Wednesday, March 27, 2024

Names And Places

As right-wingers blame collapsing bridges on President Biden, “wokeism,” and “open borders;” as Hannity says Trump should be allowed death-threat-inducing fulminations against a judge’s daughter and others; and as ever-grifting Trump is selling sixty-dollar (plus shipping and handling) “The only endorsed by Trump” Bibles, let’s change the subject to surgical ruminations before I tear out the last of my hair. So, here’s some fluff, modified from my surgery blog

It was always with wonderment that I considered the pioneers of medicine, surgery, and anatomy. To conceive of a time when every thought was a new one, when discoveries abounded for those with imagination, boldness, and curiosity, is to be thrilled, jealous, and.... bemused. What could it have been like, opening the body and its mysteries to the world, naming something new on the way out?

When it takes some effort -- maybe a microscope or some really careful dissection -- to discover something, it seems reasonable that your name gets attached. Islets of Langerhans. Ampulla of Vater. Sphincter of Oddi. Valves of Heister. Crypts of Morgani (he got "columns," too, like me.)

But where's the cutoff? I don't get why Gabriele Falloppio got to name something as obvious as an oviduct. That's not discovering. That's noticing. We don't have the Colon of Powell or the Heart of Palm. (I don't know who March was, or why he got to name the Eyes.) The white line of Toldt is sort of macro-observational and a name seems an extravagance. On the other hand, if he was the guy who figured out that it was a dotted line on which a surgeon cuts to mobilize the colon for resection -- a move that thrilled me the first time I did it and still does, for its anatomic simplicity, for its sweet entry into secret space, for the way it translates embryology into practicality -- then he deserves the kudos.

"Foramen" (for-A-men) and its pleasant plural, "foramina" are among those cool words we learn in med school. It means "opening." A hole, is what it is. Many anatomic openings are deserving of the name: foramen ovale (oh-VAL-ee) sounds good and does good; keeps a fetus alive. Lots of bony holes, especially ones through which nerves or vessels pass, are called foramina -- the obturator foramen, optical foramen, foramen magnum... But Jean-Jacques Winslow (shouldn't that be "Winsleau?") discovered he could stick his finger through a hole behind the portal vein, and stuck his name on it, too. Borderline.

I don't want to get into the Zen of what constitutes a hole, but his "discovery" is only about some things that are near each other. Inlet, maybe. We've got islets, why not inlets? Then it starts to sound nautical, which makes me think not of Winslow, but of Winslow Homer. That's it: it's the "Oddity of Homer."

Consider Morrison and his pouch. And Douglas’s. They're just places, areas. To me, it's not earthshaking. On the other hand, Broca claimed his area of the brain with some effort. I'm ambivalent about the Space of Retzius. As an anatomical concept, "space" doesn't have a lot of panache. On the other hand, the surgical dissection of it, developing it into a tissue plane, is cool: another of many places that spread themselves open for and yield to the surgeon, when their secrets are out.

Clearly the Greek and the Latin have fought for dominance of nomenclature. It's a puzzle to me that they made a truce of sorts in the kidney. We speak "nephric" and we talk "renal" interchangeably. Even to the point of naming things twice: that little yellow top-hat to the kidney, the ad-renal or the epi-nephron, as of juice it makes, two names for the same thing: adrenaline, epinephrine. What gives? Like the robin’s egg blue of the gallbladder, the bold yellow of the adrenal is a startling splash of exuberant color among the otherwise earthy tones of the belly. Sure, there's lemony lipid all over in there. But as organs go, the color of the adrenal is a surprise.

Those solid surgical soldiers of old deservedly got operations named after them; and instruments, and procedures. Because there's no end to invention, it still happens, and will. (Cotton Schwab?) Lots of the living have their names (and lucrative patents) on devices; techniques and new operations keep unfolding.

Then there’s having a position named after oneself: Trendelenberg, Fowler (and its kin, Semi-) managed to do it. If I had a position named after me, I'd rather...

Nearly unique, though, among namings, is to be remembered for a maneuver. Like Theodor Kocher, name-bearer of many things: clamps, incisions, and this, a way to make the duodenum handy and hold the pancreas in your hand. An elegant snip and slide. The Kocher Maneuver. Inspiring. Deserving a whole column in itself. I’ve written about it, here.

