Here is the back.
Friday, July 29, 2011
Here is the back.
Thursday, July 28, 2011
Last week @prsjournal tweeted
Pre-print Article: Patient Death Attributable to Implant-Related Primary Anaplastic Large Cell Lymphoma of the B... http://bit.ly/o9lQ1fThe title definitely caught my eye. I have finally read it and re-read it.
Here’s the abstract:
Implant-related primary anaplastic large cell lymphoma (ALCL) of the breast is a rare clinical entity. With increasing attention being paid to this disease, most cases reported to date in the literature have demonstrated indolent clinical courses responsive to explantation, capsulectomy, chemotherapy and/or radiotherapy.We describe a case of bilateral implant-related primary ALCL of the breast that proved refractory to both standard and aggressive interventions, ultimately resulting in patient death secondary to disease progression. We situate this case in the context of the current state of knowledge regarding implant-related primary ALCL of the breast and suggest that this entity is generally, but not universally, indolent in nature.
……..ALCL is a very rare condition; when it occurs, it has been most often identified in patients undergoing implant revision operations for late onset, persistent seroma. Because it is so rare and most often identified in patients with late onset of symptoms such as pain, lumps, swelling, or asymmetry, it is unlikely that increased screening of asymptomatic patients would change their clinical outcomes. The FDA does not recommend prophylactic breast implant removal in patients without symptoms or other abnormality.
ALCL and Breast Implants (January 31, 2011)
Breast Implants and Lymphoma Risk (June 29, 2009)
Wednesday, July 27, 2011
It sometimes was necessary to resect part of a hypertrophic masseter muscle. In addition, partial buccal fat pad removal was performed in patients with prominent cheeks. When the operation was completed, the wound was irrigated; a suction tube to allow drainage was then placed and maintained for 48 to 72 hours. The patient's lower face was lightly compressed with a dressing. Antibiotics were administered for 3 to 5 days, and the sutures were removed 7 days postoperatively.
The Reuters news article states, “The procedure typically takes an hour or two, and costs up to $10,000, surgeons said.”
Tuesday, July 26, 2011
Welcome to Better Health’s Grand Rounds Volume 7, Number 44!
This is our second time hosting Grand Rounds and we’re excited about sharing the posts we received. The theme of this week’s collection came from a recent Health Affairs blog post by CFAH president, Jessie Gruman, Patient Advocates: Flies In The Ointment Of Evidence-Based Care, which addresses a few of the many challenges of basing health care practices, policies, and decisions on evidence of effectiveness. ……….
Surgical care was recently characterized as “the neglected stepchild of public health.” Critical storages of health care workers throughout the developing world have led to “calls to action” and have reinforced the need for safer surgery. …………..
I jokingly tell my patients that I am consulting with Dr. Google when I go online in the exam room to find information, but in fact I rarely use the Google search engine to access health care information. …….When my daughter was in an entrepreneurship program at the University of Portland (e-scholars) I told her of my frustrations with having easy one click access to the best free online medical information I use in the office every day. Together we put up a web site called Exam Room Favorites that is designed to be an easy to use home page for physicians. ………….
Electronic health records (EHRs) allow for the systematic collection and management of patient health information in a form that can be shared across multiple health care settings. …….This session of Public Health Grand Rounds explored the issues of EHR implementation with particular attention to public and population health while addressing concerns of cost, patient confidentiality, and other challenges. .…….
When life draws to an end, family, caregivers and medical professionals face a flurry of often heartbreaking decisions. Are there any last treatments to try? How much longer can a patient hold on? When is it time to turn off the ventilator — and who gets to decide? ………….Lee Gutkin's essay collection, Twelve Breaths a Minute, captures the experiences of doctors, caregivers, family members, 911 dispatchers and others who have learned valuable lessons from witnessing life's final moments. …………..
When Michael Fishbach set out for his day of boating around the beautiful waters of the Sea of Cortez, he probably didn't think that it would be the day he and his friends would become wildlife heroes. As luck would have it, that's exactly what happened…….
Quilting has been part of American landscape for centuries, but each culture has taken the art form and made it its own.The quilts you see in "From Heart to Hand: African American Quilts from the Montgomery Museum of Fine Arts" at the Brigham Young University Museum of Art are "very different from the quilts that many Utahns make," says Paul L. Anderson, MOA curator for the show. Yet, they have a folk-art quality, a homespun charm that makes them appealing, he says. …..
