Clowns After Midnight

[Our day-sponsor for this post is arguably my youngest subscriber, Lucas Artigas, of Apex NC. Lucas, don’t read this when you should be paying attention in class. I know it’s been rough these past four months, but it’ll get better. If not, the motel might need a manager. Stay in touch.]

“There is nothing scarier than a clown after midnight”

That quote has been attributed to Alfred Hitchcock, Stephen King, and Vincent Price. Regardless of the source of the bon mot, it reveals a truism. Clowns, in the dark, tend to be disturbing.

And of course, we all know that cemeteries, in particular old spooky ones, give just about everyone the willies.

So let’s combine them on your next roadtrip, in Tonopah NV.

Little more than a widespot on SR 95 at the halfway point between Vegas and Reno, Tonopah, the seat of Nye County, boasts a population under 2500. The town itself, then called Butler City, was founded in 1900 by the eponymous Jim Butler, a miner looking for a lost burro. Angry at the dumb beast, he picked up a rock to throw at it once located, and noticed the unusual weight of the projectile. It turns out that he had stumbled across the second richest silver lode in Nevada history. But it was not Butler who was to strike it fabulously wealthy. One George Wingfield, a faro player briefly turned dealer at the hamlet’s soon-to-open saloon, used his winnings to invest in the Boston-Tonopah Mining Company, which, within five years, netted him a bank account of $30M.

Fortune seekers flooded into this hardscrabble town in the middle of nowhere. There was a plague that went through the population in 1902 – the etiology remains mysterious – which killed many of the inhabitants. The town’s only cemetery filled quickly, and by 1911, it had over 300 interments, then-rivaling the living population of the downtown. The boneyard was closed because it had run out of space.

Wingfield predicted the town’s imminent demise, cashed out, and moved elsewhere. Industry died. By 1920, Tonopah and the immediate environs contained less than half the population it had boasted fifteen years earlier. Things went from bad to worse. Unless you work at the now-nearby Tonopah Test Range and Nuclear Site, there’s not much economic activity in the area once the easily mined ore had dried up.

But people do need a place to stay when passing through, esp if they don’t want to drive another 70 miles to the next wide spot. And that brings us to the Clown Motel.

The Clown Motel

Not only is the inn’s lobby filled with images of clowns, but each room keeps the unsettling theme as well. From Bozo to Ronald to Punch, they’re all there in one form or another. And folks who have weathered the night as guests swear that the eyes of the pictures and figures follow you as you move around the premises.

what a view!

So if you get a bit unnerved and need fresh air, you can walk outside… and gaze at the overflowing cemetery sharing the common property line.

Oddly enough, the Clown Motel gets a 3.5/ 5 star rating on Trip Advisor.

Time to keep driving to Carson City.

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[Copyright 2013 @ The Alienist’s Compendium]

An Ethical Quandary

Physicians are almost always opposed to abdicating clinical decision-making to non-clinicians. Just ask any practicing doc what she thinks of administrators or insurance adjusters getting involved in patient-care scenarios, those that doctors feel should be solidly in the purview of medicine. I already know the response.

I attended a professional meeting recently, and the presentation of one of the speakers – the chair of the ethics department at a major east coast university – reminded me of an interaction I had thirty years ago, and have never entirely resolved in my own psyche.

In the 1980s, I was in my training at the University of Virginia. At that time, the University Medical Center had a well-established ethics consult team. Coming in the immediate wake of right-to-die cases such as that surrounding Karen Ann Quinlan, the University wanted to engage ethicists and those of related fields – social work, theology, patient advocacy – on the front end of potential problems in order to ‘do the right thing’ and avoid messy entanglements that might register seismically with the national media. CYA.

I recall being a senior medical student on the neurosurgery rotation, and rounding with my team in the NICU. We came to one unfortunate patient; I’ve forgotten the details of the patient’s situation, but I do recall that it was grave at best. The family was emotional and divided, the nursing staff was up in arms, and the attending physician was uncertain how to proceed. Being at that time an idealistic neophyte, I turned to the chief resident and asked if we should obtain an ethics consult on this unfortunate patient?

“No. And don’t let me ever hear you say that again.”

Despite being fully aware of my low rank in the food chain, I was nevertheless caught off guard by his dismissive response. The ethics team was regularly convened for just this reason, and I thought the scenario at hand was as clear-cut for such a consult as I was likely to encounter. He read my perplexity and continued:

“If you call for an ethics consult, you’ll have a bunch of non-clinicians coming down here, pontificating, and then rendering a decision on a clinical situation. Once it’s written, we’re screwed, because if we decide to proceed in a way not recommended by the consult, we’re de-facto ‘unethical.’ It’s a huge risk management and liability issue, and I think the team can come up with a sensible decision and avoid getting outsiders involved who then will be back-seat drivers.”

That exchange occurred ~1988. I’ve thought of it since, but have never yet engaged an ethicist for her input.

