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04/13/23 10:47 AM #12460    

 

James Hamilton, M. D.

John,

Good point - and making it twice, 8 minutes apart drives the point home even better  😀🕑!

Short term memory is usually the first to go. 🤔

Also, strangely enough, in this fast moving world in which we live, the answers to the same question also change quickly. In my world that happens all the time. For example : " What is the drug of choice to treat (place name of disease here)?

Jim


04/13/23 12:00 PM #12461    

 

Mary Margaret Clark (Schultheis)

Did you ever notice that when you put the 2 words "The" and IRS" together, it spells "Theirs"?!!

 

 


04/13/23 04:17 PM #12462    

Joseph Gentilini

Mary Margaret - your message about the IRS brought a laugh from me.  Thanks.  


04/14/23 03:56 PM #12463    

 

Donna Kelley (Velazquez)

               I saw an ad on FB today for this Tshirt.  I may plan my entire wardrobe around it!!


04/14/23 05:27 PM #12464    

 

John Maxwell

To those of you who consider yourselves technichly challenged, my advice is to read your manuals. Have an electronics manual and gossary handy and don't let any ddetail go unread. Then there are video manuals and comment streams available on your world wide web. All in English, Spainish if you opt it. Have a ball becomming a wizard. (The fallback option: ask your videogame playing niece or nephew.) There are books galore. Enjoy!

04/14/23 05:58 PM #12465    

 

James Hamilton, M. D.

John M.

Good advice and I do read manuals - at least part of them. Some are easier to understand than others.

Gray Day

Just sitting here now and watching the snow fall on our deck. Ten minutes ago it was raining with some thunder. Twenty minutes ago it was graupeling (you all can look that one up). Temperature is dropping fast, down to the mid 30's. Yesterday it was 80. I should have put some grass seed and fertilizer down then.

Jim ​​​​

 

 

 

 

 


04/15/23 02:31 PM #12466    

 

James Hamilton, M. D.

Dave Barbour,

I have seen a couple of articles on the massive Super bloom in California due to this year's torrential rains. If I recall correctly (and admitably, my aging brain is also struggling at times) did you not photograph that phenomenon and post some pictures of it a few years ago on this Forum? Did you get out there for this year's bloom?

Jim


04/16/23 10:59 AM #12467    

 

Michael McLeod

I'm posting this for a couple of reasons. Three, actually. One, I know we are all at an age at which the subject of this essay takes on more importance and interest. Two, its author touches on yet another subject we have in common, that being a religious upbringing. But three: I find a sentence here that I think is awkward and perhaps even technically wrong. This astonishes me and makes me doubt my own judgement, given how much I respect its author, Garrison Keillor. Anyone else see something a bit off at one point, amid his usual impeccable craftsmanship? 

Not that it detracts from the gracefullness and warmth and humor that Keillor is master of. 

Love the typically sly, off-hand, understated humor of his first sentence, playing on the philosophical difference between congregations.

He mentions a mitral valve replacement. I seem to remember my father telling me he had been transplanted with a mitral valve from a pig. Is there a doctor in the house? Just curious if that was once a thing.

So I guess that makes it four reasons I am posting this. And the sheer wisdom of it, come to think of it, would make it five.

 

Over at my church last week we celebrated the risen Lord and the promise of our own resurrection and in my friend’s Unitarian church they heard a sermon about recycling, but despite this difference we get along very nicely — and why? Because we’re older than we were. The pride of possession of the Truth diminishes; the urge to share the sunshine succeeds it.

And a day later I made my annual pilgrimage to Rochester, Minnesota, where I was twice resurrected as my congenital heart problem was fixed when heredity said I should drop dead but instead here I am, having my say. Gratitude is the prevailing attitude at my age. My older brother went skating, slipped, banged his head, and died at 71; he was five years older than I and now I’m nine years older than he; it could’ve happened to me and it didn’t. He was a good man and I am a fly-by-night operator and his demise obligates me to be a better man than I know how to be. So I’m trying.

