such expendable classes as human waste. The poor, the waste, did not disappear, and by the early eighteenth century they were seen as a permanent breed.’

Long before they were today’s “trailer trash” and “rednecks,” they were called “lubbers” and “rubbish” and “clay-eaters” and “crackers”—and that’s just scratching the surface.

Here was England’s opportunity to thin out its prisons and siphon off thousands; here was an outlet for the unwanted, a way to remove vagrants and beggars, to be rid of London’s eyesore population. Those sent on the hazardous voyage to America who survived presented a simple purpose for imperial profiteers: to serve English interests and perish in the process.

The colonists were a mixed lot. On the bottom of the heap were men and women of the poor and criminal classes. Among these unheroic transplants were roguish highwaymen, mean vagrants, Irish rebels, known whores, and an assortment of convicts shipped to the colonies for grand larceny or other property crimes, as a reprieve of sorts, to escape the gallows. Not much better were those who filled the ranks of indentured servants, who ranged in class position from lowly street urchins to former artisans burdened with overwhelming debts. They had taken a chance in the colonies, having been impressed into service and then choosing exile over possible incarceration within the walls of an overcrowded, disease-ridden English prison. Labor shortages led some ship captains and agents to round up children from the streets of London and other towns to sell to planters across the ocean—this was known as “spiriting.” Young children were shipped off for petty crimes. One such case is that of Elizabeth “Little Bess” Armstrong, sent to Virginia for stealing two spoons.

It remained difficult to find recruits who would go out and fell trees, build houses, improve the land, fish, and hunt wild game. The men of early Jamestown were predisposed to play cards, to trade with vile sailors, and to rape Indian women.

A variety of efforts were made to help foster a middle-class society, but they failed in the agricultural areas due to differential accumulation of land.

Unique among the American settlements, Georgia was not motivated by a desire for profit. Receiving its charter in 1732, the southernmost colony was the last to be established prior to the American Revolution. Its purpose was twofold: to carve out a middle ground between the extremes of wealth that took hold in the Carolinas, and to serve as a barrier against the Spanish in Florida. As such, it became the site of an unusual experiment. Conservative land policies limited individual settlers to a maximum of five hundred acres, thus discouraging the growth of a large-scale plantation economy and slave-based oligarchy such as existed in neighboring South Carolina. North Carolina squatters would not be found here either. Poor settlers coming from England, Scotland, and other parts of Europe were granted fifty acres of land, free of charge, plus a home and a garden. Distinct from its neighbors to the north, Georgia experimented with a social order that neither exploited the lower classes nor favored the rich. Its founders deliberately sought to convert the territory into a haven for hardworking families. They aimed to do something completely unprecedented: to build a “free labor” colony. According to Francis Moore, who visited the settlement in its second year of operation, two “peculiar” customs stood out: both alcohol and dark-skinned people were prohibited. “No slavery is allowed, nor negroes,” Moore wrote. As a sanctuary for “free white people,” Georgia “would not permit slaves, for slaves starve the poor laborer.”

Georgia also instituted a policy of keeping the land “tail-male,” which meant that land descended to the eldest male child. This feudal rule bound men to their families. The tail-male provision protected heirs whose poor fathers might otherwise feel pressure to sell their land. Many settlers disliked the practice. Hardworking families worried about the fate of their unmarried daughters, who might be left with nothing. One such complaint came from Reverend Dumont, a leader of French Protestants interested in migrating to Georgia. What would happen to widows “too old to marry or beget children,” he asked. And how could daughters survive, especially those “unfit for Marriage, either by Sickness or Evil Construction of their Body”?

Oglethorpe was fighting a losing battle. Many of the men demanding slaves were promised credit to buy slaves from South Carolinian traders. Slaves were a lure, dangled before poorer men in order to persuade them to put up their land as collateral. That is why Oglethorpe believed that a slave economy would have the effect of depriving vulnerable settlers of their land. Keeping out slavery went hand in hand with preserving a more equitable distribution of land. If the colony allowed settlers to have “fee simple” land titles (so they could sell their land at will), large-scale planters would surely come to dominate. He predicted in 1739 that, left to their own devices, the “Negro Merchants” would gain control of “all the lands in the Colony,” leaving nothing for “all the laboring poor white Men.”

