Eating kittens, part deux

As I posted last night, the current issue of National Review has a book review of The Bond from Claire Berlinski. The last post made the point that the review's key perspective--that the protection for pets that keeps us from eating them should be extended to other animals--is shown to be false moral posturing by the experiences of starving people. In this post, some responses to specific statements in Berlinski's article.

"Children are born with a keen curiosity about animals; their horror at the thought that the animals are to be slaughtered must be trained out of them."

This statement is simply false for being based on incorrect premises.

The phrase "children are curious about animals" is a very broad and, therefore, meaningless observation. Not all children are curious about animals. Most children who are curious about animals are not curious about all animals. And children are not curious about animals in the same way or in the same way they are curious about people. These are really very important modifiers. You will note that your dogs and cats are curious about squirrels and mice, as well. No one is daft enough to think that this means they have a special bond with squirrels and mice so that they should refrain from harming them.

"Their horror" is not universal and/or not universally applicable to all animals. Furthermore, no one (at least, very few people) trains children to stop being horrified at animal slaughter. This phrase "must be trained out of them" is very specific--i.e., if you do not actively subject your son to Clockword Orange-style conditioning, he will not be able to eat meat due to the horror--and very ridiculously wrong.

My brother and I are a good example of the reality of children's interest in animals. As a young boy, I was really interested only in dogs and horses. Now I'm older, and I wasn't trained to eat dogs and horses in the interim. I still wouldn't want to eat my compatriots, the foxhounds.

My brother on the other hand had a much more wide-ranging interest in animals, though mostly sea life. On a first trip to the Maine cost as a youth, he was eager to eat lobster but then couldn't bring himself to do it. No matter; we left him alone. Recently, he made us all sit down and watch Planet Earth with him, fascinated as he is by the natural world. Also recently, he made lobster bisque from scratch, slicing through the head of the lobster lengthwise to kill it before dismembering it. I did not note much horror, although the practice of cutting the head first is routine chefs' compassion.

What changed? Nothing but that we grew up. The prejudices, feelings, and beliefs of children are not appropriate to adults. This is not a moral statement so much as a psychological and developmental one.

"It is well known that children who torture animals have something very wrong with them: They often grow up to practice this enthusiasm on humans."

There's a reason this statement comes at the end of a paragraph in Berlinksi's article: any conclusion drawn from it would be a non-sequitur. Children who torture animals enjoy inflicting pain for its own sake. The relationship between this motivation and the motivation of adults to eat meat is completely non-existent. This is really a low point in thought for Berlinski. "Torture" is a term of moral opprobrium that we apply to the motivations of an active party, not a term of description that we apply to the experiences of a passive party. Torture, pain--two very different phenomena.

" requires tergiversations of the mind and soul to accept that animals are thus like plants and their lives no more sacred than a carrot's. We need not value animals more than children to ask, as Bentham did, whether they suffer, conclude that they do, and demand of ourselves that we limit the amount of suffering we impose upon them."

Berlinski disguises an insidious argument here with awkward construction. Let's follow her argument plainly so that, if we want to, we know what of we tergiversate:
(1) Children (implicitly) are (too) horrified by animal slaughter (to eat animals).
(2) Children's initial reactions to the world are morally superior to adults'. (Yes, this really is Berlinski's argument: ask yourself what else it means to say "we need not value animals more than children to ask...")
(3) It is morally superior to be (too) horrified by animal slaughter (to be able to eat animals).

Let's be frank, here: children are not miniature versions of adults who are innocent, giving, and loving. This view of children is held only by child molesters and aging single women who haven't had to raise children. As parents or students of child development can tell you, aging is a process of changing mental and emotional capabilities. As children age, their brains literally change, and their use of verbal, mathematical, and spatial reasoning improves along with their emotional abilities to not act impulsively, to distinguish, and to integrate their feelings with their intellectual understanding of the world. Any argument of the type Berlinksi makes here should be rejected out of hand. Is that tergiversation? Then label me a tergiversator!

" is not normal in human history to see animals as commodities... even as we live in ever greater intimacy with them as pets."

If you read that sentence and went "huh?", you are not alone. I don't think it would have passed muster when William F. Buckley was editing NR. If you didn't go "huh?", read it again. It doesn't actually make any sense unless she is arguing that people in the past viewed animals as commodities because they didn't have pets, which is factually false. Or unless she's arguing that in the past people who had pets were the only ones who didn't view them as commodities.

Let's make up an argument for Berlinski so we can pretend we understand what she means. Let's say she's arguing that the closer proximity you live in to any animal, the less willing you should be to see any other animals as "commodities." This argument is confused on several points.

It asserts that our relationship to all animals should be alike. I.e., when Fluffy purrs while sitting in your lap, it should make you want to spare the Japanese giant salamander from the vagaries of life and death in the animal kingdom. Is that reasonable? Maybe, but I doubt it. The elision of feelings between your mother, your boyfriend, your cat Fluffy, and a giant salamander seems sort of screwed up.

As an historical matter, it is false. As Melissa McEwen has pointed out, domestication (there is no other way to live in proximity or "intimacy" with animals) and commodification are not, as Berlinski suggests, opposing forces. It is hunter-gatherer peoples, who perceive animals as having their own realm of existence, who anthropomorphize their food. When people started keeping animals around their living quarters is when they stopped treating animals like kindred spirits.

Berlinski's view of our life with animals is a projection of her own lifestyle and emotional needs. Berlinksi describes having her cat in her lap and having it affectionately place its paw on her face. I submit that Berlinksi thinks we should extend the same protection to cats that we extend to orphaned children because she keeps the cat in her lap rather than sending it scurrying after rats. A farmer does not in fact live in less proximity to animals than Berlinksi, but she uses them differently. She has, in effect, commodified intimacy. Her perspective is not the natural result of living with animals, it is the result of using animals for affection.

Berlinski's use of the term "commodity" is problematic. I believe she knows enough about trade and financial matters to be held accountable for her use of language. The term "commodity" specifically relates to interchangeable items that can be traded in a market. In her statement above, she argues that we should not see animals with indifference as we live in closer proximity to them. But by using the term commodity, she obfuscates and elides the concepts of "lack of care" and "food stuffs." Before industrial farming, when cattle were raised on the open range, beef was still a commodity. What does she want? An end to industrial farming, or end to animal food?

"Animals have minds."

Berlinski spends several paragraphs telling us that animals have minds, that we don't know what types of minds, but that since animals seem to us to act affectionate, we should treat them as if they have minds like ours. Her most extreme example is a monster crocodile that seems to like getting cuddled by its trainer.

I would agree that animals have minds of some sort, although since I can't define what a "mind" really is even in the human context and I can't live as a bat, I couldn't say what sort of mind a bat or any other sort of animal had. And I agree that animals seem affectionate. In fact, I would say that dogs, my preferred animal (but not my preferred meal--that's duck), evince a whole range of emotion I can recognize. In fact, if animals couldn't do this, they wouldn't be very interesting to us until they became a cutlet. I've even read Animals in Translation. I'm down with animal minds.
But I submit as evidence attacks well-publicized in the news such as those of orca whales on their long-time trainers who they seemed to treat with affection at times. What are we to make of these? Let's assume for a moment that when the tigers and orcas appeared to be affectionate that they actually felt affectionate. Yet they could attack and kill the objects of their affection anyhow. Is that a mind like ours or isn't it? If we compare it to people, we see a similar pattern in cases of domestic abuse. The perpetrator of domestic abuse gives all signs of being affectionate during a "honeymoon period" but reverts back to aggression nonetheless. Is this an affection that we recognize? A mind that we recognize? How much greater the gulf with the mind of an "affectionate" orca whale?

