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One recent evening, just before I was about to leave my apartment and start my shift as a cardiologist in the Elmhurst Hospital Cardiac Care Unit, my phone rang. Since my wife and our baby daughter moved out to the suburbs a month ago to protect themselves from possible Covid infection, there is nobody around to answer it but me. It rang and rang. Finally, I got up. 

It was my father, calling to tell me that my grandmother, 96 years old, who recently tested positive for Covid at her nursing home, had taken a turn for the worse.    

The zoom link to her nursing home reveals a PPE-clad nursing aide hovering over my grandmother. “She hasn’t said much for the past day or two,” the aide says. Despite wearing a mask, faceshield, and body suit, the aide’s look is unmistakable to me. She knows what’s about to come. “Is there anything you want to say to her?”

My grandmother is taking irregular, raggedy breaths. Her body is slightly arched, and her chin juts straight up into the air. The aide holds the iPad to my grandma’s face. Her eyes are scrunched closed, and her shoulders heave up and down. Her bony hands, which would always grasp mine with a cold and familiar smoothness, lie motionless at her side. 

“…I love you, Grandma,” I say. “I’m thinking about you. I love you.” 

She doesn’t move. 

COVID patients are different from my normal cardiology patients.  I went into cardiology because I like fixing problems. Blocked arteries can be stented. Damaged heart valves replaced. With COVID, the sickest patients don’t seem get better. This isn’t for lack of trying – we just don’t understand this disease well. We’ve tried proning, experimental drug therapies, convalescent plasma, steroids, and advanced ventilator settings. It doesn’t seem to make any difference. Progression to acute respiratory distress syndrome – a hyperinflammatory state resulting in the destruction of lung tissue and respiratory failure – is nearly always fatal. 

Later, at the hospital, I head to the fellows room, and put on my own PPE: blue tearaway scrubs, cap, faceshield, N95, booties. Everyone does it differently. Some have helmets being fed oxygen through hoses, some have goggles, some wear white bodysuits with hoods. There’s none of the small talk so common to hospital life. Everyone walks the halls quickly and quietly. 

I head to the CCU. It has become a Covid unit with every patient on a ventilator. Next to me is a worker from nutrition services with his meal cart. Normally, he would be transporting trays of food. His cart now holds stacks of cartons containing milky, tan liquid. Tube feeds for all of the intubated patients. Dinner for my unit. 

I walk room to room with my residents, adjusting vent settings and drips, rounding and taking stock. We break patients down into organ systems, for completeness. Neuro, heart, lungs, renal, GI, ID, heme, endo. We go up on this med, down on that one. We send streams of labs. We call consultants, order imaging, and debate the best next move. That there is an underlying sense of futility for most patients goes unsaid.

You can almost feel patients’ humanity slipping away, minute by minute, forced breath by forced breath. They lie in sepulchral stillness from sedation and paralytics. After weeks of intubation, their skin becomes puffy, waterlogged, and taut, with decubitus skin ulcers and arms a deep shade of purple from repeated blood draws. Plastic IV tubing snakes from their frail bodies to pumps in the hallway. With visitors barred from the hospital, and the patients under deep sedation, each room is conspicuously silent, except for the high-pitched whooshing of mechanical ventilation. 

Squeee, hisssssss. Squeee, hisssssss. Squeee, hissssss.

A patient on a ventilator is technically breathing, but it’s all backwards. They are having breathing done to them. 

We breathe by lowering our diaphragms, which creates a negative space which air rushes in to fill. When we raise them again, the air is gently shepherded out. But a mechanical ventilator forces air in at much higher pressures than normal, and after waiting for gas exchange, sucks it back out again. 

Breathing, normally so mindless that we forget we are constantly doing it, is a complex, precise sequence that is poorly imitated by mechanical ventilation. The sustained high pressure of ventilation can cause a pneumothorax, or the collapse of lung tissue from air in between the chest wall and the lung. The endotracheal tube is often a source of infection and can lead to aspiration pneumonia. Airway secretions must be suctioned. Acid-base balance can be significantly altered. 

If patients are not adequately sedated, they buck and fight against the ventilator, causing alarms to blare. Their chests heave disconcertingly up and down, and air can build up dangerously in their lungs. It’s as if on some level, the body is fighting against the profaning of its most sacred function.

Squeee, hisssssss. Squeee, hisssssss. Squeee, hissssss.

Everyone is doing a little worse than they were the day before. Mr. Sanchez had a large cuff leak on his endotracheal tube, and had to be re-intubated, and since then his oxygen requirements have been much higher. Mrs. Arredondo was fighting the ventilator too much, and had to be medically paralyzed. Mr. Khan, thirty-four, nearly coded during the day after having his right lung collapse from the sustained barotrauma of prolonged ventilation. He needed an emergent chest tube to re-inflate the lung. He’s also being medically paralyzed to ensure ventilator synchrony. My unit is sick. Hemoglobins down, arterial blood gases with falling pH, urine outputs decreasing. Human decompensation, neatly documented.

We have to place a dialysis line on Mrs. Garcia, whose urine output had fallen to nothing and whose potassium was quickly rising. We speak with her family on the phone to get consent. They are grateful and appreciative. “Anything you need to do to keep her alive,” they say. “And thank you doctors, we are praying for you. Thanks to god for you.” We’ve been calling them daily for three weeks. Their stoicism and grace defies comprehension. I don’t feel like I’m doing anything to actually change her outcome. 

We don’t deserve this praise. 

Finally, the shift ends. I sign out the patients and head back home. 

I make some soup, and eat it on the couch. My daughter’s playmat sits unused in the corner. Her favorite stuffed animal, a purple rabbit, lies in a dramatic, almost comical, posture, stretched out in the corner. 

I turn on an iPhone app for guided meditation, meant to help relax. It instructs me to take deep breaths. I feel my chest expand all the way out, full of air.  But I can’t quiet my thoughts. My head is full of facts. The feeling of the lungs full of air derives from the filling of six hundred million tiny alveoli, two-tenths-of-a-micron thin, that comprise our lung tissue. What use is this info? I miss my girls. Will my daughter still remember me? When will it be safe for me to hold her again?

I pass out, and wake up to several missed calls from my dad. 

He says my grandma passed away during the shift. 

When he hangs up, I want to take some deep breaths to calm down, but it’s not working. I want more time with Grandma. I miss her elegant voice already. What I’d give for her to clasp my hands one more time, for one more “you’re wondahful!”

The app is… ludicrous. My breaths are unsteady, irregular. My tears make the pillow wet.

Still, the doctor in me feels relief that her passing was short and painless.  Indeed, my grandma was never on a ventilator. She was DNR. And after what I’ve seen at work, I’m strangely relieved. 

I think about the young patients I have in the CCU, about Mr. Khan and his failing lungs. We have to ventilate, to give everything to save him…right? It’s obvious. It’s what I’d want for myself… I think. Or maybe not. I’m scared for Mr. Khan. I hope that if we can’t save him, we can at least make him comfortable. In the context of multi-organ failure, besides sedating him heavily, I’m not exactly sure what that means.

