Californians: assorted humans with nothing in common

by philg

Readers will be familiar with repeated questions of how our asylum-based immigration system is supposed to work. People are invited to become U.S. residents and then citizens based on a fear of violence in their country of birth. Thus, immigrants to the U.S. may have no affinity for the U.S. and nothing in common with other immigrants or natives other than a desire to avoid being killed.

Let’s see how this is playing out in California, the U.S. leader in diversity via immigration (stats below). A native-born Jew disagreed with a Muslim immigrant and the Jew ended up dead (Wikipedia).

Paul Kessler was an instrument-rated Private pilot. I couldn’t find much else that was authoritative about him.

Loay Alnaji (from a memory-holed web page at Ventura County Community College; pulled from the Google cache):

Note that “surahmeaning.com”, listed as part of his personal contact info, may relate to chapters in the Koran (“Surah“).

Are these the only two Californians who’ve been fighting recently? Let’s check this ironic headline from ABC:

Some detail on the event from the Paper of the Deplorables… “Gal Gadot’s screening [in Los Angeles] of Hamas terror attack film ends in mass brawls between pro-Israel and pro-Palestinian protesters” (New York Post, November 9, 2023):

Police officers were already out in force around the ironically named Museum of Tolerance for the “Wonder Woman” actress’s screening of “Bearing Witness to the October 7th Massacre,” which uses Israel Defense Forces footage.

Even so, wild videos posted online showed people waving Israeli flags and brawling in the streets with pro-Palestinian protesters — kicking and punching one another.

Police formed a skirmish line in an effort to control the unruly crowd — and ultimately used pepper spray, according to ABC 7.

Los Angeles Mayor Karen Bass decried the violence in the aftermath.

“We’re not antisemitic, we’re anti-Zionist,” the unidentified protester told Rolling Stone.

UCLA:

At a decolonization rally in Los Angeles: the crowd chants “we are all Palestinians” and promises to “globalize the intifada”. Nobody wants to go to Gaza (via Egypt/tunnels) or the West Bank (easy) and fight on the side of virtue (see Why won’t the people who say that Israel is committing genocide go to Gaza and fight?). So “globalize the intifada” has to mean something that can be done in the U.S. and, likely, in California. Is it fighting with Jews in the streets? Fighting against Jewish-owned businesses? Fighting against fellow residents of California who support continued ties with Israel? Preventing fellow Californians from using the Bay Bridge (cost $6.5 billion in pre-Biden money to repair earthquake damage, up from an original budget of $250 million)?

A well-coordinated group of hundreds of Pro-Palestine protesters shut down the Bay Bridge on Thursday morning, tying up traffic during rush hour and calling out to world leaders to end the war in Gaza during the APEC summit.

The four-hour chaotic event, which started around 7:45 a.m., ended with at least 70 arrests and 29 towed cars. All lanes finally reopened just before noon, but not after at least 200 protesters had chained themselves together and purposefully tossed their car keys into the bay, stalling efforts to reopen the span to frustrated drivers.

Is it fair to say that the conflict in and around Gaza has exposed the fact that Californias have little or nothing in common?

And on the other coast… “Two women arrested in NYC attack on Jewish victim who confronted them for tearing down hostage posters: cops” (New York Post):

Mehwish Omer, 26, surrendered to police Monday morning and was charged with assault and criminal mischief — both as hate crimes — in connection to the attack on the 41-year-old woman at the corner of Riverside Drive and West 82nd Street just before 10 p.m. Nov. 9, authorities said.

Her alleged accomplice, Stephanie Gonzalez, 25, was cuffed a week earlier and also faces a hate crime assault rap, as well as an attempted robbery charge, cops said.

The duo allegedly assaulted the victim — ripping off her Star of David necklace and knocking a cellphone out of her hand — after she challenged them for ripping the “Missing Persons” posters from a light pole at the intersection, according to police.

“Mehwish” is an Islamic first name, according to The Google. “Gonzalez” suggests a Latinx individual. The victim was, presumably, Jewish. Diversity was supposed to be New York’s strength, but these three did not have enough shared values to avoid a physical fight.

What about the next stop south on I-95? “Philadelphia Jewish Restaurant Targeted With ‘Genocide’ Chants” (Newsweek):

Philadelphia lawmakers and Jewish commentators have hit out at demonstrators who targeted a falafel restaurant in Philadelphia owned by an Israeli Jewish chef, chanting slogans accusing it of “genocide.”

