Tuesday, August 15, 2017

Hello Summer: BBG 2017!



















Brooklyn Botanic Garden©2017 Am Ang Zhang 

Book I recently read: 

Fragile Lives by Stephen Westaby





A unique picture book consisting of 20 beautiful 9 x7 in. full bleed photos by the author of: corals, turtles, anhinga, blue tang, file fish, butterfly fish, cleaner shrimp, pompano, barracuda, flounder, star fish, and sting ray. A first of the kind tale of aquatic creatures in child-speak. A good introduction of nature to a young child, especially good as a follow-up to a visit to the aquarium; plus two pages of detailed companion




A coffee table quality photobook for a special child, introducing wild life in Africa. Photos of the animals (impala, nyala, kudu, wildebeest, warthog, gruffalo, zebra, rhinoceros, waterbuck, hippopotamus, giraffe, buffalo, elephant, saddlebilled stock) were taken by the author himself during safari trips in Africa.






Sunday, August 13, 2017

Berlin, Appassionata & The Lives Of Others





©2017 Am Ang Zhang

It looked as though many have stopped listening to Beethoven’s  Appassionata.


Maxim Gorky wrote about Lenin listening to Beethoven's Appassionata:
“I know of nothing better than the Appassionata and could listen to it every day. What astonishing, superhuman music! It always makes me proud, perhaps naively so, to think that people can work such miracles! 
“Wrinkling up his eyes, Lenin smiled rather sadly, adding: ‘But I can't listen to music very often. It affects my nerves. I want to say sweet, silly things and pat the heads of people who, living in a filthy hell, can create such beauty. One can't pat anyone on the head nowadays, they might bite your hand off. They ought to be beaten on the head, beaten mercilessly, although ideally we are against doing any violence to people. Hm—– what a hellishly difficult job!”
It was said that Lenin was indeed afraid he would otherwise never ‘finish’ the revolution!!!
Henckel von Donnersmarck said he based his film The Lives Of Others on the Appassionata anecdote. 
The Lives Of Others/Sony
The Times:
The Lives of Others has caused the most delicious trouble since winning Best Foreign Language film at this year’s Oscars. Few critics expected this modest thriller about the East German Stasi to lift such a glamorous award.
“The plot is as simple as an opera charge sheet. A plump and seedy minister for the arts falls for a famous actress with a drug habit. He orders his lieutenant to bug the flat she shares with her fashionable playwright boyfriend. Wiesler is duly charged to drag up the necessary dirt. Under “Operation Lazlo”, he litters their apartment with secret microphones and moves into the attic to spy on their every twitch.
“Against every trained fibre of his highly tuned mind he starts falling in love with Martina Gedeck’s voluptuous actress, and sympathising with Sebastian Koch’s idealistic writer. The mission to nail this pair of errant artists turns into a desperate soap to save them.”
With the celebration underway for the 20th anniversary of the fall of the Berlin Wall, The Times reported::
“In an extraordinary frank meeting with Mr Gorbachev in Moscow in 1989 — never before fully reported — Mrs Thatcher said the destabilisation of Eastern Europe and the breakdown of the Warsaw Pact were also not in the West’s interests. 
“We do not want a united Germany,” she said. “This would lead to a change to postwar borders, and we cannot allow that because such a development would undermine the stability of the whole international situation and could endanger our security.”
Perhaps she stopped listening to The Appassionata!
Anyway, The Berlin Film Festival refused to accept it as an official entry.
They stopped listening too!
In 2007, it was awarded an Oscar for Best Foreign Film.

Thursday, August 10, 2017

Nature & Mahler: Royal Festival Hall!

As the Mahler 3rd Symphony will be at the Royal Festival Hall on 1st Oct., 2017, I will reprint my blog on the symphony. 

Yosemite ©2007 Am Ang Zhang

Here is an extract from Julliard Online:
Gerald Fox

Mahler considered the Third his "nature" symphony. He wrote: "My symphony will be unlike anything the world has ever heard! All nature speaks in it, telling deep secrets that one might guess only in a dream!"                         

Mahler himself described his experience in writing the enormous first movement: "It is frightening, the way this music keeps growing and expanding so far beyond anything I have ever composed before. I am seized with horror when I realize where all this is leading ..."

The movement begins with a startling call to attention, an open, majestic theme for eight horns in unison, which has been compared to the main theme of the finale of Brahms' Symphony No. 1. Its origin seems to be an Austrian children's marching song which Brahms also suggested in his Academic Festival Overture. The movement is characterized by its many marches, ranging from noble and heroic to vulgar (Mahler called the latter das Gesindel, 'The rabble').

