Medical Examiner 6-17-22 by Daniel Pearson

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JUNE 17, 2022

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THE RAW POWER OF

Take two

Editor’s note: Last issue’s profile of Franz Mesmer called to mind a story we did a little over 9 years ago. The topic is too interesting to be buried that far in the past, so the following, with a few minor adjustments, is a reprise of our March 15, 2013 cover story. We’re plagiarizing ourselves.

and call me in the morning.

f there is any one subject in the entire fascinating world of medical science that stands alone in the realm of the extraordinary and the sublime, it might very well be the placebo effect. This article will explore a tiny fraction of the magic and the mystery — and how this amazing phenomenon can be put to use in everyday medicine. The most powerful drug known to mankind Know what it is? Ironically, it’s the inert “medicine” that offers no therapeutic effect whatsoever. Despite that description, placebo lives up to its name, Latin for “I shall please.” Not that placebos always please. More about that in a moment. The placebo effect has earned a lofty place in the world of medicines, and it got it the old-fashioned way: it earned it. Pharmaceutical companies spend billions of dollars every year developing new medications, and what do they measure their effectiveness against? To a significant degree, against placebos. Such studies typically pit new drugs against placebos. Half the test patients are taking the next wonder drug and half are taking an inert placebo, perhaps a concoction of cornstarch or sugar. It must be disconcerting to be a pharmaceutical researcher who has spent years developing a new drug, only to have placebos produce better results, but that’s exactly what sometimes happens. For every placebo, there can be its corollary: nocebo, the onset of negative symptoms, also caused out of thin air by inert pills, injections or creams. Nocebo means “I shall harm.”

It gets complicated Let’s get into some of the placebo research into this fascinating topic. The January-February (2013) issue of Harvard Magazine caught our attention. In the magazine, researcher Ted Kaptchuk recounts his randomized clinical trial for patients with severe arm pain. Half the patients were given pain pills, the other half acupuncture treatment. In short order, about a third of the 270 people in the study were suffering from acute side effects: some of the patients Please see PLACEBO page 3

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THE FIRST 40 YEARS ARE ALWAYS THE HARDEST

PART X OF A 26-PART SERIES

PARENTHOOD

IS FOR CHROMOSOMES

by David W. Proefrock, PhD

But not just any chromosomes. We need to spend some time Your 13-year-old son has been acting strangely. You were examining X chromosomes. We in your storage shed recently and found things there that led you to believe that he has been inhaling gasoline fumes. have to: this is an alphabetical series after all. When confronted, he claimed that he only did it once. But first a refresher course What do you do? A. Put a lock on the storage shed door so he no longer has in case we haven’t really been plugged into the topic since access to it. high school or college. B. Have a serious talk with him about the dangers of inChromosomes are found haling fumes and about other drug use. in the nucleus of every cell, C. Put him on restriction and make sure he stays away and are made up largely from his friends. D. Take him to a mental health professional for an evalua- of DNA (see illustration). Chromosomes are so tiny they tion and possible substance abuse treatment. can only be seen — even under a microscope — when they’re If you answered: A. This may or may not keep him out of the storage shed, undergoing cell division. Not that that is a rare event: since but it does not address the very real problem of substance every last cell needs a copy abuse. of the DNA blueprint unique B. It is too late for this talk. He is already engaging in to each one of us, replication serious substance abuse. He needs to be evaluated by a is constant, and is one of the professional. more amazing feats of the C. A restriction is appropriate, but not sufficient. He human body. After all, we all needs evaluation. In addition, you don’t know anything about the role of his friends in this. They could be a positive know how quickly quality suffers when you make a copy, influence. D. This is the best response. This is a serious and danger- and then a copy from that ous problem, and it is very unlikely that he has only done it copy, and a copy of that copy, and so on. A copy of a copy of once. a copy of a copy soon results Any substance abuse in a child this young is a serious in a document that’s barely problem. Inhalants are especially dangerous, and therefore, legible. especially serious. You should not ignore any signs of inhalWell, the human body pulls + this off flawlessly for decades ant use. It could be deadly. Dr. Proefrock is a local retired clinical and forensic child psychologist. at a time to the tune of trillions of copies, all of them (under normal circumstances) perfect a million people can’t be wron n duplicates of the original. a h t g. Less This doesn’t happen in humans alone; all animals have DNA-packed 706-860-5455 • AUGUSTARX.COM chromosomes. Each species has its own standard

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JUNE 17, 2022 complement of chromosomes. In humans that number happens to be 46, arranged in 23 matching pairs. Technically, though, there are only 22 matching pairs. The 23rd set leads us back to our title and opening paragraph. Of our 46 chromosomes, 44 of them, called autosomes, are composed of 22 mirrorimage duplicates of one another. The remaining two are sex chromosomes, so called because they vary between men and women, and because how they combine at conception determines the sex of the embryo that subsequently develops (and the color of the cake, powder, confetti, etc. — whether pink or blue — eventually detonated by explosives at the gender-reveal party, injuring several attendees). It works something like this: body cells in women consist of two X chromosomes, designated as XX. In men, the pairing is XY. Sperm cells, however, have one or the other, either only an X or only a Y, and which individual sperm cell has an X or a Y is roughly a 50/50 proposition.. A baby’s sex is determined at the instant a sperm cell unites with an egg call. If that sperm cell happens to be among the half carrying an X chromosome, dad’s X will bump one of mom’s Xs out of the picture, resulting in a new life with an XX (female) set of

blueprints containing genetic material from both parents. On the other hand, if the lone sperm cell that fertilizes the egg happens to be carrying a Y chromosome, when that Y replaces one of the mother’s Xs, the resulting embryo will have a set of XY (male) blueprints. Of course, the other 22 pairs of chromosomes are just as vital as the sex chromosomes. Each of them contain codes and data the others do not. Even the smallest chromosome, #21, spans nearly 48 million DNA building blocks and 200-300 genes that contain instructions for building proteins. Chromosome 22, the second smallest, still contains more than 51 million DNA building blocks and 500600 genes, and was the first human chromosome to be fully sequenced in 1999 by the Human Genome Project. By comparison, chromosome 1, the largest human chromosome, spans about 249 million DNA building blocks and contains at least 2,000 instructionbearing genes. And it’s normally too small to be seen, even under a microscope. +