On Sunday, footage emerged of a group of pro-Palestinian demonstrators gathering outside Goldie on midtown Sansom Street who were chanting “Goldie, Goldie you can’t hide, we charge you with genocide.”

According to The Philadelphia Inquirer, the march was organized by the Philly Palestine Coalition, which in October called for a boycott of “Zionist”-owned businesses in the city, including Goldie outlets and others owned by Michael Solomonov.

At the same time, other video footage of a demonstration near the University of Pennsylvania campus in Philadelphia showed protestors chanting “intifada revolution” and “long live the intifada,” though it is unclear if it is the same group that congregated outside Goldie.

Same question: How is diversity Philadelphia’s strength if the motley assemblage has nothing in common other than mutual animosity?

Circling back to California, it is the state with the highest percentage of immigrants, around 27 percent of the total population. How does that compare to the nation as a whole? “In October 2023, the Foreign-Born Share Was the Highest in History” (from the haters):

The Census Bureau’s Current Population Survey (CPS) shows that the total foreign-born or immigrant population (legal and illegal) was 49.5 million in October 2023 — a 4.5 million increase since President Biden took office and a new record high. At 15 percent, the foreign-born share of the U.S. population is also the highest ever recorded in American history. … The scale of immigration is so high that it appears to have made the new Census Bureau population projections, published on November 9 of this year, obsolete. The bureau projected that the foreign-born share was not supposed to hit 15 percent until 2033. … While a large share of the recent foreign-born growth is due to illegal immigration, legal immigrants still account for three-fourths of the total foreign-born population.

So… California shows us what the U.S. will be like if present trends continue. It wasn’t a great place for either Paul Kessler (now dead) or Loay Alnaji (the immigrant now embroiled in the criminal justice system; he couldn’t have killed a Jew if he’d hadn’t emigrated because Islamic countries have been almost entirely free of Jews since the late 1940s (900,000 Jews were forced out by Muslim neighbors or emigrated to Israel voluntarily)).

Previous posts regarding immigrants who did not enjoy diversity in the U.S.:

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Pussy Riot in Montreal

by philg

The Montreal Museum of Contemporary Art was ordered shut by Covidcrats in 2020 and allowed to reopen in February 2021. Just a couple of months later, the museum closed for a renovation that was supposed to be complete in 2024 but, according to the lady who sold me a ticket to the temporary exhibit space in a nearby underground mall, is now on track to be finished in 2028.

What’s in the temporary space? “Velvet Terrorism,” an exhibit on the decade-long protest by Pussy Riot against Vladimir Putin and Russia’s military operations in Ukraine.

From the brochure:

The first couple of rooms:

What was one of the punishments that a Pussy Riot member suffered? She was unbanked, exactly as the Canadian truckers who protested forced Covid-19 vaccination were unbanked by Justin Trudeau using “emergency powers” (NYT). (Separately, I met a Canadian who had gingerly approached some of the truckers at the time. “They were the nicest and most peaceful people you ever met,” he said. “I was afraid to stay too long, though, because I didn’t want to become a target myself.”)

Pussy Riot’s war under the sacred Rainbow Flag was covered:

(It is unclear to me how Putin can be considered responsible for “killings and kidnappings of gay, lesbian, transgender and queer people in Chechnya“. Russia has had tremendous difficulty in its attempts to control what happens in Chechnya, resulting in at least two full-scale wars.)

The public were invited to write down and post their thoughts in response to the exhibition. Most seemed to have been written by Anglophones. Almost nobody seemed to be thinking about Vladimir Putin, Ukraine, the lives of 2SLGBTQQIA+ Russians, or any of the other issues raised by Pussy Riot. Here are some of the notes that were off the main topic:

What were a plurality of the signs about? Here’s a sampling:

Although the Islamic Resistance Movement (“Hamas”), which is the elected and overwhelmingly popular government of the Palestinians, is not famous for celebrating Rainbow Flagism, there was the inevitable…

If Al-Shifa Hospital gets fixed up, the Montreal museum visitors are imagining gender affirming surgeries happening there:

Those who identify as feminists also want to see a corner of the world ruled by the guys who raped, maimed, and murdered women on October 7 (nearly all women who were born long after the events of 1948 that is the root of Arab grievance, so it is unclear how they can be blamed for the Nakba):

Ironically, after viewing an art show about criticism of Vladimir Putin, patrons were motivated to trumpet their alignment with Vladimir Putin’s position regarding Hamas (it is unclear that Putin supports “river to the sea liberation” (i.e., the elimination of Israel) but he is more supportive of Hamas than the typical national leader in Europe or North America).

