Friday, August 29, 2014

"Ether Day," by Julie M. Fenster

Anyone seen Stephen Soderbergh's new show for Cinemax, "The Knick"? Set in a New York City hospital in the year 1900, Clive Owen stars as Doctor John Thackery -- your typical grumpy, brilliant, drug addicted surgeon. Yes, it might sound a little like period version of "House," but not so far off from the reality of slightly earlier events recounted in Julie Fenster's book "Ether Day."

At least John Thackery was able to work with the benefit of ether, chloroform, and cocaine -- if not antibiotics or reliable electricity!

As early as 1800, English chemist Humphrey Davy wrote that nitrous oxide's ability to eliminate physical pain, "…may probably be used with advantage during surgical operations." Nonetheless, the concept of surgical anesthesia was not seriously considered for the greater part of another half-century.

During that time nitrous oxide (aka "laughing gas") and ether were used in theatrical entertainments, as well as recreational substances of intoxication. As for surgical patients…their options included opium, alcohol, mesmerism, ice, or nothing at all. Sometimes patients were bled until they fainted in preparation for an operation. Procedures from amputations to open heart surgery were performed without benefit of anesthesia.

Friday, October 16, 1846 is the day known as "Ether Day" – the first operation conducted at Massachusetts General Hospital on a patient rendered insensible by means of a so-called "secret" compound "invented" by dentist William Morton. Morton's secret was a mixture of sulfuric ether and orange oil (to disguise the ether smell). Just hours prior to the scheduled surgery, Morton scrambled for help in building an apparatus to deliver the ether mixed with air. His concern for the apparatus was twofold: 1) protecting his commercial control, and 2) controlling the dose to avoid killing patients.

William Morton arrived 25 minutes late to his date with destiny, but he succeeded in bringing his (very) newly designed apparatus with him. Perhaps surprisingly the untested apparatus was successful in controlling administration of ether to the patient – a young man who was undergoing removal of a complicated tumor that was wound around the blood vessels and nerves of his neck.

Another dentist, Horace Wells, who actually knew Morton and was friendly with him, had previously pioneered the use of nitrous oxide in dentistry. An early attempt at using nitrous oxide as an anesthetic for medical surgery was not entirely successful, likely due to poor quality control over the particular batch of gas used. Wells was so humiliated he became physically ill, and dropped out of sight for some time.

Morton quickly followed up his success with the ether mixture he named "Letheon" by applying for a patent. Thus, ether was not only the first successful use of anesthetic gas for surgery, it was the first commercialization of a medical procedure. The medical community was not impressed by the ethics of such a move, disliking both the concept of patenting "a gift to humanity" and the claim of "invention" over such a commonly available chemical.

Despite Morton's patent, many dentists and surgeons – including surgeons for the U.S. Army – proceeded to use ether anesthesia whenever they felt it appropriate without paying any royalties. The mass violation of Morton's patent rights rendered them valueless. Morton also had competition for scientific precedence as the discoverer of inhalation anesthesia. For one, Horace Wells resurfaced, arguing that Morton had lifted the entire concept of inhalation anesthesia from him.

In the meantime, an eminent Scottish obstetrician, Dr. James Simpson, took an interest in finding a better anesthetic gas than ether. Ether is highly flammable – a serious hazard especially at a time when artificial light and heat depended on open flames. It also has a strong smell that makes many people nauseated. Simpson hosted fellow scientists for a series of sniffing parties, eventually identifying chloroform as a promising candidate (it worked well and didn't kill anyone or blow up). 

Chloroform did have its issues though. For one thing, it sometimes killed people. Also, it could be addictive, as evidenced by poor Horace Wells who ended his days dependent on regular chloroform inhalation -- in the midst of accusations that he had been involved in acid attacks on New York City prostitutes.

In the end, chloroform and ether remained in common use well into the 20th century, when better anesthetics were finally developed.

Sunday, August 17, 2014

My Favorite Kindle Fire HD Apps for Readers and Writers

I received a Kindle Fire HD, 8.9", as a Christmas gift a couple of years ago, and on the whole I've been quite happy with it. Battery life could be better, and availability of apps is limited compared to a standard Android tablet or an iPad. While not really designed to be a fully functioning tablet computer, the Kindle Fire HD is a first class device for consuming all types of media with plenty of utility for writers as well.

While I don't personally use my Kindle Fire for writing per se, I use it a LOT for skimming blogs and other sources, saving the articles I want to read and ponder in detail, and organizing notes and reference materials. Here are four of my essential apps that I use every day.
    Docs -- Never overlook the utility of a device's native apps! I use Kindle's built in Docs storage to access pdf documents that I've emailed to my Kindle's personal email address. Once they're in your device's Docs folder, you can store them in the cloud or on your Kindle for offline reading. What's in my Doc folder as I write?
    • Instructions for my physical therapy exercises
    • The program and abstract book for a conference I attended recently (that one can go back to cloud storage now)
    • A copy of "The Orkneyringa Saga" -- an English translation of the Icelandic saga chronicling the adventures of the Viking Earls of Orkney
    Feedly -- Feedly is the newsreader that stepped up when Google abandoned their RSS reader. It serves as a one-stop shop tool for skimming headlines and article descriptions from blogs, columns, and any websites incorporating grab-able feeds. From there I can click through directly to the article at the source.