So, at the recent meeting, I stood to ask this question of the presenter. His reply:

“Certainly there are some ethicists – hopefully fewer now than was the case 30 years ago – who author poorly-worded consults. A good ethicists will never tell the medical team what they should do. A good ethicist will explore with the team the actual question at hand, and weigh with the team the pros and cons of each available avenue. Remember, a ethical dilemma is usually not about good and bad. It’s about two options – choices that likely each have good facets – that must be balanced against each other.”

This answer reminded me of what I have long said about a savvy psychotherapist: such a practitioner should never tell a patient what to do, but instead should guide the patient in exploring the situations at hand and aiding that person in coming to the decision that works best for her.

Of course, that’s in theory. I know of many therapists who cross the line, and I’m sure there are ethicists who do the same.

In the law, there is a type of civil determination called a declaratory judgment. In such a situation, a court will resolve uncertainty through a conclusive preventative adjudication, essentially affirming the rights, duties, or obligations of one or more of the parties in a non-criminal dispute. It is rendering an opinion on a hypothetical that has not yet been formally brought before the court.

But not all courts will pass declaratory judgments. And I doubt ethicists will do so either. One can hardly approach an ethicist and say, “I’d like to submit a consult on a sticky situation, but only if you’re not going to hog-tie me clinically. Perhaps you can give me a pre-decision off the record, and then I can decide whether I want to submit a formal consult or not.”

In reality, as the old saw goes, one pays one’s money and takes one’s chances.

So, three decades later, I still don’t have a good retort to the chief resident’s premonition.

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[Copyright 2013 @ The Alienist’s Compendium]

The F-Bomb

This post references an earthy and impolite word that is usually employed to describe human coitus, though it can also describe a state of total disarray, despoilment, or the act of cheating.

Whether you view the oath as vulgar or merely part of the 21st century lexicon, it has segued from an utterance of the ill-bred to a commonly employed descriptor, for better or for worse. Try going to ANY R-rated Hollywood release, watching most anything on cable TV, or visiting certain websites on the Internet, and NOT encountering it!

As a student of human behavior and history, I am curious as to how this came to pass.

Called by some the duct tape of the English language, the F-Bomb can be a noun, both a transitive and intransitive verb, an adjective, an adverb, an interjection, a freestanding expletive, an element of compound expression, or even an in-fix (i.e., inserted between two syllables of a longer multi-syllabic phrase). It is used as an intensifier, to express distaste, as an insult, or just to spice up conversation. It may in fact be the most versatile word in the entire dictionary.

And yes, it has been in dictionaries for longer than you might think. Though it appeared in A New and Complete Dictionary by English lexicographer John Ash in 1775, it was duly asterisk’d as “low” and “vulgar” speech. Interestingly, after that initial debut, the profanity did not appear in any known printed reference from 1795 (the year of the last edition of Ash’s work) until 1965. By 1972 it had made the cut for inclusion in the Oxford English Dictionary, by 2005 it scored the Canadian Press Caps and Spelling Guide, and by 2012 it went mainstream in Merriam-Webster’s Collegiate Dictionary.

Of course the Word-That-Should-Not-Be-Spoken still existed from 1795-1965. Aside from generally accepted cultural sensitivities and proscriptions, one reason it vanished from ink in the English speaking world was by statute: in the U.K. and U.S., the Obscene Publications Act (1857) and the Comstock Act (1873) respectively made it criminally punishable to print that nasty imprecation. This was one basis for banning James Joyce’s Ulysses in the U.S. for more than a decade, from its publication until the mid-1930s – the tome’s racy content included not one, but two of the nasty F’s!

Ash’s dictionary didn’t invent the expletive, but because the F-Bomb wouldn’t usually have been written in the sorts of documents that have survived from earlier epochs, it has proven difficult for linguists to determine exactly its antiquity. Experts have opined, though, that the word is indeed very old. The challenge of finding extant primary sources notwithstanding, there are a few surviving documents from the 15th and 16th centuries that inarguably employ the root.

The first, from ~1410, is a manuscript now in the Bodleian Library that attacks the chastity of a group of Carmelite friars then in Cambridge: “Non sunt in coeli, quia fvccant vvivys of heli,” or “they will not go to Heaven because they fuck the wives of Ely.”

From a century later, the Scottish poet William Dunbar is recorded as having dropped the F-Bomb in Old English: “Yit be his feiris he wald haue fukkit, ye brek my hairt, my bony ane,” or “his behavior, his fucking, has broken my heart and bones.”

And, a now-anonymous and assuredly disgruntled monk was the first known to have employed the adjectival form at his boss; in a 1528 copy of Cicero’s De Officiis in Yale’s collection, a period marginal note reads, “fucken abbot.”

Who were Ely and his wives? Who was the abbot? Who was breaking Dunbar’s heart? We are not certain. But we do know that, esp in the Scottish example, the spelling of the word in question suggests a northern European or Scandinavian etymology. This makes sense when one discovers words such as Old German ficken (to mate), Old Dutch fokken (to breed), Old Norwegian fukka (to copulate), and Old Swedish fock (the name for the male organ) in ye olde thesaurus.

What we also know for certain is that two mid-20th century urban legends about the origin of the F-Bomb are entirely false.