Wednesday, March 20, 2024

Don't Care


I don’t care if it’s traditional. It’s a “courtesy,” not a law. The fact that a party’s nominees for president have been read in to national security briefings doesn’t mean Trump should be. Not unless he, gods forbid, becomes “president” again,” in which case it won’t matter. It’d be game over for the US and jubilee for Putin, Xi, Kim, Orbán, and MBS. It’d all be for sale. We might never know the price, but by then it’d be moot. We’ve seen the carelessness with which he handles America’s secrets, and not just where he stores them after illegally retaining them. With enemy sources and fans alike, he shared them like a teenager sexting to impress. Bad analogy, maybe, if what Stormy Daniels described is accurate. In any case, entrusting Trump with state secrets would hand him trading cards for Putin’s help. Again.

I don’t care what the judge had to say: Fani Willis’ affair with her lead prosecutor should never have led to court hearings, fancy vacations notwithstanding. Where’s the conflict of interest when they’re on the same case, working in the same direction? Granted, it was poor judgment, handled poorly. But in what way was the prosecution compromised? One certain thing, though, given the credible death threats she receives, enough that the FBI initiated extraordinary methods to ensure her safety, is that she’s very brave.

I don’t care if Trump’s hardest core are a small minority of Americans: there’s enough of them that when he predicts a “bloodbath,” it could happen. “Now, if I don't get elected,” he predicted, “it's gonna be a bloodbath. It's going to be a bloodbath for the country.” No matter how MAGAphiles try to spin it (“he was talking about the auto industry”), it was “It’s going to be wild,” to the power of ten. “For the country,” he said. Not “Detroit.” Or “Japan.” The country.

I don’t care what Trump and his MAGAwashed acolytes say: people who’ve been found guilty of crimes, by a jury, in a court of law, following the dictates of American jurisprudence, are not “hostages.” They’re convicted criminals, serving time. When he says otherwise, Trump reaffirms his lifelong rejection of the rule of law, and his willingness to inflame. His all-time lack of patriotism is verified when he calls those insurrectionists “unbelievable patriots.” He wouldn’t recognize patriotism if it bit him on his about-to-be-seized assets.

I do care that, to cheers from rally-reliables, Trump says Liz Cheney and all members of the J6 Committee must be jailed. For the crime of doing their Constitutional duty. It’s a glimpse of another “presidency” for anyone who criticizes him. Including Mike Pence and dozens of other high-level people who worked with him. Those who call liberals communists are fine with Stalinist purges; including replacing RNC leadership with sycophantic election deniers, intent on winning not on thoughtful policy but on Trumpic vengeance and Democratic vote suppression. Conservatives should care. A lot.

I care that Trump is so sure of the mindlessness of his supporters that he places lies at the center of his campaign. “Rampant crime.” “No longer energy independent.” “Wrecked economy.” Obvious to the brain-alive, the truth is the opposite, but he’ll keep saying it and they’ll keep believing it. Lies are all he has, and lies are all they want.

I care that decades of right-wing attacks on education and expertise have been so successful that tens of millions of Americans can’t separate falsehood from truth; have been taught to fear and resent people unlike themselves, and find those feelings compelling enough to accept a self-serving, xenophobic liar as their leader. To believe he cares about them, “loves America,” “never lies,” and would be “better on the economy,” crashed under Trump, revitalized and soaring under President Biden. If humanity survives long enough, historians will struggle to make sense of it. Likely, they’ll consider the impact of Fox “news,” Trumpists’ main purveyor of disinformation and inventor of prevarication and fakery as business plan. To hear Trumpists interviewed is to hear every Fox talker on loop.

I care that, after wasting time and money on Trump-demanded, up-empty “investigations” of the Biden “crime family,” House Republicans are considering a fact-free “criminal referral” to the DOJ. If the DOJ takes no action, or if it does and, like those “investigations,” finds nothing, Rs can call it proof that the DOJ has been weaponized by criminal mastermind/incompetent Joe Biden. There’s been weaponization, all right. By Jims Comer and Jordan.

And I care that Trump-appointed, inexperienced, unqualified Judge Aileen Cannon is overtly working to kill the stolen secrets case against Trump. By demanding that the jury be allowed to see unredacted documents or charges will be dropped, she’s putting at risk government covert sources and operations, placing the guy who gave her a lifetime job above our country. It’s MAGA, defined and personified.

Hit the mandamus road, Jack. 