I spend the next day talking about arrangements for a virtual funeral for my grandmother. Then, the following evening, the routine repeats. I’m back wrapped up in PPE, back in the ward, facing a new list of impossible problems.

Slowly, painfully, the week ends, and I rotate off service. But I can’t stop thinking about Mr. Khan. I log in remotely and check the patient list.

Remarkably, he’s still hanging in there.

We are exactly nine days away from the release of Star Wars: Episode IX, marking the end of the Skywalker saga. Having just picked up a Disney+ membership, I found myself skimming through the prequels to fully immerse myself once again in the lore and backstory.

I watched Episode III in its entirety. It’s a very satisfying movie, however what intrigued me most in this watch-through was Padme’s death. I was always a bit confused as to why she died as a kid. I never really thought it was that well explained. In the intervening years since the movie was released, I’ve committed to a life in cardiology. I have new perspectives now, and I’ve learned a bit about human physiology. I think I may have some novel insights to provide. So, without further ado, here is my definitive take on Padme’s death.

Background events

Padme Amidala was a 27 year old human female from Naboo, according to this Star Wars wiki. She was born to a family of “modest origins,” but was quickly identified as being “gifted and brilliant,” leading to her selection to a legislative youth program, and ultimately her election as Queen. It’s clear from the imagery of the prequels that Naboo seems to be a vibrant planet with clean air, fresh water, and plenty of spaces for cardiovascular exercise.

From this we can surmise three things. First, that she likely did not have food scarcity as a child, and therefore did not have any nutritional deficiencies as a result of low vitamin intake such as iodine or vitamin B1 that can cause cardiomyopathies (thyrotoxicosis, beriberi). Second, that as a figure of political importance, she likely had regular checks with physicians who would monitor her blood pressure, cholesterol levels, and hemoglobin A1c. This would rule out fibromuscular dysplasia, familial hypercholesterolemia, and diabetes. Third, because of her intellect and good fortune to be born on such an abundant planet, she likely ate a balanced Naboo diet and got plenty of exercise. Overall: she was likely healthy with no past medical history.

After she is elected to the Senate, she moves to Coruscant. Her stress levels likely go way up as she is dealing with a multi-front war, a co-senator/chancellor from Naboo who turns out to be a Sith lord, and a forbidden romance with a Jedi. The last item here turns out to be the most relevant. Padme spends most of Episode III ruminating about how things are falling apart with Anakin, who is acting increasingly bizarrely. After Anakin betrays the Jedi and becomes Darth Vader, Obi-wan confronts Padme with evidence that Anakin has been slaughtering Jedi, including a room full of Younglings. She is visibly shaken but insists on flying to Mustafar to confront Anakin. Medically, this is where things really pick up.

Confrontation on Mustafar

Padme pleads with Anakin, who is fully bonkers at this point:

Padmé: I don’t believe what I’m hearing. Obi-Wan was right… you’ve changed. You have turned to the dark side. You’re not Anakin anymore.

Anakin: [with a growing angry look and voice] I don’t want to hear any more about Obi-Wan. The Jedi turned against me. Don’t you turn against me!

Padmé: [crying] Anakin, you’re breaking my heart. You’re going down a path I cannot follow!

Anakin: Because of Obi-Wan?

Padmé: Because of what you’ve done… what you plan to do! Stop, stop now. Come back. I love you!

Anakin: [enraged and paranoid] LIAR! [Anakin looks beside Padme and sees Obi-Wan standing at the ship’s exit overhearing them]

Padmé: No!

Anakin: You are with him! You brought him here to kill me! [Begins Force-choking Padmé]

Padmé: No!

Obi-Wan: Let her go, Anakin!

Padmé: Anakin…Obi-Wan: Let… her… go![Vader releases Padmé, who collapses]

We’ll return to this later, but the main clues are “Anakin, you’re breaking my heart,” and the fact that she is force-choked and then loses consciousness.

Aftermath and Death on Polis Massa

Padme gives birth on Polis Massa, an Asteroid Field in the Outer Rim, two days after being choked by her husband. Polis Massa is an extremely remote location, so remote that is a safe haven for the few remaining Jedi from the Empire. Think Degobah levels of remote. As such, I think it’s safe to assume that their medical facilities are not top-of-the-line. This is basically a research station, and probably had the bare minimum of medical equipment. After taking Padme to the medical center, Obi-Wan and Bail Organa hear a baffling piece of news from the medical droid, and in short order, she’s dead. What the hell happened? I have the full exchange below:

MEDICAL DROID: Medically, she is completely healthy. For reasons we can’t explain, we are losing her.

OBI-WAN: She’s dying?

MEDICAL DROID: We don’t know why. She has lost the will to live. We need to operate quickly if we are to save the babies.

* * *
OBI-WAN: Don’t give up, Padme.

PADME winces from the pain. The MEDICAL DROID is holding the BABY.

MEDICAL DROID: It’s a boy.

PADME: Luke . . .

PADME can only offer up a faint smile. She struggles to touch the baby on the forehead.

MEDICAL DROID: … and a girl.

PADME: . . . Leia.

* * *

OBI-WAN: You have twins, Padme. They need you . . . hang on.

PADME: I can’t . . .

PADME winces again and takes OBI-WAN‘s hand. She is holding Anakin’s japor snippet.

OBI-WAN: Save your energy.

PADME: Obi-Wan . . . there . . . is good in him. I know there is … still . . .

A last gasp, and she dies.

What We Know

OK, so let’s go back to the beginning of the sequence — the extreme emotional trauma that her husband and baby daddy Anakin is a murderous psychopath. Padme says “Anakin, you’re breaking my heart!” I believe that this line carries a lot of significance. Not only is she referring to her emotional state, I believe she is also referring to physical chest discomfort.

Next, she gets force choked. Permanent hypoxic brain injury occurs when the brain goes without oxygen for more than 4 minutes. The force choke seems to be well-aimed and is likely impeding air flow through the trachea, but it lasts only about 30 seconds. Padme passes out after being released, but I do not believe her death had much to do with the force choke. Sure, it was extremely traumatizing. But we have a few clues that tell us the damage from it was minimal.

Most importantly, her ability to communicate meaningfully with Obi-Wan in the delivery room says a lot. We can assume that from a neurological standpoint she is basically intact, although she might be a bit disoriented. She knows who he is, she remembers how to speak, she remembers Anakin, etc. So brain function is basically OK. Furthermore, her ability to phonate speaks (pun intended) to no lasting damage to her larynx from the force choke. And based on the medical droid’s assessment that “medically, she is completely healthy,” I don’t believe there was any structural damage to her neck and the surrounding tissue and organs.

