MOST INTERESTING ESSAYS 12/4/25: THEORY & TRUTH, MEMORY & INTELLIGENCE, PSYCHIATRY, WRITING, EGYPT IN 2019, LIVE OR DIE, GARDEN OF EDEN, SOCIAL DYSFUNCTION, DEATH ROW, RIGHT & WRONG, FRANTZ FANON, TRUTHINESS, CONSPIRACY, LIBERALITY, LIFE IS LIQUID, BECOMING god-LIKE, TIPPING POINT, VANISHING WORLD
Dr. Gawande’s fundamental point in “Being Mortal” is to provide the elderly or medically challenged the help to live based on a person’s dignity, purpose for living, and as much autonomy as their conditions allow.
Books of Interest Website: chetyarbrough.blog
Being Mortal: Medicine and What Matters in the End
One who has been fortunate enough to have lived long will appreciate Doctor Atul Gawande’s explanation and experience with people of a certain age and the terminally ill of any age. He explains “…What Matters in the End” when one is nearing death is quality of life, not survival that matters.
Quality of life is defined by Gawande as dignity, purpose, and autonomy in one’s last days.
When one is nearing the end of their life, Dr. Gawande has found in his many surgical procedures and interviews that those who have time left to them can be helped by others who assist them as best they can to achieve dignity, purpose, and autonomy. As a physician, Gawande asks what a dying person’s fears are to know what might be done to help them work through those fears. Gawande explains the trade-offs from what care an older person or terminal patient may be given to achieve what is most important to them in their remaining life.
Whether healthy or unhealthy, rational people realize death is part of life.
What “Being Mortal” explains is that the aged or medically challenged wish for as much independence as can be provided by their care. Desired independence is the gold standard for the remaining days or years of one’s life. Whether old or young, healthy or ill, the thought of incontinence, mental confusion, medical or physical limitation makes one fear loss of independence. Each of these maladies can be remedied by family members or properly organized assisted living facilities. Of course, the rub is in the cost of that assistance.
When a family member can no longer be cared for by family members, the medically or age challenged are left with two choices. One is to be institutionalized. The other is to die.
What Gawande explains is that the first alternative can be better and the second is dependent upon family research, financial commitment, religious beliefs, and States’ laws. Gawande notes his choice in the case of his physician-father is a family commitment to offer care as needed with the goal of giving as much autonomy as his aged father can handle. That is a laudable commitment but not what many struggling American families have time or willingness to do.
America has institutionalized elder and medically challenged people’s care to reduce the burden on families.
Gawande recounts the history of institutionalized care in the United States. From family aid to hospitalization to assisted living to hospice to State sanctioned euthanasia, care has evolved for the elderly and medically challenged. What Dr. Gawande explains is that any of these ways of caring must offer dignity, purpose, and as much autonomy as possible to the dying and terminally ill.
Every family has its care limitations, either temporal or financial (sometimes both).
Gawande shows research and preparation is needed to help families adjust to the physical and mental care of a significant other who is too old or too sick to take care of themselves. If a family cannot provide the dignity, purpose, and an appropriate level of autonomy to an aged or ill loved one than the job becomes the work of finding an institutional facility that can. This is where the tire hits the road because there is a cost for that service. Gawande notes there are institutions that can offer the services that are needed but family research and investigation is required.
Once an acceptable care facility is found, the next task is finding how it can be financed.
Gawande does not address cost but infers there are care facilities that are affordable. Dr. Gawande’s fundamental point in “Being Mortal” is to provide the elderly or medically challenged the help to live based on a person’s dignity, purpose for living, and as much autonomy as their conditions allow.
One may ask oneself is hospice the only humane thing to do for a dying parent. If a parent is able to make a rational decision about continuation of life, would he/she choose to be treated in a hospice or choose to end life on their own terms?
Books of Interest Website: chetyarbrough.blog
Dying
By: Cory Taylor (A Memoir)
Narrated By: Larissa Gallagher
Cory Taylor (Australian author, died at age 61 on July 15, 2016, born in 1955.)
Cory Taylor confronts the complicated question of what to do when a person knows they are nearing the end of their life. Taylor is diagnosed with terminal brain cancer in 2005. Living with that diagnosis, Taylor recounts her life, religious beliefs, and a commemoration of her family relationships. She thinks of what her life means to herself and others. She waivers between living with her physical and mental deterioration or volitionally ending her life.
Taylor, though raised in a Christian household, identifies herself as agnostic.
In the 20th century, it is estimated that 200 to 240 million people identify themselves as atheists or agnostics. In 2013, that number increased to 450 to 500 million, about seven percent of the world population. Taylor chooses medically assisted death.
Having personally experienced a parent’s death and a parent’s physical and mental deterioration, a listener/reader will either condemn or condone a choice of assisted death.
Those with strong religious beliefs are likely to blame a person for killing themselves, while those who are agnostic or atheist are likely to have a different opinion. To some, life is hardship that is a human being’s obligation to either suffer or grow from, with conscious awareness of death’s inevitability. The fundamental question is–does one have the right to choose whether to live or die?