In 1750, settlers were formally granted the right to own slaves. … A planter elite quickly formed, principally among transplants from the West Indies and South Carolina. By 1788, Carolinian Jonathan Bryan was the most powerful man in Georgia, with thirty-two thousand acres and 250 slaves. … By 1760, only 5 percent of white Georgians owned even a single slave, while a handful of families possessed them in the hundreds.

18th century Americans, including Benjamin Franklin, wanted white settlers to have as many kids as possible so as to build a larger labor force. On the other hand, people didn’t see the point of a welfare state plus a larger population to feed:

Franklin was not sympathetic to the plight of the poor. His design for the Pennsylvania Hospital in 1751 was intended to assist the industrious poor, primarily men with physical injuries. The permanent class of impoverished were not welcome; they were simply shooed over to the almshouse. He felt the English were too charitable, an opinion he based on observing German settlers in his own colony, who worked with greater diligence because they came from a country that offered its poor little in the way of relief. When he talked about the poor, he sounded like William Byrd. In complaining about British mobs of the poor that raided the corn wagons in 1766, he charged that England was becoming “another Lubberland.” Most men wanted a “life of ease,” Franklin concluded, and “freedom from care and labor.” Sloth was in itself a form of pleasure. This was why he contended that the only solution to poverty was some kind of coercive system to make the indigent work: “I think the best way of doing good to the poor, is not making them easy in poverty, but leading or driving them out of it.” The poor’s instinct of being “uneasy in rest” had been impaired; so what they needed was a jolt (of electricity?) to work again.

To be continued…

 

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Folks who are experts on ePub and .mobi format… would you mind test-flying an eBook version of Real World Divorce? The web version is derived in semi-real-time from Google Docs (with multiple simultaneous co-authors a convenient collaboration environment was important). It turns out that Google Docs turns out some crazily complex HTML. We strip out some of that for the web version and try to strip more of it with a Perl script for the ePub.

So far it seems to be readable with Calibre and Kindle for PC.

Here are links to the current versions of the files:

• ePub
• .mobi

Any feedback/corrections/etc. welcomed.

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The revamped Honda Odyssey (2018) has been announced: Automobile. Here’s the part that caught my eye:

Honda claims the new minivan will also be quietest in class, with triple door seals, acoustic glass, and generous noise attenuation. This makes for easy conversation between first, second, and third rows, says Andrea Martin, principal engineer and lead for noise, vibration, and harshness for the Odyssey.

I would have preferred to see Ms. Martin quoted with a dBA number. Successive generations of minivans are touted as “quiet” and “library-like” but don’t seem to be any quieter inside than my 1998 Toyota Sienna was. Maybe this time the improvement will be real?

Another fun part of the article:

Cabin Watch is fed through a new, 8-inch high-resolution (720P) audio screen, which also features customizable app titles and Apple CarPlay and Android Auto.

A connected rear entertainment system offers streaming video on a ceiling-mounted, 10.2-inch WSVGA Rear Entertainment System…

WSVGA is 1024×576 pixels. 720P is 1280×720 pixels (as featured on this $60 unlocked mobile phone and also used as a resolution for some baby monitors). Where is Honda finding these absurdly low-res screens? Is there some kind of vintage LCD factory run by Korean hipsters who spend half the day brewing craft beer?

Separately, would it be wise to lease any car acquired in 2017? If electric cars or self-driving cars are perfected the value of a used conventional car will plummet, right? This possibility doesn’t seem to be priced into lease residual values.

Related:

• my review of the 2011 Toyota Sienna
• my review of the 2011 Honda Odyssey

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… then reading The Elementary Particles by Michel Houellebecq should push you over the edge.

In a previous posting I excerpted passages about the protagonist going to a hippie campground. What do they do there?

To his right a fat, sallow, gray-haired woman with thick glasses breathed noisily. She reeked of wine and it was only ten-thirty. … “You feel like that . . .” said the yogi, “you feel like that because you haven’t mastered your negative energy. I can feel deep, powerful desires within you. We can help you—here and now. Let’s all stand and focus the energies of the group.” Everyone stood, joined hands and formed a circle. Reluctantly, Bruno took the hands of the old bag on his right and a revolting little bearded man who looked like Cavanna. Her whole being focused but calm, the yogi uttered a long “Om” and they were off, everyone droning “Om” as if they’d been doing it all their lives. Bruno was gamely trying to join in the resounding harmony when he suddenly felt himself pitch to the right. Hypnotized, the fat hag was toppling like a stone. He let go of her hand but was unable to break his fall and found himself on his knees in front of the old bitch, now flat on her back and writhing on the mat.