Wednesday, March 13, 2024



No comment on Senator Katie Britt’s (R-AL) melodramatic, bizarre, scary-on-many-levels response to President Biden’s State of the Union Speech: embarrassed Republicans have been panning it enough. Okay, well, since she harped on the border crisis (and lied about it, MAGAly), let’s note that she was one of the bipartisan group of senators that hammered out a bill addressing the crisis more significantly than any previous attempts. And then, as demanded by Trump, under indictment, out on bail, voted against it. It’s doubtful she’ll take this advice from one of her constituents.

The president’s speech put the lie to Trumpofoxians’ perseverating claims that he’s sleepy, weak, and/or befuddled. So much so that they’re suggesting – seriously! – that he must have been given drugs to hype him up. Except that Ronny Jackson’s no longer there. 

President Biden presented a progressive vision for America, in which there’s less poverty and more opportunity. His subsequent budget proposal provides for that and lots more, by raising taxes on wealthy individuals and corporations. And it’d lower the national debt by $3 trillion over ten years. There followed, of course, screams to low Hell from Republicans’ ultra-wealthy paymasters. With Rs controlling the House, it’s DOA. 

There were, as usual, energetic standings and pejorative sittings. No Republicans rose to applaud Mr. Biden’s call for an end to political violence. That, and other regressive accouterments of autocracy, including encouraging riots like J6, are what, in their support of Trump (under indictment, out on bail) they desire.

Joe all but dared them to interrupt, which they did, disrespecting the office and themselves. He responded with delight, while Holy Moses Mike sat shaking his head at everything; reinforcing his and his party’s devotion to Trump (under indictment, out on bail) and their bankrollers; forsaking average Americans, including their own supporters, too Foxotrumpified to realize it.

That Trump, under indictment and out on bail, fawns over dictators and would emulate them, has been evident since day one. Underscoring it, he invited Viktor Orbán, Hungary’s autocratic “president” (not Turkey’s, as Trump, out on bail, once asserted) to Mar-a-Lago, where he heaped servile praise on him: “There’s nobody that’s better, smarter or a better leader than Viktor Orbán,” said Trump, under indictment, out on bail. “He’s fantastic… because he says, ‘This is the way it’s going to be,’ and that’s the end of it. Right? He’s the boss...” Like Putin, Orbán is lionized by democracy-fearing MAGA Republicans and their media. Given the opportunity, Trump, UIOOB, will strive to out-autocrat both.

Less certain, but suspicious, is the possibility that the $92 million bond he finally posted while appealing the E. Jean Carroll verdict, was backed by Russian – i.e., Putin’s -- money. It came from the Chubb Group, now operating out of Russia. True or not, it’d be nice to know the terms of the bond. Likewise, the explanation for his sudden flip-flopped love of TikTok, in which a pal’s hedge fund has a $33 billion stake. Trump, under indictment, out on bail, strapped for cash, seems to have a price for anything. What do top secret documents go for, nowadays? 

To support him at all, to overlook his promises to weaponize government against all enemies, domestic and domestic, to rationalize his immature, petty nastiness and lies, people must not just acquiesce to it, but desire it. With their electoral choices, today’s Republican Party confirms the premise.

For governor, North Carolina Republicans just nominated Mark Robinson, a conspiracist, homophobic, Holocaust denier, school-shooting mocker, who says the purpose of the Affordable Care Act is to “enslave everybody.” Out on bail, Trump called him “Martin Luther King on steroids.” Presumably because he’s black.

The presence in Congress of MTG, Gosar, Gaetz, Boebert, et al., further proves the point. They’re there because they’re what their voters prefer (grammar lesson): people performing base-pleasing, kangaroid “investigations” rather than legislators committed to working on solving problems.

It all comes down to Trump, UIOOB, the proof positive, the tone-setter. At his rambling rallies, when he’s not stumbling over words, incoherent, and mixing up names, he’s taken to mocking President Biden’s stuttering. Were any attendees repulsed? Did they question whether it befits a would-be President of The United States of America? Of course not. They laughed and cheered. It’s who they are and what they came for. It’s what that party has become. Mean and demeaning. Lies and empty promises.

Speaking of lies, Special Counsel Robert Hur, whose final report of his Biden investigation luridly included implications of a failing memory, conveniently left out Biden’s actual transcribed words, showing the opposite. MAGA-normal is blatant lying, confident the truth will be smothered on Fox “news” and both-sided by mainstream reporters.