Seeing a parent’s life deteriorate despite the care of an attentive family member is heartbreaking.
An example is a son whose mother is dutifully cared for by her husband but recognizes the husband is too aged to handle the mother’s incapacities. What should a son or extended family do? There are hospice alternatives for the mother, but should she have a voice in deciding how she is to be treated? The husband realizes, a care facility is the only practical alternative for her needed care. The son or daughter is married and is consumed by their employment and making a living for their own career and family. The mother may or may not be able to express her opinion. The table is set for institutionalization.
The mother’s response may be to curl up in her new bed, refuse to eat and waste away in the eyes of a loving husband and a career consumed son or daughter.
One may ask oneself is hospice the only humane thing to do for a dying parent. If a parent is able to make a rational decision about continuation of life, would he/she choose to be treated in a hospice or choose to end life on their own terms?
Like Proust, Niall Williams draws one into his story to make one think about their past as a child, young adult, and parent.
Books of Interest Website: chetyarbrough.blog
Time of the Child (A Novel)
By: Niall Williams
Narrated By: Dermot Crowley
Niall Williams (Irish Author, writer of novels, plays, and non-fiction.)
“Time of the Child” is a story of an Irish family in 1962 that lives in Faha, Ireland, a fictional town created by Niall Williams in his novel. It is a wonderfully written story about family relationship. It is written from the perspective of a parent with a marriageable age daughter. “Time of the Child” particularly resonates with those of a certain age who remember their parents, their life as a child, their adult marriage or marriages, and the child or children they have raised.
Marcel Proust (1871-1922, died at age 51, French novelist, literary critic, and essayist.)
Like Marcel Proust’s “Remembrance of Things Past”, a listener/reader of Williams’ story looks back at their experience as a child, an adolescent, an adult, and for some, a parent. Williams’ focus is on a 70-year-old father, who is the only doctor in Faha. His wife has died. He has a marriageable daughter who handles household duties and assists him in his practice. The doctor is an introverted, somewhat anti-social, person who laconically addresses his patients and acquaintances with reserved attention and respect. This is a person some would interpret as standoffish but pleasant enough as an important part of their community.
After the death of his wife, the doctor goes about his work as he has in the past.
He visits many of his patients at their homes. Some are elderly and nearing the end of their lives. Their maladies range from minor injuries, to strokes, or advancing dementia. Faha has an extended care facility for the elderly that cannot be taken care of by their families anymore, but it has a reputation as a house of death. Many families refuse to use it and cope with the demise of their parents or older family members on their own. The doctor makes house calls to attend some of these families, though little can be done for those who are beyond the help of medication and treatment.
One of these families with a dying parent has a young son near the age of the doctor’s daughter.
The young man is going to America but has shown an interest in the doctor’s daughter which is noted by the doctor as reciprocated interest. The young man leaves for America without overtly addressing his interest in the doctor’s daughter. The doctor recognizes the importance of the young man’s departure to his daughter and decides to send a letter to America advising the young man he should come to see his mother before her nearing death.
Like Proust, Williams draws one into his story that makes one think about their past as a child, young adult, and parent.
One wishes they had a father like the doctor, i.e. a father who understood more than he explained and acted in ways to make other people’s and their children’s lives better. At the same time, Williams’ idyllic picture reminds one of the faults of their parents when they were children, the harshness of their own lives, and the failures they have made in raising their own children. This does not make Willaims’ story less enjoyable to reader/listeners. It makes one recognize their parents did the best they could do, and hope that mistakes they made raising their own children will be overcome.
There are many brain discoveries and therapies to be discovered that will extend the ability of human beings beyond today’s capabilities. Those discoveries are like the discovery of fission. The science of brain plasticity has potential for either programing destruction or liberating the mind.
Books of Interest Website: chetyarbrough.blog
The Brain That Changes Itself:Personal Triumphs from the Frontiers of Brain Science
By: Norman Doidge, M.D.
Narrated By: Jim Bond
Norman Doidge (Author, Canadian psychiatrist, psychoanalyst, studied literary classics and philosophy at the University of Toronto.)
To an older person, there is a sense of disappointment and optimism from what Norman Doidge writes in “The Brain That Changes Itself”. The disappointment is the feeling of lost opportunity for some because of their ignorance of how the brain works. The optimism is that the past is passed while Doidge explains brain improvement is not completely lost with either age or injury. For older people, improving brain function is more difficult but not impossible. For the injured or medically challenged brain improvement is a dire necessity. For the young, improving brain function is at its best unless there are medical complications.
Doidge explains as one grows older or suffers from brain injury; the brain can be rewired to improve learning or restore bodily function.
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Age slows the synaptic process of learning, but the brain is still receptive to synaptic improvement. Older brains simply have to work harder to compel new neuronal synaptic connections. With brain injury or disease, new connections must be made by different parts of the brain to restore the relationship between thought and action. A youthful brain is likely to improve faster than an older brain, but experimental studies show improvement is possible for both. Doidge explores brain plasticity in “The Brain That Changes Itself”.