The second movement is in complete contrast: a delicate minuet of moderate length, full of grace and lightness. It bears much the same relationship to the first as the Andante moderato second movement of the Second Symphony does to its highly dramatic, extensive first movement.

The second movement, with the title, "What the flowers in the meadow tell me," was described by Mahler as "carefree, as only flowers are. Everything floats on the height with lightness and suppleness, like flowers waving on their stems in the breeze."

©2008 Am Ang Zhang


In the third movement, scherzando, there are two main elements. The first draws on Mahler's earlier Wunderhorn song with piano accompaniment, Ablösung im Sommer ("Relief in Summer"). The second element is Mahler's use of an offstage posthorn in many of the trio sections. The posthorn solo includes a large fragment of a popular Spanish tune that is the main theme of Glinka's Jota Aragonesa, and also appears in Liszt's Spanish Rhapsody. The coda of the movement is apocalyptic.

Deep isolation characterizes the fourth movement, in which the contralto sings lines from Das trunkene Lied of Nietzsche's Also Sprach Zarathustra (coincidentally, Mahler's friend, Richard Strauss, was working on his symphonic poem at about the same time). The movement grips the listener with its dark mystery, despite the occasional ecstatic shafts of light.

The fifth movement follows without pause, and is a sprightly setting of a poem, Es sungen drei Engel, from Des Knaben Wunderhorn. It is sung by all the vocal forces: contralto, boys' choir and women's chorus. It opens with the boys' choir brightly singing, "bimm, bamm, bimm, bamm…" in onomatopoeic imitation of matins bells. The effect of cheerful, bright, and tingling bells abruptly dispersing the dark shadows of the previous movement is startling. A darker mid-section exhorts sinners to repent. At about four minutes in length, the movement vies with the Purgatorio of the Tenth Symphony as Mahler's shortest. As befits the music's light and playful nature, timpani (and violins) are silent.

Again following without pause is the first of Mahler's sublime Adagios; its opening theme a near quotation from the Lento assai of Beethoven's 16th String Quartet, Op. 135. It is amusing to note that a moment later, the second theme seems to have inspired the World War II popular song, "I'll Be Seeing You."
 Yosemite©2007 Am Ang Zhang
Mindful that the symphony is a glorification of all nature and all creation, Mahler ends it with a D-major, fortissimo apotheosis.

Listen: BBC
Related:

Performers
Philharmonia Orchestra
Esa-Pekka Salonen conductor
Michelle DeYoung mezzo-soprano

Philharmonia Voices

Sunday, August 6, 2017

Hiroshima & Nanjing!

hiro1.gif (64778 bytes)
Photo by US Army

On a Monday in August 1945, Little Boy was dropped on Hiroshima by the crew of an American B-29 bomber Enola Gay. Around 80,000 people were killed immediately. By the end of that year another 100 to 150 thousand died from radiation. It was estimated though that at least 43 % of the cockroach population survived.

For nearly 300 million years, most species of cockroaches (and there are nearly 4000 of them) did not evolve at all and the chances are that they will be around in another 300 million years.

The ability of cockroaches to survive a nuclear winter has drifted into urban mythology, so much so that the Discovery Channel found it necessary to 'bust' that myth.

Yes, the cockroach, being an insect, can withstand at least 6 times the radiation a human can. It is still no match for the fruit fly, one of the most studied insects in biology.


Nanjing

77 years ago, the people of NankingChina's ancient capital city, were in the midst of one of the worst atrocities in history, the infamous Rape of Nanking. The truth of what actually happened is at the center of a bitter dispute between China and Japan that continues to play out in present-day relations. Many Chinese see Japan's election last month of ultraconservative nationalist Shinzo Abe as prime minister as just the latest in a string of insults. And it was recently reported that Japan is considering rolling back its 1993 apology regarding "comfort women," the thousands of women the Japanese army sexually enslaved during World War II.

In 1937, the Japanese Imperial Army, captured Nanking on Dec. 13. No one knows the exact toll the Japanese soldiers exacted on its citizens, but a postwar Allied investigation put the numbers at more than 200,000 killed and at least 20,000 women and girls raped in the six weeks after the city fell.
It was the mass rapes in Nanking and the brutalization of an entire populace that eventually convinced Japanese military leaders that they needed to contain the chaos. Japanese soldiers began rounding up women and forcing them to serve as sex slaves in so-called comfort stations.