Mayo put me through the tests, then sedated me to do some electrical work on the defibrillator implanted in my upper left pectoral, which, if my heart stopped at your dinner table during a discussion of hush money paid to a porn star, an electric jolt would bring me back to life. The surgical team ran into problems inserting a wire and five hours later I awoke in the hospital in a state of stupidity and they explained what the problem was, something about a vein, or perhaps personal vanity, and there I was, an invalid, wires attached, feeling like a failed experiment.

     

I revere Mayo, a place where two surgeries, one to repair the mitral valve, one to replace it, gave me two excellent decades I had no right to expect, and I remember the air of competence and intense concentration among the team in white and blue scrubs in the OR, no small talk, no false moves, and because Medicare paid sixty-some thou for each procedure, I feel obliged to go on being useful in any way I can. Modern health care has made me a person of privilege.

There are progressive zealots among us who scorn me as a privileged person, the people who want to rename the Jefferson Memorial the Sally Hemings Acknowledgement and get National Public Radio to change its name to Inter-relational Public Radio because the word “nation” evokes the evil of nationalism and the racism in our nation’s history, but those projects are amusements, and I’m in the amusement business myself so I don’t object.

The real idealists are the ones who teach third grade, which is hard work and carries with it the possibility of making an enormous difference in people’s lives, just as Mrs. Fern Moehlenbrock made in mine. She let me spend recess in the library so I could read Dickens and it changed my life. Changing NPR to IPR is like renaming Little Falls Great Falls, it doesn’t affect the water flow.

A medical clinic is where it all happens. I see old people facing their mortality with good grace, I see to my amazement that guys can master the art of nursing, the delicacy, the empathy, the soulfulness of caregiving, something I never thought possible.

And I sit with my doctor who’s looking at the chemical analysis of my blood and urine tests, and he reports that my cholesterol level is a small fraction of what’s normal, my level, me, a man who lives on bacon cheeseburgers and onion rings. There is injustice in the world and some of it is in our favor.

Yes, gratitude is the prevailing attitude at my age, far ahead of confusion or dread. I haven’t been angry for years. Mortality is all around us, which makes each day beautiful. Sitting in a waiting room, I imagined making a museum of my boyhood in the mid-20th, the old school desks with iron scrollwork on the sides, the Regulator pendulum clock on the wall, Mrs. Moehlenbrock, her upper arms jiggling as she wrote sentences on the blackboard. Uncle Jim’s hayrack and his team of horses, his Model T, the outhouse. Riding my bike into Minneapolis, I passed massive printing plants, a slaughterhouse, warehouses, a sawmill, they’ve all been renovated into offices where people look at screens and never make anything tangible. I am privileged to tell the story.

     

 


04/16/23 01:00 PM #12468    

 

James Hamilton, M. D.

Mike,

I'll leave sentence structure to you and other English experts.

As for porcine (pig) mitral valve replacement grafts, they are still "a thing".

Valve types are based on age, life expectancy due to co-morbid conditions, patient preference (mechanical valves require lifelong anticoagulation with Coumadin) and other factors. Today's choices include several types of mechanical valves or the bioprosthetic valves: porcine, bovine or equine.. 

Mechanical valves usually last longer than bioprosthetic ones but the anticoagulation is often a big deciding factor due to inconvenience (dietary, monitoring, bleeding etc.).

Jim


04/16/23 02:15 PM #12469    

 

Michael McLeod

wow jim. I don't know why that surprises me but if it works, as it obviously does, shout out to the piggie wiggies for their sacrifice. Seems to me I heard someone say you can hear the manufactured valves making soft little noises, which would totally creep me out, whereas there is nary a single oink from the piggie valve department.

ok now I am creeping myself out.


04/16/23 05:10 PM #12470    

 

Mark Schweickart

Mike – I will take a stab at your grammar question. I think you are probably referring to this sentence:

And I sit with my doctor who’s looking at the chemical analysis of my blood and urine tests, and he reports that my cholesterol level is a small fraction of what’s normal, my level, me, a man who lives on bacon cheeseburgers and onion rings.