1. Forceful and Unlawful Carnal Knowledge. The theory holds that this phrase is a late 17th century legal term for rape, and that it was abbreviated in period court documents as F.U.C.K. Sounds good, but totally bogus. Sorry, Van Halen.

2. Fornication Under Consent of the King. Another attempt to finger jurisprudence as the source of the vulgarity, this is another weak suggestion that an acronym – based on supposed royal permission for abandoned women to again enter into intimate romantic unions – gave us the malediction-in-question.

Besides, while abbreviations did exist in centuries past, pronouncing the resulting acronyms as neologisms is a relatively modern phenomenon. Scholars point to the only known pre-20th century example of such: Colinda, which rhymes with Melinda, and was coined by Fleet Street from the truncation of the Colonial and Indian Exposition, a world’s fair of sorts, held in London in 1886.

But back to the original question: how did a tawdry exclamation become today’s commonly employed descriptor?

Such verbal segue is not entirely unknown, and linguists actually have a term for it. A dysphemism treadmill describes a scenario in which words that initially carried highly pejorative or ribald connotations, with repeated use, are rendered less vulgar, import diminished shock value, and finally become in time more publicly acceptable.

Proving, at last, that familiarity does in fact breed contempt. Or at least meh.

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[Copyright 2013 @ The Alienist’s Compendium]

The Axeman

It’s easy to believe, in this epoch awash in social media with 24/7 coverage of everything, that the world is a far more messed-up place than back in “the good ol’ days.” While certainly our capacity for destruction has increased – high capacity magazines, bio-terror, nuclear proliferation – I offer that man’s basic instability (read: cruelty, sociopathy, violence) likely has not changed very much.

As evidence, I further offer the story of an American serial killer who, despite having a body count comparable to Jack the Ripper’s and being much closer to those of us in the U.S. than is Whitechapel, seems to have been largely forgotten by history.

I offer you The Axeman.

This murderer was active in New Orleans and neighboring Gretna at the end of WWI, and only for a period of about 18 months. A considerable public panic arose, and like most serial killers, he left as abruptly as he came.

His first known victims were Joseph and Catherine Maggio, owners of a grocery store and bar who were attacked while they slept in their apartment over their business on the evening of 22 May 1918. The killer broke into the house and slashed both of the victims’ necks, and then proceeded to bludgeon both with the dull side of a heavy axe blade. Catherine was killed on the spot, while Joseph lived long enough to give details to his brother, who found him, before expiring himself. Nothing valuable – including cash in plain sight – had been stolen. Police found the killer’s bloody clothing in another room of the apartment, as he apparently changed into clean clothes before fleeing the crime site; they also found his bloody straight razor tossed carelessly on the neighbor’s front lawn. That straight razor was determined to belong to Andrew Maggio, the same brother who found the victims, and who owned a barber shop down the street. Police focused on him as the perpetrator when he said he had been at his adjoining apartment and, though drunk, had heard nothing of the attack. Only much later, and sober, did he claim to detect “a strange groaning noise,” and going to investigate, found the bodies. Andrew told police that he had seen a strange man lurking around the block prior to the crime, and the straight razor notwithstanding, as police had nothing more with which to charge Andrew, he was released.

The next two victims were Louis Besumer, another grocer, and his mistress, Harriet Lowe, who were found early on the morning of 27 June 1918 by a bakery delivery truck, lying in pools of their own blood in the back of the store, both with slash and bludgeon wounds. Once again, nothing of value had been taken. The police arrested a new employee, but without any evidence, released him shortly thereafter. The media turned to their attention to the fact that Lowe, as she regained consciousness, accused Besumer of being a German spy who had attacked her, and sure enough, a search of the store uncovered letters written in strange tongues (turns out to have been Russian and Yiddish). Lowe died after botched surgery, and Besumer was charged with her murder once he recovered. Police, though, were unable to explain how he sustained his own injuries. He was acquitted after a ten minute jury deliberation.

And there were more victims. At least eight more. Elsie Schneider, discovered grievously wounded by her husband returning from work. Joseph Romano, an elderly pensioner found by his nieces with his head gashed and a bloody axe in the backyard. Charles and Rosie Cortimiglia and their infant daughter, all sustaining skull fractures, leading to the child’s death and lifelong disabilities for the parents. Steve Boca, another targeted grocer who sustained severe brain damage from his assault. Sarah Laumann, a single teen living alone who was gored and amnestic after her attack. Mike Pepitone, killed by the axe-wielding intruder as his wife and children were elsewhere in the home.

The city panicked. Axes were found at the crime scenes. Neighbors were arrested but released without evidence. The authorities wondered if this were a Mafia-influenced spree, given that many of the victims were Italian. Police began to suspect that the same individual was responsible for murders of other Italian couples stretching back to 1911, though this was never confirmed.

Then came the following letter to the local newspaper [the byline ‘Hell’ is no doubt a hat-tip to Jack the Ripper]:

Hell, March 13, 1919

Esteemed Mortal:

They have never caught me and they never will. They have never seen me, for I am invisible, even as the ether that surrounds your earth. I am not a human being, but a spirit and a demon from the hottest Hell. I am what you Orleanians and your foolish police call the Axeman.