Doidge explains medical or physical deterioration of brain function can be improved with repetitive effort.
What brain disfunction has in common is the ability to adapt to the circumstances of people’s lives. With the appropriate help of teacher, clinician, and self exercise, people can rewire their brain.
The difficulty is in societies willingness to invest in the professional needs of those who are affected by brain dysfunction. Treatment of the aged requires commitment to repetitive learning and relearning which can be done with personal commitment. It is not the same for those who lose motor control of their body from injury or medical conditions. The requirement Doidge and others have found for medical or physical brain injury is the training and availability of clinicians and physicians to provide the therapeutic treatment that will aid recovery. How many medical clinicians have been trained to aid brain-dysfunction’ patients to re-wire their brains to think, see, hear, or walk? How many patients can afford the treatment?
The potential of rewiring the brain extends to returning old brains to their childlike state of openness with drugs. It is a new frontier that illustrates how human brains are superior to A.I.
“The Brain That Changes Itself” reveals a lot about the science of re-wiring the brain. Re-wiring the brain for older people is possible with minimal assistance but it requires repetitive work. For the brain damaged, the need for neurologists, clinicians and other professionals are essential for treatment success. The difficulty is in balancing need with cost and the public’s ability to pay.
Brain plasticity can either aid or destroy society.
Doidge notes how North Korean children are taught from grade school through high school to see their leader as a god, not a fallible human being. The less formed minds of the young are more easily programed than adults. He shows brain plasticity is a new frontier in medicine that can be abused.
There are many brain discoveries and therapies to be discovered that will extend the ability of human beings beyond today’s capabilities. Those discoveries are like the discovery of fission. The science of brain plasticity has potential for either programing destruction or liberating the mind.
With the death of Riley’s brother from suicide, a spiraling downward seems inevitable for Lisa Marie Pressley. Surprisingly, Lisa Marie rallies after the suicide of her son, but the negative consequence of fame remain. The pressure of fame, like poverty, are equal opportunity killers.
Books of Interest Website: chetyarbrough.blog
From Here to the Great Unknown (A Memoir)
By: Lisa Marie Presley, Riley Keough
Narrated By: Riley Keough, Julia Roberts
Lisa Marie Presley (Singer, song writer, daughter of Elvis)Danielle Riley Keough (Actress, eldest grandchild of Elvis)
“From Here to the Great Unknown” begins rather shakily because it is unclear about who is narrating and being represented in the story. Listeners who stick with the story begin to see that Keough’s voice is of herself while the non-tape-recorded voice by Julia Roberts is Lisa Marie, telling and filling gaps in Danielle Riley’s story. The two photographs above are meant to show Lisa Marie in her prime and Riley in the present.
This memoir explains Danny Keough (Danielle’s father and Lisa Maries first husband) is an ever-present person in Riley Keough’s life.
The book reveals the thrills, fears, and tragedy of inheriting fame. Danielle Riley Keough assembles a memoir from tape recordings by her mother and recollections of Elvis Pressley’s only daughter, Lisa Marie Pressley. “From Here to the Great Uknown” infers genetics may have something to do with descendants’ lives but the consequence of fame magnifies life’s proclivities.
Lisa Marie is shown to idolize her father who loved her dearly.
As most know, Elvis descended into addiction. This is not a story about Elvis but about Lisa Marie who loved her father, struggled with her mother, and created a career for herself in the music industry. She never achieves the fame of her father but had some success with “Lights Out”, “You Ain’t Seen Nothin’ Yet”, “Dirty Laundry”, “S.O.B”, and “Over Me”. Keough briefly talks about traveling with her mother on tour. Keogh explains her mother dabbled with drugs in earlier years but seemed to kick the habit as she began establishing her own career. Lisa Marie meets and marries Danny Keough, and has two children with her, Riley and a son named Benjamin. Despite a divorce in 1994, Riley Keough and even her mother remained close with Danny.
Lisa Marie’s divorce seems precipitated by a growing intimate relationship between Lisa Marie and the famous King of Pop, Michael Jackson. After divorce, Lisa Marie marries Jackson in 1994.
Keough mentions Jackson’s pedophilia accusations in 1993 that makes one wonder if the marriage had anything to do with the accusations of five boys. Lisa Marie and Jackson divorced in 1996. Riley suggests Jackson’s desire to be in control created friction between the couple that led to the divorce. Jackson was acquitted of any pedophilia charges in 2005.
Lisa Marie marries again in 2002 to the actor, Nicolas Cage, but they are divorced two years later.
Despite three failed marriages, Riley explains her mother wishes to have more children and decides to marry Michael Lockwood in 2006. Through invitro fertilization, Lisa Marie becomes pregnant with twins. She has a cesarian delivery that births Harper and Finley who become Riley’s sisters. Riley explains her mother had quit drugs which she had gone through in her younger years but recovering from the cesarian operation led her back to drugs. She separates from Lockwood in 2016, and they divorce in 2021.
One begins to think about the famous film “Alfie” that came out in 1966.