One thing the force choke almost certainly did was raise central venous pressure. This would increase the demand on the left and right ventricles, as well as activate baroreceptors in the vagus nerve which can cause bradycardia and syncope, which could explain why she passed out. But I also can attribute this to the pure shock of the situation, so vasovagal syncope could be a culprit here as well.

At this point, she is unconscious on the surface of a hot lava planet. She is pregnant with twins, and therefore her total body volume is high. But she is likely relatively hypovolemic at this point. She isn’t taking in any PO fluids, and in addition she’s likely quite dehydrated from insensible losses to the environment. Eventually, Obi-Wan gets her and brings her to Pollis Massa, which brings us to the medical droid’s strange report.

“Medically, she is completely healthy. For reasons we can’t explain, we’re losing her.” What does it mean by this? Let’s take stock.

Padme is lying flat. There seems to be a screen with diagnostics, probably trended vitals. There are no central lines in her neck or groin, no intravenous lines, no bags of inotropes… nothing. It’s unclear what, if any, labs have been drawn. In fact, there seems to have been no invasive monitoring or intervention done at all. So I don’t know what the medical droid is referring to by “medically” here. My best guess is that it’s probably referring to some method of advanced imaging like a CT scan or MRI. Normal imaging would rule out a lot of major things like tension pneumothorax, pulmonary embolism, and large pericardial effusion causing cardiac tamponade (these things could also be picked up on exam, but I’m assuming the med droid has a decent exam). Also, as I alluded to earlier, it would rule out traumatic injury from the force choke: broken bones, penetrating trauma, vascular injury, and hematoma. It also rules out necrosis from a large scale burn injury, although, again, this would have been evident on exam. Lastly, it greatly reduces the likelihood that there are active issues with her pregnancy – it rules out intrauterine hemorrhage, and likely shows two healthy babies. The medical droid probably would have been alerted to something like placenta previa, which would have been picked up on imaging and made it a high risk pregnancy. In that case they probably would have gone right to C-section.

It’s hard to image the coronaries like this – you need a detailed coronary CT protocol that involves breath holding and a slow heart rate – but let’s assume that they have the technology. If it showed normal coronaries, this would have really confused the medical droid. Given that Padme is a young pregnant female who was found down, the med droid could have reasonably thought this was a case of Spontaneous Coronary Artery Dissection, or SCAD. Gold standard to diagnose would be angiography, but I’ll assume that their advanced imaging could detect this. With normal coronary anatomy, that is ruled out, as is myocardial infarction.

So the imaging is normal, and the medical droid relays this info to Obi-Wan. So why did the medical droid report that they were losing her? I’m guessing it’s because her vitals were likely normal-ish but heading in the wrong direction. Probably her oxygen saturation and blood pressure were low-normal, BP 90s/60s and oxygen saturation in the low 90s, but continuously trending downwards. So the droid knew something was up, but didn’t quite know what.

Putting It Together

We have a force choke that we know did not cause brain damage and based on normal imaging did not cause any blunt force crush injuries to her internal organs. We have normal imaging and likely no labs or invasive monitoring of left and right sided pressures and cardiac output based on her absence of any IV or central lines. We have dehydrated (low intravascular volume) but overall hypervolemic (high extravascular volume) woman with twins. Even though her overall plasma volume was likely elevated from the pregnancy, she probably had a low intraarterial volume.

What didn’t the medical droid know? It didn’t know the history. It didn’t know the severe stress she had been under. Critically, due to a lack of modern medical facilities, it appears that it did not have any real-time imaging of the heart, only snapshots with MRI and CT. Ladies and gentlemen, I give you my diagnosis:

I think Padme died from an underlying undiagnosed Takatsubo cardiomyopathy as a result of her being force choked. Takatsubo cardiomyopathy is also known as stress-induced cardiomyopathy, or “broken-heart syndrome.” Takatsubo is the japanese word for a fishing pot used to trap octopuses. Its shape is very similar to the heart’s shape in this condition – a ballooning at the apex with preservation of the mid and basal segments.

The pathophysiology is unknown to this day. Patients typically present with chest discomfort after severe emotional stress. They have electrocardiogram changes consistent with myocardial infarction and are urgently taken to the cardiac catheterization lab, where they are found to have normal coronaries. Left ventriculography (shooting dye into the left ventricle to define it’s shape, as seen above) shows the typical Takatsubo pattern, and the diagnosis is made. Patients often have a very good prognosis, and are treated with beta blockers and ACE inhibitors. Most will fully recover their left ventricular function, however acutely patients can lose up to half of their heart’s pumping capabilities, or cardiac output.

Normally, this type of thing is survivable, but Padme is not in a normal situation. She is hypervolemic from carrying twins, and underwent severe physiologic stress between the choke and lying around on Mustafar for what must have been hours. She therefore was likely in a state of undiagnosed cardiogenic shock. A simple venous lactate or troponin-I level would have been able to point the medical droid in the right direction. An EKG would have helped as well, however due to the time that elapsed between event and presentation, the acute ST changes may have resolved, and the only thing left would have been nonspecific T wave changes. With no prior EKG, the medical droid may have been left in the lurch even if he did have an EKG.

Padme now goes into labor with a greatly reduced cardiac output. This is an extremely dangerous condition, as delivery is one of the greatest physiologic stressors there are on the body. Even women with normal hearts can develop peripartum cardiomyopathy, a brutal condition which carries a very high mortality. Forget heart issues – out of hospital maternal mortality from normal child birth is quite high.

Now, what exactly killed Padme? This is less certain to me. She names her son, then her daughter, then has a brief conversation with Obi-Wan before dying. It’s possible that her elevated left sided pressures from the Takatsubo cardiomyopathy caused flash pulmonary edema. Because she was lying completely flat, she would have had worsening fluid buildup in her lungs which would have caused her oxygen saturation to plummet, causing her to become hypoxic and drift into unconsciousness and ultimately losing her brainstem reflex to breathe. This is, I think, the most likely explanation.

Other possibilities include hypovolemic shock and and circulatory arrest from extreme fluid loss after delivering her twins and being left alone on Mustafar for so long. Ventricular arrhythmia is possible given the severe electrolyte abnormalities from her fluid shifts from pregnancy and dehydration, although I suspect her presentation would have been more dramatic and wouldn’t have had such a slow-burn feel to it. We also have to consider things like amniotic fluid embolus or a new, massive pulmonary embolus that wasn’t present on initial imaging that occurred during childbirth causing hypotension, shock, and death.

What I’m fairly confident about is that the Takatsubo cardiomyopathy greatly weakened her, making what was an already high risk pregnancy extremely risky, weakening her and opening her up to a range of fatal pathologies all stemming from greatly reduced cardiac output. It’s hard to blame the medical droid entirely – I think it was doing its best. But it was probably used to minor scrapes, headaches, the flu, and the occasional broken bone from a mining accident. With limited diagnostics, it just couldn’t get a handle on what was a fairly complex case. I think the obstetrics/pediatrics droid performed very well. Clearly, the babies ended up being fine. They ended up being very close.