He had a brief glimpse of [the “liberating the voice” workshop] as he walked up to the massage workshop: there were about ten of them, very excited, jumping around to the directions of the Tantric woman and screeching like startled turkeys.

He fails to impress a woman or the Brazilian Tourism Council:

Are you from Brittany?” he asked. “Yes—from Saint-Brieuc!” she replied happily. “But I really like Brazilian dance,” she added, obviously trying to absolve herself for her disinterest in African dance. Much more of this and Bruno would really get irritated. He was starting to get pissed off about the world’s stupid obsession with Brazil. What was so great about Brazil? As far as he knew, Brazil was a shithole full of morons obsessed with soccer and Formula One. It was the ne plus ultra of violence, corruption and misery. If ever a country were loathsome, that country, specifically, was Brazil. Sophie,” announced Bruno, “I could go on vacation to Brazil tomorrow. I’d look around a favela. The minibus would be armor-plated; so in the morning, safe, unafraid, I’d go sightseeing, check out eight-year-old murderers who dream of growing up to be gangsters; thirteen-year-old prostitutes dying of AIDS. I’d spend the afternoon at the beach surrounded by filthy-rich drug barons and pimps. I’m sure that in such a passionate, not to mention liberal, society I could shake off the malaise of Western civilization. You’re right, Sophie: I’ll go straight to a travel agent as soon as I get home.”

The characters say a lot of the same stuff as the academic author of Sapiens, but a decade earlier and more succinctly:

On 14 December 1967 the government passed the Neuwirth Act on contraception at its first reading. Although not yet paid for by social security, the pill would now be freely available in pharmacies. It was this which offered a whole section of society access to the sexual revolution, which until then had been reserved for professionals, artists and senior management—and some small businessmen. It is interesting to note that the “sexual revolution” was sometimes portrayed as a communal utopia, whereas in fact it was simply another stage in the historical rise of individualism. As the lovely word “household” suggests, the couple and the family would be the last bastion of primitive communism in liberal society. The sexual revolution was to destroy these intermediary communities, the last to separate the individual from the market. The destruction continues to this day.

Children existed solely to inherit a man’s trade, his moral code and his property. This was taken for granted among the aristocracy, but merchants, craftsmen and peasants also bought into the idea, so it became the norm at every level of society. That’s all gone now: I work for someone else, I rent my apartment from someone else, there’s nothing for my son to inherit. I have no craft to teach him, I haven’t a clue what he might do when he’s older. By the time he grows up, the rules I lived by will have no value—he will live in another universe. If a man accepts the fact that everything must change, then he accepts that life is reduced to nothing more than the sum of his own experience; past and future generations mean nothing to him. That’s how we live now. For a man to bring a child into the world now is meaningless.

That last paragraph represented a best-case scenario for Houellebecq’s character. What about his actual situation?

After divorce—once the family unit has broken down—a man’s relationship with his children is nonsensical. Kids are a trap that has closed, they are the enemy—you have to pay for them all your life—and they outlive you.”

Could we bring Houellebecq over here to help the LGBTQ community deal with the impending threat of King Donald I’s coronation?

Bruno thought, people are wrong to talk about homosexuals. He had never—or very rarely—met a homosexual; on the other hand, he knew a great many pederasts. Some pederasts—thankfully, very few—prefer little boys; they wind up in prison for a long stretch and no one ever talks about them again. Most pederasts, however, are attracted to youths between fifteen and twenty-five. Anyone older than that is, to them, simply an old, dried-up asshole. Watch two old queens together, Bruno liked to say, watch them closely: they may be fond of each other, they may even be affectionate, but do they really want each other? No. As soon as some tight fifteen-to-twenty-five-year-old ass walks past, they will tear each other apart like panthers; each will rip the other to pieces just for that tight little ass—so Bruno thought. In this, as in many things, homosexuals had led the way for society as a whole, Bruno figured. Take him, for example—he was forty-two years old. Did he want women his own age? Absolutely not. On the other hand, for young pussy wrapped in a miniskirt he was prepared to go to the ends of the earth. Well, to Bangkok at least. Which was, after all, a thirteen-hour flight.