Monday, July 25, 2011
An old PRS journal article came to my attention recently thanks to a tweet by @prsjournal: “Most Emailed Article Langer's Lines: To Use or Not to Use: Thirty-six differently named guidelines have develope... http://bit.ly/mPR6v1”
[I’m not sure the time frame involved in the “most emailed.” Not sure if it’s for the day, the week, etc.] –
The tweeted article (first full reference below) is a short one and I would recommend it to young plastic surgeons and students.
A state of tension exists naturally in skin. For instance, wounded skin will gape, becoming elliptical instead of round. The first to notice this skin property was Dupuytren. In 1834, he encountered a corpse of a man who had stabbed himself with a round-tipped awl. Dupuytren noticed these stab wounds were elliptical instead of round. Then in 1838, Malgaigne wrote about the direction of these ellipses being different in different areas of the body. These two men did not drive home their point; Karl Langer, however, exhaustively studied the direction of these ellipses by stabbing a round-tipped awl into hundreds of cadavers. …….. but he is best remembered for his lines. ……….In 1897, Kocher recognized the surgical importance of Langer's tension lines. He advised that surgical incisions follow these lines. However, Langer, an anatomy professor, did not intend for his lines to be used as guides for incisions. Later, Borges pointed out that Langer's lines represent lines of cleavage in cadavers and not lines of relaxed tension……….Langer's lines are quite different from the relaxed skin tension lines of the face. These lines were described by Borges in 1962,and they are probably the most-accepted guide for incisions of the face………..Langer's lines are almost perpendicular to Borges's relaxed skin tension lines in the areas of the scalp, forehead, glabella, midcheek, and lateral eye…………….Cornelius Kraissl maintained that scars were least conspicuous when placed in wrinkle lines. … Kraissl recognized that wrinkles occurred perpendicular to muscle action. From this, he developed a scheme for elective incisions. However, these incisions might not be inconspicuous in patients without wrinkles or with ill-defined wrinkles. Also, wrinkle lines do not always coincide with Borges's relaxed skin tension lines. Hence, Borges's lines are the best guide for elective incisions of the face. …………….Developed from cadavers with extremities in extension, Langer's lines are longitudinal over joints. Blocker and Hendrix recognized that Langer's longitudinal lines predisposed patients to contractures when they were used over joints. Oriented perpendicular to muscle action, Kraissl's lines have a more transverse orientation than Langer's. Accordingly, Kraissl's transverse lines of the upper extremity do not predispose patients to contracture formation. ……….
Sunday, July 24, 2011
Last weekend I went on a fabric postcard making spree! These have been sent to friends/family I think will appreciate them as birthday cards.
This first one is going to a friend who loves purple (background fabric) and loves to photograph feet (bare, in sandals, etc). It is 5 in X 7 in.
This one is going to a friend whom I’ve known since grade school. It is 3.5 in X 5 in.
and this is the back!
This one is going to a nephew-in-law who is an artist (photography and painting). The background fabric is black linen with “fussy-cut” Batik figures machine appliqued with gold metallic thread. It is 5 in X 7 in.
Here is the black of it.
This one is for another friend whom I’ve known since elementary school. She too is an artist (photography, graphic arts). Not counting the quarter inch fringe, it is 5 in X 9 in.
Here is the back of it.
Friday, July 22, 2011
The back is a simple blue cotton.
Thursday, July 21, 2011
It seems to me this topic of surgeon and their lack of civility gets pulled out ever on a fairly regular basis. This latest discussion in the news media is due to a short article in the current Archives of Surgery (full reference below).
Uncivil behavior is so present in society at large that we should not be surprised to find it among health care workers. This article is meant to raise the awareness of the costs—both in dollars and in human misery—of incivility in the practice of medicine by looking in particular at the case of surgeons.
The surgical community has an incredible opportunity to lead a civility initiative in health care. The first step is to recognize the power that civility has to improve the surgical workplace, the patient outcomes, and the workers' quality of life. Organizations should commit to developing a universal code of conduct that is identical for surgeons, nurses, staff, administrators, and patients. This code must have clearly defined expectations as well as consequences for violations. More important, the code should be applied fairly and consistently, without modification or special allowances based on an individual's actual or perceived status in the group. ………
“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” --Maya Angelou
My past article on the topic
Behavior of Surgeons (July 24, 2008)
A Surgeon's Outburst (August 13, 2008)
Consultations (May 24, 2010)
Tips on Dealing with Difficult Colleagues (May 9, 2011)
Barbers of Civility; Andrew S. Klein; Pier M. Forni; Arch Surg. 2011;146(7):774-777; doi:10.1001/archsurg.2011.150
Wednesday, July 20, 2011
Tuesday, July 19, 2011
Live, from New York, it’s med-blog Grand Rounds, volume 7, number 43!