Almost certainly, limited medical resources played a large role in Padme’s death, as basic labs, an echocardiogram, and/or invasive hemodynamic monitoring could all have been used to hone in on the correct diagnosis. But this was a remote base in an asteroid field. It is doubtful there was much else besides the two droids and the monitor screen, which was probably a glorified EMR. That the Joint Commission would ever travel that far for inspections, much less recognize it as a Center of Excellence for Advanced Cardiac Therapies, is similarly doubtful.

Additionally, one wonders what the channels of communication were between the two droids. Could the droids understand eachother? The obstetrics droid did not appear to speak English, and the medical droid did. I’m not sure if it was the culture of the institution to have the medical droid assume all diagnostic responsibility, or if this was shared. Limited communication may have been a factor – the two droids are never shown talking to one another. Perhaps if they spoke a similar language, the delivery droid could have assisted in pointing the medical droid in the right direction (ie heart failure) given its expertise in maternal/fetal medicine.

The Final Chapter

Thank you for going on this long journey with me. Hopefully you learned something, either about heart physiology or octopus jars or my bizarre obsession with Star Wars. Anyway, I’m very excited for The Rise of Skywalker, and oddly sentimental that the journey is finally over. Here’s waving goodbye to our favorite space family. Thanks George Lucas/Disney for the drama, the music, the lightsaber battles, the ships, the wisdom, and the amazing prequels dialogue… and one particularly interesting and enduring medical mystery.

I’m a cardiology fellow, and so a good chunk of my time is now spent consenting patients for various procedures and tests. You go over the risks and benefits with the patient, and ask if they have any questions.

But all this consenting led me to a realization: I had never been consented to become a doctor! This seems to me a glaring hole in current med ed. After all, the future consenters of America must themselves be properly consented.

But you can’t live life in the past. Future MDs, I’m looking out for you. See the attached below for your very own consent for medical training form.

I, __________, hereby consent to receiving my MD from __________ medical school, and my residency from _____
_______. I agree that the risks and benefits of this invasive and interminable set of standardized tests and call obligations was fully explained to me by Benjamin Gold, MD.

Explanation of the Procedure

1. I agree to sacrifice all of my free time to either study for or become extremely anxious about a series of never-ending, expensive board exams.
2. If I pass the exams, I agree to yield the remainder of my free time to being in the hospital.
3. I agree to be in debt for the next ___ years at a cost of roughly $_ _ _,000.00 dollars.
   • Corollary 1: I agree to wholeheartedly endorse the debt as “worth it” in conversation.
4. I agree to commit to choosing a specialty based on a few weeks of exposure to a given field.
   • Corollary 1: The decision will largely be based on how cool the residents are, and the degree to which the attending is or isn’t a dick.
5. I agree to profess my undying, unyielding love for performing medical research.
6. Due to the inherent difficulty of dating during medical training (testing, stress levels, The Match, etc.) I hereby renounce all claims to a love life.
   • Acceptable love objects during training include: ice cream, coffee, alcohol, netflix.

Medical Risks

1. Permanent eye bags
2. Dysthymia
3. Arrythmia (from the coffee. See: Explanation of the Procedure, point 6)
4. Insomnia / circardian rhythm disorder
5. Delusions of grandeur
6. Retching / vomiting (see: anatomy lab, first year; see also: GI rotation)
7. Bleeding, infection, damage to internal structures

Anesthesia

Several narcotic agents will be used to induce sleep. These include, but are not limited to:

1. Online Hospital Certification Modules
2. HIPAA Compliance Training
3. EPIC Training
4. Powerpoints on how to avoid burnout that recommend getting more sleep.
5. 24 hour call followed by Grand Rounds.
6. Trying to obtain a prior auth over the phone.
   1. WARNING: only long telephone holds cause sedation. If speaking with a representative, known side effects include severe rage and extreme psychological torment.

Benefits of Procedure

1. Being able to reassure family members over the phone that they aren’t dying.
2. Replacing whatever baseline psychological orientation you had towards the world with a grim cynicism that reduces time wasted on things like optimism or hope.
3. A realization that the human capacity for suffering is far, far, greater than you had imagined.
4. Being able to help someone at their lowest, when they have nowhere else to turn, no insurance, no family, and no clue what is wrong with them. Being able to look someone in the eyes and tell them that it’s going to be OK, that we’re going to figure this out. Showing someone that you care about them, they aren’t alone, and you’ll work together to help them live a longer, better life. Witnessing bravery you couldn’t imagine was possible in a human. Being hugged in clinic by a patient in tears who tells you that without you, they wouldn’t be alive. Being a voice for science, reason, and compassion in an increasingly chaotic, conspiratorial, and bitter world. Knowing that you’re trying to make the world a better place.
5. Wearing scrubs to work. It’s the best.

I remember Grandpa Larry’s visits remarkably vividly. He would lumber into the house hunched over, grunting loudly and reeking of cigarettes. He was unshaven and haggard, with wild grey-black hair streaking out horizontally from the sides of his head. He would rock and turn uncomfortably until he could find a chair, then once seated would begin rhythmically swaying back and forth. He spoke in a flat, rough voice. He had considerable difficulty getting words out.

Grandpa Larry rarely made eye contact, which was a good thing. If he did, you would want to look away. His expression verged between hollow detachment and frenzied searching, as if he was trying to escape from something he couldn’t see.

Once the spectacle of his arrival had passed, it was time for his injection. My parents would drag him into the bathroom and give him a depot injection of Thiothixine, a powerful antipsychotic.

The strangest thing of all? Underneath the madness, he was incredibly sweet.

He would drawl out my name and the names of my siblings as we’d bashfully enter the room. He didn’t quite look at us, but he’d raise his head and look to the side. We would tell him about how school was going, our favorite movies, favorite colors. He would grunt and nod and shake around, utterly respectful of my little fourth grade self. I usually couldn’t quite make out exactly what he was saying, but it didn’t matter. I knew what he was trying to say.

Over the years, I had a lot of questions about Grandpa Larry. Who was this wild creature, my mom’s dad, the man in whose body resided roughly 25% of my DNA? I knew that he had something called schizophrenia, something that no one else I knew had. I knew we didn’t see him very often. And I heard a lot of stories about him.

Stories about the old Grandpa Larry, before his ‘break,’ abounded. They told of a handsome, brilliant athlete who graduated Columbia University in three years and Columbia Law School in two. A man with an eidetic memory who would play bridge with his law professors because he didn’t need to study. Legend had it that people had wanted to run him for mayor of New York.

Then there were other stories, the ones describing his swan dive off the cliff of sanity. How he was abused by my great-grandfather. How he was forced to marry my grandmother after it was discovered that they had been sleeping together out of wedlock. How the birth of my mother led to him losing control of his thoughts, his mind, his life. He started to suspect aloud, to his colleagues at the posh law firm that he had just been hired at, that the FBI was tracking him and trying to poison him. He was fired.