Michael Caine, who is Alfie, looks back on his life and his famous line in the film is “What’s it all about Alfie?” Riley suggests Lisa Marie was a great mother because she had an instinct for caring about her children. Riley believes her mother slipped back into drugs because of the pain killers she took from the cesarean delivery of her twins.
Living a life of fame has consequences. One can argue that no singer in modern times has exceeded the fame of Elvis Pressley. Maybe Taylor Swift is nearing Elvis’s fame. Time will tell.
The price of fame is loss of privacy, mental strain to maintain an image, isolation, hangers-on self-interests, constant public exposure, and personal security concerns. Riley’s memoir of her mother’s life suggests fame influences Elvis’s, Lisa Marie Pressley’s, and Ben’s lives and deaths. All three had problems with drug use, but Elvis had a heart attack and Lisa Marie had a bowel obstruction thought to have caused excessive weight-loss and death.
With the death of Riley’s brother from suicide, a spiraling downward seems inevitable for Lisa Marie Pressley.
Surprisingly, Lisa Marie rallies after the suicide of her son, but the negative consequence of fame remain. The pressure of fame, like poverty, are equal opportunity killers.
The well-made point of Orlean’s history of the Los Angeles Central Library is that a listener/reader can learn a great deal about the world and other people’s life experience from books. The loss of a book is not like human death, disease, or disability. A book is a liberation and broadening of life’s narrowness.
Books of Interest Website: chetyarbrough.blog
The Library Book
By: Susan Orlean
Narrated By: Susan Orlean
Susan Orlean (Author, American journalist, tv writer, staff writer for The New Yorker.)
“The Library Book” is not a thriller, but it is an appreciation of a public service available in nearly every community of the United States. Libraries can be found in communities of less than 8,000 people or megalopolises of millions. Susan Orlean focuses her book on the great fire in 1986 at the Los Angeles Central Library where over 400,000 books were destroyed, and an estimated 700,000 were damaged. Though this was not the largest library in America, it was the largest library fire in U.S.’ history. Orlean’s research suggests the arsonist was a Wanna-Be actor named Harry Peak. However, there is no concrete evidence to confirm his guilt. No one is convicted for the library’s alleged arson. The cause remains undetermined.
It is interesting to note that Orlean admits there were electrical problems in the old building that had been recorded by building inspectors, but fire inspectors concluded it was arson.
It seems somewhat disingenuous for the City or Orlean to accuse Peak as an arsonist but that is not the primary message of her book. Her message is that many, including this reviewer, love the knowledge and experience of others who write books. Arguably, public libraries are one of the greatest public services in America, and at a cost much less than most public services in America.
The last chapters of her book address the history of the creation and renovation of the Los Angles Central Library. It reaches back to the 19th century. She recalls the liberal leaning of librarians and their early adoption of women in the workplace. Two women became Library’ managers in the 1800s. Orlean notes in a joking conversation with a manager of the library about the unlikely promotion of a political conservative as a head librarian.
An interesting note from the author is that the Los Angeles library has historically been a haven for the homeless, a problem that has dramatically risen in the 21st century. Some librarians have expanded their services to help the homeless. It seems noteworthy that the libraries in Las Vegas and those visited in other cities do not lock their bathroom doors the way private businesses like Starbucks choose to do.
The Los Angeles Library took six years to rebuild while workers carried on during the course of reconstruction. She notes that a new book generally requires a week before it hits the shelf because of time needed for proper cataloging. A somewhat distracting habit Orlean uses is recitation of a book’s Dewey Decimal’ number that begins most of the chapters. An interesting note from the author is that the library has historically been a haven for the homeless, a problem that has dramatically risen in the 21st century. Some librarians have expanded their services to help the homeless. It seems noteworthy that the Los Angeles Central library and libraries in Las Vegas do not lock their doors the way private businesses like Starbucks have chosen to do.
The Los Angeles Library is rebuilt to be better than it was before the fire.
Orlean explains library managers in LA are pushing to expand services their libraries provide. Having personal experience of traveling the world, countries like Finland show they have modernized libraries with a concept highly recommended in Orlean’s history of the Los Angeles’ library. Helsinki, Finland’s state-of-the-art library is a dramatic example of the services a library can provide. Everything from music instrument rentals, to recording studios, to sewing machine tables, and cooking kitchens are added to the library’s book inventory. All of these features have been created in Helsinki’s modernly designed library. It is a multi-purpose building that serves both children and adults.
The well-made point of Orlean’s history of the Los Angeles Central Library is that a listener/reader can learn a great deal about the world and other people’s life experience from books.
The loss of a book is not like human death, disease, or disability. A book is a liberation and broadening of life’s narrowness.
Many of the Los Angeles Library books were recovered but the process of recovery required the help of many of LA’s businesses. The books that got wet needed to be frozen to keep them from molding. City businesses made room for soaked books in their commercial freezers. The Los Angeles Central Library is rebuilt to be better than it was before the fire. Many of the books survived with the feint smell of smoke. The library continues to expand and enlighten Angeleno’s lives.