The domestic abuser is not a facetious line of argument, because what Berlinski wants us to believe is that the apparent affection of an animal is a sign that we have made a connection with the animal, formed a "bond" with it. And that it's wrong to break the bond by killing the animal. Yet, what do we think about the bond formed between a couple in domestic abuse? Is the intermittent exhibit of affection proof of a bond in domestic abuse, or simply proof of some other one-way emotional reaction on the part of the abuser such as guilt, dependence, or supplication? If we cannot believe in a bond in these human affairs, can we believe in a bond with violent animals? And if the exhibited affection of violent animals is not a sign of bond, why the exhibited affection of non-violent animals?

I think that, at least to some extent, Berlinski's problem is that the term and concept "bond" is antiquated. We live in a world of broken relationships, and to use terms like "bond" today is like going to the grocer and asking him to "pluck" some raspberries from the fruit stand or asking the butcher to "track down" some fillets.

Let me quote from a letter by Abigail Adams to John Adams:
I received yours of October 23. I want to hear from you every day, and I always feel sorrow when I come to the close of a Letter. Your Time must be greatly engrosed, but little of it to spaire to the calls of Friendship, and I have reason to think I have the largest share of it. Winter makes approaches fast. I hope I shall not be obliged to spend it without my dearest Friend, I know not how to think of it.
They wrote to each other like this all the time. Nobody does that today. I can believe that Berlinski thinks of bonding with her cat or Adam Weitz of communicating with animals, because I think their concepts of human interactions are degraded, as are all of ours, by modern life.

Anyhow, she undermines herself later in the article...

"Our treatment of animals is a measure of our character..."
"I feed [my cats] meat--yet I have rescued and liberated mice from their clutches. No reason for this, I know; just sentiment."

Ah, sentiment. You see, Berlinski is a good person. We know this because we can measure her character by her sentiment. More to the point, she has no bond with these mice, and she doesn't pretend to: she just doesn't like killing, no different from the children, than whom she would never deign to be better.

" is morally relevant that no one has ever said, 'He's loyal as a snake.'"

True, but like the example of psychopathic children, the relevance is only in signs. Animal torture--the desire to submit animals to pain--is a sign of a broken moral compass, but the alleviation of animal pain is not on a moral footing with the alleviation of human pain. Likewise, to treat a dog that licks and nuzzles you the same as a snake that does not interact with you would be a sign of unnatural indifference, but the dog does not have a claim on us by this. I refer you, as in the last post, to the experiences of the starving: no doubt those Parisians were eating dogs that had licked and nuzzled them; why not their children and enfeebled adults?

"To me, those cows and pigs in factory farms look a lot like the cats and dogs who have laid their heads on my chest."

Berlinski tells us she is against only factory farming, not meat eating. Yet her sentiment and perception of bonding would make this statement belie a larger desire to avoid eating meat in all its forms. The fact that, earlier in her article, she addresses the issue of animals killed during crop harvesting indicates that in fact, to her, the question is one of killing animals at all. I don't believe it is right to compare Polyface Farms with crop harvesting, ask which is less hurtful to animals, and conclude that eating meat can be permissible. That is a very different line of reasoning from comparing Polyface Farms to factory farms and asking whether we can afford to make the latter more like the former. I would like to see changes in factory farming, too, but the changes Berlinski would like are different and based on the sentiment that makes her take mice away from her cats.

"After all, if you come across a paper bag in the gutter and it seems something's in it and you don't know if it's alive, you don't kick it, do you?"

The article ends with another statement that, were it teased out into an argument, would fail. No, nobody would kick the bag, but kicking the bag would serve no purpose. Slaughtering animals for meat is not analogous in any way. This sort of statement of Berlinski's is what I would expect from junior high students, not from PhDs publishing in NR.

National Review has now published several articles and reviews like this one. It's a disappointment. If the editors want to take a stand on animal husbandry, they should do it. Publishing weak quasi-vegetarian tracts by building straw-man-like arguments against factory farming is a waste of everyone's time and money.

Eating kittens

Kittens: "either smothered in onions or in a ragout they are excellent"
-Henry LaBouchere, Diary of the Besieged Resident in Paris

The current issue of National Review has a book review of The Bond from Claire Berlinski, a freelance writer who "lives in Istanbul with a menagerie of adopted stray animals." I haven't read the book, perhaps it's great. The review, however, is a grab-bag of muddled thinking. The core of the article is the contention that we shouldn't eat animals that we care for, or, umm, that we shouldn't eat animals unless we care for them...
the cat in my lap stretched out her paw and tenderly patted my cheek. "She would taste good," I thought, was not a morally serious answer to the question, "Should I eat her?" And if it was not, how could it be a serious answer to this question: Should I eat an animal that has been separated from its mother at birth... pain, fear... slaughter... dismembered...?
Yes, I get the point that she wants us to consider the morality of meat-eating on grounds other than our desire to eat meat. Do you get that she's saying that we can't eat the cow because we treated it like food, but we can't eat the cat because we treated it like a pet? By intimation, this seems to be the argument of The Bond: people shouldn't eat meat because they have a bond with animals. Berlinski presents this as the evo psych update on natural law arguments against buying your steak at Safeway and launches into some invalid Rousseau-ist statements suggesting children are natural vegetarians before they're corrupted by society.

I would submit that, in fact, "she would taste good" is a morally serious answer to the question. At least, it's as morally serious as the answer "I would feel bad to eat Fluffy." The idea that people would feel revulsion at eating pets is intuitive. Likewise, the desire to kill something because it is defenseless and trusting is immoral. However, it doesn't follow from either of these points that having a "bond" with an animal makes it categorically immoral to treat it as food.

Berlinski's essential sentimentality on this point is revealed by the Siege of Paris of 1870, when the residents were forced to resort to eating their pets. Henry LaBouchere: "This siege will destroy many illusions, and amongst them the prejudice which has prevented many animals being used as food. I can most solemnly assert that I never wish to taste a better dinner than a joint of a donkey or a ragout of cat..." LaBouchere confesses to feeling like a cannibal while eating a dog, but somehow the Parisians were still able to distinguish between feeling bad about eating a dog and feeling bad about eating each other.

What sort of bond do people have with animals? People are animals! Animals kill and eat each other! Temple Grandin makes the point that if a dog attacks a baby, it is not some sort of canine opportunism, but a failure on the dog's part to associate baby with man. People's general intelligence--the ability to make associations and distinctions of class--is more pronounced than other members of the animal world. The dog may attack a baby by mistake, but it can attack a squirrel without compunction. Man will not attack a baby by mistake, but it may feel awkward attacking the squirrel that came bounding on the porch innocently searching for nuts and twitching its tail. What gives? Man by his nature can create subtleties and ambiguities of class distinction not available to the dog, and the squirrel moves from prey to non-prey and back.