As I’m staying home for the summer, I’ve asked bloggers to share images of where they’re from, or where they go, so we could take a virtual tour together:We’ll start with a post from the Washington, DC-based Prepared Patient Forum, where Jessie Gruman clarifies that Engagement Does Not Mean Compliance. As Jessie says, “I am compliant if I do what my doctor tells me to do. I am engaged, on the other hand, when I actively participate in the process of solving my health problems.” ……….
If you live in New Hampshire, or some other state that is withdrawing Planned Parenthood funding, you may need to find an alternate source of affordable birth control, at least until the states get their heads screwed back on straight. In the meantime, please, don’t stop your birth control because you think you can’t afford it - the costs of not using it are much, much higher…………
I delivered a keynote presentation a few weeks ago entitled “Personalized Medicine: Tailoring Healthcare in the Information Age” to a group of parents who had taken their kids to the Bristol-Myers Squibb Science Horizons summer science camp. ………….That said, below is a list of female docs who are currently engaged in social media, at least via Twitter, and in many instances, through other social media channels, including blogs. In each case their respective Twitter handle is provided for easy reference (often, additional information, such as a blog link, can be obtained by visiting the respective Twitter page). …... The order shown provides no indication of either personal or professional qualification.…….
This month's cover feature is on femtosecond laser refractive cataract surgery. This new technology has the potential of dramatically changing the manner in which cataract surgery is performed. How are such innovative ideas developed? Many ophthalmologists may have a new idea for an instrument but do not know how to pursue the idea. I interviewed Claes Dohlman, M.D., professor of ophthalmology, Harvard Medical School, and chair emeritus, Massachusetts Eye and Ear Infirmary, Boston, who pioneered numerous innovations in cataract and corneal surgery, including a well-functioning keratoprosthesis. He shared some advice on how to take an idea and develop it into a product. . …..……………………………………….
Apps rule the world of smartphones, and the world of plastic surgery has certainly taken notice and jumped on this trend. ……Most of the apps designed for consumers range from free to $1.99 to download to an iPhone, iPod Touch, or iPad, but some tools designed for surgeons may run into the hundreds of dollars. ……….This growing category of apps gives prospective aesthetic patients a lot of information. One might argue that some of these apps give patients too much information, such as the ability to digitally morph photos of their faces and bodies into a desired state of perfection that may not be physically possible even using a scalpel or syringe.Now, in no particular order .…..
Chimecco is an interactive instrument and kinetic sculpture by artist, architect, and designer Mark Nixon, which was recently exhibited at Sculpture by the Sea in Aarhus Denmark …..
Monday, July 18, 2011
There is a nice article on a 2-stage ear reconstruction for microtia (full reference below) in the current issue (May/June 2011) of the Archives of Facial Plastic Surgery journal.
Friday, July 15, 2011
With some of the left-over fabric, I planned and pieced this which I call my Ohio Star color wheel.
Color wheels are used to help learn color theory. My color wheel kit was designed by Susan McKelvy (author of Color for Quilters.
From the insert which came with my color wheel kit:
Color terms illustrated in the color wheel
…………….Pure Colors: The color wheel is made up of pure colors (the truest and brightest versions of each color). This wheel is made up of twelve pure colors.Light-Dark Contrast (Value): There are many values of each color from light to dark. Three are included in this wheel – a light value (tint), the pure color, and a dark value (shade).Warm-Cool Contrast: Colors have warmth. On this wheel, the cool colors (greens and blues of the sky and sea) are on the left and the warm colors (the yellows, oranges, and reds of fire and the the sun) are on the right.Analogous Colors: Any colors next to each other on the wheel are analogous.Complementary Contrast: Every color has a complement – the color directly opposite it on the wheel.Colors look different on different backgrounds.