Katherine Eban infers the lure of money, power, and prestige, continues to incentivize fudging, if not outright lies, about the effectiveness and safety of generic drugs.
Books of Interest Website: chetyarbrough.blog
Bottle of Lies (The Story of the Generic Drug Boom
By: Katherine Eban
Narrated By: Katherine Eban
Katherine Eban (Author, American investigative journalist focused on public health issues.)
Katherine Eban’s book is tedious, but it tells a story that challenges the generic drug industry and exposes the strength and weakness of capitalism. Eban makes one suspicious of the efficacy of generic drug treatments. Society depends on drug discoveries that can return one to health when struck by known and unknown malefactors. At the same time, Eban indirectly attacks capitalism as a primary force for discovery of life saving drug treatments. Capitalism is motivation for drug manufacturers to discover new drugs, but profit motive and human nature incentivize deception that can harm the public.
America’s police department for the drug industry is the Food and Drug Administration.
The difficulty of a policing function is in human nature and an investigators’ effort to find incriminating evidence that proves guilt. The consequences of poor policing in the generic drug industry are loss of health, and sometimes, life. The FDA is responsible for protecting public health by ensuring the safety, efficacy, and security of human and veterinary drugs manufactured or imported to the U.S.
Just as every police force is not perfect, the FDA has made mistakes and failed to uncover evidence for crime. There have been instances of drug manufacturers around the world, including America, that have adulterated approved generic drugs. (A U.S. generic drug manufacturer, KVK Research Inc in Pennsylvania, pled guilty in 2024.) Generic manufacturers and distributors around the world have misled the public on the efficacy and/or addictive qualities of drugs. A primary source of generic drug manufacturing crimes is the lure of increased profitability.
Eban focuses on a pandora’s box opened when the world’s generic drug industry began producing substitutes for previously patented drugs.
Patents for new drugs have a determinate shelf life but expire after a stipulated period of time. One can complain and challenge the price of patented drugs, but patented drugs require a level of scientific experiment and reporting to prove efficacy. When patents expire, there is a rush by generic manufacturers to produce the same drug at a lower cost. The trouble arises when a generic drug’s lower cost is achieved with substituted or reduced ingredients; also, it may be adulterated by poor manufacturing practices.
Eban offers the history of the AIDS’ epidemic to illustrate how generic drugs became supercharged in the 1980s.
Three companies in India and one in South Africa began working with the Clinton Foundation to offer an AIDS’ generic drug that fell to a cost of $.40 per day when patented AIDS’ drugs cost as much as $8,000 per year. Millions of people were at risk, none more than those who live in Africa. However, the effectiveness of the generic drug came under suspicion. It was found that data was being falsely created by India and Africa. It was manufactured data that falsely reported generic drugs effectiveness in treating AIDS. The generic African and India manufacturers were cutting corners in production to increase profits. No one checked the effectiveness of the produced drugs and posted false patient reports. Because the data was not based on patient experience but on falsely created data, it became unclear whether the drug was working. Without any reports showing the generic drug’s effectiveness, incentive grew to continue reducing costs. Manufacturers pushed production, compromised AIDS ingredients, and falsely reported treatment results of patients.
Dinesh S. Thakur (Received the Joe A. Callaway award for Civic Courage in 2014.)
Eban explains how Dinesh Thakur. a former executive at Ranbaxy Laboratories, became a whistle blower who “spilled the beans” on falsely created data sent to the FDA.
Thakur was the Director and Global Head of Research information & Portfolio Management at the Ranbaxy company. He began asking questions of the people reporting the generic AIDS Drug efficacy data. Thakur found that 50% to 100% of information on generic AIDS drug’ efficacy was manufactured and not related to actual use by AIDS sufferers. Ranbaxy Laboratories pleaded guilty of falsifying information in 2003. Ranbaxy agreed to pay $500 million to settle their guilty plea.
Despite the Ranbaxy settlement, the author shows generic drug misinformation is still being produced. Further reviews by FDA inspectors found continuing violations of protocol and testing of generic drug manufacturing and reporting.
Ranbaxy is no longer an independent company. It was purchased by Sun Pharmaceutical Industries Ltd in 2014. Eban explains how FDA inspectors fell victim to India manufacturers malfeasance by accepting luxury hotel accommodations and gifts that clouded their judgement about the companies they were investigating. A bad report from an FDA inspector could and did cost millions of dollars to companies that produced tainted generic drugs.
Eban explains the FDA has changed their policy of giving advance notice of inspections while inferring inspectors are advised to avoid conflicts of interest in their inspections. One takes this inference with reservation because human nature is an immutable force.
The incentive for increased profitability by reducing the cost of manufacturing generic drugs continues to threaten the public. Eban infers the lure of money, power, and prestige, continues to incentivize fudging, if not outright lies, about the effectiveness and safety of generic drugs.
Two points that offer the greatest value in Schwartz’s history of brain surgery is that those who survive become different human beings, sometimes disabled or cognitively impaired. The second–those who need a neurological operation should look for an empathetic doctor who limits his/her excision of brain matter to what science knows of its consequence.