My guess is that Garrison was perhaps thinking in terms of how he would read this aloud, and failed to help us out by adding a few question marks that would be evident if he were saying this to us at one of his live performances. Without changing the word order, the question marks would clarify things.

And I sit with my doctor who’s looking at the chemical analysis of my blood and urine tests, and he reports that my cholesterol level is a small fraction of what’s normal. My level? Me? A man who lives on bacon cheeseburgers and onion rings?


04/16/23 05:16 PM #12471    

Joseph Gentilini

Glad to hear that your ticker is working relatively well after your procedures!  Getting older is not for sissies!  Glad Jim, our resident doctor, is able to give us all a bit of medical information that I, at least, can understand.   joe


04/16/23 05:55 PM #12472    

 

James Hamilton, M. D.

Mike,

Yeah, some of those mechanical valve replacements do produce significant sounds. This is particularly true of the "ball-in-cage" design such as the aortic Starr-Edwards valve. Devices that replace the aortic valve stream blood to the aortic arch which has quick exits to the carotid arteries that funnel blood to the brain passing in close proximity to the ears. Just like any other tube sound is conducted and can be heard so the clicking of the ball against the metal cage can be heard with each heartbeat.

As I recall this effect was somewhat mollified when some models instituted wrapping the metal bars in a type of cloth to dampen the sound.

And yes, that constant clicking noise did drive some patients batty! 

Jim 


04/16/23 08:22 PM #12473    

 

Michael McLeod

Mark:

Nope.

 

This sentence is the one that doesn't look right to me:

 

Mayo put me through the tests, then sedated me to do some electrical work on the defibrillator implanted in my upper left pectoral, which, if my heart stopped at your dinner table during a discussion of hush money paid to a porn star, an electric jolt would bring me back to life.


04/16/23 08:44 PM #12474    

 

Mark Schweickart

I don't know Mike, this sentence you are puzzled about seems less confusing than the one I picked. I think that in this sentence you quote, it is fairly obvious that he is positing that he could be saved in a situation that would otherwise prove fatal because he has had a pectoral-defibulator implanted. Although to be fair to you, I suppose he is being a bit vague as to how this device is activated once one is keeled over, face-down in a dessert plate at a dinner party. Does the implanted device somehow sense the need and activate by itself, or does it rely on a quick thinking dinner guest to jump up, wipe the Key Lime pie off poor Garrison's face, and then somehow know how to activate the defibulator? Is that what you are driving at, or have I missed the point again?

 


04/16/23 11:02 PM #12475    

 

James Hamilton, M. D.

Mark and Mike,

Before you English language experts get too involved in how Garrison was thinking, l think you need a little tutorial on how an automatic implantable defibrillator works.

It is NOT activated by anyone sitting at the table with the victim. These devices are programmed to recognize a potentially fatal cardiac dysrhythmia, usually ventricular fibrillation or ventricular tachycardia. The pulse electrical generator (buried under the skin of the chest wall) will recognize the need for an electrical shock and deliver that shock through a wire that goes from the generator to the heart itself and (hopefully) terminates the abnormal rhythm by temporarily stopping all cardiac electrical activity and allowing the heart to reestablish its own normal rhythm.❤️

This differs from an automatic external defibrillator (AED, like you see in stores, airports, etc.) with which a bystander places two pads (leads) on the victim which, like the internal battery pack, senses the abnormal rhythm and instructs the operator to press a button that delivers (a much higher voltage) shock which then travels through the skin, chest wall muscles and into the heart. 

O. K., you two can now continue with how Garrison was thinking. 🤔

Jim


04/16/23 11:09 PM #12476    

 

Michael McLeod

Mark: In the sentence I cited the phrase that comes after the relative pronoun, "which," doesn't clearly and gramatically align with anything that came before. 

"which," as you deduced, appears to be a reference to the defibrillator. So, grammatically, the phrase that follows after "which" should immediately and clearly say something about what the defillibrator does.

it doesn't. Not directly. It backs into the statement in a way that doesn't give the defib due credit and is therefore confusing at the very least, and I'd dare to say officially and gramatically incorrect.