In most traditional societies, these mental equivocations are solved quickly and easily: people feed each other and do it with other animals, so you can't stay confused between babies and squirrels long at the subsistence level or you'll exit the gene pool quickly. However, in modern society, people like Berlinski or Francis of Assissi, who--on this question of prey distinction--are too many standard deviations away from the norm in the direction opposite Hannibal Lector, can survive.

What has this to do with morality? I'm not what you might call a "deontological egalitarian," but more a virtue ethics type, and I don't see Aristotle, St. Thomas Aquinas, or most of humanity condemning meat eating. If you treat your cat like a baby, it might not be a good sign if you want to eat it, but that doesn't mean it's wrong to eat the cat. Our "bond" with animals is morally neutral except as it reflects our mental state with regard to human society.

I write the above because I think, despite what she says about factory farming, Berlinski really wants us to stop eating meat altogether. Factory farming poses its own problems, but they are not those of causing death or pain in prey animals per se. Berlinski starts by asking us to justify meat-eating. I think we should start by taking meat-eating as a given.

김치, fried eggs, and NorCal margarita

Today was sort of a crappy, overcast day that sapped my energy, and I didn't get in my whole floor workout before spinning. But dinner picked up.

For dinner tonight, I had Korean kimchi over fried eggs with a NorCal margarita. This was sort of a scrounged meal, but it turned out to be delicious.

Egg is a typical ingredient in dishes like Korean bokkeumbop, or fried rice, but I'd never heard of kimchi being served with western-style fried eggs before. I broke the yokes and let the velvety yellow insides run out and comingle with the kimchi. Then I cut off bites with my fork and ate the kimchi-yoke mix piled on pieces of egg white.

I had never had the NorCal margarita before, either, but it was definitely a passable drink and went well with the kimchi-fried-eggs.

Netter anatomy sleeping bag

A Japanese company sells a sleeping bag decorated with a Netter anatomy illustration. Now you can take work with you even when you're camping!

H/t to 2nd Opinion, which is a Tumblr of interesting medical images.

Wiley textbook discount

Until Halloween, Wiley is offering 25% off microbiology and virology texts. So I took two books from their offerings that looked interesting and compared them to the Amazon prices:
Studies in Viral Ecology, volume 2 sells, used, for $106 on Amazon and, with discount, $104 from Wiley.
Fundamental Medical Mycology sells, new, for $88 on Amazon and, with discount, $74 from Wiley.

Contagion review, part deux

Contagion is the new Soderbergh film about a viral epidemic. As I posted previously, I won't see the film, because I think Soderbergh is an over-rated director and also, ergo, I will waste my time sitting through a film I won't like.

National Review's film reviewer, Ross Douthat, reviews Contagion in the last issue. As expected (see my links above), the film has moralizing elements, 2-dimensional characters, and inhabits a socio-political space in the "avante-guarde establishment," which is to say it presents routine leftist thought (in this case, big federal agency=heroes) as something interesting and new. said they would review the movie. I'm still waiting, but they did link to this rather interesting video, which shows the development of an advertising billboard made out of bacterial cultures.

May I suggest that you instead watch this next generation show on contagion, which I can almost guarantee will be time better spent than with the Soderbergh film.

The Big Apple circa 1941

Okay, the September 11 anniversary is well past, but it's still September. I thought these photos of New York City on the cusp of World War II were interesting.

Albert Szent-Györgyi

Google reminds today of the discovery of Vitamin C.

Contagion review

Steven Soderbergh has released a new film called Contagion about a viral epidemic. I've sworn off Soderbergh films, so I'm not going to bother with this one, but you might want to. said they were going to review the film, but nothing so far. Steve Sailer at TakiMag reviews the film recently:
after Paltrow’s autopsy, momentum dissipates as Contagion is revealed to be a half-vast non-thriller. Overall, Contagion isn’t bad, but in the same amount of time you could watch an episode of House M.D. and a NOVA documentary about bird flu and be more entertained and enlightened.

The Derb on 9/11 & the Mata Hari

This evening was composed of a weight routine, spinning class, shower, dinner, and RadioDerb accompanied by a Mata Hari (actually several... tee hee) from Speakeasy. Next I will stumble downstairs, if I can, to watch some TV, which I think will devolve into sleep.

(The excess inebriation tonight is due to McEwen's blog post indicating she is depressed and breaking up with other Paleo celebrity Masterjohn. Oh, the humanity. Was such a worthy woman ever beset with such unhappiness?)

The Derb basically agrees with me on the commemoration of 9-11: we should be 'defiantly normal'. From the transcript of his exceptionally-fine web radio show:
we should act defiantly normal. In 1983, on a Saturday just before Christmas, Irish terrorists set off a car bomb outside Harrods department store in London, killing six people, one of them an American citizen. As soon as the mess had been cleared and the store re-opened, the father of one of the victims went and did his Christmas shopping at the store. Denis Thatcher, the Prime Minister's husband, went with him. That's defiant normality.

By all means grieve in private; remember and honor those who have gone. In the public square, though, stand up straight, keep a stiff upper lip, and stare down the vermin who think they can destroy our civilization. Quite apart from other benefits, doing so will drive them crazy. Crazier, I mean, than they are already.

The Mata Hari is shaping up to be one of my favorite drinks.
I haven't bought the book yet, but I have made several versions of the recipe (excepting the simple syrup) using a home-made chai-infused sweet Vermouth. It is an excellent drink. Like the classic dirty martini that really highlights olive and salinity, the Mata Hari is a bitter and sour blend that could accompany almost any occasional. When I have some excess, I will buy the book. Pray that the other drinks have the same quality. Thanks.

Manic? following Sinead O'Connor's blog

I would bet that sex blogger Violet Blue is right on the money in suggesting that Irish singer Sinead O'Connor's strange, recent blog posts discussing her sexual appetite are a sign she is going through a manic phase of her bipolar disorder.

In addition to saying she wants to have sex with trucks and asking Bob Dylan for oral sex, she has put out a call for "sweet and filthy" men to e-mail her to be her boyfriend. And she's asked for "innocent young Irish ladies to corrupt" for her two male nannies, Jamie and Luke.
(In addition to any 'yewww' factor, does anyone else think it is strange that someone so critical of Catholic priests' abuse of children would hire male nannies?)

So we learn that Sinead does anal, used a banana as a dildo, and likes stinky men with facial hair stubble. But mostly, it is her sort of stream-of-consciousness writing that makes one think she is going through a phase. She started blogging at, then switched to She's also switched her dating e-mail to On her blog, she describes herself as a genius and a "fine filly."

As Violet Blue says, maybe she is just very horny, but the whole picture presented on her website seems a little more stretched, like someone unable to contain themselves. On the other hand, she no longer has the look that attracted people like Violet Blue and myself, so who knows what this is about. Maybe the lack of grooming is a sign in itself.

Nurses on Sept 11: 'there were no patients'

No doubt many nurses today are remembering the attacks on the World Trade Center on September 11, 2001. I wasn't a healthcare professional at the time. I had moved back home and was trying to figure out my next move after a web start-up I had been involved with went belly-up. My father was at the university, my mother was gardening, and my brother was at school. I got up and wandered around the house, read the newspaper. For some reason, I turned on the TV to flip through the channels and came across some live coverage.