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Cybertruck history from the Elon Musk biography

by philg

The Cybertruck is officially launched. I wrote about this product in 2019:

With today’s Teslas, one expects the driver to emerge and deliver a lecture on climate change, the merits of Elizabeth Warren, unions (except at Tesla itself), and a larger government, etc. What would the image be of someone who drives what looks like a high school kid’s first SolidWorks project?

How did they pick the name? This is for people who used to say “I’m using the Interweb”?

How are they going to deliver this car at $40-50k profitably? Isn’t stainless steel expensive?

(The announced 2023 base price is 61,000 Bidies; it is fair to say that this is the same or less than 50,000 2019 dollars?)

What does the Elon Musk book describe? A 2018 design session:

The Chevy Silverado was still on the showroom floor for reference. In front of it were three large display boards with pictures of a wide variety of vehicles, including ones from video games and sci-fi movies. They ranged from retro to futuristic, sleek to jagged, curvaceous to jarring. With his hands casually in his pockets, von Holzhausen had the easygoing and loose-limbed manner of a surfer looking for the right wave. Musk, arms akimbo, was coiled like a bear searching for prey. After a while, Dave Morris and then a few other designers wandered in. As he looked at the pictures on the display boards, Musk gravitated to the ones that had a futuristic, cyber look. They had recently settled on the design for the Model Y, a crossover version of the Model 3, and Musk had been talked out of some of his more radical and unconventional suggestions. Having played it safe with the Model Y, he did not want that to happen with the design of the pickup truck. “Let’s be bold,” he said. “Let’s surprise people.”

Every time someone would point to a picture that was more conventional, Musk would push back and point to the car from the video game Halo or in the trailer for the forthcoming game Cyberpunk 2077 or from Ridley Scott’s movie Blade Runner. His son Saxon, who is autistic, had recently asked an offbeat question that resonated: “Why doesn’t the future look like the future?” Musk would quote Saxon’s question repeatedly. As he said to the design team that Friday, “I want the future to look like the future.” There were a few dissenting voices suggesting that something too futuristic would not sell. After all, this was a pickup truck. “I don’t care if no one buys it,” he said at the end of the session. “We’re not doing a traditional boring truck. We can always do that later. I want to build something that’s cool. Like, don’t resist me.”

(maybe Musk was right on the highlighted point; Ford and GM are selling traditional-looking electric pickups and demand is weak)

What did the in-house design nerds think in 2019?

When Musk walked in the door leading from the SpaceX factory, his reaction was instantaneous. “That’s it!” he exclaimed. “I love it. We are doing that. Yes, this is what we are going to do! Yes, okay, done.” It became known as the Cybertruck. “A majority of people in this studio hated it,” says von Holzhausen. “They were like, ‘You can’t be serious.’ They didn’t want to have anything to do with it. It was just too weird.” Some of the engineers started working secretly on an alternative version. Von Holzhausen, who is as gentle as Musk is brusque, spent time listening carefully to their concerns. “If you don’t have buy-in from the people around you, it’s hard to get things done,” he says. Musk was less patient. When some designers pushed him to at least do some market testing, Musk replied, “I don’t do focus groups.”

An Australian hater:

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How is it legal to run a bank that lends only to women?

by philg

I was chatting with an executive from Grameen America, the U.S. division of Grameen Bank, winner of the Nobel Peace Prize. I learned that, out of the rainbow of 74 gender IDs recognized by Science, Grameen American will lend to those who identify with just one gender: “women” (at an 18 percent interest rate).

Everything financial in the U.S. seems to be tightly regulated, so I’m wondering how this is legal. If a bank seems not to be lending with alacrity to Black and Latinx borrowers, the federal government is right there to sue them (recent example). How is it legal for Grameen to say “No men need apply”?