This is what most historians believe. But not in Japan, where a large faction of conservatives, led by Abe, denies that the Japanese military forced women into sexual slavery. They maintain that any suggestion to the contrary is simply anti-Japanese propaganda and probably spread by China. At the furthest end of the spectrum, the minimizing turns to flat-out denial; one professor we interviewed at a top Japanese university adamantly insisted there were no killings or rapes in Nanking.

Not surprisingly, all this minimizing and denial enrages the Chinese and others in Asia. But this is a familiar pattern.

Nanking Poster: THINKFilm


On July 2, 1996, the anniversary of Ernest Hemingway’s own suicide, Margaux Louise Hemingway, his grand daughter was found dead in her studio apartment in Santa Monica, California at age 41.

On November 9, 2004, Iris Chang (張純如), who was propelled into the limelight by her 1997 best-selling account of the Nanking Massacre “The Rape of Nanking: The Forgotten Holocaust of World War II”, committed suicide. Earlier she had a nervous breakdown and was said to be at the risk of developing Bipolar illness. She was on the mood stabilizer divalproex and Risperidone, an antipsychotic drug commonly used to control mania. There was a detailed report in San Francisco Chronicle.

Now back to the Japanese atrocities in the Nanking Massacre in 1937, one of history’s worst but relegated to obscurity. The impact of Iris’ book and her tragic death was such on Ted Leonsis, Vice Chairman of AOL, that he went on to produce a film on the subject. The film, Nanking, premiered in Sundance Festival last year, was shortlisted in the documentary feature category of the Academy Awards, and won the Humanitarian award for documentary in the Hong Kong International Film Festival.

Mariel Hemingway, younger sister of Margaux, read the words of Minnie Vautrin in the film. Minnie Vautrin was an American missionary renowned for saving the lives of many women at the Ginling Girls College in Nanking, China during the Nanjing Massacre. In 1941, Minnie Vautrin committed suicide.

In July, 2007 the film premiered in Beijing. The 
BBC said:

“It is doubtful, though, it will ever be shown in Japan, where historians claim the massacre has been exaggerated.”

Experts estimate the Japanese killed 150,000 to 200,000 people and raped more than 20,000 women and children, but a group of MPs from Japan's governing party recently said no more than 20,000 were killed.
 


Batter my heart, three-person'd God ; for you
As yet but knock ; breathe, shine, and seek to mend ;
That I may rise, and stand, o'erthrow me, and bend
Your force, to break, blow, burn, and make me new.
I, like an usurp'd town, to another due,
Labour to admit you, but O, to no end.
Reason, your viceroy in me, me should defend,
But is captived, and proves weak or untrue.
Yet dearly I love you, and would be loved fain,
But am betroth'd unto your enemy ;
Divorce me, untie, or break that knot again,
Take me to you, imprison me, for I,
Except you enthrall me, never shall be free,
Nor ever chaste, except you ravish me.

HOLY SONNETS. XIV John Donne (1572-1631)


Doctor Atomic Metropolitan Opera House

At the end of Act 1 of Dr Atomic (premiere at the Metropolitan Opera House, New York this season - composer: John Adams), Oppenheimer, the father of the Atomic bomb, faces his own personal crisis alone in the desert, recalling this sonnet by John Donne.

Gerald Finley as J. Robert Oppenheimer in "Doctor Atomic." Terrence McCarthy
This opera was first performed in San Francisco in 2005. You can read about that here.

The Cockroach Catcher and his wife were at the Met’s performance on the 13th of November 2008, a review of which you can read 
here.

I am not here to discuss the rights and wrongs of the Atomic bomb and its derivatives. There are now 50,000 such weapons worldwide. What is clear is that it has always been humans who hold the key to mass destruction. In 
Nanking. the Japanese grew bamboo through living Chinese as a means of destruction. It did not take an Einstein to work that one out nor an Oppenheimer to execute it.

In Dr Atomic, at the high point of the final countdown to the test firing of the bomb, there was a tape recorded voice of a Japanese woman repeatedly asking for a glass of water. 



5:29:45 am Mountain War Time on July 16, 1945 Los Alamos National Laboratory
What would the effect have been if images of Japanese atrocities in Nanking or in Hong Kong were projected on stage at the same time? Or perhaps Pearl Harbour, for an American audience?
After all there have been recent attempts by Japan to change their history textbooks. Guilt must in the end find its proper home.