The towers had already been hit. Not knowing NYC well, I wasn't particularly shocked, mostly just gawking, as you get passing a car accident on the road. I told my mother what was going on, but she wasn't interested enough to stop gardening. So, I road my bike down to the university. My father was teaching a class. Some people in his department office were talking about it casually. But when I went over to the student center, where there was one large projection TV, the students were crowded around and there was a lot distress on faces and in voices. Our university is a popular spot for kids from NYC and Long Island.

In the afternoon, I went to the hospital's blood donation center, but there was already a line snaking out the door and down the sidewalk. I was turned away as they had all the volunteers they could handle and were mostly looking for rare blood type donors.

Like everyone else, I was riveted to news media for days and even weeks afterward. I briefly considered going down to NYC to see if I could help, but realistically there was nothing I could offer. Some people, like this flight attendant, said they went into healthcare following September 11th. I can't say that, although I do enjoy thinking that if something like the attacks ever happened again, I would be able to help out. (I tried going to Haiti, but was unsuccessful.)

Reflections on our response

Unlike most people, I have been unhappy with our response to the devastation. During the initial discussions of what to do with Ground Zero, someone at National Review suggested that we should rebuild the trade towers, only this time with Vulcan cannons on the roof. That about sums up my attitude to the situation: we should have demonstrated that we still had the self-confidence and optimism necessary to rebuild along with the defiance to keep the attacks from happening again; to not rebuild at Ground Zero and move on is a bad omen. I am concerned that our actual response demonstrates our diminishment as a nation. Although many people claim to have felt "united" by the events, I see the widespread focus on negative emotions such as fear and anguish as a socially-directed manifestation of many individuals' obsession with their own problems (as seen across news and entertainment media on a daily basis).
Take the National 9-11 Memorial. Prime real estate in NYC has been given over to two large gaping holes in the ground that serve no purpose other than to act as a reminder of the fact that we were dealt pain and death. The memorial has no meaning in the sense that it does nothing to tie the attacks to the broader cultural conflicts or actual physical conflict that preceded or came after September 11th. It isn't, in fact, a memorial in the sense that it commemorates nothing. Horrified as I was to see the jumpers on TV that day, those who died (rescue workers excepted) simply died.

Compare the 9-11 Memorial with other memorials: they commemorate actions and actors, not victims. For example, the Gettysburg Memorial commemorates those who gave their lives fighting to change the course of history. The 9-11 Memorial is more like a cross and wreath placed beside a highway where someone died: it doesn't turn our thoughts reverently toward a past that was necessary for some to live through so that we today could have better lives, it turns our thoughts inward as a reminder of personal hurt and the pain of others. The 9-11 Memorial is like a wound that won't heal or a trauma that a person can't leave behind. In 100 years, the Gettysburg Memorial will remind our grandchildren that Americans died for freedom; in 100 years, the 9-11 Memorial will remind our grandchildren that people die senselessly because there is evil in the world. The fact that the pools and fountains are not ones in which children and parents can find delight and relief only reinforces the sense of loss, that the whole site is a monument to death and not to, as the Romans put it, agere.

There are those who will say that the 9-11 Memorial commemorates our "unity" on that day. To them, I can say only that it is a sad day when our national monuments in DC are not our symbols of national unity, when people identify with helplessness but not with national aspirations. To a generation that needs to feel fear and anger together to recognize their nationhood, I say it is a sign of your decadence and dysfunction. A generation that scoffs at a "mission accomplished" sign but feels sublimity in empty loss is a sign of the times. In an age of terrorism, what should our cities be? Centers of art and commerce or a pock-marked moonscape of monuments to our enemies' success?

Hermeneutic research on nursing narratives

In the year following 9-11, researchers publishing in the Journal of the New York State Nurses Association conducted interviews with nurses about their experiences of working on that day. They analyzed the narratives using a Heideggerian Hermeneutic approach, looking for thematic commonalities across narratives. The results are interesting in themselves, and also highlight some of the critique of the 9-11 Memorial that I make above.

From the findings section of the paper:
Seventeen nurses, 2 males and 15 females, comprised the informants. The mean age was 47.7 years (s.d. = 8.4) with a range of 32-64. Ethnicity included 13 white, 2 black, 1 Native American and 1 Asian. Education of the participants included masters (9), baccalaureate (5), associate (2), and diploma (1). Specialty areas included emergency room (4), acute care (2), home care (1), administration (3), pediatric (3), psych/mental health (3), and nursing education (1). The nurses' roles in the disaster included triage (3), coordination (7), care giving and counseling (7). Six themes and one constitutive pattern emerged. The themes are: (a) loss of a symbol, regaining new meaning. (b) disaster without patients. (c) coordinating with and without organizations. (d) rediscovering the pride in nursing. (e) traumatic stress. (f) preparing for the future.
In a more detailed explanation of these themes, their fundamental support of my interpretation of the 9-11 Memorial is given some support. One nurse said, "I usually see the towers ...I looked up 14 Street and there were no towers, absolutely no towers, and my body just shuddered, very fearfully," and another, "on my way home that night I would see the towers, and that night, - not seeing them there - still looking - maybe I am not looking in the right place... you can't believe they're not there ... disbelief ... stunned ... not being able to comprehend."

Nurses experienced ongoing stress from the trauma of the day:
Symptoms of post-traumatic stress were felt by many of the nurses. Some experienced nightmares and flashbacks of victims they cared for. Others described themselves as emotionally fragile and being able "to cry in a New York minute." One nurse has "a lot of pop-up fears that are triggered." Physical symptoms of stress, such as high blood pressure, were reported less but still significantly impacted their lives. One nurse had to change her diet, exercise more, and stop reading the newspaper and listening to the news to help decrease her blood pressure. She realized that "I couldn't leave it alone. It was affecting my health and I had to step back."
This sense of loss and stress is what the 9-11 Memorial will permanentize. And when a generation grows up that never knew the presence of the towers as normality, they will be asked to imagine the loss by visiting the Memorial. Is that a healthy long-term response to loss?

Of the researchers findings, the one probably most salient to all healthcare professionals--at least, it was the most salient for me--is the nurses' frustration at the lack of patients. One said, "We went to Chelsea pier, to the triage center, about 500 doctors and nurses, and they came from all over, we just waited and set up triage, the IVs, the tables and waited for causalities but they just didn't come," and another, "Everything was in place by 10:30 AM. and we got one patient up until 1:30 AM. We got scared then. There was a lot of death. At that point we got the body bags."

Nurses' first-person accounts of September 11

Google searches can turn up quite a few accounts of nursing on September 11th. The best of the first two pages of Google results seems to be the one from the army chief of nurses. Two others, printed in the 2002 Journal of the NY State Nurses Association, I will reproduce here in part. The remainder of these articles can be read on the journal website [PDF].

Nursing at Ground Zero: a life-changing experience. by Maria Gatto, RN

Reluctantly, we have joined past generations for whom history was made through unthinkable events of death and destruction. Our children and grandchildren will ask us where we were on that fateful, tragic day when terrorists destroyed the Twin Towers in New York City, killing thousands of innocent men, women, and children.