When I see fit, I shall come and claim other victims. I alone know whom they shall be. I shall leave no clue except my bloody axe, besmeared with blood and brains of he whom I have sent below to keep me company.

If you wish you may tell the police to be careful not to rile me. Of course, I am a reasonable spirit. I take no offense at the way they have conducted their investigations in the past. In fact, they have been so utterly stupid as to not only amuse me, but His Satanic Majesty, Franz Josef, etc. But tell them to beware. Let them not try to discover what I am, for it were better that they were never born than to incur the wrath of the Axeman. I don’t think there is any need of such a warning, for I feel sure the police will always dodge me, as they have in the past. They are wise and know how to keep away from all harm.

Undoubtedly, you Orleanians think of me as a most horrible murderer, which I am, but I could be much worse if I wanted to. If I wished, I could pay a visit to your city every night. At will I could slay thousands of your best citizens, for I am in close relationship with the Angel of Death.

Now, to be exact, at 12:15 (earthly time) on next Tuesday night, I am going to pass over New Orleans. In my infinite mercy, I am going to make a little proposition to you people. Here it is:

I am very fond of jazz music, and I swear by all the devils in the nether regions that every person shall be spared in whose home a jazz band is in full swing at the time I have just mentioned. If everyone has a jazz band going, well, then, so much the better for you people. One thing is certain and that is that some of your people who do not jazz it on Tuesday night (if there be any) will get the axe.

Well, as I am cold and crave the warmth of my native Tartarus, and it is about time I leave your earthly home, I will cease my discourse. Hoping that thou wilt publish this, that it may go well with thee, I have been, am and will be the worst spirit that ever existed either in fact or realm of fancy.

The Axeman

On 19 March, the dance halls, saloons, and bars of New Orleans were filled to capacity, with the citizenry all partaking of loud jazz music.

There were some locals, though, who not only refused to be intimidated, but took out ads in the paper, telling the Axeman that they’d be waiting for him with back doors unlocked, and 12-gauge shotguns in hand, and then provided street addresses.

There were no attacks that night. And shortly thereafter, the Axeman vanished.

And like Jack, he was never apprehended.

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[Copyright 2013 @ The Alienist’s Compendium]

The City of Lights and Medicine

Denizens of the 21st century complain of how super-specialized the practice of medicine has become. Few modern medical students aim to be generalists – even the discipline now known as Family Practice is a specialty – as most aim for many additional years of training to become expert in scientific minutiae.

It would appear, however, that our world has nothing on 19th century Paris.

The City of Lights in the epoch between Napoleon and the Franco-Prussian War was an epicenter of medical study, one reason being that French citizens were entitled to free medical care by royal decree. Students and young doctors flocked there from all over the continent, and from across the Atlantic, because of the amazing proliferation of facilities dedicated to very specific conditions and illnesses. No where else could doctors-in-training see so much pathology at the sides of renowned clinicians all in the same place.

Obstetrical complications? That would be Hôpital de la Maternité, with no fewer than a dozen births per day. Gravely sick children? The largest such hospice in the country was Hôpital des Enfants-Malades, sadly filled to capacity. Venereal diseases? There were two: for the women, Hôpital Lourcine, and for the men, Hôpital du Midi – the former being a house of tertiary-staged horrors, and the latter, while equally ghastly, mandating in the earliest years the additional ‘treatment’ of public whippings to teach patients to stay away from strumpets and keep their trousers on.

Lunatic women of childbearing years, idiots and imbeciles and morons of both genders, the terminally ill, the deaf, the blind, the dumb… all had their own specific destinations in the capital. There was a hospital for elderly married couples who wanted to die together in the same room (they could bring their own furniture and effects, the price of admission in part being bequeathment to the facility on joint passing of all personal property).

Lepers, however, were not welcomed, and instead were shipped out of the city limits should any show up at the front doors.

There was even Hôpital des Enfants-Trouvés for homeless children (distinct from an orphanage, as Enfants-Trouvés had physicians on staff to tend to the lesser ailments of the abandoned whose sicknesses didn’t quite require admission to Enfants-Malades). Some of the arrivals were orphaned when their mothers died at la Maternité (1:50), while others were voluntarily surrendered by caretakers unable to provide for their special needs. When these youngsters were deemed medically stable, they were offered for public adoption, though without surprise, many stayed at Enfants-Trouvés until they reached majority and were turned back to the streets by the hundreds.

Enfants-Trouvés had an anonymous drop-zone called le tour d’abandon (‘the desertion tower’) where sliding doors and a small bell would herald to the nurses within the arrival of a new human deposit. The citizens of Paris were encouraged to mark their children so they could potentially be reclaimed, though very few were ever later sought.

The American doctors in town, however, were most astonished by École Pratique d’Anatomie. While not a hospital per se – it was more of a pathology foundation – it allowed any physician, for the equivalent of $6, to access his own personal cadaver for dissection (no doubt many of whom were unfortunate former patients of Paris’ other healing institutions). In the early 19th century, human dissection remained illegal in the U.S., and many practitioners there had to resort to grave robbing to obtain specimens. In Paris, for a modest fee, cadavers were plentiful for the taking.