Here. I'll rewrite the sentence, giving the defibrilator the positioning it deserves as announced by and connected to the relative pronoun "which." 

"Mayo put me through the tests, then sedated me to do some electrical work on the defibrillator implanted in my upper left pectoral, which, if my heart stopped at your dinner table during a discussion of hush money paid to a porn star, would deliver an electric jolt that would bring me back to life."

I put the subject and the verb it's connected to in bold to emphasize the much clearer connection to the process he's describing. 

Take another look at his version. The way he wrote it doesn't make it gramatically clear what is doing the jolting. An act of God, perhaps? The upper left pectoral suddenly gets religion and kicks in? Anyone sitting at the table?, (as Jim, given the grammatical cluster copulation, felt compelled to rule out?)

Yes, the careful reader can figure out that the defib is the hero here but it's confusing as GK has written it because he didn't provide  the grammatical scaffolding -- namely a clearly implied subject, in this case "defillibrator," connected to the preceding, relative pronoun, "which."

 

 

 

 

 


04/17/23 11:02 AM #12477    

 

John Maxwell

I'm sorry my contribution contains javascript and other attributes not found...means what????? Any takers. It's a technical question. So you can stop asking, what'd he say?

04/17/23 11:53 AM #12478    

 

Mark Schweickart

Mike -- I think, given the good doctor's clarification (thanks for that, Dr.J) and your own explanation of GK's error, this dinner party faux pas can be put to rest. However, before leaving the topic completely, I must congratulate you on your exquisite phrasing, when you said, "grammatical scaffolding." That was brilliant.

(And in case you're wondering, I am not being sarcastic here, your phrasing seemed precisely right and imaginatively descriptive. One does not often think of "scaffolding" in relation to word choice. Well done. ) 


04/17/23 12:22 PM #12479    

 

Janie Albright (Blank)

For those of you who need a that/which refresher and actually care, like me, this was great. I tend to use which when I shouldn't.  surprise

https://prowritingaid.com/art/438/-Which--or--That-%3A-Know-When-to-Use-Each.aspx


04/17/23 12:27 PM #12480    

 

Janie Albright (Blank)

I also like Jim's explanation of how the ICD (defibrillator) works. I'm on my fifth device in 22 years, an internal cardioverter device and pacemaker. This one has 3 leads. And yes it for my ventricular tachycardia. Fortunately I don't have to sit next to DJT at dinner so mine has not needed to revive me in some time. 


04/17/23 12:41 PM #12481    

 

James Hamilton, M. D.

Janie,

Good refresher course on English.

I think I know now which use of that is that which is correct. 

Or do I???

Jim


04/17/23 01:01 PM #12482    

 

Michael McLeod

Thanks Mark.

That was fun and if I sounded like a pompous ass I don't mind at all. I just felt like I was playing one on tv. I was thinking: Jim knows how the inside of our bodies look like and function; I know how the insides of a good piece of writing look like and function. And yup when the word "scaffolding" came to me I was grateful because it was a tactile way of illustrating the abstract elements of grammar.

But back in the day I hated grammar, which to me felt like looking at pictures of a building instead of just frigging building it, which turned out to be what I wanted to do with my life.

It was interesting to double back and think about the bylaws and underpinnings of good writing and suddenly see myself channeling whatever English teachers we had. They knew what they were telling us was important but we didn't, at least I didn't. Grammar felt like a salad. I wanted meat and potatoes. I just loved words and what you could do with them, and over the years it kinda grew on me. 

But I do wish I could assemble all the teachers who were busting their hinies to get grammar across to us and thank them for that thankless task.


04/17/23 01:22 PM #12483    

 

James Hamilton, M. D.

Jack,

The only java script that I understand is regular vs. decaf.

Jim 


04/17/23 02:02 PM #12484    

 

Mary Margaret Clark (Schultheis)

Meanwhile our very eloguent speaking President just returned with his son, Hunter, from a taxpayer funded trip to Ireland where he promised that there is nothing our nations cannot achieve if we "do it together.....and go lick the world"!


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