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PLACEBO… from page 1

were experiencing abnormal swelling and redness at the acupuncture sites; some of the pain pill patients reported that the drug made them so sluggish they could barely get out of bed in the morning. For the two-thirds majority, however, the results were better. The pain pills gave them genuine relief, and those who received acupuncture treatments reported even better results. Given the context of this article, you might expect what’s coming: both groups got placebo treatment. The pills that offered relief and caused terrible side effects were made of cornstarch. The acupuncture was also fake. It was performed with retractable needles which never pierced the skin. Researchers didn’t conduct this study simply to humiliate 270 people. Then why do it? What’s the point? There are research applications of course, but also real-life, non-laboratory, everyday ways the placebo effect can be harnessed for healing. For starters, the point should be made that no physician or medical researcher with two brain cells to rub together thinks a malignant tumor or a broken leg can be cured by the power of positive thinking. There are legitimate ethical concerns over deliberately deceiving patients by offering “fake” medicine. Enrolling a patient with asthma into a placebo study, for example, would be viewed as unethical in many quarters. However, medical scientists have been able to identify and measure real physical and physiological reactions caused by placebo treatments. For example, decades ago researchers found that by blocking the release of certain endorphins — natural pain relievers released by the brain — they also effectively blocked the placebo effect. The obvious conclusion was that placebo treatments can and do spark the release of endorphins just as effectively as real medicines do. Yes, the brain is what puts the “effect” in placebo effect. And it isn’t all in the mysterious inner workings of the brain, either. Some of its effectiveness comes from learned behaviors. For instance, all other factors being equal a placebo injection will be more effective than a placebo pill. A placebo with elaborate packaging will “work” better than the same inert drug in plain packaging. And patients who are told that a medication is very expensive will experience more beneficial results and fewer nocebo effects than patients given the same drug — a placebo in both cases — and told the drug costs pennies. Perception is reality — sometimes Obviously, it would be a shame to waste the tremendous power of the placebo effect. Scientists are continuing to study exactly how it can be harnessed. In the meantime, how can a doctor tap into this power — starting today? Please see PLACEBO page 10

“And whoever saves one — it is as if he had saved mankind entirely.”

HOW MANY SENSES ARE THERE? We know what you’re thinking. It’s hot. It’s humid. We don’t really want to work so we chose a softball question so we can knock out a quick answer and head for the pool. If only. Instead, this is a complicated question. Sure, it would be easy to say “five” and grab some sunscreen and water wings and be done with it. But it’s not that easy. In fact, some people take a minimalist approach on this issue. By their broad definition we have only three senses: mechanical, chemical and visual. The last one is self-explanatory, but for the other two, chemical would include taste and smell, and mechanical would include touch and hearing (as sound waves strike our eardrums and other listening devices). The very common belief that we have five senses is absolutely ancient; it seems to date back to De Anima (“On the Soul”), a treatise written by Aristotle around 350 B.C. in which he identifies our senses as five in number: vision, hearing, touch, smell and taste. Most of us (at least before reading this article) would agree. But try this experiment: close your eyes and then touch your left elbow with the tip of your right index finger. It’s not hard to do at all, but it doesn’t fall within the standard five senses. It requires an innate self-awareness, specific in this instance to where the elbow is and where the tip of your finger is. The word for it is proprioception (pro-pree-oh-SEP-shun), and it would seem to definitely be a sense all by itself. A person who is blindfolded and therefore deprived of any visual clues can sense speed - acceleration or deceleration - and movement, such as an elevator going up or down. Would you call that touch, taste, feeling, smell or hearing? Or is that yet another sense to add to the list? What about pain? Or the sense that you need to go to the bathroom? How about thirst and hunger? Or the various sensations of temperature, hot or cold, external (opening a freezer door) or internal (feeling like you’re coming down with a fever). What about sensing that your blood pressure or blood sugar is up? Do any of these fall into the standard five? Some speak of having a “sixth” sense. Others say, “only six?” +

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JUNE 17, 2022

AUGUSTAMEDICALEXAMiNER

#167 IN A SERIES

Who is this? ON THE ROAD TO BETTER HEALTH A PATIENT’S PERSPECTIVE Editor’s note: Augusta writer Marcia Ribble, Ph.D., is a retired English and creative writing professor who offers her unique perspective as a patient. Contact her at marciaribble@hotmail.com by Marcia Ribble

hat made this gentleman so unusual was his ability to apply scientific discoveries to the outside world. The pages of history are full of inventive geniuses who died penniless, even though others may have built immense fortunes on their innovations. We refer to him in the past tense because, as you can tell from his image, he hails from another era (date of birth: June 11, 1842). Even so, you may have seen his name outside a hospital as recently as today. If you did, it was probably on a tanker truck emblazoned with his name - which is also the name of the company he founded on June 21, 1879. It is the largest of its kind in the world today, and it owed much of its initial success to beer. You see, this man, Carl von Linde, had been doing a lot of experimenting with refrigeration, even founding a company that manufactured and sold ice-making machines. His own discoveries, however, started to put a serious crimp in the ice business, as the refrigeration processes he developed began to replace ice in the food and beverage world - particularly in beer brewing. In fact, some of his earliest refrigeration customers were the Heineken and Carlsburg breweries. The raw material for Linde’s success started with another well-known name, Joseph Priestly, the man who discovered oxygen. Linde, however, perfected the art of making oxygen (among other gases) available for all kinds of applications. As early as 1902, his processes could isolate and extract 1,000 cubic feet of oxygen from the atmosphere every hour. If you’re wondering how in the world can a single element in the air we breathe be separated from the other gases, well, first you turn the air into liquid. Simple enough. Then you separate the various liquids you’ve created from each other. That’s it. If that sounds massively oversimplified, the slightly longer version is that air can be liquefied by intense pressure or compression followed by cooling or expanding. The liquid can then be heated, and various elements (oxygen and nitrogen, for example) evaporate at different temperatures, allowing their separation and collection. That’s why you may have seen tanker trucks with the name Linde on the side making deliveries to hospitals. They’re delivering oxygen, or perhaps nitrogen or other gases, in liquid form, which can then be converted to gas to help patients with breathing difficulties, in cryotherapy and cryosurgery, and to use in super-cold storage of vaccines and tissue samples, among many uses. Linde also founded an American branch of Linde in 1907 known as Praxair, although that name was retired in 2020. Although the Linde company focuses much of its global business on medical gases, Carl von Linde’s advancements produce gases for everything from welding to liquid-fueled rockets sent into space. The company believes hydrogen will be a major player in fuel cells in the near future and plans to be a key player in that application. Carl von Linde, the man whose global empire was built from air, died in 1934 at age 92. +