My grandmother, with a new baby and a delusional and psychiatrically unstable husband, was forced to institutionalize him to protect my mother. My mom met her dad when she was twenty-five.

I thought about him a lot as a kid. Sometimes I would talk to myself – did I have schizophrenia? Could I ever turn into him? If I did, would I even be able to recognize it? Was schizophrenia hereditary? Were there triggers that could be avoided? Was there some age at which I was safe? Or would the specter of mental disease always be there for me, lurking, waiting for me.

I never got to know my grandpa that well. As I grew up his body began to deteriorate. He died when I was in high school.

It was a sparsely attended funeral, mostly just family. But a few friends came, including a man named Sidney Zimmer. He was the owner of the Hotel Belleclaire, on the upper west side of Manhattan, where my grandpa had been allowed to live (at a reduced rent) for many years.

My parents thanked him profusely for his kindness over the years, for allowing a tenant like him to stay. He smiled and nodded. That he had driven all the way out to Long Island for the funeral of his longstanding psychiatric tenant was fairly astounding to me.

Before he left, he reached into his pocket, pulled out a pen, and handed it to me. It was from Hotel Belleclaire, with a richly stylized “HB” in red and black on the outside of the pen. “Think of your grandpa when you use this pen,” he said.

His funeral was thirteen years ago. I never took the pen out of my jacket pocket. It’s still there, zipped safely away, always within reach.

The pen is a sort of totem for me. It’s comforting to hold it, out of everyone’s view, and be reminded of my grandpa. I think about his legacy of struggle and hardship and foiled aspirations. About how kind he was to me. And about how lucky I am to be sane.

But it also reminds me of Sidney Zimmer, a man with a remarkable capacity for good. It reminds me that people with compassion are out there, trying to help people like my grandpa. Holding that pen, I like to think that I could be one of those people too.

Stop what you’re doing. Really. Put down your phone, and before reading any further go through the following flowchart:

1. Have you bought Marie Kondo’s book The Life Changing Magic of Tidying Up? If yes, good. If no, proceed to 2.
2. Go to your hamper.
3. Pick out the dirtiest, smelliest sock from all the way at the bottom.
4. Stuff it into your mouth.

You’ll probably notice that this is extremely gross. Congratulations, you have now been properly punished for not immediately buying this tiny, wonderful book. I honestly don’t know how you expect us to advance as a civilization when people like Marie Kondo take the time to write books like this and we (civilization) don’t adhere to her wisdom.

Admittedly, you probably have heard of her by now. The book has sold something like 50 billion copies, and Marie Kondo now has a Netflix show where she shows people how to tidy up. I’m probably just feeling silly that I didn’t know about this earlier and compensating. But for the tens of people that haven’t heard about her yet, this is for you.

It all sounds quite banal: combing through your possessions, deciding which to keep, and then storing the ones you want to keep in an intelligent way. But this is a case of 1+1=3. The whole is really more than the sum of the parts, here. There is something utterly freeing, enjoyable, and even addictive about her methodology of choosing, discarding, and storing.

Famously, it revolves around the concept of keeping only the objects that “spark joy.” You make a big pile of all your stuff, going through each one and holding it in your hands. It’s refreshingly simple. You make your way through clothes, paper, sentimental items, books, and desk items, carefully gauging your emotional reaction to each one.

First, you experience a pleasant, subtly wistful feeling of time passing, like a deep exhale. You appreciate which clothes have soldiered on since high school, and which ones just won’t make the cut. You comb through old letters, reliving old birthdays and holidays, tracing the connections between the item and the person or place it came from. You also start to realize how much just how much stuff you actually have.

Then the experience really starts blossoming. As you go through each item you enter a flow-state, conducting a meditative tour of yourself via the medium of underwear. You finish one drawer excited for the next one. What missing article of clothing will be buried on the bottom? What item you loathe have you now been given permission to jettison? What thing, once forgotten, will be found?

The feeling of rediscovery spreads. You finish your drawer, and then it’s on to the closet, under the bed, the storage areas, the bathroom. I recently threw out four garbage bags full of utterly unneeded stuff, as well as a fifth one with clothes for goodwill. You find yourself looking at your entire apartment (your life??) differently.

But it goes even beyond that. I started going through my phone, deleting old whatsapp notes and unused apps. I’ve been going to bed earlier, waking up earlier, going to the gym more. I became a sort of evangelical Kondoite, texting pictures of my newly sorted drawers to my wife and tsk-tsk’ing her about a jacket slung over a chair. She was a disbeliever at first. But lo, the awesome cleansing power of the KonMarie method was too much for her to resist. Within hours, she was diving headlong into her drawers, reorganizing her closet, and filling trashbags with unneeded jetsam.

Where does this all lead? I don’t know. I can’t promise that it will enrich you, solve global warming, or help elect a new president. But I think it does do something to tangible you. It’s like a firmware upgrade to your brain. Like the technique itself, the effect on your life is subtle yet persistent. It’s a reminder to fight off the entropy of our daily lives with a bit more vigor. To respect yourself and your surroundings more. To care more.

That all being said, I may just be crazy. In that case, this might not be nearly as rewarding for you as it was for me. Even then, you at least get a set of organized drawers out of it.

Thank you for your time, everyone, you can go about your lives again.

You can take the sock out of your mouth now.

Yoga and I have a strange relationship. I do it every few months, greatly enjoy it, then inexplicably ignore it for a while. Recently, however, a friend told me about Hot Yoga, and would I want to try? I agreed. How different could it be?

What follows is a partial record of my Bikram experience.

6:55 PM: I arrive at Yoga One. Exhausted looking yogis trudge out of the studio as I enter. They stare straight ahead and avoid eye contact. They are replaced by a stream of attractive men and women in their 20s and 30s gliding into the studio.

6:56: I have to register at the front desk. “Would you like a towel?” the lady at the desk asks cheerily. She has the most wholesome smile I’ve ever seen.  Not wanting to appear novice, I shake my head no. “Oh, I’ll be fine,” I say. She nods her head, her eyebrows arching slightly.

6:57: I walk into the hot yoga room. The air is warm and wet, and it sends shivers down my spine. It was a warm 82 degrees in Houston that day, a comfortable 72 degrees in the studio lobby, and at least 90 degrees in this room. My friend tells me the heat goes up to 98 during the class, smiling. Humans are strange creatures.

6:58: Slight panic as I realize that all the good spots near the teacher are taken. The only ones left are near the large, jet black, wall mounted heater that looms ominously from the wall. I spread my mat out, take off my shirt, and sit cross-legged.

6:59: The teacher enters wordlessly, and sits at the front of the room. Forty faces look up at him, reflected on large mirrors on the wall. They are stoic faces, focused and attentive.