Books of Interest Website: chetyarbrough.blog
Gray Matters (A Biography of Brain Surgery)
By: Theodore H. Schwartz
Narrated By: Sean Pratt
The largest part of Dr. Schwartz’s book is about the history of brain surgery. The first chapters address his education for brain surgery and the history of well-known Americans who died or might have survived from its practice. It addresses the consequences of brain trauma of modern times but leaves tumor and disease treatment for the remaining chapters. “Gray Matters” is about the 19th and 20th century history of brain surgery, how it evolved, and the pioneers who most influenced the author. Schwartz personalizes brain surgery by explaining how he treated what he estimates to be over 10,000 patients.
William Macewen (1848-1924) Scottish surgeon who pioneered neurosurgery,
Harvey Cushing (1869-1939) American neurosurgeon–father of modern neurosurgery,
Wilder Penfield, (1891-1976) American-Canadian neurosurgeon–noted for mapping the brain,
Carl-Olof Nylén (1892-1978) Swedish otologist who pioneered microsurgery with a surgical microscope he designed,
Wolfgang Draf (1940-2011) German otolaryngologist who pioneered Skull Base Surgery using sinuses as the avenue of entry to the brain.
Schwartz identifies Wiliam Macewen (upper left photo) as the pioneer of neurosurgery. He notes Harvey Cushing (upper right photo) is referred to as the “Father of Modern Neurosurgery”. Cushing was the first to employ X-rays to diagnose brain tumors and introduced the use of the elector-cautery device to minimize blood loss during surgery. Dr Wilder Penfield (middle left photo), a Canadian neurosurgeon pioneered brain mapping by stimulating the brain with mild electrical shocks. Brain mapping gave neurosurgeons a guide that let them know what areas of the brain would be affected when making decisions on diseased tissue removal. Microsurgery on the brain is pioneered by Carl Nylen (middle right photo) in the early 1900s. In modern times, Dr. Wolfgang Draf (bottom photo) began using a skull cap microsurgery device to remove brain tumors through nasal passage access. This less intrusive form of brain surgery is used and detailed by the author.
Dr. Kris S. Moe (Board certified surgeon at UW Medical Center, University of Washington Facial Plastics and Reconstructive Surgery.)
Schwartz explains one of his most important training experiences was in Seattle Washington with Dr. Kris S. Moe. Moe pioneered what is called transorbital neuroendoscopic surgery (TONES) that influenced the field of minimally invasive neurosurgery. Schwartz explains how Moe would test patients during an operation to identify areas of the brain being affected during treatment for tumor removal. Schwartz gave the example of a series of pictures shown on a monitor seen by the patient during surgery. The patient is asked to name the object in the picture as the surgeon is operating to determine whether the tumor being excised affects his/her ability to identify the image. In Schwartz first attendance at one of these surgeries, he accidentally spilled the pictures across the operating floor. Moe directed him to reassemble the pictures and went on with the surgery when they were reassembled. The embarrassed Schwartz admired Moe because he never brought the incident up after it happened and completed the operation without criticizing Schwartz.
Two points that offer the greatest value in Schwartz’s history of brain surgery is that those who survive become different human beings, sometimes disabled or cognitively impaired. The second–those who need a neurological operation should look for an empathetic doctor who limits his/her excision of brain matter to what science knows of its consequence.
Schwartz’s book implies the NFL’s prevention and protocols for brain trauma are a cost of doing business. Sadly, this seems similar to the American public’s misinterpretation of the “right to bear arms” and its resistance to gun control.
Books of Interest Website: chetyarbrough.blog
Gray Matters (A Biography of Brain Surgery)
By: Theodore H. Schwartz
Narrated By: Sean Pratt
Theodore H. Schwartz (Author, American medical scientist, academic physician and neurosurgeon.)
“Gray Matters” feeds a curiosity for those interested in the human brain. Written by a brain surgeon, it offers a clearer understanding of brain function while offering insight to the causes and consequences of brain trauma. The author has treated many patients with brain infections and trauma and offers analysis of athletic, gun-related, and accident injuries of people who have died from or survived brain trauma.
Schwartz explains the arduous education for one to become a brain surgeon and how physicians surgically treat brain disease and trauma.
He explains how long hours as an intern are required after spending years to become an academically qualified physician, let alone surgeon. Not only are the hours long but acceptance into an internship is highly competitive and difficult to achieve. That seems counterintuitive in view of the public’s need for qualified medical help. One suspects the fundamental cause is the cost to the hiring hospital and the staffing required to teach new physicians.
The brain is protected by a skull, three layers of membrane, cerebral spinal fluid, a blood barrier, skin, and a scalp.
These structures, cells, and tissues protect the brain from physical damage and infections so the brain can provide organic function, thought, and action. Physical or infectious damage to the brain can affect any one of these natural human’ functions.