The twelve colors in my color wheel are
The 3 primary colors: Red, yellow and blue
The 3 secondary colors: Green (yellow and blue), orange (yellow and red) and purple (red and blue)In traditional color theory, these are the 3 pigment colors that can not be mixed or formed by any combination of other colors. All other colors are derived from these 3 hues
These are the colors formed by mixing the primary colors.The 6 tertiary colors: Yellow-orange, red-orange, red-purple, blue-purple, blue-green and yellow-green.
These are the colors formed by mixing a primary and a secondary color. That's why the hue is a two word name, such as blue-green, red-violet, and yellow-orange.
Thursday, July 14, 2011
As such, they are delivered pursuant to the practice of medicine and all state and federal guidelines. This is a distinction without difference because, although they are not prescriptive, medical devices – as categorized by the United States Food and Drug Administration (FDA) – can only be utilized in a medical facility and delivered to patients by an appropriate medical provider.
Recently, many CMAs have wrongfully asserted that they are allowed to inject and, therefore, have been injecting botulinum toxins, dermal fillers and sclerosants. CMAs are marginally trained, non-medical personnel………It will also be a huge problem in any professional negligence claim, because there will be no coverage for such a loss. An insurance carrier will not provide a defense or indemnity for any claim related to these procedures. …….
For example, some “certified laser technicians” and their employers incorrectly believe that the designation “certified” elevated their stature and allows them to perform medical services. Certified Laser Technician, Certified Medical Esthetician, and Medical Esthetician are not categories of medical providers. ……..
Wednesday, July 13, 2011
Melanoma Review (February 25, 2008)
Melanoma Skin Screening Is Important (April 29, 2009)
Tanning Beds = High Cancer Risk (August 3, 2009)
Skin Cancer (March 24, 2010)
Safety of Sunscreens (June 14, 2010)
Dear 16-Year-Old Me (May 18, 2011)
Tuesday, July 12, 2011
Our theme this week is "Personal Responsibility" - only posts that address this issue have been included. I was quite impressed with the creativity that potential contributors brought to the table to make sure their posts fit the bill.We like outside-the-bun thinkers.The concept of personal responsibility (or accountability, if you prefer) has been a consistent meme here at IB since our earliest days some 6+ years ago. So it seemed appropriate to use that as the theme for this edition of the venerable Grand Rounds: ……….
I have a long list of backlogged posts but am taking a brief break from tracking global sustainability to check my personal operating systems.* A stroke will do that to you.I summarized one moral of the story below in this Tweet:
Don’t stress your carotid arteries if you like your brain & the things it does for you.There are other lessons here, one being that stroke is not restricted to what you might call “the usual suspects.” Here’s what happened. …..……………………………………….
This year, a Seattle nurse named Kim Hiatt committed suicide. Ms. Hiatt’s death came nearly seven months after she had given an unintended overdose to an infant heart patient, a medical error that was said to have contributed to the child’s death days later. ….This story makes me feel sick — sick for that dead baby and her parents, and sick for Kim, who must have felt so alone with her pain.It’s a pain that I, and every nurse and doctor, can relate to on some level. We’ve all made mistakes, most of them small and inconsequential to the patient’s health, but sometimes the mistakes are serious……….
Slowly the public is coming to realize that hospitals are not always safe places. …. The series is archived here.I have just returned from England, where as a Fulbright Senior Specialist I attended a conference of European health journos and participated in meetings with health care academics and government officials. …. At the NHS Institute for Innovation and Improvement I learned about some pretty cool stuff that has found its way into UK hospitals and improved care for patients. ….One practice that intrigued me was a way to cut down on errors made by nurses when they give patients their meds. Taylor told me that medication errors are a problem in the UK as they are in the US. Any reporter who has spent time examining hospital or nursing home inspection reports knows how frequent they are. Taylor explained that nurses administering medications too often are interrupted, causing them to lose focus and increasing the chance for a deadly mistake. To solve this problem nurses started wearing red pinafores over their uniforms when they gave patients their medicines. That signaled to others not to bother them. “It’s so simple,” said Taylor…….
A personal journey to find the oldest person in the city of Barcelona. After weeks of taking photos I thought the search was over after meeting Matilde who is 101. However, the next day I visited another retirement home and after taking a couple of photos I was ready to leave when one of the care takers told me ¨There is a person you should meet before you go, her name is Ana Maria, she is 108 years old and will be 109 in July¨…
We could diagnose and heal the human frailties found in literature. But why?Not long ago, members of my American lit survey class decided that the disturbing behaviors of Herman Melville's Bartleby the Scrivener -- staring out the window at a blank brick wall, preferring not to do pretty much whatever he's asked to do -- were symptoms of clinical depression.Paxil or Prozac, along with some good counseling, maybe group therapy to help with his peer interactions, was what the poor fellow needed. …..