There was one small catch. The stuffy and warm dissection room often contained two dozen physicians whittling away on unpreserved corpses. The smell was said to be overpowering, and at the end of the day, leftover chunks of the deceased were tossed to packs of snarling street dogs who waited out back.

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[Copyright 2013 @ The Alienist’s Compendium]

Oxygen From Thin Air

All who fly the friendly skies regularly can probably recite from memory the safety instruction that bored-appearing flight attendants are mandated to present as planes at U.S. and Canadian airports taxi for takeoff. But as a parrot ignorantly mimics its keeper, oftentimes I wonder if any of the proffered information is actually sinking into stupefied passengers?

For example, we all know from being told countless times that if there is a change in cabin pressure, oxygen masks will fall from the overhead compartments; hopefully you also recall that you’re supposed to yank on the tubing, and then put your own mask on first before helping those next to you, especially since, depending on the altitude, you might have less than 15 seconds of useful consciousness left once the masks deploy.

Why that yank? And where is the oxygen stored that will sustain a hundred or more passengers, all breathing through masks at the same time? Has anyone who is not in the aviation industry ever stopped to think about that?

Actually, there is no oxygen stored on planes. Not only would such a combustible be dangerous to have onboard, but the storage needed – either one big centralized tank, or many smaller individual ones – would take up valuable space within the limited confines of the jet fuselage.

When you pull on the tubing, the tug triggers a spring-loaded mechanism that sets off a spark inside a small generator, the size of a canister of tennis balls, that is located over each seat. The resulting spark ignites tablets of lead styphnate and tetracene, which in turn generate heat. A mixture of sodium chlorate, barium peroxide, and potassium perchlorate inside the canister, once heated, releases oxygen.

[sidebar: of course, you might also smell a faint burning odor from the spark and heat, but this is no cause for alarm in light of what else is probably ongoing at that time all around you. In fact, if the plane is actually on fire, the masks usually won’t deploy, so as not to make the fire even worse due to the addition of extra oxygen in the immediate environment]

This chemical reaction won’t last for long, and production inside the canister starts to fade after ~15 minutes. But assuming that you put on your mask as soon as it dropped from the ceiling, you should have enough oxygen from the bubbling compound overhead to sustain you until the pilot can quickly get the stricken jet below 10,000′ altitude. At that point, ambient air pressure will be high enough for relatively normal atmospheric breathing.

Bon voyage!

[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at]

[Copyright 2013 @ The Alienist’s Compendium]

[from the medical records dept] Sanctioned Theft

[I’m engaged in a segue to a new job and state, which hopefully explains the relative dearth of fresh material recently. In the meanwhile, this post, from early 2014, remains one of my favorites]

As a psychiatric resident in the late 1980s, I didn’t sleep much (at least for the first couple of years), my diet consisted of carry-out or unhealthy hospital fare, and I was paid a pittance. This was the expected rite-of-passage through medical specialty training. But because of the hardships, seemingly minor things took on great significance: a girlfriend who would cook for you, a freebie from a drug rep, an afternoon of total peace and quiet – all are lovely, but all are even more lovely for those who feel so deprived.

thank you, Mastercard

thank you, Mastercard

Which is why taking blatant advantage of our chairman’s credit card was so much darned fun.

In the autumn of each year, we would host senior medical students from around the country who were looking for places at which to do their post-graduate residencies. These were important visits in the eyes of program faculty everywhere. If potential applicants enjoyed their visits, they were more likely to rank the program highly on their ‘match list.’ If the visit were a disaster, though, the program would get ranked lowly, or not at all. This directly effected the quality of the incoming class at every residency program in the country. Thus, heads of departments of all specialties everywhere wanted to see happy visitors at the end of the day.

Enter the credit card lunch scam.

At UVa, we had potential applicants come to the medical center on Mondays, Wednesdays, and Fridays during ‘the season,’ which stretched from September through early December. A sign-up sheet would be posted near our on-call room for those residents who were interested in going to lunch with the visitors on any given day. Because the season stretched for more than three months, and there were several designated days per week, it was not uncommon to host relatively small groups of visitors – three constituted a busy day, and more often than not there might only be one potential applicant visiting.

But for that one visitor? Many times half-a-dozen or more residents would sign up to take her to lunch. I recall once that there was a single interested party… and thirteen residents going to eat.

And as we were taking said prospective applicant out to eat, the chairman’s secretary always handed over the gold MasterCard and told us to bring back the receipt. That was it. No other instructions. No limits. No preferred restaurant list. Just go and enjoy.

So naturally we were cost-conscious and went to modest restaurants. Not.

It was during one of these junkets that I first sampled escargot. Seafood bisque was ordered around the table more often than not – often with seconds. Can’t decide on which appetizers to order? Heck, get them all. And while I don’t recall any ‘Surf and Turf,’ that wasn’t because we couldn’t have done so – it was because the restaurants in town didn’t serve such on their lunch menus.

Hundreds of dollars later, we’d return to the secretary that well-worn credit card, only to repeat the sanctioned theft later in the week.