ABRAHAM LINCOLNJOHN F. KENNEDYROBERT F. KENNEDYJAMES BRADYGABIELLE GIFFORDS
Schwartz reviews incidents of gun-shot brain trauma of famous figures like Abraham Lincoln, John F. Kennedy, Robert Kennedy, James Brady, and Gabrielle Giffords. He notes the differences in the bullets used as well as the power of the weapons to explain the damage done. He argues John Kennedy had no chance of survival while suggesting Lincoln, because of a lower power weapon, might have survived with today’s advances in treatment. However, he suggests Lincoln would have lost much of his skill as an orator and political theorist because of damage to a particular part of his brain from Booth’s attack. Schwartz believes Robert Kennedy might have lived with more rapid and qualified treatment but would have been physically and mentally disabled. James Brady, Ronald Reagan’s press secretary, lost speech clarity and physical mobility because of his brain trauma. Similar consequences occurred with Gabriell Giffords’ injuries, but she relearned how to walk, talk, and perform basic tasks. Schwartz notes the only positive political accomplishment to come out of these violent acts was the Brady Handgun Violence Reform Act.
Schwartz goes on to explain non-traumatic brain injury from infection and stroke to traumatic brain injury from Shaken Baby Syndrome (SBS) to Chronic Traumatic Encephalopathy (CTE) with Second-Impact Syndrome often seen in athletes. Diagnosis of SBS from a shaken baby’s head has changed to include the shaking accompanied by impact with a hard surface.
Diagnosis of CTE and Second-Impact Syndrome in sports are still being defined. The return of football players to the field of play is a judgement call by a sideline physician which raises questions about qualifications, let alone judgement.
The NFL initially objected to the brain trauma threat of their sport based on improved protective equipment.
However, Schwartz writes they have increased their protocol for injured players and have paid over a billion dollars to former athletes suffering from symptoms of brain trauma. Some big names in football like Junior Seau, Frank Gifford, Ken Stabler, and Tommy Nobis were autopsied after their death to show they suffered from CTE.
The lure of fame and money are unlikely to change elite athletes desire to compete despite the threat of brain injury. Schwartz’s book implies the NFL’s prevention and protocols for brain trauma are a cost of doing business. Sadly, this seems similar to the American public’s misinterpretation of the “right to bear arms” and its resistance to gun control.
Eubanks is wrong to think digitization ensures a future that will create a permanent underclass. The next four years may not show much progress in welfare, but American history has shown resilience in the face of adversity.
Books of Interest Website: chetyarbrough.blog
Automating Inequality (How Hich-tech Tools Profile, Police, and Punish the Poor
By: Virginia Eubanks
Narrated By: Teri Schnaubelt
Virginia Eubanks (Author, American political scientist, professor at the University at Albany, New York.)
At the risk of sounding like a “bleeding heart” liberal, Virginia Eubanks assesses the inefficient and harmful effects of technology on welfare, childcare services, and homelessness in America. Eubanks illustrates how technology largely reduced the cost of Indiana’s welfare. However, cost reduction came from removing rather than aiding Americans in need of help. She shows southern California is better organized in the 2000s than Indiana in their welfare reform movement in the 1990s. However, the fundamental needs of the poor and homeless are shown to be poorly served in both jurisdictions.
In the last chapters of the book, Eubanks looks at Pennsylvania’s childcare services (CCW). She argues her research shows digitization of personal information, societal prejudice, and inadequate financial investment as fundamental causes of America’s failure to help abused children. Eubanks implies the cause of that failure is the high-tech tools of the information age.
Eubanks offers a distressing evaluation of Indiana’s, California’s, and Pennsylvania’s effort to improve state welfare programs.
The diagnosis and cure for welfare are hard pills to swallow but Eubank’s research shows welfare’s faults without clarifying a cure. She clearly identifies symptoms of inequality and how it persists in America. Eubank infers America’s politicians cannot continue to ignore homelessness and inequality. America needs to reinforce its reputation as the land of opportunity and freedom. Eubank implies technology is the enemy of a more equal society by using collected information to influence Americans to be more than self-interested seekers of money, power, and prestige.
Eubank explains how Indiana welfare recipients were systematically enrolled in an information technology program meant to identify who receives welfare, why they are unemployed, and how they spend their money.
She argues this detailed information is not just used to categorize welfare recipients’ qualifications for being on welfare. The purported reason for gathering the information is to help those on welfare to get off welfare and become contributors to the American economy. What Eubank finds is the gathered information is used to justify taking citizens off of welfare, not improve its delivery. Poorly documented information became grounds for denying welfare payments. If someone failed to complete a form correctly, their welfare payments were stopped. The view from government policy makers was that welfare costs went down because of the State’s information gathering improvements. In reality welfare costs went down because recipients were rejected based on poorly understood rules of registration. Indiana did not have enough trained management personnel to educate or help applicants. Welfare applicants needed help to understand how forms were to be completed and what criteria qualified them for aid.
From Indiana State’s perspective, information technology reduced their cost of welfare. From the perspective of Americans who genuinely needed welfare, technology only made help harder to receive.
Eubank notes there are three points that had to be understood to correct Indiana’s welfare mistakes:
information algorithms qualifying one for welfare must be truthful, fair, and accurate,
the information must reflect reality, and
training is required for welfare managers and receivers on the change in welfare policies.