Happily, a pair of doves decided to create a nest behind the meter on my patio. So far, they have raised and successfully fledged two more doves. Now they are nesting on two more little white eggs. I have gotten so much enjoyment from sitting in my doorway and watching them. I suppose watching can be viewed as either active or passive, perhaps both. The first thing every the morning, I go to the door and check to see if they are all OK. They are, and I can start my day with everything else that needs doing. What first? Taking my blood sugar reading so I know where I stand, then breakfast, or maybe just chilling for a while. I’m a slow starter since I have no absolute demands on my time, like kids to feed and get off to school, or a job I must be at by 8:00 am. I lived for many years meeting those demands, so now I don’t have to. That open schedule gives my life great flexibility. I can read. I can watch the news. I can make up my grocery list. I can watch Let’s Make a Deal and The Price Is Right. Or I can wrap back up in my throw and drift back to sleep. I thought that not having a schedule might be difficult after so many years of having them, but I am quite contented with my freedom of choices. The one nagging must-do that occasionally irritates me is trying to figure out what to cook for supper. I started to cook at 13 and I am close to 79 now, so that all adds up to a whole lot of decision making. Don’t get me wrong, I love to cook and usually enjoy it. It’s not the cooking that bothers me; it’s what-to-cook decision making. I look in the refrigerator and am often glad to find leftovers of food I enjoy that only need to be heated up! Other days, not one single thing in the fridge looks edible, let

alone desirable. There is food in the freezer, but it isn’t thawed. I feel like a whiny twoyear-old yelling, NO! at the top of my voice. Some days I decide to wait a while to see if I get inspired. Still other days I pull out my cinnamon raisin bread and go from there. Let’s see. Cinnamon raisin bread with butter and peanut butter. Cinnamon bread toast with cream cheese. There are lots of variations on that theme. All are easy and none require cooking. Another favorite is cereal and milk with a piece of fruit. If I have enough energy to get milk out, tomato soup is a possibility. Grilled cheese sandwiches hardly count as cooking. Neither do eggs and toast. Tuna salad in a tomato is pretty good too. Usually breakfast and lunch are easy and supper is the problem, but the other day it was breakfast and the only thing that was remotely palatable was a little tub of Mediterranean mint gelato. I thought about all the breakfast rules I had enforced for so many years, and then I decided at my age I do not need to be bound by them and ate some gelato for breakfast. Not the whole tub, just enough to wet my whistle. Then some fried potatoes and onions came into inspiration, so I cooked them too. I admit that by my definition cutting up a whole Vidalia onion counts as cooking. So does the long slow process of getting potatoes and onions well-cooked before browning them. But that satisfied my hunger and left me pleased with myself. It also gave me enough leftover potatoes to go with sauerkraut and kielbasa. And some more to go with this morning’s bacon and eggs. Truth be told, there is a plate in my fridge with leftover bacon, onions, and an egg and a half. I have tomorrow’s breakfast nicely covered, and I ordered dinner from Bob Evans, which is always enough for more leftovers. +

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JUNE 17, 2022

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AUGUSTAMEDICALEXAMiNER

ADVENTURES IN

Middle Age

EVERYBODY LOVES A GOOD STORY

BY J.B. COLLUM

ty, but it sure has been a problem for me. My regular doctor keeps asking if I have gone to the podiatrist yet, and I keep saying something like, “no, not yet.” I guess it is past time for me to do that, but it just seems like my regular doctor could take care of that without me having to pay the specialist co-pay amount, which is double. Oh well. At least this leads into my next observations. • If you have met your deductible and maximum out-ofpocket medical expenses for the entire year by April, then you might be middle-aged. Now, before you go saying that I have said this before in a previous column, like the wrong drivers earlier in this piece, I must tell you that I know that I did this. The difference is that previously, I think I met it in May or June. This year, it was April. How about, next year, I go for meeting it by the end of January? I think I can do it. • If you have just given up and gone ahead and put a recurring medical appointment on your work calendar for every week of the year and then just update it weekly to the correct day of the week and time, then you might be middle-aged. I had to do this after missing a couple of appointments. And that leads us to… • If you have so many medical appointments that you sometimes get the days and times mixed up and show up three hours early, like I did a couple of weeks ago, and then you forget again and show up five minutes late for the same appointment, then you might be middle-aged. I think I understand now why my dad kept showing up earlier and earlier to appointments as he got older. He never wanted to be late and realized that he couldn’t trust his memory as much as before, so he compensated. I am compensating now by letting my smart watch and phone remind me of every important thing. Appointments, medication, etc. When I get a new medical appointment, I immediately create the reminder. You can even do that with your voice assistant now. It’s very handy. I encourage other people who are absent-minded to use that feature as well.

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I decided to take a break from the heavier ruminations and considerations about serious middle age health issues and have a little fun this time by talking about some observations I’ve made recently about people in the same boat as me, namely, middle-aged people. I’ve borrowed from Jeff Foxworthy before for a couple of “You might be middle aged” columns, and I feel like I’ve collected enough new material for an update. So, here goes: • If you tell the same story to the same person within a 24-hour period, you might be middle-aged. Of course, I never do this. Just ask my kids and grandkids. On second thought, please don’t. Anyway, what was I talking about? Oh yeah, I wanted to tell you about… something. Hmmm. I’ll remember later. • If you find yourself fussing at someone blocking your way as you are going down the lane in a parking lot and get mad and shake your fist, only to discover that it is a one-way and YOU are the one going the wrong way, you might be middle-aged. I saw an epidemic of this on my last hospital visit. There must have been a mass brain-cell extinction event that day. I saw it at least three times, and in one instance the person going the wrong way led a convoy of three other cars as, like lemmings, they circled the wrong way in the parking deck of Piedmont Hospital. One lady, going the wrong way, solo in this instance, pulled right into the parking spot I was about to back into with my truck. I rolled down my window to tell her that it was the only spot left on this floor that I could fit my very long truck into without partially blocking the way through, but she beat me to it and said that she knew she was going the wrong way and was just using the spot to turn around to go the right way. In another instance on the same day in the outdoor out-patient parking lot at Piedmont, a lady was trying to turn left, the wrong way, to where I was, and she gave me the dirtiest look because I was in her way. I smiled and pointed to the signs and the lane she was supposed to go into to circle around. She proceeded, but in an obvious huff. I had hoped that would be the end of my interactions with her, but as I circled through on another pass I saw her coming down the wrong way again. This time, she was blocking me. I rolled down my window and nicely said that she was still going the wrong way and she said that she had figured that out and was just trying to get out. At least the interaction was pleasant. • If you tell the same story to the same person within a 24-hour period… Wait a minute. Sorry. Never mind. • If you discover cuts on the bottom of your feet that you have no idea how you got, you might be middle-aged. Maybe this is just a diabetes-related thing and not endemic to every one of us in the middle-aged communi-

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If they tell you you’re 3 hours early and you still end up being late for your appointment...