Note the “Meet more of our incredible women entrepreneurs” at the bottom. Why is “incredible women” a common phrase (3.3 million Google results) while “incredible men” is only about 1/8th as frequently used and “incredible nonbinary” occurs just 1,020 times on the Web? Are women 8X more incredible (“less credible”?) than men and vastly more incredible than the nonbinary?

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Ireland creates a mural for the Oakland, California schools

by philg

A tweet from a Northern Irish politician (my mole on the island says that she is “Sinn Fein IRA”):

We can zoom in on the scene of two Jews attacking a helpless Palestinian child with teddy bear via AH-64 Apache helicopter and Hellfire missile. (This fits with the media tendency to depict Palestinians as helpless victims, which is the opposite of how Palestinians see themselves.)

(I do find it interesting that a 31-year-old woman would say that she wants to “stand with Palestine” right after the Gazans (combination of Hamas, Palestinian Islamic Jihad, and “civilian” males) went through the fence and did what they wanted to do with 31-year-old women (and other ages). Maybe she means “stand with Palestine, but not in or around Gaza”?)

How soon before we see poster versions of this mural in UNRWA and Oakland, California schools?

Separately, the Irish in Ireland (proper) seem to have managed to host plenty of violence recently without any helicopters or missiles. “34 arrested in Ireland riots after child is stabbed in Dublin” (Fox):

Police in Ireland arrested 34 people in relation to riots that swept through Dublin on Thursday, when cars and a bus were burned following a stabbing earlier in the day.

Around 500 people wreaked havoc on the streets, with about a dozen stores looted while rocks and bottles were thrown at crowd control officers equipped with helmets and shields. An empty tram train that had been left at a stop had its windows smashed and was also set on fire.

The violence began after rumors circulated that a foreign national was responsible for a stabbing outside a school on Thursday afternoon.

The suspect, who is understood to be of Algerian descent and is a naturalized Irish citizen, attacked three children with a knife outside an elementary school in the city center just after 1:30 p.m. A 5-year-old girl was seriously injured, while the two other children, a boy and a girl, suffered minor injuries.

Last month, Yousef Palani, who is of Iraqi descent, was convicted of murdering two men in an apparent anti-gay attack. One murder victim was decapitated with 43 stab wounds, and the second man was stabbed 25 times mainly to his head, neck and chest, according to court reports.

The Daily Mail has some more details:

The chief suspect in the multiple stabbing that left a five-year-old girl fighting for her life was arrested earlier this year for possession of a knife, the Irish Daily Mail has learned.

The man, originally from Algeria, has been living in Ireland for the past two decades. He took Irish citizenship more than a decade ago.

The man, who is in his late 40s, has come to Garda attention several times in the past year.

Sources have told this newspaper that the man was living in Dublin City Council hostel accommodation before he went on the rampage off Parnell Square on Thursday afternoon.

I think the “diversity is our strength” story here is that the guy arrived in his 20s, a prime age for working, but after 20 years was still living at taxpayer expense.

An elite Irish friend finds little to admire among the rioters. He sent me this:

Speaking of the elites, the unrest in Dublin yielded one of my more popular Twitter replies (to some sort of BBC TV personality):

Related:

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Advocate of gender discrimination loses gender discrimination lawsuit

by philg

“Robert De Niro: Hillary Clinton Should Be the Next President” (Daily Beast 2016):

“I think that she’s paid her dues. There are going to be no surprises, and she has earned the right to be president and the head of the country at this point. It’s that simple. And she’s a woman, which is very important because her take on things may be what we need right now.”

I.e., hiring for the President of the U.S. job should be done based on gender.

“Robert De Niro’s Company Is Found Liable for Gender Discrimination” (New York Times, November 9, 2023):

A federal jury in Manhattan on Thursday found Robert De Niro’s company liable for gender discrimination against a former employee who claimed that the actor assigned her “stereotypically female” job responsibilities such as washing his sheets and attending to his home even as she climbed the ranks of his company, awarding her $1.3 million in damages.

In more than six hours of sometimes colorful and explosive testimony, Mr. De Niro fiercely denied any wrongdoing and dismissed Ms. Robinson’s claims as “nonsense,” though he acknowledged that he could have called Ms. Robinson a “bitch” and a “brat” when she was his employee. He also addressed Ms. Robinson’s claim that Mr. De Niro asked her to scratch his back on occasion, saying that it may have happened one or twice, but that there was never any “disrespect” or “lewdness” attached to it.