Madeleine Vionnet was a revolutionary designer for her time; not as universally well known as Coco Chanel but just as influential to the world of fashion. She is credited with creating the bias cut, a technique of cutting on the diagonal grain of the fabric which creates a sinuous and slightly clingy silhouette. The designer regularly had fabric custom made for her as wide as 180 inches to cut her dresses from. …..
If you want to read more on Madeleine Vionnet and her influence in fashion, Betty Kirke wrote a wonderfully comprehensive article for Threads magazine which you can check out here.
Monday, July 11, 2011
H&E staining of pretreatment tissue samples revealed an atrophied epidermis and flattened rete ridges within the papillary dermis. No intact collagen fibers were identifiable in the striae before treatment, and the degenerated appearance of the fibers resulted in uneven staining as well as indistinct borders.In contrast, following three 1540-nm treatments with the 10-mm tip at 40 mJ and 10-ms pulse width, significant neocollagenesis was observed. Elastic fibers in the reticular dermis appeared sparse and fragmented prior to the 1540-nm treatment.One month after the third treatment, elastic fibers were uniformly increased in number throughout the reticular dermis.
Friday, July 8, 2011
The inspiration for this baby quilt was a Facebook friend photo montage. Different size photos were placed together in the montage. I sketched out the measurements and then went through my fabrics. This is the result.
The quilt is machine pieced and quilted. It measures 39 in square.
These next few photos allow you to see the fabrics better. Here the baby/child will be able to find dogs, a donkey, horses, zebras, and a tiger.
This section contains sunflowers, a turtle, a butterfly, more of the horse/zebra fabrics, and a peacock feather.
This section contains bees, a boy and his dog, a cow, and more zebras.
The baby is a lovely yellow and white cotton. The label has a monkey.
It has been given to a friend and his wife.
Thursday, July 7, 2011
The power lawn mower is considered one of the most dangerous tools around the home. Each year, more than 74,000 small children, adolescents and adults are injured by rotary, hand and riding power mowers due to improper handling.
Lawn mower injuries include deep cuts, loss of fingers and toes, broken and dislocated bones, burns, and eye and other injuries. Some injuries are very serious. Both users of mowers and those who are nearby can be hurt.
The kinetic energy (motion) imparted by a standard rotary blade is comparable to the energy generated by dropping a 21-pound weight from a height of 100 feet or is equal to three times the muzzle energy of a .357 Magnum pistol. Blade speed can eject a piece of wire or an object at speeds up to 100 miles per hour.
The most commonly injured person is an adult 25-64 (those most often doing the mowing) or a child under age five. About a fourth of all lawnmower injuries (22%) involve the wrist, hand or finger. About 14% involve foot, ankle or toes. Of all the hand and foot injuries, about 25% will result in amputation.
- As with other power tools and equipment, do not operate a lawn mower when consuming alcohol.
- Wear appropriate clothing: sturdy shoe, not sandal; eye and hearing protection.
- Children should be at least 12-years-old before they operate any lawn mower, and at least 16 years old for a ride-on mower.
- Children should never be passengers on ride-on mowers.
- Young children should be at a safe distance from the area you are mowing.
- Pick up stones, toys and debris from the lawn to prevent injuries from flying objects.
- Use a mower with a control that stops it from moving forward if the handle is released.
- Never pull backward or mow in reverse unless absolutely necessary - carefully look for others behind you when you do.
- Start and refuel mowers outdoors - not in a garage. Refuel with the motor turned off and cool.
- Blade settings should be set by an adult only.
- Wait for blades to stop completely before removing the grass catcher, unclogging the discharge chute, or crossing gravel roads. (As a safety feature, some newer models have a blade/brake clutch that stops the blade each time the operator releases the handle.)
To help educate the public and prevent injuries, the American Society for Reconstructive Microsurgery (ASRM), American Society of Plastic Surgeons (ASPS), and American Society of Maxillofacial Surgeons (ASMS) offer a video, “When Lawn Mowers Attack,” with tips on how to avoid injuries
U.S. Consumer Product Safety Commission, National Electronic Injury Surveillance System (NEISS) Online.