Well, that’s all we have room for in this issue. I have to save some for next time, though I could probably re-use some later since I will likely forget, and you middle-aged folks who are the most likely people reading this column, will forget anyway. Have fun out there in your middle age but be careful. Don’t drive down the wrong way, don’t miss your medical appointments, and most importantly, take care of yourselves. + J.B. Collum is a local novelist, humorist and columnist who wants to be Mark Twain when he grows up. He may be reached at johnbcollum@ gmail.com

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JUNE 17, 2022

THE FIFTH DIMENSION SINGS AGAIN! by Ken Wilson Steppingstone to Recovery

As a child of the 60s, whenever I hear the Fifth Dimension of the ASAM (American Society of Addiction Medicine) Criteria in this series on Patient Placement Criteria, I can’t help but have euphoric recall of one of my favorite musical groups from back then, the 5th Dimension! One of their top 10 hits was Sweet Blindness: “Let’s go down by the grapevine, drink my daddy’s wine, get happy, happy! I’m just a bit of a shade hung over; Oh sweet blindness, ain’t that sweet-eyed blindness good to me!” (I hear some of you humming this now!) I doubt the authors of the addiction-evaluating dimension had the group or the song in mind, but I did when I read the bold words Relapse Potential. Relapse often happens with euphoric recall of past

good times – how happy wine made us, hangover or not. It is for this reason that professionals consider past history with relapse when recommending an appropriate level of care for treatment. Cancer tends to re-occur, but it doesn’t always. In like manner, relapse doesn’t have to happen, but it is prone to happen. Like all diseases, body conditions that cause illness tend to come back. A question to ask a client applying for Intensive Outpatient treatment is, “What is your relapse history?” If there have been a number of treatment attempts followed up by short periods of sobriety the recommendation might be to complete a program and then enroll in a long-term sober living environment to give the brain more time to heal before heading back into the cruel world of stress and drama. Resistance is an understandable response to

such a suggestion. Another issue might be dual-diagnosis and non-compliance with medication, the client preferring to “self-medicate” through his or her highs and lows. This never works. (Did I say never? I think so. Perhaps I should underline or bold-print it!). Proper diagnosis (don’t even get me started here), proper prescription medication (I’m warning you, don’t get me going here!) and proper oversight and accountability is crucial to minimize high-risk relapse potential, and needs to be part of effective discharge planning. By the way, discharge planning begins upon admission to treatment, not the last day of treatment. That’s an idea for another column I think. Another diagnostic question to ask is, “Does this client have the proper coping skills to avoid relapse?” Many, many times a client comes to me for an evaluation and says “I don’t drink

anymore.” I ask “When was your last drink?” and get “a week ago when I stopped.” LOL! This client would pass a polygraph test: they sometimes sincerely believe their sweet blindness! But their coping skills to stay sober are of course sadly lacking. As evidenced by the fact that they are sitting in my office. If relapse potential is high, treatment needs to focus heavily on the ability to maintain sobriety, not just enjoy it for a few weeks at a time. Regrettably, insurance reimbursement these days does not always honor the time-tested and proven ASAM criteria when further treatment or more intensive treatment is indicated. Families have to do the best they can with the coverage they have, and often it’s not the coverage of their own choosing. (More column ideas.) I have euphoric recall of that 60s music! Fortunately, my euphoric recall of bever-

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age alcohol is accompanied by the skill of “playing the tape through all the way to the end.” Quickly. I don’t want to practice my own insanity – doing the same old things over and over, expecting different results like those lovers meeting down by the grapevine drinking Daddy’s wine and being a shade hung over. The musicians told the story well, but sweet-eyed blindness was never any good to me. +

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JUNE 17, 2022

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Steppingstones to Recovery

HIGH INFLATION EQUALS HIGH I-BOND INTEREST RATES High inflation has been in the news a lot recently. It has been almost 40 years since we have experienced inflation this high. So, for a lot of us this is the first time in our life that we have seen prices increase this fast for basic items we consume each day. So, it makes sense that most folks also do not know about I bonds which are a silver lining during periods of high inflation. An I bond is also known as a treasury inflation-protected bond. They are U.S savings bonds and the interest rates are adjusted based on the inflation rate. So, as inflation goes higher these bonds pay high interest rates. Below are answers to some of most common questions about I bonds. What is the current rate? In May 2022, the rate was set at 9.62%. This means that for any I bond purchased between May and November of 2022, the bond will earn

9.62% for the next 6 months after the purchase date. How is the interest rate determined? The interest rate is adjusted twice a year in May and November. It is adjusted based on the Consumer Price Index’s trailing 6-month change. So, if inflation remains high the bond will continue to pay a high interest rate. What are the potential downsides? Each individual or business can only purchase $10,000 per calendar year online. You must wait 12 months before you can cash them in and get your money back. If you cash them in before five years, you will lose the previous three months of interest. If inflation goes down, the interest rate will decrease. The current rate is locked in for 6 months once you pur-

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chase the I-bond. How do you buy I-Bonds? You can purchase I-Bonds from the Treasury Direct website: www.treasurydirect. gov Are I-Bonds right for you? If you have cash or CDs earning only a small amount of interest that you do not plan to use for 12 months or more, then purchasing an I-bond makes a lot of sense. By purchasing I-bonds, you will earn more interest on that cash. + by Clayton Quamme, a Certified Financial Planner (CFP®) with AP Wealth Management, LLC (www.apwealth.com). AP Wealth is a financial planning and investment advisory firm with offices in Augusta, GA.

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CRASH

COURSE

More Americans have died on US roads since 2006 than in World Wars I & II combined

One of the best preventive steps is to embrace a mindset that road trips are not a precidely-timed road race. They aren’t timed at all. If you’re driving down the road on an epic $5-a-gallon summer roadtrip to see the sights or visit far-off family, neither family nor scenery will likely notice if you’re 15, 30, or even 60 minutes late. And why would you be “late”? Because whenever you started to feel drowsy you stopped in a safe place and took a little walk (or even a quick nap). Or maybe you didn’t wait until you felt drowsy; you set a timer and took a break every 100 miles or two hours or so. Take turns with another driver when possible. Some cars allow drivers to override or deactivate features like lane departure warnings; don’t do that. Tips like these can apply on local trips like the aforementioned sleepy commute, where that super-drowsy feeling can be quickly conquered with a stop and a 20-second walk around the car. It’s safe to say that if all the people who died in drowsy-driving crashes were offered a do-over, they would rather take awakening breaks and show up a few minutes late than never show up at all. +

{ WAKE UP!