7:00: I get a good look at the teacher, Clemente. He seems to be about 30, with a shaved head and a neat, well-manicured beard. His proportions are, and I’m trying to be as scientific as I can here, impossible.  He’s absolutely ripped, with pecs and traps that bulge out of his sinewy yoga tank top.  His torso looks like an upside down triangle.  “Let’s begin,” he says softly, invitingly. “Oojayee breathing.”

7:01: The class begins breathing in unison. The large heater, approximately 10 feet from my head, whirs to life.

7:02: We’re breathing in and out, in and out. We’re standing now, stretching our arms out and puffing out our chests out as we breathe in, and then bringing our hands together in front of us as we exhale. It feels really good.

7:04: A bead of sweat forms on my brow, cascading down my face and falling with a plink on my yoga mat. All we’re doing is breathing. I ponder the rejected towel offer. What was I thinking?

7:05: Sun Salutations. We spread our hands to the sky, then bend over, forward fold, and drop into downward facing dog. We move to cobra and arch our backs. Then it’s back to the forward fold, with hands to the sky, then back at the heart. My heart’s racing.

7:06: Oof. It turns out we are doing circuits of sun salutations.

7:10: “We’ll begin our standing series with Warrior One,” Clemente says. My entire body is now covered in sweat. There is an audible, rhythmic pitter patter in the room as my sweat droplets fall to hit my mat. I spread my feet into a lunge and spread my arms sideways. The convection cooling of my soaked arm as it moves through the air feels wonderful, but only for a second. The heat is oppressive and stagnating. I feel my senses dulling.

7:12: Clemente walks around, making subtle corrections. A hand on a back here, a sculpting of a stance there. “Maybe you try to sink a few inches deeper with your heels,” he says. “Maybe you only focus on keeping your vertebrae aligned.” My thighs are burning. I begin to notice that my feet are wet, and starting to slide along the yoga mat in slow motion.

7:15: “Maybe you let something go today,” Clemente offers. I’m letting go of my serum sodium level, at least.

7:20: We are now bent at the waist, looking through our legs upside down. I can’t tell if it’s the impending heat stroke or the hypovolemia, but I feel like I’m in a dream. It looks as though the class is now attached to the ceiling, clinging like spiders with their hands and legs. Clemente, our arachnid mother, delicately walks between us, patrolling his web, training his spiderlings.

7:22: Vvvvhhhhhhhhhhh. The heater drones on. My thoughts are stretchy, now. Untethered. “The heat is the source of my suffering,” I think. “And the only way to defeat it is to finish this class.” Is Clemente my mentor? My enemy? What am I learning right now?

7:30: “Dancer pose,” Clemente purrs. “Allow yourself to reach out.” My arm stretches out, out, out towards the mirror at Clemente’s suggestion. In the mirror, it looks like we’re all reaching towards ourselves.

7:31 I lose my footing and have to abort the pose. Balancing on one foot is extremely difficult in my current situation. My yoga mat has become less of a mat and more of an estuary. My accumulated runoff now supports a burgeoning ecosystem. There are rivers, lakes, major and minor tributaries, dams, nature preserves, research stations. Hopefully it’s low tide soon.

7:35 We’re doing slow motion squats now. “Who’s feeling playful?” Clemente asks. I’m actually not feeling that playful. I’m feeling more like a prisoner of war.

7:37 “Maybe you wiggle your toes on the way down. Keeps you grounded on our heels, and also it’s fun. Yoga should be fun. Let me see those smiles.” My calves are screaming at me psychically. I make a mental note to google “early signs of rhabdomyolysis” if I ever escape this. I manage to curl a single toe. Close enough.

7:40 Suddenly, without warning, Clemente dims the lights. “Vapasanah,” he says, and everyone stretches out on their mats and rests. Clemente flicks another switch, and a few seconds later the infernal heater stops, and a large ceiling fan turns on. A glorious cool breeze wafts over my body.

7:41 I don’t think I’ve ever really felt happiness until this moment.

7:42 I’m staring up at the ceiling. Dim light is emanating from small lamps spaced every few feet, with dark patches in between. There seems to be something cosmically significant about it.  The light is happiness, or positivity, or contentment, or something, and it’s up to us to turn it on and eradicate the darkness in our lives. We want to be near radiant individuals, but we can also become radiant individuals and thus be a shelter from the darkness for others.

7:42 continued: Why did I reject the towel? Maybe I wanted to be seen as someone with foresight, someone who acted with purpose and didn’t forget things. But I think it’s deeper than that. Maybe subconsciously I wanted to play the role of the inexperienced practitioner, the outsider. Maybe life is about changing the roles that we set for ourselves.

7:42 continued, part 2: Am I hypoxic, or did I just have a major breakthrough?

7:42 continued, part 3: How long have I been sitting here?

7:44 Clemente flips the lights back on. Still more work to do. God damnit. Maybe the light isn’t such a good thing after all.

7:45 “Pidgeonnn,” Clemente says, knowingly. There are some chuckles from the class. This doesn’t sound too bad. I lower myself onto my mat, which creates a horrible wet sucking noise from all the moisture. In a former life, when I wasn’t on the brink of unconsciousness, I would have been embarrassed by this.

7:46 This pose is torture. You tuck one leg under the other then stretch forward, dropping your head as far down as you can. My quads erupt in a series of fiery spasms. There should be a new pidgeon pose, Modern Pidgeon, where you walk around cockily with a group of your friends and eat leftover food.

7:50 I’m in rhythm, now. My body moves mechanically to Clemente’s suggestions. I feel a deep sense of calm, triggering a feeling of elation.

7:56 The last stretch. Clemente clicks the lights and heater off for the last time. The angelic ceiling fan, my sun and stars, whirs to life once more. We return to the breathing exercise we started with in a seated position.

7:59 “Thank you for sharing in your practice today with me,” Clemente says. I would take a bullet for this man. “Namaste.”

8:00 I chase off a school of catfish from my swamp mat, roll it up, and leave the room. The lobby air is crisp and refreshing on my boggy, erythematous skin. I see my friend, who is all smiles. “What did you think?” he says.

I laugh. I have lived a thousand lifetimes, suffered a thousand deaths. My mind is free and clear. I’m swimming in endorphins. I’m whole. “It was good,” I say. “We should do it again sometime.”

Hey everyone!

Here’s my latest for the Houston Chronicle, about the difference between a patient and a person, and why it’s probably a good idea to separate the two concepts when we treat disease.

 

Our society has seen a big shift towards the appreciation and practice of spirituality. In seemingly all corners of life, from diets to religion to exercise, there has been an incorporation of eastern ideas about meditation and yoga into the mainstream.

Medicine has not avoided this trend, particularly in training doctors to avoid burnout, the process by which doctors become disillusioned, cynical, and depressed.  This topic is usually addressed in the form of a lecture, where speakers identify ways to self soothe, stay active, eat well, and make time for hobbies. However, they also usually include bits on mindfulness and meditation as a way to have equanimity in the face of stress.