Perhaps there remain actual conservatives who, repudiating his despotic intentions, lies, and fear- and hate-mongering, will reject Trump, under indictment, out on bail; taking an America-honoring, KAG stand against MAGA’s embrace of totalitarianism. There’s at least one.

Wednesday, March 6, 2024

Getting Real


The Supreme Court was right to overrule the Colorado decision to remove Trump from the state’s ballot, unanimously. It can’t be up to individual states to decide, on their own, who can be on the ballot for a national race. But, going further, five asserted it’s up to Congress to define and declare who is and isn’t an insurrectionist. Four otherwise concurring justices argued that current federal law suffices; that the majority made it nearly impossible for candidates to be disqualified for insurrection. In effect, they rewrote the Constitution. You know: originalism.  

The SCOTI chose not to challenge the Colorado ruling that Trump is an insurrectionist. He is, and so remains. The ruling, in other words, is NOT the “big win” for Trump that he claims. SCOTUS’ slow-walking of Trump’s absolute immunity claim, however, is. There won’t be a Congressional definition of insurrection as long as Republicans control a Congressional house or the white one. Which is another reason why survival of the Republic depends on Democrats keeping two and regaining the third. At this historical moment, it couldn’t be more critical.

What’s an analogy for the lunacy of American politics? If your house were on fire and two men were approaching, one bearing a can of gasoline, the other pulling a fire hose, to which would you turn?

Or this: A baseball player attempts to steal second base; arrives after the catcher’s throw, already in the second-baseman’s glove, which tags the runner ten feet before he gets to the bag. Insisting he was safe, the runner refuses to exit the diamond. Replays from all angles confirm the obvious out. Nevertheless, the umpires gather at home plate to discuss it, carrying on through the night, the next day, and for days after that. Fans blame the ball.

Or: You have neighbors on either side of your house. To one of the houses people come at all hours, handing cash to the occupants, receiving unmarked packages in return. Cops often show up to haul someone away, cuffed. The other is a family who smiles and says hello when you see them. They go to church every Sunday, occasionally leave little gifts on your doorstep. Mom is a teacher, the kids are on the honor roll, dad runs a green energy company listed as one of the top 100 to work for.

Which is the “crime family”?

Final try: Donald Trump runs for president. He loses the popular vote by millions, and the Electoral College by a wide margin, making him the loser by all measures. He claims he was cheated, files scores of lawsuits in multiple states, initiates several recounts, hires a company to search for fraud. None is found. His suits are rejected. The recounts find he’d lost by even more votes than initially recorded.

A mewling documentary is made (see what I did there?), purporting to show massive fraud. Every claim is disproved, definitively. Three years later, Trump continues to insist he won; as seen in interviews, his supporters believe in him the way they believe in Jesus (despite not following His teachings), re-mouth his mendacity, refer to that “documentary.” What would it take for MAGAs to recognize they’re being used

As a person who values truth and respects, if not always agrees with, the laws of our land, what are you to think? If your education taught you to distinguish, or at least try to, between fact and fiction, and if, in half the country, you see efforts to make education into its opposite, where’s the hope? How can you not fear for your grandchildren’s future? Write a column? Trust me: it doesn’t work.

Confirming that citizens of the “exceptional” US are no less susceptible than were pre-WWII Germans, the power of Third-Reich-style big lie and scapegoating is disturbingly evident here. Nor is there reason to think the current, repetitious, MAGA Republican liars have any less malevolent intent than Joseph Goebbels and his master-race master. That it worked then is confirmed by the carnage of a world war.

That it works now is proved by that party’s shameful capitulation to Trump, a recidivist liar and dictator-loving, would-be authoritarian; and by the clueless gullibility with which his supporters repeat his lies, ignoring his increasingly confused rally-ramblings.

If Republicans loved America and the Constitution as much as they claim, Trump’s approval would be asymptotically approaching the x-axis. But Fox “news” and its wishfuls, along with the current crop of Republican leaders, are making sure it won’t happen. Pounding the same propaganda constantly (“terrible economy!” “wide-open borders!”), even using AI to make fake photos of Trump with Black voters and dishonestly edited news stories, they treat supporters like the dupes they know them to be.

As to the recent, ballyhooed NYT poll, here’s why we should calm down.

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