{

e’ve all been there: driving along and feeling like you could lay down in the middle of Washington Road and be sound asleep within ten seconds. The drowsies probably strike most often on long road trips, but it can happen during the relatively brief local commute from home to work and back too. Sometimes all it takes is a temporary lull in traffic. Let’s say you’re just fine driving down Riverwatch, but then there’s a huge backup way before Costco and it takes you 15 minutes of crawling just to get to Alexander Drive. You’re ready for that self-driving car and a nice nap, but alas, you’re still driving an ’87 high-top van with captain’s chairs in back. And when you start moving again the sleepies chase you down the highway. What’s a safe driver to do? First must come the realization that this is a pretty serious issue: the National Highway Traffic Safety Administration (NHTSA) says that according to police data there are an estimated 100,000 drowsy-driving crashes resulting in some 50,000 injuries and nearly 800 deaths. However, the American Automobile Association’s Foundation for Traffic Safety conducted independent research not based on police statistics

and found much greater numbers, more than three times the police-reported number at some 328,000 drowsy driving crashes. Their research concluded that 109,000 of those accidents resulted in injury, some 6,400 of which were fatal.

No matter which study is more accurate, the numbers paint an alarming picture. Although everyone can and probably has experienced this danger, the risk is highest for male drivers under age 25, responsible for at least half of all drowsy driving collisions. Other risk factors include being sleep-deprived, and driving long distances with rest breaks. Driving through the night can be an obvious trigger, but so can driving during mid-afternoon hours when many people get drowsy. Medications can cause sleepiness, and so can alcohol. In fact, drowsy driving is practically the identical twin of drunk or buzzed driving. Knowing the dangers and the risk factors paves a clear path to avoiding driver fatigue.

JUNE 17, 2022

PLACEBO… from page 3

Harvard Magazine reported on an earlier study by researcher Ted Kaptchuk that gave him an epiphany into the application of placebo in everyday medicine. In the study, 262 adults with irritable bowel syndrome (IBS) were divided into three groups: the control group who got no treatment but were told they were on a waiting list for treatment; a second group who received fake acupuncture and limited interaction with the study’s practitioner; the third group also received sham acupuncture, but with great attention lavished upon them—at least 20 minutes of what Kaptchuk describes as “very schmaltzy” care — “I’m so glad to meet you,” “This treatment has provided excellent results.” “I know how difficult this is for you,” Group 3 practitioners were required to touch the hands or shoulders of patients in the third group and — get this — with each patient spend at least 20 seconds lost in thoughtful silence. The results were not surprising, says Harvard Magazine: the patients who experienced the greatest actual relief from their IBS symptoms were those who received the most personal attention — even though no actual care was administered. “In an age of rushed doctor’s visits and packed waiting rooms,” said the magazine, “it was the first study to show a ‘dose-dependent response’ for a placebo: the more care people got—even if it was fake—the better they tended to fare.” Amazingly enough, Kaptchuk has blown the lid off placebo studies without affecting the results: one of his more well-known studies was born one day when he thought, “What if I told people up front they were taking placebos?” And so that’s exactly what he did. Two groups of IBS sufferers were compared. Group One got nothing. Group Two participants were told they would be taking inert medicines, drugs actually given to the patients in bottles marked “placebo pills.” However, they were also told that placebos sometimes have healing effects. After all, that is what the placebo effect is all about, right? Sure enough, in results that came as something of a shock to researchers, Group Two people who knew they were taking placebos reported symptom relief as good as the improvements seen in trials for real IBS drugs. You can see why it can be such a challenge for pharmaceutical companies to develop real drugs that are consistently more effective than fake drugs. That brings up another realm of medical research. As mentioned above, scientists have been able to block the release of endorphins and in so doing stop the placebo effect. Since then, gene sequencing has led to the identification of a gene variation that makes some people more susceptible to the placebo effect. If people who are predisposed to the placebo effect can be eliminated from clinical drug trials, investigators say many false results caused the placebo effect could be avoided. That could significantly reduce the costs and duration of clinical trials, and improve the accuracy of trials, potentially bringing cheaper drugs to the market years earlier than before, a major breakthrough that could benefit us all. +

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the blog spot — posted by David A. Goodkin, MD, on June 6, 2022 (Edited for space)

THE ARMOR IS IMPERFECT I had wanted to take a long motorcycle trip for years, and I finally carved out two weeks to do so. My pal Doug and I packed our gear onto our Harleys and headed out without an itinerary. We would select the day’s route each morning. Initially, we enjoyed spectacular scenery and good times. One day, however, we encountered pouring rain while winding through remote mountains. There was no shelter, so we donned our rain clothes and pressed on at a slow pace. Visibility was poor. Around a curve we were flagged us to a halt behind a line of stopped cars. We were told there was an accident ahead. 911 had been called, but due to the remote location no rescue unit had yet arrived. I snaked my bike forward to see if I could help. Further around the curve rested a single vehicle flipped onto its roof, blocking both lanes. The road was littered with shattered glass, metal scraps, a doll, clothes, plastic soda bottles, and a magazine. A bright blue plastic tarp was spread on the pavement in front of the vehicle, bulging up in the middle. Two men stood nearby. I said I was a doctor and asked who was hurt. They stoically reported that they had covered a girl with the tarp because they didn’t think there was anything they could do for her. They had moved her parents a ways up the hill. My friend is not a health worker, and he distanced himself before I peeled back the tarp. A young girl lay on her side, perhaps six years old, unmoving. The top of her brain was exposed. Her face was undamaged; her expression was peaceful, and she bore some resemblance to my daughter. I could find no pulse. I decided that an extremely delayed attempt at CPR would be inappropriate and replaced the tarp. I moved on to the two other victims. A man wearing a T-shirt and jeans sat rocking by the side of the road, trembling a bit and staring disconsolately. He had a small cut on his arm, already cleaned and bandaged. His companion had suffered a trivial scalp laceration from flying glass, and she denied symptoms or head trauma. She seemed OK, though unemotional considering the circumstances, maybe numb in reaction. Fire-rescue personnel arrived and took over. Images of the accident and of the little girl stayed in my mind for days, accompanied by sadness and malaise. I was surprised at this prolonged reaction. As physicians, we get desensitized to blood, wounds, tragedy, and death. We’ve participated in surgery and autopsies, at least during training. I’ve observed grotesque sequelae of all manner of violence. Previously I have been able to leave the bedside and professionally move on to the next patient or to my home life, even after witnessing an awful death. But this time, I couldn’t detach. In the hospital, you are accustomed to seeing nasty illnesses and outcomes. You are on home turf, with tools of the trade at hand and teammates to pitch in. Suddenly encountering a violent death in the mountains was far from business as usual for me. The most distressing factor of all: This was the death of a young child, clearly a parent’s nightmare. I had been unable to help her. I kept picturing the anguish and despair on the father’s face. His life has been absolutely and irrevocably divided into two pieces, before and after this horrible moment. No matter what worries he may have had before the accident, they pale before the grief and loss he will carry from now on. When I played ice hockey as a young man, a rocketing puck would occasionally find a small opening not protected by my pads or helmet, and it would do some harm, even draw blood. The accident similarly inflicted a painful surprise when I thought I was well armored. But do we want to be completely impervious? +