We thought we were pulling the wool over our chairman’s eyes, and marveled that he didn’t put a stop to it when he saw the bills. But he never did.

Actually, I realized much later that we were doing his bidding without knowing it.

Happy well-fed residents put across the best faces possible for potential applicants. Smiles and laughter were all around. I know that research grants and faculty-to-resident ratios are important, but when those same applicants were later sitting at their homes, finalizing their match lists, they remembered how contented were the residents at the various programs and not necessarily how many papers were published by a particular medical center.

Thus, UVa always had a bumper crop of excellent residents back then. And I think that the chairman’s credit card and our ‘abuse’ of same were in no small part responsible.

[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at]

[Copyright 2013 @ The Alienist’s Compendium]

Dial Z For Zombies

[today’s post is sponsored by Lisa S. Kaplan RN, the best nurse practitioner with whom I’ve ever had the pleasure to work. As she is also skilled in those aspects of the time-space continuum not of this plane, what follows seems an appropriate article to which to affix her name… ]

“The Zombies Are After Brains. Don’t Worry, You’re Safe”
~seen recently on a coffee mug at the office

bon apetite!

bon apetite!

Ask any teen, or horror movie aficionado, and they’ll tell you that zombies of modern western pop culture – not those of Caribbean or African folklore – eat brains. Why that is odd is because the cinematic masterpiece that jumpstarted the whole modern zombie craze, George Romero’s Night Of The Living Dead (1968), makes no mention of brain-eating. As a matter of fact, none of Romero’s six ‘Of The Dead’ films do.

So from where did this near-diagnostic facet of zombie behavior arise?

When asked, even Romero didn’t know. In a 2010 interview with Vanity Fair, he noted, “whenever I sign autographs, they always ask me [to write], ‘Eat Brains!’ I don’t understand…. I’ve never had a zombie eat a brain. But it’s become this landmark thing.”

He went on to say that while his zombies do feast on flesh in general, he is amused that people even care about the specifics of it all (i.e., if they actually have favorite body parts or cuts of human meat). He closed by asking rhetorically if the next question will be, “do zombies shit?”

Turning back the clock, mention of brain-eating didn’t first appear, and then only fleetingly, until Return Of The Living Dead (1985). You’re forgiven if you thought that Romero had a hand in that film, but he didn’t. You see, like an amicable marital divorce, when Romero and his erstwhile collaborator John Russo parted ways in the 1970s on good terms, they agreed that all subsequent releases with ‘Living Dead’ in the title would be Russo’s, while those ‘Of The Dead’ belonged to Romero.

[sidebar: the two split over their differences re: zombies. Romero’s can be killed, whereas Russo felt that his should be essentially immortal]

So that 1985 release was Russo’s. Fans asked him about it vis a vis brain-eating.

He professed ignorance too about the etiology of the whole cerebrum schtick.

But his chief writer and director, Dan O’Bannon, once made a flip comment – one that would have unforeseen cultural consequences – that zombies probably eat brains to “ease their pain.” This was seconded by Bill Stout, the production designer of the 1985 film, who, when ambushed by interviewers, said that such an explanation “made sense” to him. Those with way too much time on their hands took these clues and offered that zombies are merely trying to boost their serotonin levels to produce the desired analgesia, and brains are a great source of that particular neurotransmitter.

Romero has expressed surprise/ amusement at the attention to such zombie detail, especially as he has noted repeatedly that the focus of his movies was always on us, and how we react to the zombies, not on the zombies themselves. He has frequently criticized those who “take it all too seriously.”

And although the definitive answer may never be known, it has been suggested by film and TV critics that neither O’Bannon nor Stout are directly responsible for the focused brain-eating craze. Paradoxically, Matt Groening of The Simpsons may have earned the honor of popularizing what is now universally held. And Groening ain’t talking.

You see, in his 1992 Halloween classic, Dial Z For Zombies (itself a parody of Return of the Living Dead), Groening had his cartoon zombies eat brains, perhaps as a nod to Russo, et al., or perhaps for entirely silly and comedic effect. But as Matthew Belinki of has since opined, “millions of kids saw [Dial Z For Zombies] before they were old enough to see a real zombie film. I suspect that for a whole generation, [the cartoon] was the first zombie story [they] ever saw. And that, my friends, is why we think that zombies eat brains, even though most of us have never seen a movie where this is actually the case.”

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[Copyright 2013 @ The Alienist’s Compendium]

Nasty Little Holes

those horrible lotus seeds

those horrible lotus seeds

Three caveats before I dive into this very strange topic:

First, I own a pet Lesser Sulfur Crested Cockatoo which was rescued from a meth lab outside Gastonia NC (where she was being employed as the proverbial ‘canary in a coalmine.’) As her subspecies is critically endangered in the wild, it’s almost certain that she was hatched here in the U.S. Because of that, Koko has never seen any of the predators that would normally populate her home in East Timor. But she totally ‘loses it’ when one of my family approaches her cage wearing a leopard print blouse. Evolutionarily, Koko knows that such a pattern is bad news, and she reacts quite viscerally to it.