ACT UP activists thought it was important to run ads which others thought pornographic, depicting homosexual practices in close-up. Their lives seemed busier and more fulfilled, full of exciting incident. They had multiple partners, fucked each other in back rooms; sometimes the condom split or slipped off and they died of AIDS. Even then their deaths seemed radical, dignified. Television gave lessons in dignity, especially TF1. As a teenager, Michel believed that suffering conferred dignity on a person. Now he had to admit he had been wrong. What conferred dignity on people was television.

Is there any hope for our planet and species? Maybe…

Thirty years later he could not come to any other conclusion: women were indisputably better than men. They were gentler, more affectionate, loving and compassionate; they were less prone to violence, selfishness, cruelty or self-centeredness. Moreover, they were more rational, intelligent and hardworking. What on earth were men for, Michel wondered as he watched sunlight play across the curtains. In earlier times, when bears were more common, perhaps masculinity served a particular and irreplaceable function, but for centuries now men clearly served no useful purpose. For the most part they assuaged their boredom playing tennis, which was a lesser evil; but from time to time they felt the need to change history—which basically meant inciting revolutions or wars. Aside from the senseless suffering they caused, revolutions and wars destroyed the best of the past, forcing societies to rebuild from scratch. Without regular and continuous progress, human evolution took random, irregular and violent turns for which men—with their predilection for risk and danger, their repulsive egotism, their irresponsibility and their violent tendencies—were directly to blame. A world of women would be immeasurably superior, tracing a slower but unwavering progression, with no U-turns and no chaotic insecurity, toward a general happiness.

More: read The Elementary Particles

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From our anonymous insider..

“I thought I was in a nightmare,” one classmate wailed the day after election day. Every classmate seems to have voted, but none openly support Donald Trump. Type-A Anita held a class election party at her apartment with “I’m with Her” plastered on every wall. One classmate commented about the ease of registering to vote in a new state. He used an out-of-state ID as proof of identity but never had to show any proof of residence: “I just typed my address into the online voter portal. They never requested a utility bill, or anything. The bouncer at Friday’s bar looked at my ID more closely than the election volunteer.” Jane and I left before the results were in, but the mood of our hostess gradually darkened.

On post-election Wednesday, our class president sent a GroupMe message to the class: “If anyone would like to talk about last night’s election, please reach out to myself or the VP.” I stopped to join a conversation among three students in the hall. A proudly gay student said, “I always believed most people thought like me. I feel so alone. I don’t feel safe. I never realized how many racists there are in America.” I asked him what he thought about Peter Thiel’s speech at the RNC? He had never heard of Peter Thiel. A rural West Virginian said that her entire family supports Trump, but she cannot. She described half of American voters as “brainwashed over guns,” but said she still loves her family.

At our monthly journal club, where an instructor leads a six-person discussion of an academic paper, a student asked to be excused to make a phone call. The female biophysicist replied, “Well, apparently, anything goes now. Why not? Go ahead.” I chuckled, but Anita began to cry and excused herself.

Anatomy lab was not as exciting as last week: a short dissection, mostly identifying different structures that had not yet been removed from the thoracic cavity. We observed the descending aorta as it passes through the diaphragm into the abdominal cavity. One cadaver had an enlarged aorta, many had plaque build-ups. We observed the venous drainage system including the azygos and hemiazygos veins that drain the thoracic wall. We compared this system among cadavers and noticed the immense amount of normal variation. Some cadavers have the hemiazygos system drain the entire left thorax into the azygos vein, a tributary to superior vena cava. Another variant had divided drainage basins with some going to the azygos system and some draining into the left subclavian vein. One cadaver had a visibly enlarged azygous vein. The trauma surgeon immediately started looking for deep venous thrombosis (DVT). If a large vein in the leg is occluded, the azygos vein acts as collateral circulation, partially bypassing the blockage. We could not find any blockage.

We also observed the paravertebral ganglia column, a fascinating bunch of neurons that run on either side of the vertebrae. These sympathetic nerves have their cell body, e.g., nucleus, in the spinal cord but their axon exits the vertebrae and runs parallel alongside the vertebral column. It was small and easily mistaken for connective tissue. An instructor complimented our group for identifying this nerve!