Lawyers for Mr. De Niro, 80, portrayed Ms. Robinson, 41, as someone who exploited the trust and generosity of her boss, who had already given her significant perks and gifts — including a Rolex watch and part of a vacation in Hawaii — while also agreeing to pay her a salary of $300,000 per year in 2019, far more than other Canal office workers were paid. They argued that even though she received title changes, per her own request, her job responsibilities remained that of a personal assistant throughout her 11-year employment, and they repeatedly underscored the fact that she had not made any formal complaint over gender discrimination until she had been accused of financial improprieties.

Related:

  • “Years after presidency, Donald Trump is still living rent-free in Robert De Niro’s head” (Los Angeles Times, October 17, 2023): The actor has welcomed his seventh child, which he mentioned in passing earlier this year. The mother is his girlfriend Tiffany Chen, whom he credited with doing the “heavy lifting” with the newborn — De Niro may be an octogenarian, but she is a martial arts instructor. He told the Guardian: “[S]he does the work. And we have help.” … He’s also a grandpa several times over.
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How did Ron DeSantis do in the debate with Governor French Laundry?

by philg

Americans have so few shared values or interests (see my favorite Harvard analysis on why we can’t agree on whether open borders are good or bad; low-skill immigrants are great for the rich and terrible for the working class) that they can watch different political events even while watching the same political event. Was last night’s debate between Gavin Newsom and Ron DeSantis an example of that phenomenon?

Based on a casual sampling of Twitter, every account with rainbow flags, #FreePalestine banners, etc. declared that Newsom was the winner while all of the conservative accounts tweeted how impressed they were with Ron D. Here are two that happened to show up adjacent:

Readers who watched: How did Ron DeSantis do? Is it time for me to switch allegiance from Nikki Haley?

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Checking the COVID-19 Olympics scores for Florida and California ahead of the DeSantis v. Newsom debate

by philg

Governor French Laundry and Governor Science Denial are debating this evening. Let’s do a little pre-debate fact-checking. Americans have agreed that all of a society’s success can be measured by the society’s score in the COVID-19 Olympics. A society that achieved 0 COVID-tagged deaths by pushing all of its citizens into Hamas-style tunnels for 10 years (until a vaccine-style vaccine became available that definitively reduced deaths on a population-wide basis) would, for example, be celebrated as the best of all possible societies.

Lockdown-champ California starts off in the lead in the COVID-19 Olympics by having a lower COVID-19-tagged death rate. Once you adjust for the percentage of the population over 65, however, the death rates are about the same and the excess death rate may actually be higher in California (the CDC makes these data available, but somehow doesn’t bother to make it easy to compare states).

Where is SARS-CoV-2 having a field day right now? The CDC’s wastewater page:

The Science-denying Republican strongholds of Minnesota and Vermont are seriously plagued (God hates Republicans and loves #Science). California is moderately plagued and the plague level in Florida is “low”. In other words, if we accept that current Scientific dogma that humans, especially politicians and bureaucrats, are in charge of viruses, Gavin Newsom’s lockdowns, mask orders, forced vaccinations, school closures, etc. have resulted in a higher rate of SARS-CoV-2 infection than the Team Sweden approach that Ron DeSantis adopted in the summer of 2020 (see Ron DeSantis and Coronapanic for excerpts from the not-so-great man’s book).

I continue to maintain my position that Nikki Haley would be more likely to prevail over Joe Biden in November 2024 because Ron D doesn’t have the soothing optimistic tone that Americans love. For example, Americans want to believe that someone who hates Jews and loves jihad will do a 180-degree flip once exposed to suburban life in Michigan or Minnesota. Ron just says “no”:

(Possible influence for Ron D’s rejection of Immigration Dogma: Florida is where, in 2016 (prior to Ron DeSantis assuming the governorship), first-generation Afghan-American Omar Mir Seddique Mateen killed 49 people at a gay nightclub. Mr. Mateen came from a “moderate Muslim” family and had spent his entire 29-year life in the land of Diversity is Our Strength (TM).)