Second, looking back over my medical training and subsequent career, I’ve encountered some fairly disgusting things. Self mutilations? Check. Head traumas? Been there. Major abdominal surgeries? Yup. Autopsies? Yawn. But far and away, the most revolting cases came from… dermatology. To really churn one’s stomach, nothing compares with skin diseases.

Third, I still, to this day, remember a vivid and upsetting dream I experienced as an adolescent. It involved seeing a classmate, nameless, faceless, with her arms bandaged. In the dream, she removed the wrap, and underneath, both of her forearms were covered with deep holes, and inside of each one was an insect. I don’t have any idea what triggered this thought in my subconscious, but the dream occurred years before I had ever heard of the subject matter of today’s post, and it has obviously stayed with me all of these years.

Keeping those observations in mind, I now present you with Trypophobia, the fear of small irregularly shaped cavities (or blisters, fissures, and bumps, from the Greek root trypo, for hole). This may sound like a joke, but to those who are purported to suffer from it, the condition is anything but funny. And from a quick Google search online, there seem to be a lot of folks out there who are afflicted – or at least who talk about it. Which is even more odd given that in my 27+ years of clinical work, I’ve never encountered a single patient who endorsed these symptoms, nor was I ever instructed that the condition may even exist!

Specifically, trypophobes say that certain images are ‘triggers’ that reliably produce gastrointestinal symptoms (e.g., diarrhea, nausea, vomiting) as well as more classically psychogenic ones (e.g., sheer panic, dread, diaphoresis, tachycardia, vertigo).

If you look online, you will see frequent mention of triggers both innocuous and nightmarish:

skin conditions, such as severe athletes foot, chicken pox, measles, and deep cystic acne;

maggots doing their thing;

plants with cystic structures or reproductive pods, such as lotus seed heads, cantaloupes, or pomegranates;

porous coral formations;

soap foam;

the honeycombs of bees;

pancakes with little bubbles in them;

circular shower drains;

popcorn (and bumpy popcorn-finishes on ceilings);




weathered sandstone;


and pregnant Surinam Toads, the dorsal aspects of which are pockmarked by gestating young under the skin – and then those little buggers squeeze out of holes in mamma’s back when developed.

There are researchers who claim that some people’s repulsion to certain stimuli is an unconscious evolutionary association vis a vis dangerous animals/ organisms or infectious conditions that have ‘the look,’ and from which we’re wired to stay far far away, for our own safety.

Others, however, state that so-called trypophobia is nothing more than conditioned yet over-generalized disgust to possible contaminants and unpleasant images – think rotting corpses – fanned by pop psychology, photoshopping, armchair diagnosis, and the internet.

[sidebar: and we all know that if something is on the internet, it must be true]

Anyone who has read my blog for a length of time will be aware of my jaundiced view of ever-increasing disease categories in the Diagnostic and Statistical Manual. That noted, there is a lag-time between identifying a condition and having it gain wide acceptance within the profession (e.g., Seasonal Affective Disorder, about which Scandinavians have known for centuries, but which didn’t make ‘the cut’ in early editions of the DSM).

Will trypophobia also make ‘the cut,’ or instead join the ranks of far more suspect ailments like sex addiction and multiple personalities? I’m not sure yet. Either way, don’t now go to YouTube and look for videos of parasitic bot fly infestations. You have been warned.

[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at]

[Copyright 2013 @ The Alienist’s Compendium]

[from the medical records dept] Alas, Poor Yorick!

[this missive first appeared from The Alienist in early 2013]

“Bones are all that survive of the body. They are keys to our collective past and reminders of our own mortality, so it is no mystery that they have a magic aura for artists, for the faithful of many religions, for collectors, for all of us.”
~Barbara Norfleet (1993)

In the winter of 1983 I engaged in that time-honored rite of passage known as the campus visit. In this case it was pursuant to my applications to medical school. Of the schools I had tentatively chosen, all of the curricula were similar, and the work load at each appeared predictably onerous. But one thing that stood out almost immediately was the manner in which the respective schools addressed and dealt with the dead. And I don’t necessarily mean dead patients. I mean dead teaching tools and specimens.

Case in point: at one public university, as part of the prospective students’ tour, we were brought through the anatomy lab. I remember that it was a large antiseptic room with gurneys, tables, and bodies in zipped bags, along with some articulated skeletons on stands next to the walls. I didn’t sense anything lurid about the showing of this area to the applicants; it was just another part of the tour: “on your left, you see some cadavers, and over here on your right….”

However, later at a private university, it was entirely different. The prospectives’ tour stopped outside the doors to the anatomy lab, and the tour guide said, “here is the anatomy lab. I can’t take you inside because it would violate the sanctity of the area. Every day before we begin our dissection, we have a moment of silence and introspection to thank the deceased for their priceless gift to us and our ability to learn from them and assist in the care of those who are still living.”

What a contrast! It’s not that I’m advocating for disrespect, but the second institution struck me as utterly dour. Being accepted at both, I wound up going to the first school, and I didn’t regret the choice. And yes, I did later give my cadaver a name, one rather tongue-in-cheek and in keeping with the usual ‘whistling past the graveyard’ approach to death employed by many in the health professions.