That I may rise, and stand, o'erthrow me, and bend
Your force, to break, blow, burn, and make me new.

Saturday, August 5, 2017

Bipolar Disorder: Lithium-The Aspirin of Psychiatry?

Australian Trilogy:

Bipolar Disorder: Lithium-The Aspirin of Psychiatry?

 

Fremantle: Medical Heresy & Nobel

 


Tasmania & SIDS: The wasted years!


©Am Ang Zhang 2013

Cade, John Frederick Joseph (1912 - 1980)
Taking lithium himself with no ill effect, John Cade then used it to treat ten patients with chronic or recurrent mania, on whom he found it to have a pronounced calming effect. Cade's remarkably successful results were detailed in his paper, 'Lithium salts in the treatment of psychotic excitement', published in the Medical Journal of Australia (1949). He subsequently found that lithium was also of some value in assisting depressives. His discovery of the efficacy of a cheap, naturally occurring and widely available element in dealing with manic-depressive disorders provided an alternative to the existing therapies of shock treatment or prolonged hospitalization.

In 1985 the American National Institute of Mental Health estimated that Cade's discovery of the efficacy of lithium in the treatment of manic depression had saved the world at least $US 17.5 billion in medical costs.

And many lives too!

I have just received a query from a reader of this blog about Lithium, and I thought it worth me reiterating my views here.      It is no secret that I am a traditionalist who believes that lithium is the drug of choice for Bipolar disorders.

The following is an extract from The Cockroach Catcher:
“Get him to the hospital. Whatever it is he is not ours, not this time. But wait. Has he overdosed on the Lithium?”

“No. my wife is very careful and she puts it out every morning, and the rest is in her bag.”

Phew, at least I warned them of the danger. It gave me perpetual nightmare to put so many of my Bipolars on Lithium but from my experience it was otherwise the best.

“Get him admitted and I shall talk to the doctor there.”

He was in fact delirious by the time they got him into hospital and he was admitted to the local Neurological hospital. He was unconscious for at least ten days but no, his lithium level was within therapeutic range.

He had one of the worst encephalitis     they had seen in recent times and they were surprised he survived.

Then I asked the Neurologist who was new, as my good friend had retired by then, if the lithium had in fact protected him. He said he was glad I asked as he was just reading some article on the neuroprotectiveness of lithium.

Well, you never know. One does get lucky sometimes. What lithium might do to Masud in the years to come would be another matter.

I found that people from the Indian subcontinent were very loyal once they realised they had a good doctor – loyalty taking the form of doing exactly what you told them, like keeping medicine safe; and also insisting that they saw only you, not one of your juniors even if they were from their own country. It must have been hard when I retired.

Some parents question the wisdom of using a toxic drug for a condition where suicide risk is high. My answer can only be that lithium seems inherently able to reduce that desire to kill oneself, more than the other mood stabilizers, as the latest Harvard research shows.

Lithium has its problems – toxic at a high level and useless at a low one, although the last point is debatable as younger people seem to do well at below the lower limit of therapeutic range.

Many doctors no longer have the experience of its use and may lose heart as the patient slowly builds up the level of lithium at the cellular level. The blood level is a safeguard against toxicity and anyone starting on lithium will have to wait at least three to four weeks for its effect to kick in. In fact the effect does not kick in, but just fades in if you get the drift.

Long term problems are mainly those of the thyroid and thyroid functions must be monitored closely more so if there is a family history of thyroid problems. Kidney dysfunction seldom occurs with the Child Psychiatrist’s age group but is a well known long term risk.

Also if there is any condition that causes electrolyte upset, such as diarrhea, vomiting and severe dehydration, the doctor must be alerted to the fact that the patient is on Lithium.

Could Lithium be the Aspirin of Psychiatry? Only time will tell!

Related Posts:


Chile: Salar de Atacama & Bipolar Disorder.



NHS: The Way We Were! Free!
FREE eBook: Just drop me a line with your email.

Email: cockroachcatcher (at) gmail (dot) com.

Tuesday, August 1, 2017

Junior Doctors & Sunset: 1st day & Tears?


No, it was not the sunset that brought tears:


From Avatar Land© 2015 Am Ang Zhang

This is extracted from another post that is about not just the strange medical condition that I have to wait 30 plus years for an answer but to the Junior Doctor that I fondly remembered. This brought tears to my eyes as it was NHS at its best.