I wonder what it would be like if most doctors, through extensive meditation training, really did gain enlightenment.

 

Scenario 1 – Stomach Pain

PATIENT: Hi doc.

DOCTOR: Blessings, child. What brings your light into the presence of my light today?

PATIENT: Well, I’ve got this pain in my side that started suddenly, which is why I came on such short notice. I’ve been vomiting and I think I have a fever too.

DOCTOR: All suffering stems from desire.

PATIENT: …OK, well, I desire to have this pain stop. It really hurts.

DOCTOR: Afflictions of the body portend afflictions of the mind. Pain is but a mere input into the brain. We create suffering by the negative interpretation of  pain.

PATIENT: You’re saying this is all in my head?

DOCTOR: That is all that can ever be said of anything.

PATIENT: I’m going to get a second opinion. This is ridiculous.

DOCTOR: You can run from your problems, but eventually you will realize you are lost in thought. When you are ready, I will train you to focus your attention. Only then can you truly be free.

PATIENT: I’m going to puke.

DOCTOR: Breattheeee.

PATIENT: *vomits*

 

Scenario 2 – The Physical Exam

DOCTOR: Welcome to physical exam rounds, everyone. We’ll start with Ms. Jones, in bed 4. Hi, Ms. Jones!

PATIENT: Hi, doc.

DOCTOR: Alright everyone, so even before we begin our examination, notice that her aura is off. It’s a pale, hazy amber. No bueno. We usually like to see our patients with either a rich, bright blue or a deep purple.

STUDENT: I don’t see anything.

DOCTOR: And you won’t, at first. Some of these maneuvers will take years to fully master.

PATIENT: You’re seeing red around me? Like blood?

DOCTOR: Nothing to worry about, dear. Just using some doctor-talk here, we’ll break everything down for you once I’ve finished the exam.

PATIENT: OK.

DOCTOR: Alright, ma’am, open your palms for me?

PATIENT: *opens palms*

DOCTOR: I feel for her vital life flow through her palm lines with two fingers, like so. Now, I’m not going to get technical here, you can all refer to Harrison’s for the advanced stuff, so for now we’ll keep it basic. Life Line, Head Line, Heart Line. At your level of training, you’ll be expected to locate these consistently. Watch my motions.

STUDENT: This is in Harrison’s?

DOCTOR: Quiet, please. I need my full concentration for this.

PATIENT: How’s it looking, doctor?

DOCTOR: *to patient* Just fine, dear.

DOCTOR: *to the students* So, everyone, it looks horrible. Real thready lines here, very weak qi pulsations. She’s heading towards a major accident soon, weeks I’d say.

PATIENT: WHAT?

DOCTOR: Just doc-lingo ma’am, I know it sounds scary but it’s a lot of mumbo-jumbo. Everything’s going to be fine. Alright, class, we’ll end by astrally projecting our mind into hers, do a mental checkup.

PATIENT: Is that safe?

DOCTOR: I’m not going to let these learners try it, but with me, yes, it’s safe. OK, so everyone, I take a deep breath, and focus on unlocking and merging with her sub-conscience. Don’t be alarmed if you can’t get it at first, it took me years of training to be able to do what you’re about to see.

*The doctor closes his eyes and furrows his brow. His concentration intensifies gradually. He begins rocking back and forth, then stops moving altogether for a full minute*

STUDENT: …..

PATIENT: ……

DOCTOR: Alright, done!

DOCTOR: *to patient* Everything looks great in there, ma’am.

DOCTOR: *to students* Questions?

 

Scenario 3 – Detailed History

DOCTOR: OK, so just going to run through some basic questions here.

PATIENT: Sure.

DOCTOR: Any drug use?

PATIENT: Nope.

DOCTOR: Any alcohol use?

PATIENT: Not much, just socially.

DOCTOR: Prior surgeries?

PATIENT: None.

DOCTOR: OK, how’s your alignment been recently?

PATIENT: Huh?

DOCTOR: Your energy centers – have the chakras been in full alignment recently, or do you feel that there’s a center of discord blocking full flow.

PATIENT: Uhh what? Flow? I mean, it’s been a bit more difficult to urinate recently…

DOCTOR: I’m not a urologist, sir. Please, allow me to continue. Spiritually speaking, your alignment you’d say has been OK?

PATIENT: Yeah, sure.

DOCTOR: Scale of 1-10? 1 being utter desolation of the soul, 10 being Buddha, how would you rate your alignment right now.

PATIENT: Probably like a 6.

DOCTOR: *scribbles in notepad* Hmm. Not great.

PATIENT: …

DOCTOR: OK, how whole have you been feeling recently?

PATIENT: Very?

DOCTOR: You’re basically feeling centered? One with yourself, your consciousness, your community, and the universe? A sense that the threads of light that comprise your being are inexplicably linked with the fabric of reality? That you aren’t in the universe, but that you are the universe? That this flickering, fleeting, dancing moment that is now is all that we can ever have? That, fundamentally, we are from the cosmos, and will return to it one day, and that embracing this fact will help to overcome your suffering? That to live is a joy beyond joys, and a sorrow beyond sorrows, and it’s the duality of this paradox that powers the beautiful, absurd, terrifying journey called life?

PATIENT: ……..sure.

DOCTOR: Great. See you in 3 months. I’ll send your meds to the CVS on Greenbriar.

 

I’m grateful to BCM for many things. For accepting me into their medical school and internal medicine residency. For allowing me to meet my now-fiancee Shira Sachs at a residency mixer at OKRA charity bar. For teaching me how to be a doctor. But something that I’m particularly grateful for was the opportunity to start a unique internal medicine tradition – BCM Live.

BCM Live is a culture and arts show produced by and for internal medicine faculty and residents, and this year was our strongest yet. We had 10 unique acts, featuring music from Rachmaninoff to Radiohead, original spoken word poetry, and reflections on a life in medicine.  Here is my recap of the acts:

Elizabeth Godfrey and Ray Wang, two BCM medical students, kicked off the night with a jazzed out viola-piano cover of Sinatra’s “Fly With Me.” They both are part of an organization, AMP, that plays live music for patients during their hospital stays.

Next was Dr. Wayne Shandera, an attending at Ben Taub General Hospital, who dazzled the crowd with romantic and neo-romantic piano masterpieces: Nocturne in C minor, by Frederic Chopin, and Prelude in B minor, by Sergei Rachmaninoff. There’s an intensity, a nobility even, in hearing a seasoned attending play piano at a high level. It was profoundly moving.

Faiz Jiwani urged the crowd to, in the words of Anis Mojgani, “Shake the Dust.” It was a riveting performance: visceral, impassioned, yearning, and inspiring. My favorite quote from that piece:

“Do not let one moment go by that doesn’t remind you that your heart, it beats 900 times every single day / And that there are enough gallons of blood to make everyone of you oceans / Do not settle for letting these waves settle / And for the dust to collect in your veins.”