As nurses, we all have definitions of ourselves based on our degrees, specialties, educational experiences, and background. In the hours and days that followed the attacks, however, I realized that those really had no bearing at all. A nurse is not what you are, but who you are. In your being is your capacity to heal, help, and comfort. Your presence itself means care. During those days, I didn't have to identify myself with a license or a diploma. I just had to say, "I'm a nurse and I'm here to help." That gave me the right to go into the heart of the disaster site called Ground Zero.

There was no policy, no procedure, no one to report to or "get report from." There was no routine, no schedule, no assignment. It was nursing knowledge and skill the true nursing instinct you find when you're faced with a totally unknown experience. Life hung in the most delicate of balances. Death was everywhere; bodies, minds, and souls were waiting to be resuscitated. The living and the dead needed to be treated with the utmost respect and dignity. No drug book, care-plan, or text could prepare you for this.

Terror on the Television

That fateful day began when I was awakened by my mother. I will never forget the look of sheer terror on her face. She screamed, "We are under attack. A plane just crashed into the Twin Towers!" At first, I thought I didn't hear her correctly. Call it shock, call it denial, but I asked her to repeat what she'd said and then ran downstairs to the television. I sat in disbelief, watching the events unfold. I remember thinking, "This must be just a tragic accident." Then the unimaginable happened as a plane crashed into the second tower. The worst fear was confirmed.

A cold numbness ran through my body. I no longer felt shock and disbelief, but the ultimate in terror. In the moments that followed, I felt a pull in my heart. A message from deep inside came through loud and clear: "You must help. There is a great need and a purpose to be served. You must go there." Confused, but trusting in a faith in God, I prayed for guidance. Where to begin was now the question.

As part of a generation accustomed to going "on line" for everything, I immediately e-mailed my brother and sister-in-law on Staten Island, where my brother, James Gatto, is a sergeant at the 120th Precinct. I was frantic, wondering if my family was okay and if my brother was on duty in that area. As I waited for a reply, I tried the phone. The lines were down, so I just tried to focus myself and know that I would be led to whatever I was supposed to do.

I hoped that my brother Jim might be able to help me get into the city, because all transportation was being canceled. I phoned him again and finally got through. He told me that if I really wanted to help, there was only one way to get to Manhattan. The Staten Island Ferry was open to emergency medical and rescue personnel only. I would have to take the ferry and then find my way. "Find my way?" I asked. "What do you mean?" He told me that there would be no one to show me where to go or what to do. The entire city was in shock and total chaos. "You'll have to make your own way," he said. "Just follow the smoke, and do what you have to do. If you really need to do this, I will support you 100%. Don't worry, you will know what to do. God will be with you."

I immediately got into my nursing gear, packing a bag with an extra uniform and my nursing identification. I told my mother and father, who accepted my decision without hesitation. I was bolstered by their support and confidence in me.

Ferry to a War Zone

Jim picked me up, and we headed to the 120th Staten Island Precinct. My brother, being a man of very few words but of much quiet strength, was brief but firm in his counsel. "It will be ugly," he explained. "Nothing you have seen before can prepare you for what you will see now. No one will tell you what to do. You must tell them what must be done. The chaos of mass destruction has no rules. Make them up along the way in whatever situation you are in." He opened the car door as we arrived at the precinct. I asked him how could I get back. He smiled and said, "Exactly the way you came."

I made my way into the terminal and down to the ferry. I could feel my heart beating with a sense of urgency, and my steps got faster as I got closer. I explained to some officers that I was a nurse and needed to get on the ferry. They said to hurry and check in because the ferry was about to leave. I ran up to a woman at a small table, introduced myself, and showed her my license and ID. I jumped on the ferry just before it left. That was it. I was given no briefing, report, direction, or instruction.

There were about six other nurses on the ferry. After brief introductions, we talked about what our plans were and where we would go. One group was going to the Ferry Station, where food and supplies were being handled. Another group was going to Liberty Street, where they needed nurses to volunteer at the site. I looked out at the skyline and for the first time saw the dense cloud of rising smoke. I remembered my brother's words - "Just follow the smoke."

We rode the rest of the way in silence.

As the ferry docked, I tried to follow the group of nurses that was going to Liberty Street, but I was distracted by a nurse who tried to talk me into going to help with supplies. I declined, saying that I wanted to go to Liberty Street. We wished each other luck with a hug, and I turned around and followed the smoke.

A Modern-Day Pompeii

I began walking. There were some military officers and police nearby. I went up to a police officer and asked how to get to Liberty Street. He asked for my ID, and then told me to follow the park and make a left. I have never had any sense of direction, and I ended up in the financial district of Wall Street. This was my first introduction to Ground Zero. The story of Pompeii was the first thing that came to my mind. I was the only person walking in streets covered ankle-deep in ash. Papers were everywhere. Buildings, once shining brilliantly in the sun, were now dimmed by thick, choking dust. There was an eerie silence and then the screams of terror-stricken people.

I was directed a few more times and eventually found my way to Liberty Street. Tables were set up like a makeshift but still incomplete MASH unit. There were medical professionals everywhere trying to unload, organize, and care for the rescue workers. I felt out of place, not knowing where to begin.

I heard a familiar voice call out, "Maria?" As I turned around, I saw Angela Appuzzo, one of the clinical lab instructors from New York University. We gave each other a hug, and she asked how I had gotten down here. I told her briefly that I had felt the need to come, hopped the ferry, and walked on down. She gave me a "thumbs up" sign and a big smile. I asked her what I should do. Within two minutes, Angela gave me the basics of setting up triage. I rolled up my sleeves and got started.

All of a sudden, there was an evacuation alert. Rescue personnel and police yelled at us to run. A stampede ensued. That was my last contact with Angela...

Through the eyes of a New Yorker
by Lucille Yip, RN

September 11, 2001

I am surprised when I wake up at 3 a.m., since I had been so tired after coming home from a late dinner. I don't feel right. Somehow I feel the need to go to my living room and look at the New York skyline. It is a spectacular view, full of lights and beautiful skyscrapers. I stand at the window to absorb the peaceful beauty of the city. I return to my bedroom at 5:30 a.m.

A few hours later, I wake up to a sound of an explosion. My apartment is located at the top of a 44-floor high-rise, facing what used to be the most beautiful skyline in the world. I turn on the TV and see the news. Hoping this is a dream, I run out to my living room window in horror and shock. The World Trade Center that I had grown up with is burning out of control.

After the second plane crashes, I call my sister, who works at the Federal building [six blocks from the World Trade Center]. "I'm leaving," she says, and I don't hear from her for six hours after that. I later learn she was on the train when the power shut down and smoke began to enter the car, but she was able to get home safely.

I witness the collapse of Tower 1 and then Tower 2. They both fall like a deck of cards. My "backyard" now resembles a war zone. Shortly after the collapse, I am told to evacuate the building. Hundreds of people from the Wall Street area are walking through my neighborhood in Chinatown. People are painted with thick, white soot. Cell phones are down and long lines begin to form at the payphones. There are no subways, no buses. The sounds of sirens fill the air and New Yorkers gather around car radios to listen to the news. It is total chaos.