Now are we seeing the end game that Jeremy Hunt is playing. Well, only 54,000 pawns left on the Chess Board.

.........Perhaps we should catheterise her. She had not been seen to use the toilet for hours although she was not drinking much. She was still going round in her room – we gave her the side room and a nurse – and we put on an input output chart so we knew. The new junior doctor’s car broke down so she was late in examining her.
         Bother, I forgot it was changeover time, when new doctors came in for their new six-month rotation.  This is one of the days of the year not to be ill.
         “Good work Sister. What do we do without you?”
         Sister did the catheterisation but only got about 150ml. The mass was still there.
         I phoned Ob-Gyn. The consultant had left for home, but I got her Senior Registrar.
         He came over. Yes, it was possible that she was pregnant but unlikely as there were no breast changes. He would hate to do an X-ray but that seemed justified in the case of an undiagnosed abdominal mass.
         My mind was racing now. Sometimes you do have to believe what you see. Sometimes you have to believe the parents. She was not one of those girls. She could not be pregnant. So now we had to go through the differential diagnosis for abdominal mass in a young girl of thirteen.
         Ovarian cyst was the obvious one.
         This big?
         Possible.
         No. It cannot be.
         The x-ray came back. The tell tale tooth was there and yes – a Teratoma, the distinctive type of tumour that can include teeth, hair, sometimes, even a jaw and tongue.  I guessed just a split second before the results came back. How annoying.
         Working diagnosis: Teratoma with possible toxic psychosis.
         Emergency operation was arranged. Yes, she would be fine a little while after the operation, I reassured the parents.
Junior Doctor arrived:
         The junior arrived and took some history and did a quick physical before she was prepared for the theatre. This petite doctor with a very babyish face told me that on her first day in her last job she had to do an emergency tracheotomy. This time she had been on call for the last three nights and the battery in her old Mini could not cope with the heavy frost so she had to wait for AA before coming. She was most apologetic for not having got in earlier. 

She asked if I had seen many toxic psychosis cases and I asked if she had come across any in her psychiatric placement. As with all good psychiatrists answering a question with another is in our blood and here it worked well.
         Neither of us knew what was to hit us next.


At 2 A.M. I had a call from her.
        “Your patient – I mean our patient could not be aroused after the operation. Yes they removed the teratoma, complete and intact. It is bigger than any specimen I have seen but she could not be aroused.  Any ideas?”
        “Call the paediatrician on call in the regional paediatric unit and I will be in.”
        What happened?  I asked myself as I drove to the hospital.
        What had we done? This was fast becoming a nightmare situation.
        What was I going to say to the parents?
        Something else was going on here, and I was not happy because I did not know what it was. I was supposed to know and I generally did. After all I was the consultant now.
        Thank goodness she could breathe without assistance. That was the first thing I noticed. I saw mother in the corner obviously in tears. She asked if her daughter would be all right. I cannot remember what I said but knowing myself I could not have said anything too discouraging. But then I knew I was in tricky territory and it was unlikely to be the territory of a child psychiatrist.
        A good doctor is one who is not afraid to ask for help but he must also know where to ask.
        “Get me Great Ormond Street.”
        “I already did.”
        She is going to be a good doctor.
        “Well, the Regional unit said that they had no beds so I thought I should ring up my classmate at GOS and she talked to her SR who said “send her in”.”
        Who needs consultants when juniors have that kind of network?  This girl will do well.
        “Everything has been set up. The ambulance will be here in about half an hour and if it is all right I would like to go with her.”
        “Yes, you do and thanks a lot.”

        I told mother that we were transferring her daughter to the best children’s hospital in England if not in the world and the doctor would stay with her in the ambulance. She would be fine.


.........She was impressed with mother’s faith and trust in God.
        She said mother was near to tears. It was bad enough to have such a large Teratoma and then to have the patient unconscious with no one knowing what was going on was very frightening.
        “I have seen some deaths as a medical student but never since I was registered. I do not want this to be my first.”
        I knew the feeling well but what could I say? A doctor has to face it some time.
        “Do you believe there is God?” She asked
        “Do you really think I can answer that one?”
        “Well, you have more experience.”
        “To me it is like reading a good book. You would not know until the end.”
        “So you mean I am not going to know until then.”
        “Interpret whichever way you like. I remember Jung in his Memoir gave quite an account on the Holy Trinity.  There were seventeen bishops in Jung’s family including his own father. Jung had always been puzzled by deity and the bible and most of all by the concept of the Holy Trinity. I know many religious philosophers struggle with that too. By some accident he had access to his father’s inner library. He saw this folder clearly marked Holy Trinity. The relief was phenomenal. He could now have the answer. He hesitated before opening the folder.”
        “What did the folder contain?”
        “See, you want the last chapter. I wanted to know as well. The folder contained pieces of blank paper.”
        “That was it?”