Lawn Mower Safety; American Academy of Pediatrics
Keep Your Hands Safe: Follow Lawnmower Safety Tips; American Society for Surgery of the Hand
Lawn mower-related injuries to children; J Trauma. 2005; 59(3):724-8; Abstract
Wednesday, July 6, 2011
New Breast Cancer Screening Guidelines (November 17, 2009)
Screening Mammogram Recommendations (January 7, 2010)
The New Mammogram Guidelines - What You Need to Know (December 27, 2009; TBTAM)
Dr. Marya Zilberberg’s, Healthcare, etc, post: Why medical testing is never a simple decision (December 15, 2010)
Tuesday, July 5, 2011
I attended my very first grand rounds as a third year med student. The talk was given by my former pathology professor to a large auditorium packed with students, residents, fellows, and attendings. I don't remember the topic of the lecture, but I do remember this:All in all, not my favorite grand rounds.
Midway through the lecture, the professor called on me. In an hour-long lecture, he called on one person out of 200 in the audience, and somehow that person was me. I almost choked on my cinnamon-raisin bagel. ……..
But this week's grand rounds are going to be awesome. I'm dedicating it to all the medical trainees that got humilated during lectures, pimped during rounds, or tried to answer three beeping pagers at once. ……….
TODAY, after four arduous years of examinations, graduating medical doctors will report to their residency programs. Armed with stethoscopes and scalpels, they’re preparing to lead the charge against disease in its ravaging, chimerical forms. They carry with them the classic tomes: Harrison’s Principles of Internal Medicine and Gray’s Anatomy. But I have an unlikely addition for their mental rucksacks: “Grimm’s Fairy Tales.”………….
……Lifeguarding consultant Francesco Pia has some advice for the summer about drowning. He worked as a lifeguard in New York’s Orchard Beach, and he made a documentary called “The Reasons People Drown,” that challenged a lot of misconceptions about drowning. He found that:1.) Drowning is often silent: …..2.) Drowning happens very quickly: ….3.) Drowning often happens when people are around others: ….
What do slouching, back pain, and a middling forehand or weak shot off the tee have in common? Often it’s a weak core—the girdle of muscles, bones, and joints that links your upper and lower body. Your core gives you stability and helps power the moves you make every day……..Core Exercises: 6 workouts to tighten your abs, strengthen your back, and improve balance is available from Harvard Health Publications. You can read an excerpt here from the report with tips on checking and improving your posture. ……..Core Exerise #1: Plank
My frail, 92-year-old mother was prescribed 80 mgs of the cholesterol-lowering drug, or statin, simvastatin for years. She fell four times in the last four years of her life: the last fall was the least forgiving. Doctors diagnosed her with rhabdomyolysis, a life-threatening condition, and acute kidney failure; she was dead within 8 weeks. …..
The 2011 American Sewing Expo is coming right up - September 23-25 at the Suburban Collection Showplace in Novi, Michigan…..A staple exhibit at ASE is the annual entries in the "Show Your Support Bra Challenge." Sponsored by Coats & Clark and BurdaStyle, the contest showcases some amazing lingerie decorated by the skills of sewers across the country…..You can find the Show Your Support Bra Challenge full rules and the entry form online at the ASE site. Good luck, and good for you if you enter!
Monday, July 4, 2011
I made cheesecake for the family cookout. On the healthier side, I am also roasting corn-on-the-cob to contribute.
I thought about our enemies tonight, and why and how we physicians care for them. ….…, but the reason I went nearly sleepless that night is so that I can sleep all the other nights. It's essentially the same reason I take extra care with each patient at home. A common phrase in my operating room is “I do it this way so I can sleep at night.” I can go to bed knowing I cut no corners, I gave each patient the best possible chance at a good outcome. There are still bad outcomes, and I agonize over those, replaying each decision in my head afterward. But I did the best I could by each one. ….One mark of a civilized people is our response to wounded enemies. …… Yes, caring for our enemies consumes resources: helicopter flight time, ICU days, operating room hours, sleepless nights, expensive medications and equipment. Because we ought to. Because I’ll have to live with my actions. “Do good to those who hate you,” we read in Matthew's gospel. And tonight, I can sleep, because last night I didn’t.
Friday, July 1, 2011
The back fabric is a lovely white on white with large polka dots.