Loosely related:

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Medical School 2020, Year 4, Week 35 (Advanced Anatomy)

by philg

It is March 30, 2020. Our rotations are now “socially-distanced”: medical education (Zoom meetings with M1s and M2s), pathology (share a screen with a pathologist), and anatomy (handful of masked people in a large lab). The most popular choice is an additional two-week block of “study time” (i.e., vacation) for the Step 3 exam, a two-day multiple choice exam that costs $895 and duplicates material from Step 2. It is impossible to register for the exam until after we graduate, so nobody is actually studying. Jane and I have decided to learn anatomy from our favorite retired trauma surgeon for two weeks.

There are just two other students on our elective, including Buff Bri who matched into neurosurgery and a Canadian who matched into Internal Medicine. School administrators have decreed that everyone wear masks in the anatomy lab and that no more than two students at a time can be present in the thoroughly ventilated cavernous anatomy lab. Jane: “I’m surprised that our professor is teaching. She’s the ideal patient to actually be harmed by COVID-19.”  We will meet five times over two weeks, starting at 10:00 am and working until the early afternoon.

The first week we focus on trauma exposures. Jane and I start Monday on a cadaver with an untouched abdomen! Our attending first goes over how to make a midline incision. “A lot of residents do not extend the incision all the way to the xiphoid process. That few extra centimeters gives you a much better exposure.” We both take turns cutting, then suturing each fascial layer back together, and then cutting the sutures. Next we play the “Exposure Game”: she tells us an organ or structure, and we have to describe how to get to it once inside the peritoneal cavity. We perform the Kocher maneuver, medialization of the duodenum through incision of the inferior lateral border of duodenum, and the Cattell-Braasch, medializing the lateral edge of the ascending colon. A typical abdominal organ can be mobilized (or “medialized”) from its natural resting place by incising a thin layer of connective tissue (“peritoneum”) thereby releasing its long blood supply attachment (mesentery) to its full length. From this principle, you can bring the right colon or spleen out of the abdominal cavity while still attached to its blood supply. 

We quickly realize that the cadaver’s anatomy is way out of whack, which makes winning the game a lot more challenging. There is a seven-inch predominantly solid mass in her midline, which encircles the aorta and pushes her vena cava to the right. We cannot identify the abdominal aorta at all, but slowly dissect it out moving backwards from the bifurcated right and left iliac arteries. We also perform the Mattox maneuver in which the left colon and kidney are medialized to reveal the aorta.

We go in Wednesday and Thursday to continue to dissect the abdomen and remove the mass. During our dissection, we find that she had a ureteral stent placed in her left ureter due to obstruction from the mass. Our professor hands us a bucket to save the specimen for future classes. “Next year’s class wont have cadavers because authorities are requiring all cadavers be Covid-negative. There just won’t be any supply.”

We then perform a resuscitative thoracotomy (creating a hole in the chest). I make an oblique incision from below the nipple to the sternum, dissect down to the ribs, and place a rib expander (“Finochietto”) device in between the two ribs. Jane starts turning the crank to expand the ribs apart. We switch and Jane takes over to dissect out the heart and lungs. “Bedside thoracotomy is a procedure that is a last ditch effort to bring a trauma patient back from death,” our attending explains. “Imagine a 30 year old with multiple stab wounds is dropped off at the ED entrance. He is in extremis – he doesn’t open his eyes and is groaning only. His heart rate is 160, and the automatic BP cuff cannot get a reading. He has a pulse when he is transferred over to the trauma bay bed, but shortly thereafter, an astute medical student says that she cannot feel a pulse. What do you do?” A resuscitative thoracotomy is performed to try to bring this dead patient back to life. A large incision is made, the ribs are spread. The heart is delivered out of the chest. The aorta is clamped to decrease the circulating blood volume and divert blood flow to the brain. Frankly, attendings sometimes let residents do it to practice even though it doesn’t significantly improve patients’ outcomes.” She concludes, “The best evidence suggests performing resuscitative thoracotomy after traumatic arrest from penetrating injuries to the chest – maybe you can stitch a hole in the heart – or penetrating injuries to the abdomen where you can halt massive hemorrhage by clamping the aorta.”