Another point made by Eubank is the danger of computer algorithms that are consciously or subconsciously biased. A biased programmer can create an algorithm that unfairly discriminates against welfare applicants that clearly need help. This seems a legitimate concern, but Eubank misses the point of more clearly understanding the need of welfare for some because of the nature of American capitalism and the consequence of human self-interest. Contrary to Eubank’s argument, digitalization of information about the poor offers a road to its cure not a wreck to be avoided.
WELFARE CATEGORY ELIGIBILITY PERCENTAGES IN INDIANA
Eubank tells the story of a number of Indiana residents that had obvious medical problems making them unemployable but clearly eligible for welfare payments. They are taken off welfare because of mistakes made by government employees’ or welfare recipient’ misunderstandings of forms that had to be completed. From the government’s standpoint Indiana’ welfare costs went down, but many who needed and deserved help were denied welfare benefits. The rare but widely publicized welfare cheats became a cause celeb during the Reagan years that aggravated the truth of the need for welfare in America. The truth, contrary to Eubanks opinion, becomes evident with the digitization of information as a basis for legislative correction.
Eubank notes Skid Row in Los Angeles lost many of its welfare clients with gentrification of the neighborhood. The poor were moved out by rich Californians who rebuilt parts of Skid Row into expensive residences.
Eubank explains a different set of problems in the Los Angeles, California welfare system. The technological organization of the LA welfare system is better but still fails to fairly meet the needs of many citizens. The reasons are similar to Indiana’s in that algorithms that categorize information were often misleading. However, the data-gathering, management, and use of information is better. The more fundamental problem is in resources (money and housing) available to provide for the needs of those who qualify for welfare. It is not the digitization of the public that is causing the problem. Contrary to the author’s opinion, digitization of reality crystalizes welfare problems and offers an opportunity for correction.
Homelessness is complex because of its many causes. However, having affordable housing is a resource that is inadequately funded and often blocked by middle class neighborhoods in America. Even if the technological information is well organized and understood, the resources needed are not available. Here is where the social psychology of human beings comes into play. Those in the middle class make a living in some way. They ask why can’t everyone make a living like they have? Why is it different for any other healthy human being in America? Here is where the rubber meets the road and why homelessness remains an unsolved problem in America.
People are naturally self-interested. One person’s self-interest may be to get high on drugs, another to steal what they want, others to not care about how they smell, where they sleep, look, live, or die. Others have chosen to clean themselves up and get on with their life. Why should their taxes be used to help someone who chooses not to help themselves? Understanding the poor through digitization is the foundation from which a solution may be found.
Traveling around the world, one sees many things. In India, the extraordinary number of people contributes to homelessness. In France, it is reported that 300 of every 100,000 people are homeless. Even in Finland, though there are fewer homeless, they still exist.
It is a complex problem, but it seems solvable with the example of what Los Angles is trying to do. It begins with technology that works by offering a clear understanding of the circumstances of homelessness. A detailed profile is made of every person that is living on the street. They are graded on a scale of 1 to 17 based on the things they have done in their lives. That grade determines what help they may receive. Some may be disqualified because of a low number but the potential of others, higher on the scale, have an opportunity to break the cycle of poverty with help from welfare. It is the resources that are unavailable and social prejudice, not gathered personal digital information, that constrain solutions.
With informational understanding of a welfare applicant, it principally requires political will and economic commitment by welfare providers. There is no perfect solution but there are satisficing solutions that can significantly reduce the population of those who need a helping hand. American is among the richest countries in the world. Some of that wealth needs to be directed toward administrative management, housing, mental health, and gainful employment.
Like all countries of the world, as technological digitization improves, human services will grow to become a major employment industry in the world.
America, as an advanced technology leader, has the tools to create a service economy that is capable of melding industrial might with improved social services.
Eubanks travels to Pennsylvania to look at their child services program.
What Eubanks finds in Pennsylvania is similar to what she found in LA and, to a degree, Indiana. Children who are at risk of being abandoned, abused, or neglected are categorized in a data bank that informs “Child Services” of children who need help. The problem is bigger than what public services can handle but the structure of reporting offers hope to many children that are at risk. Like LA, it is a resource problem. But also, it is a problem that only cataloging information begins to address.
Parents abuse their children in ways that are often too complicated for a standardized report to reveal. Details are important and digitization of personal information helps define what is wrong and offers a basis for pragmatic response.
Computerized reports, even with A.I., are only a tip of the reality in which a child lives. This is not to argue child-services should be abandoned or that reports should not be made but society has an obligation to do the best it can to ensure equality of opportunity for all. Every society’s responsibility begins with childhood, extends through adulthood and old age–only ending with death. Understanding the problems of the poor is made clearer by digitization. Without digital visibility, nothing will be done.
Eubanks gives America a better understanding of where welfare is in America. She is wrong to think digitization ensures a future that will create a permanent underclass. The next four years may not show much progress in welfare, but American history has shown resilience in the face of adversity.
REVIEWS AND VIEWS OF LIFE 