I need to get to the ER [at St. Vincents Catholic Medical Center] and help, but I have no way of getting there. I decide to hitchhike, something I never would have thought about doing in New York before today. I find a sanitation worker who is willing to take me.

I arrive in the ER to what appears to be controlled chaos. I am assigned to triage patients. I see patients with severe burns, smoke inhalation, and open fractures. The ER is prepared for any victims that may have survived. The trauma team, anesthesia team, nurses and doctors are situated inside and outside. Stretchers, wheelchairs, and oxygen tanks line the sidewalks. The news media have stationed their cameras across the street, hoping to catch a glimpse of any survivors.

The ER is overstaffed because volunteer nurses and doctors have come in from Long Island, Queens, Manhattan, and as far away as Maryland. Doctors and nurses I have not seen in years come to the ER, hoping to help. The camaraderie is uplifting.

The staff is informed that we can't leave the hospital until further notice. We don't know if the night staff will be able to enter the city. I am physically and emotionally tired. Late in the afternoon, Starbucks donates fresh coffee and water. It sure hits the spot. The Starbucks on Greenwich Avenue has closed its doors to the public in order to cater to our needs. The local restaurants donate sandwiches, hot food, and gallons of water. Residents from Greenwich Village came in, wanting to help and donate blood. I am moved to hear that an elderly woman brought over one plate of spaghetti for anyone who might be hungry. I am so touched to see the outpouring of support from my fellow New Yorkers.

The ER is busy, but also painfully quiet. We do not receive any survivors from the collapse. The silence after the initial rush of patients is deafening. The night shift arrives, and the staff is able to leave. I have to ask a police officer for a lift home, since there is no public transportation south of 14"' Street. I manage to squeeze into a police van filled with officers and they drop me off at Varick and Canal Streets.

As I walk through the streets of lower Manhattan, I feel like someone had sucked my spirit out of me and ripped it into pieces. The streets are empty, there are barricades on every block, stores and restaurants are closed, police and state troopers are standing on every corner, and people are wearing face masks. I am consumed by the silence, smoke, and emptiness in my neighborhood. Is this my New York?

A passerby looks at me. We share the same pain but say nothing. Near my apartment, I am stopped by a police officer standing in front of several barricades. "Where are you going?" he asks. I show him my ID and tell him I'm going home. He allows me to go through the barricades and comments, "Get some rest. We're in this together."

My husband has not been able to get home. The apartment smells of smoke. I turn on my TV for the latest news. My neighbor knocks on my door to see if I'm all right. She offers some of her dinner to me, knowing that I haven't eaten anything. I'm touched by her kindness.

I can't sleep and watch the news until 2 a.m. The sound of the explosion still echoes in my head. I need to rest - tomorrow will be another long day. September 12, 2001

I wake up after sleeping only three hours. The phone lines are still down and I am unable to reach my husband. I know he is safe at his restaurant and hope to call him later.

My street is blocked off to all traffic except official cars. I will have to hitchhike to work again. I flag down a patrol car, which drops me off in front of the ER. The street has been blocked off to pedestrians, except hospital personnel. There is a crowd of reporters, cameras, and onlookers across the street.

I am assigned to triage again, which means I have to see every patient who enters the ER. A 38-year-old fireman comes in with a crushing chest injury caused by falling debris. Surprisingly, he is sitting up, talking, and coherent. Despite his ashen color and his concave chest, in my heart I hope he will survive his injuries. In my head I know that his chances of surviving are slim. Nevertheless, I am shocked when I'm told later that he died on the operating table...

  1. Dickerson, Jezewski, Nelson-Tuttle, Shipkey, Wilk, & Crandall (2002). Nursing at Ground Zero: Experiences During and After September 11 Word Trade Center Attack Journal of the New York State Nurses Association, 33 (1), 26-33

  2. Gatto, M. (2002). Nursing at Ground Zero: A Life-Changing Experience Journal of the New York State Nurses Association, 33 (1), 4-8

  3. Yip, L. (2002). Through the Eyes of a New Yorker Journal of the New York State Nurses Association, 33 (1), 9-15

Cepacol... now it sucks... thanks to the FDA

Cepacol lozenges used to be a great product. Too bad they suck now. Is the FDA to blame?
You can't get many really effective medications as an over-the-counter (OTC) formulation. APAP (aka Tylenol) seems to be a good fever reliever, but as a pain reliever, I think it mostly has placebo effect. Same with ASA (aka aspirin), which is effective during heart attacks, but doesn't do much as a pain reliever.

Pseudoephedrine (aka Sudafed) used to be an effective OTC medication, but of course now you have to sign for it, the volume you can buy is restricted, and its replacement--phenylephrine--doesn't work as well.

Like old Sudafed, Cepacol pain relief lozenges were an effective OTC medication, containing 15mg of the sodium-channel blocker benzocaine in each lozenge.

Discovering real oral relief

I first discovered Cepacol the winter before last. After starting in the hospital, I came down with an awful case of sinusitis with a sore throat so bad I couldn't sleep for swallowing. I decided to buy simply everything in the store that might work, and Cepacol turned out to be the winner by far for relief.

Although it was difficult to get the numbing agent onto the back of your throat as the lozenge dissolves, it wasn't impossible. You swish spit around the lozenge and then swallow it purposefully so that it slides down in the right place. This method delivered very effective pain relief. After a lozenge, you could count on about 15 minutes of numbness. Combined with a Percocet, Cepacol gave me blissful sleep that winter.

Since that experience, I used Cepacol several times since for sore throats and found it to be an effective cough suppressant as well. I'd even got it ordered for ICU patients who were complaining of sore throats--patients who every other nurse was telling, "well, your throat's going to be sore for several days because of that tube you had down."

New packaging...

So yesterday, I woke up with wicked post-nasal drip and sore throat. I ran out of Cepacol lozenges during the Concert Band of Cobourg performance I mentioned in the last post. So as soon as the concert was over, I went off to the pharmacy, only to discover that Cepacol was being marketed in a new package.

"No matter," I thought, "every graphic designer needs a job."

I should have been highly suspicious, though, at the fact that the new packaging was a larger box with fewer lozenges and a fancy-looking but completely meaningless graphic on the outside. Most telling is the new box's Orwellian declaration that it provides the "same relief." In today's world, that's an almost sure indication that it won't.
What I didn't count on was that the lozenges were different as well. Different as in slimey textured, sickly sweet tasting, and ineffective for relief. They might as well have been a Halls cough drop.

As I popped the first one in my mouth, expecting that familiar, distinctive, Cepacol flavor, I was greeted instead with a strong taste of artificial sweetener. Using the swallowing technique I described above, I passed this vile nectar over the back of my throat to no avail. No numbness did I feel at all! And after dissolving the whole lozenge, I was left with an unpleasant greasy residue in my mouth as well.

What gives?

... new formula!