The car was flipped on its roof

David A. Goodkin is a nephrologist.

11 +

AUGUSTAMEDICALEXAMiNER

From the Bookshelf There is a lot about the human body that is aweinspiring and fascinating, but if you’re going to award a Most Amazing Body Part trophy, it’s going to go to the brain just about every time. Imagine a bowl of jello, as the brain is frequently (and insultingly) described, which can generate electrical fields, communicate in multiple ways — this jello can create songs and lyrics, sometimes speak in several languages, write poetry, and even send silent signals to others — undertake the study of the universe and calculate complicated equations, contemplate its own jello-ness, as well as its own mortality. This jello can even tell the bowl containing it to get up and go across the room or across town and the bowl will usually obey. Yes, the brain is one pretty amazing quivering blob, and it is the subject of this fascinating book. If you like history, buckle your seatbelt for this ride, because Sam Kean (our author) has done his homework, tracking down brain researchers from the

14th century right up to recent developments like the NFL’s agreement last year to fund concussion research. Truth be told, this book is a lot more about the people who were the pioneers of brain research, primitive though they may have been by today’s standards, than it is about the brain itself. Even so, if you put a quarter in a jar every time you run across a word like “cortex” or “neurotransmitter” or “hypothalamus” or “cerebellum” or “dendrite,” or... well, you get the idea... you’re going to have a nice little chunk of change by the time you reach page 416.

And chances are you will reach that page fairly quickly, because this isn’t some stuffy and arcane treatise prepared for the sole edification of brain surgeons and their ilk, and nothing but a brainteaser for the rest of us. No, Kean writes with a style that will cause your brain to tell your eyes to move back and forth across lines of text until it reaches a point where it commands your arm to move your hand to the right hand page and to flip it over and across, revealing the next two pages to your roving eyes, and it will do all these things and more with great regularity. (Of course, your brain will continue to regulate your autonomous nervous system and such routine chores as breathing, so no worries there. Read away.) + The Tale of the Dueling Neurosurgeons — And Other True Stories of Trauma, Madness, Affliction and Recovery That Reveal the Surprising History of the Human Brain, by Sam Kean, 416 pages, published in 2014 by Little, Brown and Company.

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The Examiners +

Exercise can cut the risk of obesity, but it wouldn’t do Why would me any good. you say that?

by Dan Pearson

Because no matter how much I exercise I’ll still be overweight. I don’t think that’s It runs in my family. the problem.

The problem is that no one runs in your family.

Then what is?

EXAMINER CROSSWORD

PUZZLE

39 43

46 49

47 50 56

The Mystery Word for this issue: ECANAPA

Simply unscramble the letters, then begin exploring our ads. When you find the correctly spelled word hidden in one of our ads — enter at AugustaRx.com

Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, JUNE 27, 2022

We’ll announce the winner in our next issue!

E X A M I N E R

22 24

THE MYSTERY WORD

61 64

2 9 2 1 3 9 1 2

1 5

S U D 1 O K 9 U

6 1

6 5 8 4 9 3

DIRECTIONS: Every line, vertical and horizontal, and all nine 9-square boxes must each contain the numbers 1 though 9. Solution on page 14.

33. Double-______ 35. Basic meteorology instrument 36. Written demand for payment 38. Resembling skeletal parts 41. Brain ___ 42. Electrically charged atom 43. Twist 44. Augusta’s ______ Park 46. Couch for two or more 50. What some donors donate 51. Liquefy 52. Largest continent 53. Unpleasantly moist 55. Egyptian goddess 56. Portend 57. Component 58. Obtains 60. Health Sciences Bldg.

Solution p. 14

QUOTATIONPUZZLE H C T G I G O T N E M H

P I A H

M A A N

T Y M M N E O O ’ K I N A N T L

Y E O R K P S N O O L S W

5 8 9 3 1 2 2 1 Y 4 9 6 T7 7 O5 8 E6 3 4

— Steven Wright

DIRECTIONS: Recreate a timeless nugget of wisdom by using the letters in each vertical column to fill the boxes above them. Once any letter is used, cross it out in the lower half of the puzzle. Letters may be used only once. Black squares indicate spaces between words, and words may extend onto a second line. Solution on page 14.

Use the letters provided at bottom to create words to solve the puzzle above. All the listed letters following #1 are the first letters of the various words; the letters following #2 are the second letters of each word, and so on. Try solving words with letter clues or numbers with minimal choices listed. A sample is shown. Solution on page 14.

S 1 2

I 1 2 1 2 3 4 1 2 3 4 5 6 F O 1 1 2 1 2 3 4 5 6 1 2 3 4

1 2 1 2

O 1

E 1 2 3 4 5 6 2

— Kent Nerburn

1 . F M AT T O B I B I T E 2 . O O U A H S A N T E E 3 . TA C C E S 4 . H H O N I 5 . M E E 6 . E R R

SAMPLE:

1. ILB 2. SLO 3. VI 4. NE 5. D =

L 1

O 2

V 3

E 4

I 1

S 2

B 1

L 2

I 3

N 4

D 5

20 21 ACROSS 1. Back of the neck 23 5. Before (in poetry) 26 27 28 29 10. Skin 14. Black (in poetry) 34 35 36 15. Standard for comparison 37 38 16. Fencing sword 17. Cried 40 41 42 18. Regions 45 19. Mend with rows of stitches 48 20. Wide awake 51 52 53 54 55 22. Confused; unclear 23. Torn clothing 59 60 24. Of the ear 62 63 26. Ambulance svc. 29. Long-tailed rodent 65 66 30. Wink or blink, technically by Daniel R. Pearson © 2022 All rights reserved. 34. Lesser and Greater festivals after Ramadan DOWN 36. Dead 1. On-the-hour radio program 37. Sicilian volcano 2. First murder victim 38. Future flower 3. Avenue in Augusta medical 39. Male deer district 40. Cancellation (var.) 4. Word on many doors 43. Camembert, for one 5. Dental filling 45. Town between Edgefield 6. Land covered with trees and Aiken 7. Lyric poems 46. Type of flour, milk, 8. Thought logically sauce, or bean 9. Golfer known as The Big Easy 47. Blood cell type 10. Reducing enzyme 48. Pool type 11. Apple product 49. Prefix for -scopy. 12. Dweeb 51. Letter opener 13. Repudiate 54. Public slob 59. Son of Isaac and Rebekah 21. Medic intro 22. Medical guinea pigs? 60. Prefix meaning tissue 25. Twitch 61. Departed 26. Late Pulitzer Prize-winning 62. This is Life TV journalist film critic 63. Lindsey Vonn is one 27. Dura_____ 64. Mine entrance 28. From that time 65. Dave Brubeck’s ___ Five 31. Garden flower 66. Plague, beleaguer 32. Tantalize 67. NBA team

WORDS NUMBER

JUNE 17, 2022

4 6 7 3 8 5 2 9 1

2 8 9 4 6 3 1 7 5

3 7 5 8 1 9 6 4 2

6 1 4 5 7 2 9 3 8

JUNE 17, 2022

AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE ha... ha...

mother was making pancakes for her two sons, Moe and Joe. The boys started arguing over who would get the first pancake. Their mother saw an opportunity to teach her sons a life lesson. “Boys, if Jesus were sitting here,” she said, “do you know what he would tell me? He would say, ‘Please, let my brother have the first pancake. I can wait.’” Joe turned to his brother and said, “Moe, you be Jesus.”

A first-year teacher got stuck teaching summer school because she had the least seniority. Summer school was filled with kids who were academic underachievers and troublemakers, so her work was definitely cut out for her. One day during a grammar lesson she wrote on the board, “I ain’t had no fun all summer,” and turned to the class, gestured toward the sentence and asked, “Who can tell me me how to fix this?” A boy named Paul who rarely participated in class discussions raised his hand. “Get a boyfriend?” suggested Paul.

The

13 +

Advice Doctor

Moe: Did you go to that new tattoo parlor? Joe: Yes, unfortunately. The guy has no experience! Just a few months ago he was an accountant! Moe: But you got a tattoo anyway? Joe: Yeah, and boy did he do a number on me!

Moe: Man, the salad at that strip club I went to was totally blah. Joe: Wonder why? Moe: I asked the manager. He said they don’t use dressing. Moe: I’m investigating my family tree. I don’t know anyone past my grandparents. Joe: I tried digging into my ancestry a while back and it didn’t go too well. Moe: What happened? Joe: I got kicked out of the cemetery. Moe: Man, I spent almost an hour looking for that thing that peels potatoes. Joe: Did you ever find it? Moe: No, I remembered she’s at work. Moe: What do you call a group of domestic abusers? Is there a word for that? Joe: I believe it’s called a Heard. Moe: I guess Amber Heard can truthfully say now that Johnny Depp beat her. Joe: Well that’s certainly ironic. Moe: What should an attorney never say in a trial between Amber Heard and Johnny Depp? Joe: “Move to strike.” +

Why subscribe to theMEDICALEXAMINER? Staring at my phone all day has certainly had no Effect on ME!

Because try as they might, no one can stare at their phone all day.

Dear Advice Doctor, Several times a week I get up in the middle of the night to answer nature’s call. Sometimes I fall right back asleep, but more often I will lie there thinking for what seems like hours. Do you have any suggestions on how I can break this cycle? — Midnight meditations Dear Midnight, Frankly, I’m jealous. I wish I was like you. Not only that, I think it would be great if everybody was. Yes, I said everybody. From a personal standpoint, I have to admit I almost completely ignore nature. The windows at my house are painted shut; I couldn’t hear nature’s calls if I wanted to, and I’m not going to change that by stepping outside in this heat either. Sad to say, I am more or less a stranger to the very planet that sustains me. And thinking about this situation for hours, as you do? I’m ashamed to admit I don’t think about nature at all. I’m sure the birds are singing when I back my car out of the garage in the morning or fetch the mail from the box at the end of the day, but I don’t hear them. Thank you for your letter, however, and making us all ponder this extremely important issue. There are billions of people crawling all over this planet, and every one of us has a responsibility to help maintain the place. After all, if earth isn’t healthy, people can’t be either. The experts in matters of climate and the environment seem quite concerned. Sure, social media is full of people who say climate change is a hoax, but really, what do they know? They are not the experts, and the experts are worried. So what can we do? Lots of little things that add up when millions of people do them: compost, recycle and avoid litter; keep plastics out of the natural environment; avoid wasted trips and sitting in idling cars; imagine a million people who each cut out 100 miles of driving per month, or even per year; we could pull weeds in our yards instead of spraying them with herbicides; plant trees; feed the birds; go for walks or bike rides: getting out into the natural world will help us all appreciate its value and beauty and remind us that we are part of the natural world. I hope this answered your question. + Do you have a question for The Advice Doctor about life, love, personal relationships, career, raising children, or any other important topic? Send it to News@AugustaRx.com. Replies will only be provided in the Examiner.

SUBSCRIBE TO THE MEDICALEXAMINER +

Why read the Medical Examiner: Reason #714 BEFORE READING

By popular demand we’re making at-cost subscriptions available for the convenience of our readers. If you live beyond the Aiken-Augusta area, or miss issues between doctor’s appointments — don’t you hate it when that happens? — we’ll command your mail carrier to bring every issue to your house! NAME ADDRESS CITY STATE ZIP Choose six months for $20 ____ or one year for $36 ____. Mail this completed form with payment to Augusta Medical Examiner, PO Box 397, Augusta GA 30903-0397

AFTER READING

8 + 14

1 5

THE MYSTERY SOLVED The Mystery Word in our last issue was: CRANIUM ...cleverly hidden in the tablets in the p. 8 ad for PARKS PHARMACY

THE WINNER: ROBERT LOAR! If that’s your name, congratulations! Send us your mailing address using the email address in the box on page 3. The new Mystery Word is on page 12. Start looking!