So much for that moment of silence and introspection.

But I’ve pondered at length since then the manner in which we collectively interact with the dead in the 21st century. I’m not a policy-maker, a mortician, a crime scene investigator, or a hospice-worker. But I do think our society’s approach is rather schizophrenic, perhaps reflecting our own conflicted feelings.

Another case in point: later, as a second year medical student, one recurrent exercise in pathology class was known affectionately as the “pot case” or, better, “the man in a can.” Teaching assistants would obtain the leftovers from recent autopsies performed in the medical center and would place the offal in large plastic buckets. Hearts, livers, pertinent bones, brains, kidneys. Any part of a human body was potentially sloshing around inside. After pots were distributed, we would divide into groups and dump out the contents. We’d be told that we had an hour to look through the contents and then to report on our findings. It seemed entirely scientific and not in the least lurid. But while I remember the pathologies encountered in the pots quite well, I have no recollection of ever having pondered the ultimate question: “who WAS this person, and did she ever think that she was going to wind up like this?”

When one looks, human remains are everywhere. There are medical museums – the Armed Forces Institute of Pathology in Washington DC and the Mutter in Philadelphia come to mind – with vast collections of bizarre wet and dry specimens. The Smithsonian has anthropological exhibits of human skulls from around the world, and other academic and research centers possess similar holdings. There are the Capuchin ossuaries in Italy, charnal houses in Egypt, and bone chapels in Portugal that are filled with piles of skulls and stacks of femurs and pelvic bones upon which we gaze. Extant life-sized statuary of saints from the Middle Ages often employ real bones as accessories. And as a lapsed Freemason, I can personally attest that human crania do indeed find their way into lodge ritual more often than not.

So then there is the unavoidable question: how to treat those remains that are not in the ground? It’s not as easy a question as it might at first seem. Many answer by waffling on the age and apparent anonymity of the original owners – specimens from ancient Paleolithic sites rarely stir visceral emotions, whereas that difficult grey zone is encountered, skirting frank grave-robbery, when the remains at issue are nearly identifiable or at least bear an association with someone(s) still living.

For example, at legislative hearings in the 1990s over the fate of the Dickson burial mound in Illinois (active 9thc – 13thc CE), Professor Raymond Fogelson of the University of Chicago spoke for (a distinct minority within) the scientific community when he characterized the curated display of human remains from that site as “obscene pornography.” I prefer to think that another academic who testified, Professor William Sumner, also from the University of Chicago, was closer to accurate when he said that the display “fires the imagination of school children and adults alike…. It inspires a striking recognition of how the past is a continuation with the present and leaves a lasting impression that leads to an enriched intellectual life.”

Besides, it’s not as though such academic collections are spread out to gawkers like a carnival side show. As author Christine Quigley noted in 2001, “the bulk of institutional collections of human remains is rarely visible to the public, despite the fact that displays of [such] are among the most effective tools for luring people into museums.”

And admittedly, not all displays of human remains fall into the academic realm. The successful Bodies tour that has been viewed by hundreds of thousands in cities all across the U.S. is one example of the (some would say crass) commercialization of the dissected dead. There are businesses that specialize in providing “osteological specimens” – certainly a sanitized description – to just about anyone with interest and cash. Prominent auction houses have sold remains when they have historical interest. And human skulls and other bones are freely available online to anyone, no questions asked, as long as the items are listed as “medical teaching tools” to circumvent purported bans on selling body parts on the Internet.

This dichotomy is perhaps easier to understand when viewed through the prism of the early modern age, a time when the scientific method was blossoming alongside P.T. Barnum. Or as Alberti and Hallam presciently noted, “the macabre seeds sewn in the Enlightenment bore their morbid fruit in the Victorian era. Medical collections founded in the late 18th and 19th centuries were at the intersection of a number of cultural and scientific currents: the development of pathology and comparative anatomy as disciplines, the formalization of medical education, European colonial expansion, and the spread of popular shows and exhibitions.”

There is a wonderful book entitled Dissection: Photographs of a Rite of Passage in American Medicine, 1880-1930, by Warner and Edmonson. Based on the vintage collection of the Dittrick Museum of Case Western Reserve University, the book illustrates a surprisingly common form of group photography that became popular around the turn of the 20th century – medical students and house staff posing with skeletons and cadavers. If you search ‘cadaver’ and ‘antique’ and ‘photograph’ on Google Images, you’ll find dozens of these pictures. It seems that just about every American medical school and hospital of the day had students and staff posing openly with the dead.

This ‘art form’ died out after WWII – students would risk expulsion were they to try this today – but even when viewed through the lenses of modern sensibilities, the photos, at least to me, do not seem exploitative or pornographic. Instead the scenes appear innocent, good natured, and in a manner, curious and inquisitive.

But the question remains answered, if at all, unsatisfactorily. It is still unclear what has changed in our collective consciousness of, and appreciation for, the dead. Is it political-correctness run amok? Or something deeper that we are only now coming to understand?

[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at]

[Copyright 2013 @ The Alienist’s Compendium]