On Friday, we perform a mastectomy, much to Jane’s disappointment after her two-week breast service rotation. “After a few mastectomies, it is boring. You’re just cutting into fat.” I make an oblique incision along the cadaver’s breast and find the pectoral fascia (connective tissue plane overlying the pectoral major muscle). I then dissect, mostly with my hands, to remove the breast tissue (all fat in this 86-year-old). We then perform the much more exciting axillary lymph node dissection! Jane begins it by reflecting the pectoral major to identify the clavipectoral (“clavipec”) fascia which runs up to the coracoid process (bony protuberance on the front of your shoulder). “The coracoid is the key to the axilla,” exclaims our attending. Jane and I have not studied this anatomy for awhile, having not been in the hospital since almost January, let alone on a surgery rotation. We pull out Netter’s Atlas of Human Anatomy, multiple copies of which are strewn around the lab, and turn to the axilla plates. We receive a ten-minute tangent about the most important books for surgeons to have: Netter’s Atlas of Human Anatomy,  Maingot’s Abdominal Operations, Skandalakis’ Surgical Anatomy, Netter’s Surgical Anatomy and Approaches.

We review the shoulder anatomy, and head back to our dissection. “In an axillary node dissection, you typically should not see the neurovascular bundle. You mostly have to watch out for what two nerves?” Jane responds, “The thoracodorsal (latissimus dorsi) and the long thoracic (serratus anterior).” Women are already self-conscious enough about losing a breast. It’s best not to also give her a winged scapula [injury to long thoracic nerve leading to impaired function of the serratus anterior].” 

Buff Bri comes in every day for several hours, defying social-distancing orders from the administration, but our elderly trauma surgeon doesn’t care (“the cadavers are far enough apart”). From the first two cadavers he removes the brain by removing the skull and cutting the brain stem from the spinal cord. On the third cadaver, however, he spends hours meticulously dissecting out each vertebral arch/lamina to have an undisturbed nervous system from the brain to the end of the spinal cord. When it was time for final removal, our attending hands him the scalpel. “You know what to do.” He shrieks, “No, no, I can’t! You do it!” After a few more shrieks, he begins cutting each of the spinal nerves to finally remove the entire central nervous system – the brain connected to the spinal cord. I am amazed how small it looks. “We’re saving this one,”  as she grabs a bucket. “Not a bad haul for two weeks. Two interesting specimen buckets!”

Type-A Anita is actively sharing “Sassy Socialist Memes” on Facebook. She adds her own gloss: “People, if we’re afraid that giving people $600 per week in unemployment benefits will stop them from working, that’s an argument for raising wages, not for refusing to bail out the people!” If any of her friends are turning to her posts in hopes of reassurance regarding coronavirus, they will be disappointed: “viruses can mutate into different strains. Look at how hard it is to guess which flu strain to account for in annual vaccines. We just don’t know enough about this virus to assume anyone is immune.”

During small group sessions, Anita frequently expressed her hatred of immunology (e.g., “Who cares about CAR-T cells and HLA types?”). A classmate who has specialized in immunology responds to Anita’s fear of lethal mutations: “The mutation rate of this virus is orders of magnitude less than either the flu or HIV, two viruses that have much more genetic diversity than SARS-CoV-2 due to extremely error-prone replication machinery. This bodes well for development of effective vaccines and possibly antibodies in comparison to circulating influenza viruses. Doesn’t change the fact that the duration of post-infection immunity is unknown, though!”

[Editor: Maybe they were both wrong, like most people who made predictions about COVID-19. SARS-CoV-2 never mutated into a virus capable of killing people with different characteristics than the early victims (i.e., the death rate kept falling because the virus killed those susceptible to death in the first year or two). But the immunology nerd was also wrong. We never developed a vaccine that reduced infection or transmission and maybe the vaccine had no effect on the death rate either. See “Where is the population-wide evidence that COVID vaccines reduce COVID-tagged death rates?” and “Did vaccines or any other intervention slow down COVID?”. Anita’s prediction that Americans would go back to work after long-term unemployment was at least partly wrong. Bureau of Labor Statistics data showed that the U.S. labor force participation rate remained lower in 2023 than it had been in 2019, though the most dramatic fall was from 2009 through 2015, after the 99 weeks of unemployment authorized by Congress during the first weeks of the Obama administration (“99 weeks of Xbox”).]

Statistics for the week… Study: 0 hours. Sleep: 9 hours/night; Fun: 2 nights. Jane and I continue packing up our house and training our two puppies. We go to the dog park every other day.. Pinterest Penelope ordered graduation-themed tee-shirt pullovers for each dog and arranged a class dog photoshoot. Wine night every night.

The rest of the book: http://fifthchance.com/MedicalSchool2020

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