        “That was it.”

  A  reprint:

NHS & Ham: World Class Medicine without trying!

Those doctors that grew up here may not know but those of us from overseas looked forward to coming for our specialist training in this country. A number of us went to the US and they did well too. There was little doubt that for many the years of training in the top hospitals here will guarantee them nice top jobs in Hong Kong or the rest of the commonwealth. 

Why?

We provided World Class Medicine without trying. A quote from a fellow blogger, Dr. No.


Dr No said...
Excellent post - and yes, that is exactly how it used to be. World class medicine without even trying - we just did it, because that is what we did, just as the dolphin swims, and the eagle soars. A key, even vital feature was that the doctors looking after their patients did not need to worry about money or managers. They just got on with it. There was no market to get in the way of truly integrated care. Some may point out that 13 year olds with teratomas are rare, and that is true, but what this case shows us, precisely because of its complexity, is just how capable the system was. And most of the time (of course not always), it dealt just as capably with more routine cases. "How is (sic) the new Consortia going to work out the funding and how are the three Foundation Trust Hospitals going to work out the costs." Exactly. And then: who is going to pay for the staff and their time to work out out all those costs and conduct the transactions?
What many politicians may not know is that pride in what we do is often more important than money or anything else. Our pride is one sure way to ensure quality of practice.

Do we really want to take that away now? Years of heartless re-organisation has left many of us dedicated doctors disillusioned. Many young ones have left. Poorly trained doctors that have no right to be practising medicine now even have jobs in some of these well known hospitals. 

Can we continue to practise World Class Medicine even if we wanted to?

Back to the patient:

Would my patient be dealt with in the same way in 2015?


     GP to Paediatrician: 13 year old with one stiff arm. Seen the same day.
     Paediatrician to me: ? Psychosis or even Catatonia. 
           Seen same day and admitted to Paediatric Ward, DGH.
     Child Psychiatrist to Gynaecologist: ? Pregnancy or tumour. Still the same day.
     Gynaecologist to Radiologist: Unlikely to be pregnant, ? Ovarian cyst.
     Radiologist (Hospital & no India based): Tell tale tooth: Teratoma.
     Gynaecologist: Operation on emergency basis with Paediatric Anaethetics Consultant. Still Day 1.
     Patient unconscious and transferred to GOS on same day. Seen by various Professors.
     Patient later transferred to Queen’s Square (National Hospital for Nervous Diseases), 
             Seen by more Professors.
     Regained consciousness after 23 days.
     Eventually transferred back to local Hospital.


None of the Doctor to Doctor decisions need to be referred to managers.


We did not have Admission Avoidance then. 

How is the new Consortia going to work out the funding and how are the three Foundation Trust Hospitals going to work out the costs.


The danger is that the patient may not even get to see the first Specialist: Paediatrician not to say the second one: me.


Not to mention the operation etc. and the transfer to the Centres of excellence.



Of 100 patients with anti-NMDA-receptor encephalitis, a disorder that associates with antibodies against the NR1 subunit of the receptor, many were initially seen by psychiatrists or admitted to psychiatric centres but subsequently developed seizures, decline of consciousness, and complex symptoms requiring multidisciplinary care. While poorly responsive or in a catatonic-like state, 93 patients developed hypoventilation, autonomic imbalance, or abnormal movements, all overlapping in 52 patients. 59% of patients had a tumour, most commonly ovarian teratoma. Despite the severity of the disorder, 75 patients recovered and 25 had severe deficits or died.

Related paper:



Post Script:
“Ten years later mother came to see my secretary and left a photo. It was a photo of her daughter and her new baby. She had been working at the local bank since she left school, met a very nice man and now she had a baby. Mother thought I might remember them and perhaps I would be pleased with the outcome.

I was very pleased for them too but I would hate for anyone to put faith or god to such a test too often.”

King’s Fund: Million £ GP.

See also:

NHS Reform: Dr House & Integrated Service.



Can it be that it was all so simple then
Or has time rewritten every line
If we had the chance to do it all again
Tell me - Would we? Could we?
                                                                      The Way We Were

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