Well, if you take a close look at the ingredients lists, new and old, you can see that they look very similar with some minor differences.
In case you can't read these, old Cepacol contained:
  • cetylpyridnium chloride (Ceepyn),
  • flavor,
  • isomalt,
  • maltitol syrup,
  • propylene glycol,
  • sodium bicarbonate,
  • sucralose,
  • yellow 6,
  • yellow 10
New Cepacol contains:
  • cetylpyridnium chloride,
  • yellow 10,
  • yellow 6,
  • flavors,
  • isomalt,
  • maltitol,
  • propylene glycol,
  • purified water,
  • sodium bicarbonate,
  • sucralose
One thing you have to know about old Cepacol is that its distinctive color and flavor came from Ceepyn. So what does the fact that yellow dyes 10&6 were moved up the ingredients list and water added to the new Cepacol tell us? It tells us that Cepacol's tradition ingredients have been diluted and the coloring dyes increased to cover up this fact. Supposedly, the amount of Benzocaine in both formulas is the same, but I wonder...

By the way, in case you don't think the lozenges are different now, take a look:
That orange color is from old Cepacol's blend of Ceepyn. The yellow color is new Cepacol's blend of food dye additives.

Did the FDA kill oral relief?

What happened to Cepacol? Well, there are two answers. One is that the distributor changed. Cepacol used to be owned by Combe, Inc, an American company from White Plains, NY. But this year, Combe sold the Cepacol brand to a foreign corporation, namely Reckitt Benckiser.

But the real question is, why did Combe sell Cepacol in the first place?

We know that President Obama's new, more progressive FDA is a heavier regulator, less willing to leave choices up to American consumers. And just this year, the FDA released a warning about benzocaine, claiming that it has been receiving more reports of a rare condition called methemoglobinemia in which hemoglobbin is oxidized, reducing its ability to deliver oxygen to tissues and resulting in a hypoxic state.

In the FDA's report, they claim that they received 21 reports of methemoglobinemia associated with benzocaine numbing agents. However...
  • Almost 75% of these cases were in pediatric patients and more than 50% of the cases were in patients under 2 years old. Uhh... dosing. No need to get worked up about lozenges for adults.
  • In less than 25% of the cases did the patients claim to have used the medication as suggested on the packaging. And if there is anything we know from watching House, MD, it is that everybody lies.
Yes, patients do lie all the time. Let's say you're a dumb mother with a baby crying incessantly from teething. So you slather on way more of the benzocaine teething gel than you're supposed to. Then your baby turns blue, and you take it to the emergency room. The doctor asks, "did you use more of the benzocaine gel than recommended?" What are you going to say? Of course, "oh, no, doctor, I used just the amount it says on the package." The fact that the FDA is not savvy enough to understand this human dynamic points to the fact they are really interested in increasing regulation for its own sake.

The FDA's warning ends with the line "FDA will continue to evaluate this safety issue and will take appropriate regulatory actions as warranted."

I guarantee you, when Combe, Inc, saw this release from the FDA, the only words they remembered from the whole report were FDA... will take appropriate regulatory actions... and then they started looking for a buyer for Cepacol before the medication got regulated into unprofitability.

(Oh by the way, FDA, the new owner of Cepacol is a foreign corporation rather than an American one. Thanks for that during this recession.)

What can I do?

Well, you could write to the FDA and to your local Congress-critter, but we all know that won't really do anything. Your best bet is to stock up on the old Cepacol formula wherever you can find it, and then give up on relief of your canker sores and sore throats once that's gone. That's what I'm doing....And by the way, next time you can't swallow, think to thank President Obama and his progressive FDA.

September 11, Battle of Plattsburgh, & Royal Marine Band of Cobourg

Tomorrow is September 11th. Most Americans remember the day as the anniversary of the World Trade Center attacks. But there is another more uplifting anniversary that Americans can celebrate on that day as well.

In 1814--the last year of the War of 1812--the British advance from Canada was stopped on Lake Champlain and at the city of Plattsburgh, NY. This action, which potentially saved the integrity of the present US borders, has become known as the Battle of Plattsburgh, and the city hosts a commemorative celebration each year on this weekend.
For several years now, Her Majesty's Royal Marine Concert Band of Cobourg has attended the event as well, putting on a marching show during the day and a concert show at night.
I attended the night performance this evening, and it was quite a good show, starting with God Save the Queen, performed without irony. You can sample mp3's of their music, such as The Army of the Nile [mp3].

Celia Green: The Human Evasion & Letters from Exile

Earlier this week, I wrote about Lucid Dreaming, a book by Celia Green. Today, I briefly review two of her other works, The Human Evasion and Letters from Exile, looking for their applicability or usefulness to health care professionals.

Review: these books are not useful for healthcare professionals. Voila!
Although I believe Ceila Green (now about age 75) is a smart woman who did some pioneering work in lucid dream states, these two other books by her reveal her to be a crank with a massive chip on her shoulder. She was, apparently, a precocious child who went to university in England but was then not able to advance to a tenured academic position. She blames this failure on 'the system' and its insistence on conformity of different kinds. This history is chronicled ad nauseum in Letters from Exile...

I first ordered Letters from Exile because it has a section devoted to the medical profession, and I am always interested in the minority report. However, Celia Green's critique of the medical profession is pretty much limited to (1) it's unfair for the medical profession to be gatekeepers to medicines and treatments, and (2) medical professionals' insistance on performing their own physical exams and coming to their own conclusions is an unwarranted invasion of privacy.

The rest of Letters from Exile consists mostly of her repeating the story of how she wasn't allowed to enter university at a young age because the educational establishment wouldn't let her take the required exams. Yawn.

Frankly, while her critiques of the establishment have some merit, they are not original or insightful and have been made much better by various other people over the last 50 years. Letters from Exile is not worth buying or reading. The author tells us she is a good writer, but I could have been fooled into thinking otherwise.

In The Human Evasion, available online for free, Green takes a long time making the point that most people's analytic efforts are expended on food, reproduction, and day-to-day activities rather than on problem solving or scientific or philosophical questions. Since people are designed for eating and fucking and not for research, it is hard to understand what Green's point is, other than that the book allows her an opportunity to make some debating points with modern theologians and physicists on the irrationality of their respective fields. Green deals in radical skepticism, a perspective that is indubitably true on some level. On the other hand, the success of modern technology goes to show that it is not really a necessary assumption for the advancement of science and civilization. The fact that Green might be smarter and more insightful than some people who are publishing in peer-reviewed journals today is... yawn.

The Human Evasion, is essentially Green's apologia for being an ass in human affairs. She suggests that people who are interested in answering questions about the nature of the universe will feel a sense of urgency that justifies their eccentricities. Of course, it is not clear why Green or anyone else should feel a sense of urgency in answering questions about the universe. What will the knowledge get them, other than their name in lights? And what will that get them other than money, power, sex, and the other things Green derides? No, this too, while better written than Letters from Exile, is not worth the time and effort.


I recently had a patient who takes a shot of brandy every night before bed. For this essentially recovered patient, I was trying to get the routine re-normalized, so I obtained some brandy. I had to have someone go to the store for me, and the delivery ended up being Remy-Martin cognac.

That Remy-Martin smelled so good when I poured it over ice in a plastic hospital cup! So when I got home, I broke out my bottle of armagnac.

For a long time, I couldn't find armagnac in my town. When it turned up, it was a lot more expensive than cognac. But it is also a small production area. Since cost is a reflection of scarcity, armagnac's prohibitive price is no guarantee of anything. What are the chances of getting a good bottle of a rare spirit in a small town? But I decided to try it anyhow.