He followed it by an equally impressive original spoken word composition, On Tolerance. He mused on the common origins of words like Shalom and Salaam, and how compassion is a common value across cultures.

Next was the legendary Dr. Daniel Musher, archon of BCM, brilliant physician, and humanitarian. In addition being a world renowned ID expert, he is a fantastic violin player. He, his son Dr. Ben Musher (also an incredible doctor), and Dr. Elaine Chang played the Andante from the Kegelstatt Trio by Mozart. It was followed by a surprise encore Mozart string quartet featuring Ben Musher’s kids Talia on violin and Avi on cello.

They were followed by Alokananda Ghosh, Hayden Byrd, and Aaron Hocher, who did a sweet vocals / saxophone / violin cover of Radiohead’s “No Surprises.” It featured, among other things, Alokananda hitting the notorious descending major 7th from that song in tune, which was very impressive.

Dr. Michelle Schmidt, who attends at Ben Taub as well, delivered a powerful and deeply human oratory about the struggle against time in her original story “Slay the Dragon.” She detailed the grinding, unrelenting, and often hilarious struggle of practicing modern academic medicine. She described holding together a family, caring for loved ones, and realizing that you are progressing through life faster than you realize:

Don’t blink. You don’t get a mulligan. Really, I mean it, don’t blink. Don’t get worked up about stuff that doesn’t matter. 87 year old grandpa was 28 years old 10 minutes ago and life happened in the mean time.  Life is still happening. Listen.

Rani Bhatia told the powerful story of one of her patients, a 20 year old woman with congenital HIV, who she cared for in the MICU. The patient died exactly one year ago, from a disease that she was given by her mother at birth. After reading a personal reflection on the patient, she sang “Angel,” by Sarah McLachlin, as a tribute to her. It was one of the most touching experiences I’ve ever been a part of. We spend a lot of time as doctors discussing the medical aspects of a patients life and death in great detail. We spend almost no time on the psychological consequences that caregivers face when treating patients who suffer so unfairly. Rani reminded us that although her patient died too young, there was release and relief in her passing from a lifetime of unendurable pain. There wasn’t a dry eye in the auditorium.

Holland Kaplan, one of the organizers of the event, was next. She read a reflection about a patient who just won’t go along with medical advice despite the doctor’s pleading.

“Doc,” the patient said, “I’d rather have one good day than twenty bad days.”

He was nearing the end of his life, and was miserable. So despite strict orders for diuresis and limiting fluid intake, she recalls handing him a bottle of water and watching him smile broadly after finishing it.  In the end, she learned, sometimes the best treatment for heart failure really is a glass of water.

I went next. I wrote a song about the night float experience at Baylor College of Medicine, and how it changes you as a person:

Our closing act was epic – an entirely PGY-1 pop/rock cover band featuring Jefferson Triozzi, Michael Hughes, Dorothy Pei, Sam Hatfield, and Ben Moss. Honestly, what is better than a piano-trumpet-sax-drums-guitar-banjo jam band? Nothing. Nothing is better. They rocked out with hits by Madonna, Johnny Cash, and Men at Work. It was pure ‘tude, pure passion, and pure, bodacious first year swag.

So that’s the recap! Thank you, BCM, for the support in making this event happen. I’ve had a blast organizing it these past three years. If last night was any indication, the future is bright. Jefferson Triozzi, my other co-conspirator in pulling this event off, said it best:

I have so many ideas for next year!

The Center for Disease Control’s 2017 budget document has finally been released, and it has raised a few eyebrows. For one of the first times in American history, we have bans on words that the scientists and doctors who keep our nation healthy can use. They can’t use the words “diversity,” “fetus,” “transgender,” “vulnerable,” “entitlement,” “science-based” and “evidence-based.”

Fear not! The Trump administration has kindly provided alternative phrases that can be used in lieu of “evidence-based.” Per the memo,

An analyst might say, “The CDC bases its recommendations on science in consideration with community standards and wishes,” a source said.

But why stop at banning words like “evidence” and “science?” The CDC makes medical recommendations, after all, and doctors will still be allowed to use whatever heretical terms they like! I’ll be submitting a list shortly to the CDC’s budget office highlighting additional words that may be tainting our public medical discourse with reason or rationality. Here some of my suggestions:

 

Antibiotics

Reason to Ban: Literally translates to “against life.” What kind of pro-choice agenda are we covertly supporting by using these death-dealing agents?

Replacement Suggestions:

-God Juice

-Faith Water

-Happiness Potion

 

Mortality

Reason to Ban: Is death final? Who knows? According to “science,” probably. But not according to multiple holy scriptures. The word is biased against nearly every major religion which claims an afterlife.

Replacement Suggestions:

-Transcendence

-Rebirth

-Crossing Over

 

Sexually Transmitted Infection

Reason to Ban: Talk about a contradiction in terms. Young, unmarried people are at increased risk for contracting sexually transmitted infections, but unmarried people shouldn’t be having sex! The very phrase encourages our youth to adopt the libidinous sexual mores of a depraved society. Ban it!

Replacement Suggestions:

-“The itchies”

-Righteous Punishment

-[not actually a word, just a slow, solemn shaking of the head ‘no’]

 

Vaccine

Reason to Ban: Yes, the rates of illnesses prevented by vaccines have plummeted over the past 100 years. But you know what’s risen? Popular sentiment against vaccines. Democracy functions best when all voices are given equal weight, no matter how inane or conspiratorial they may be. It’s simply too hot-button of an issue right now to continue to be able to use this controversial word.

Replacement Suggestions:

-Autism generator

-Secret government sterilization and control program

-Poison

 

Mental Illness

Reason to Ban: I’m surprised we didn’t submit this one on the first ban list. There is no such thing as mental illness, only people who are unhappy. Your brain is the most complicated system ever created, but surely nothing can ever go wrong with the delicate balance of neurotransmitters and billions of neurons in your head. People raving on the street aren’t schizophrenic, they’re just hungry.

Replacement Suggestions:

-Demonic possession

-Debbie Downer

-Moody

 

Hospital

Reason to Ban: In academia, there’s the ivory tower. It’s removed from society, and full of liberals and communists. Well, hospitals are like healthcare’s ivory towers. Have you seen how many MDs they can cram into those buildings? There’s no telling what crazy schemes to save lives and improve community health is occurring at these nefarious buildings. We need a new name that reflects the misery of getting sick, stripped of left-wing pomp and frill.

Replacement Suggestions:

-Ailment Abode

-Suffering Citadel

-Hemorrhage Hermitage

 

Ban

Reason to Ban: Let’s face it – banning has a very negative connotation. Dictators and authoritarians throughout history have banned words, ideas, religions, you name it. We don’t want that kind of negative PR. We need something softer, something that will appeal to the kids.

Replacement Suggestions:

-Words with no chill

-Negative dabs phrases

-Government censorhip