Lectures featured a pediatric cardiologist. The whole class quickly fell in love with her three decades of stories about saving babies with congenital heart defects. Congenital heart defects, such as atrial septal defects (ASD), ventricular septal defects (VSD) and patent ductus arteriosus (PDA), are not uncommon. She explained these in the context of embryological heart development. Fetal circulation is quite different than after a child’s first breath. The fetus uses hemoglobin with a higher oxygen affinity to steal oxygen bound to the mother’s hemoglobin.

Most fetal blood bypasses the pulmonary circulation of the lung through the ductus arteriosus, a shunt between the pulmonary artery and aorta. The ductus arteriosus typically closes within a few hours to days after a baby’s first breath. However, if the ductus arteriosus fails to close, the PDA could lead to severe hypoxia, heart development problems and death. Cardiothoracic surgeons can now close this using a catheter guidewire system instead of open heart surgery. Frequently the PDA patient has other heart defects that require more invasive surgery. Babies with an ASD, VSD, or PDA can live completely normal lives once this is fixed. She concluded by showing the class pictures of her “extended family”.

The patient case followed the story of a baby with an exceedingly rare genetic disorder. Based on an ultrasound, physicians determined that “Kate” would never be able to talk, and would suffer from severe neurological impairment. Only fifty percent of babies with this disorder do not make it to birth, and a mere five percent make it to one year of age. Physicians advised her parents to terminate the pregnancy. The parents refused, “She deserved a fighting chance. Her fight was between herself and Him (pointing up to the sky).”

An early C-section saved Kate and the mother. Kate was then whisked off to the infant operating room to begin work on her full range of birth defects. These would include several life-threatening heart defects, respiratory distress and terrible GI troubles. She was placed on extracorporeal membrane oxygenation (ECMO) which functions as the baby’s lungs and heart. The father broke down when he recounted his memory of this machine. Each ECMO machine has a lever attached. In the event the power goes out at the hospital, he would have to crank the lever to continue pumping oxygenated blood into Kate.

Now seven years old, Kate is fed using a G-tube and is unable to speak words. However, she can smile, laugh, and walk with assistance. Kate enjoys playing with her two younger, but already bigger, siblings. Medicaid pays for a daily caretaker to assist the parents. One classmate asked, “What are your hopes for Kate.” The parents responded, “Kate has surpassed everything we hoped for. We were told she wouldn’t survive the pregnancy. She did. We were told she wouldn’t survive past the age of one. Every additional day is a blessing.”

Statistics for the week… Study: 15 hours. Sleep: 7 hours/night, still staying at Jane’s; Fun: 1 outings. Example fun: Dinner party with Jane’s family.

The Whole Book: http://tinyurl.com/MedicalSchool2020

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A friend recently shelled out $105,000 for a Mercedes GLS 550. We took it on a proving run through the rugged terrain for which it was designed (i.e., to the Natick Mall).

There are some dedicated buttons on the dashboard, e.g., for climate control and audio volume. Then there is what looks like an Android tablet stuck on top of the dash. This is where most of the car’s functions, including navigation, are controlled. If you’ve ever used a smartphone you’ll be completely confused by this tablet because it isn’t a touchscreen. A trackpad/trackball-like controller is down by the driver’s right hand.

The navigation database in this brand-new car didn’t know about the Total Wine, which opened more than a year ago. We used Google Maps on our phones to get the address. It took my friend three tries to get the address into the Mercedes via the voice interface.

One inherently confusing thing about the system is that most things, but not everything, are controlled from the big screen. Everything having to do with climate control is on dedicated buttons. Only some stuff related to audio, however, is on dedicated buttons.

Given the importance of navigation to the typical driver, an actual Android tablet or iPad stuck on the top portion of the dashboard would have been much more useful. Maybe Mercedes would want to tweak the software a little to enable control of the seat massage feature, etc. And maybe they’d have to redo the mechanical adapter every two or three years to adapt to new Android/iOS tablets. But it would be cheaper and better for everyone, I think.

• Smug, Rich Bastard for a Weekend (Tesla X review)
• Tesla X big-screen navigation

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