I have to say I have been disappointed.

Corvoisier, Remy-Martin, and Hennessy cognacs are all distinctive. Remy-Martin is sweeter, fruitier, and smoother. Corvoisier has more casket flavor, more appropriate for smoking than food. Hennessy is trending toward Corvoisier from Remy-Martin, but subtley.

I would say that this armagnac has earthier tones compared with the cognacs--more mineral and plant than fruit or casket. However, it is, comparatively, extremely harsh. I had to add water to open it up, as you would with a Scotch. Even then, from one mouthful to the next I am vasilating between thinking I can detect a variety of undertones of flavor and hoping the skin in my mouth will still be there when I'm done drinking.

Of the two armagnacs in my town, I purchased the cheaper, which was expensive. The other is aged 25% longer and costs 50% more. Knowing myself, I will buy it to try it, but unless there is a clear improvement, I am going back to my cognacs.

TSN baloney, cont'd

Does The Sexy Nurse baloney never end? An "artist" named Aya produces t-shirts with "pin-up art" on them.

Note the tacky, unimaginative captions. I draw attention to these particular examples, because I think it is instructive to see The Sexy Nurse portrayed alongside the nun and policewoman. The image below of "Nurse Jackie" is one that is probably unremarkable to most people. Is it to you?
Does it look ridiculous to portray a nurse like this? Or does Jackie simply look like a nurse to you? Now compare this photo to the "pin-up art" Sexy Nurse above. Almost exactly alike, no? Consider how foolish the nun and policewoman look. The Sexy Nurse art was produced by the same mind that produced the nun and policewoman, and it is equally as foolish an image. It should appear equally as foolish to us. And Nurse Jackie should appear to us just as foolish as that nun and policewoman as well.

more of The Sexy Nurse Report

(Incidentally, the ID badge Jackie is wearing in this photo is identical in design to the one at my hospital. Maybe there is one manufacturer that dominates in this market?)

Musk, for remembering cholinergic subtypes

Depending on where you went to school and what type of pharmacology class you had, you may or may not have gotten into receptor subtypes for drugs that affect the nervous system.

Of course, you might not find receptor subtypes helpful. I do. Remembering which pressors affect alpha-1, etc receptors helps me remember the therapeutic and non-therapeutic effects of Levophed, Dobutamine, etc.

But I always have a hard time with the cholinergic system. I've been out of school and working for a while now, and every time I try to recall this information, I get it scrambled.

But now I think I have a trick for getting it right!

let's review:

The cholinergic system refers to those parts of the nervous system that use acetylcholine as a neurotransmitter. This pretty much comprises the entire peripheral nervous system except for the stimulation of various organs by adrenaline and noradrenaline.

The differences in the way acetylcholine affects the body have to do with the cholinergic system's different types of neurotransmitter receptors. There three major types. (Actually, the situation is a lot more complicated, but this works for our needs.) They are:

muscarinic receptors (M)
nicotinic-M receptors (NM)
nicotinic-N receptors (NN)

The three types correspond to three major functions of the cholinergic system. They are:

stimulating other nerves
stimulating skeletal muscles
stimulating organs

In the diagram below (original here), adrenaline and noradrenaline are basically the dotted red lines, and the cholinergic system is the solid red and blue lines.
The solid red lines stimulate other nerves, while the solid blue lines stimulate organs. Stimulation of the skeletal muscles isn't shown.

So how do you remember which receptors do what?

Well, one of them is easy. The stimulation of other nerves at neuronal ganglia require NN receptors. N is for "N"erves and "N"eurons.

Likewise, we can remember that "M" is for skeletal "M"uscle. But this is where I always get mixed up because is it the M for muscarinic receptors or the M for nicotinic-M receptors? So I have a new memory trick.

Remember that adreneline is mostly responsible for "fight or flight" symptoms. The odd man out is sweating. Although getting chased by a sabertooth tiger is going to make us sweat, it isn't adreneline that stimulates sweating. Sweating comes from cholinergic stimulation*.

And what does sweating cause? It causes "musky" scents. "Musk" for "muscarinic." Yes, it is the M receptors that are found on organs and sweat glands, and it is the "M" in NM receptors that stands for "M"uscle. NM receptors allow stimulation of skeletal muscle.


* If you can't remember that sweating is cholinergic, you're probably screwed. But if you can, try to remember that during Operation Desert Storm, the army couldn't use atropine because atropine would stop sweating, and the soldiers would overheat in their biochemical warfare suits.

Sedation and lordosis

Other than the occasional inappropriate patient (male genital exposure + wink), I have experienced only two instances of the sexualization of caregiving since being in the ICU.

In the first instance, a middle-aged woman was engorged and obviously aroused during insertion of a foley catheter for bladder drainage.

In nursing textbooks, the matter of male arousal and erection during catheter insertion is explicitly discussed and addressed to female nurses. The possibility of female arousal is never mentioned. (Sociologists, make of this what you will.) Unlike an erection, female arousal doesn't really interfere with catheter insertion, but the position and movements of the hips as well as the appearance of the clitoris and labia can still be distracting and disconcerting when performing the procedure.

In the second instance, a younger woman was incontinent, needed to be cleaned, and presented herself in a posture that would be referred to as lordosis in other animals such as the rat.
Only partially awake, the patient was following commands in a limited way. I had asked her to turn onto her side to be cleaned but after a few passes with a washclothe still couldn't clean properly, so I asked her to move again. She then arched her back in a way that really did present everything that needed to get cleaned.

From Psychology Today:
Consider the rat... The female performs stereotyped physical actions associated with sexual interest... This culminates in lordosis: assuming a submissive stationary posture with arched back and raised hips. Lordosis is controlled by a specific region of the hypothalamus, a subcortical brain structure. An analogous part of the brain controls submission postures in female primates.

...a woman's preference for physical sexual submission appears to be controlled by the unconscious, inaccessible subcortical part of her brain...
Although Bancroft's Human Sexuality says "There is no equivalent of lordosis in the human female, and in non-human primates, a form of lordosis is only found in the prosimian suborder (e.g. lemurs) ..."

I believe what Bancroft means here is that unlike, say, the rat or the common house cat, female primates do not have a lordosis reflex reaction when they are fertile. Fertility cycles and mating patterns are different. But I think it's pretty clear that, as PT says, this sexual availability posturing behavior is programmed somewhere deep in the primate brain.
lordotic-like postures in P. troglodytes and H. sapiens

In this second case, the patient was sedated from overdose and, as I say, would follow commands without being fully alert. She was somewhat immodest about being covered, and the "history of present illness" touched on related issues. The patient's behavior was not a reflexive response to anything I did. It was also not, technically, following a command, as I did not instruct the patient how to move, only that she needed to.

My interpretation of her behavior is that it was not a response to a specific instruction per se but to instruction as such. Why that would be is another question to be taken up by psychologists and sociologists. I have wondered what was going on in that overdosed brain in terms of awareness. Was this behavior an indication of some previous sexual abuse? Or was it the response of an essentially "sub" personality to being given instructions? Or, because of the patient's low state of mental arousal, was some lower or older center of the brain predominating?