JUNE 17, 2022

AUGUSTAMEDICALEXAMiNER THE PUZZLE SOLVED N E W S

A B E L

P O P E

E B E R T

M A T E R

S I N C E

M E L T

A S I A

D A N K

E A N M T A E P L R A G R A R A M A I S I N T O G E N A M U H G S E B

F O R E S T

O D E S

R E A S O N D E B U D O N N S E E L I T I S T K I E E S E

E L S

M T I I C C E C O N T O R T

R E D U C T A S E

I P A D

N E R D

D E N Y

A S T E R

T E A S E

E D G E D

U N I T

G E T S

H Y D O E R B G O A D N E

SEE PAGE 12

The Celebrated TheSUDOKUsolution MYSTERY WORD CONTEST 5 8 4 2 3 6 1 9 7

...wherein we hide (with fiendish cleverness) a simple word. All you have to do is unscramble the word (found on page 12), then find it concealed within one of our ads. Click in to the contest link at www.AugustaRx.com and enter. If we pick you in our random drawing of correct entries, you’ll score our goodie package! SEVEN SIMPLE RULES: 1. Unscramble and find the designated word hidden within one of the ads in this issue. 2. Visit the Reader Contests page at www.AugustaRx.com. 3. Tell us what you found and where you found it. 4. If you’re right and you’re the one we pick at random, you win. (Winners within the past six months are ineligible.) 5. Prizes awarded to winners may vary from issue to issue. Limited sizes are available for shirt prize. 6. A photo ID may be required to claim some prizes. 7. Other entrants may win a lesser prize at the sole discretion of the publisher. 8. Deadline to enter is shown on page 12.

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IN THE FACE OF TERROR Valjean Edward Aquila Harris flopped back in his VA hospital room chair. His lips were blue. Cold sweat streaked his exhausted forehead and face. Huffing and puffing, he struggled to get his O2 level back up to somewhere near the acceptable-for-living range. “Anything wrong, Mr. Harris?” ask a minimally concerned VA nurse. “Nothing much, ma’am.” His words struggled out. “Just a little lung cancer. I’m whipped from pushing my roommate a half mile over to Vanderbilt for his treatment.” (The VA hospital was across the street from Vanderbilt.) “So nice of you,” the nurse said flatly, adjusting the window blinds. She was used to seeing World War II veterans die and was trained to not get teary eyes at less than semi-terminal distress. “Not really,” Harris said. “Yesterday was his day to push me over there.” Harris was dying of cancer, and he knew it. This was back before the days when nurses or orderlies manned wheel chairs even for the shortest move. Back when US men were real men and did for themselves, opened doors for women (regardless of the age of either),

BASED ON A TRUE STORY (most of the time) A series by Flatwoods Frankie

said Ma’am, Sir, and please, won wars and such. When Valjean was drafted in the early days of WWII, they said he could not have four names and Aquila had to go. Nobody cared what was on his birth certificate. After Marine boot camp, they said being a master carpenter and brick mason, he could stay state-side and build military buildings. Valjean didn’t see it that way. In his stern Southern tone, he informed God and the Marines, “No, sir. The way I figure it, there is a whole bunch of Germans and Japs that need killing. Gonna do my part. Yes sir, I am.” Not wanting to disappoint a self-driven man, the Marines assigned him to an island-hopping tour of places he had never heard of and where Japs didn’t have welcome mats out for US Marines. He built new airplane runways on islands of coral while trying to stay

alive and killing anyone who shot anywhere near him. And he was good at both. His M1 carbine was a tool, just like a hammer, shovel, or trowel. He ate C-rations. Slept in the open. Wore dirty pants and torn shirts. Slapped mosquitos. Sweated until his skin was crusty. Wrote letters home, carefully skipping the hardships. No sense in worrying homefolks. Finally, Japan had the good sense to surrender after two atomic bombs flattened Hiroshima and Nagasaki. The war was over, the killing done. Thank the Good Lord. Marines unloaded ship after ship onto Japanese piers. But all was not well with Valjean. Marines had spent months sweating on war torn islands, dodging strange insects and snakes. Bombs and bullets. Day and night. Watching fellow Marines die. Nerves were on edge. (Nobody had ever heard of PTSD back then.) When ordered to unload a Baby Grand Piano off a US cargo ship, Valjean was more than a little perturbed. While Marines had suffered and died, some sorry S.O.B. officer was concerned with having a piano to play. The cable lowering the piano somehow slipped. (Imagine

JUNE 17, 2022 that.) The Baby Grand split the waves and settled onto the floor of the bay. Marines sailors muffled humorous snickers as that unnamed but highly exasperated office cringed, knowing he had screwed up big time. He dared not say a word. Probably to this day, assorted sea creatures struggle to lay eggs on this foreign object, wondering why Americans carved elephant tusks into piano keys and hid them in a Japanese bay. After the war when the smoke and blood cleared, Valjean returned to Tennessee to raise a family, sell cars, and continue a few habits the Marines had helped him cultivate: a pack of cigarettes a day and sips of whiskey at night. He never got drunk. It would not be becoming of a Southern Gentleman. Along came two daughters, Victoria (Certified Registered Nurse Anesthetist) and Gloria (Registered Nurse) and a son William (Viet Nam Marine, college graduate, and hightech AT&T employee). Mother Evelyn Harris reared them to be respectful, up standing, contributing-to-society citizens. William (and several of his Nam buddies) died from cancer secondary to Agent Orange. Finally, lung cancer did something the horrors of war could not do: killed Valjean. Painfully. His wife lived a number of years before cancer

ravaged her as well. Victoria, who already held a bachelor of science in nursing, went back to Nashville to care for her mother for two years while attending Middle Tennessee School of Anesthesia. She was up every morning at 4 AM and in the hospital by 5 AM. Then rotating night call. When Victoria slept was a mystery. Why she didn’t succumb to terminal exhaustion is beyond me. And why tell you all this? To show what to do in the face of terror, conflict, or trouble. What does the Harris clan all have in common? They performed. Yes, performed. It mattered not what difficulties, horrors, or burdens each labored under. They performed. They did what was expected, what was necessary, what was needed. Not once did they stop to consider “how do I feel?” or “what do I want?” or any of that weak-kneed, whining, self-centered stuff that saps our society these days. Valjean was a man, a real man. His family was cut from the same cloth. All solid people. Admirable people. Most people, me included, pale in comparison. My hat is off the Harris family. And other people like them. Will we have another generation who performs for the betterment of mankind and suppresses desires for immediate gratification? If so, when, pray tell … when? +

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