    I often skim headlines in Feedly on my iPhone and "save" those of interest for later reading on the larger format of my Kindle Fire. Yes, as you might have noticed, Feedly operates across platforms from Android to iOS to Windows PCs. It's also free -- a paid upgrade is available, but so far I've been happy with a free account.

    Evernote -- Evernote is  simply the best productivity tool out there. I use it to organize everything from recipes (shared in a virtual notebook with my son) to travel documents (shared in another notebook with my husband). Most of all I use it for keeping track of article and story ideas, notes and drafts, and virtual clippings of my work as it appears on the web.

    Evernote is also a tremendous aid in paper reduction. Hard copy documents can be scanned directly into Evernote for archiving -- as a backup or to save real world file space for truly critical items.

    A basic Evernote account is free, but as it is another cross-platform app I use a lot, I do use the additional functionality of a paid account. One drawback of the Kindle Fire version is that it does not allow maintenance of offline notebooks -- a feature that is normally part of a paid account. So, you must be connected to the cloud to have access to your Evernote-stored data.

    Pocket -- Last but not least, Pocket is the newest addition to my collection of productivity tools. Pocket is another web clipper, but unlike Feedly it doesn't depend on the original site having set up feed capabilities. While Pocket lacks much of the amazing functionality of Evernote, it does allow offline storage of clipped articles to read at your leisure.

    I use Pocket to clip and save articles I want to read, but not necessarily keep. For example, I might see a link while scrolling through Facebook and save it to Pocket for later reading. Once read, most of my Pocket contents get deleted, though some things I'll then pin to Pinterest or move over to Evernote where they're tagged and saved for future reference.


    Wednesday, August 13, 2014

    Mystery Settings and Travel Destinations

    I posted not long ago about how I've enjoyed reading Dan Brown's novels as travel guides for Paris and Rome. We're currently planning a trip to Scotland where Dan Brown doesn't have many locations -- apart from the Rosslyn Chapel, which we might try to see.  So I went hunting for some fiction set in the highlands and islands, just to get a feel for setting and to heighten the anticipation.

    I started with an audible credit to spare, and found a recorded version of Anne Cleeves' novel, "Dead Water." I've seen this mystery described as "the 5th book in a quartet," as the author has four previous novels in the series. All are set in the Shetland Islands. I would have started with the first one, but for some unknown reason only "Dead Water" was available on the audible site. I particularly wanted to listen to it (rather than read) because I wanted to hear the accents, cadence, and phrasing.

    The narrator gave me what I was hoping for -- a sense of atmosphere -- and overall, I quite enjoyed the book. In particular, it gives what seems to be a credible feel for life in a constrained but no-longer-so-remote area where traditional fishing and farming, tourism, and a high-tech oil industry all intersect. The  mystery plot flowed from the well-drawn characters and setting without being obvious or relying on a contrived twist.

    Even though I'm now thoroughly spoiled for some major events of earlier books, I'll probably pick up e-book versions of the first one or two in the series to take along with me. I think they'll prove diverting while waiting around in airports or ferry terminals, or just relaxing on a rainy afternoon.

    My second attempt, "The Orkney Scroll," by Lyn Hamilton, was somewhat less successful. This novel is also part of a series -- featuring Toronto antiques dealer, Lara McClintoch -- who travels the world on buying trips and solving crimes as she goes. Again, I jumped into the middle of series without having read earlier books. In "The Orkney Scroll" she's trying to track down the origin of a fake Art Nouveau writing cabinet and uncover a swindle that led to a murder.

    What I enjoyed about the book was a great look at the setting. Lara manages to take in many of the important archaeological sites on Mainland (Orkney) while pursuing her own quest. Her enthusiasm for the island and its inhabitants is engaging. The modern story is interwoven with a tale supposedly from the Orkneyringa Saga -- a real Norse saga about the Viking Earls of Orkney, though I've no idea whether a "Bjarni the Wanderer" appears in it. I actually found a translation of the Orkneyringa Saga available online, and may have a go at reading it.

    I also enjoyed learning a bit about Art Nouveau furniture -- in particular, that Glasgow Scotland was a major center of the style movement. The mystery itself, I'm sorry to say wasn't as successful for me. Apart from Lara herself, who is engaging enough, most of the characters were on the flat side, and the story wrapped up with a few too many coincidences forced together. Still, next time I'm planning a trip I may have a look to see whether  Lara Hamilton has been antique hunting in my chosen destination.


    Monday, August 11, 2014

    Ursula K. Le Guin, "Steering the Craft"

    In a recent interview, Ursula Le Guin discusses "genre, gender, and broadening fiction," with Michael Cunningham. She describes the strength of science fiction: making up worlds and peoples, I can recombine and play with what we have and are, can ask what if it were like this instead of like this—What if nobody had a fixed gender, as on the planet Gethen?
    On Gethen, as described in Le Guin's novel, "The Left Hand of Darkness," the inhabitants are ambisexual humans. That is, a single individual's gender may change from neutral to female or male, depending on the physical and social environment. A Hugo and Nebula award winner, the novel is as thought-provoking in 2014 as it was when first published in 1969.

    "The Wind's Twelve Quarters" is a collection containing possibly Le Guin's most-taught story, "The Ones Who Walk Away From Omelas." Don't let the "taught" part put you off! The story is a simple but powerful parable, and the telling of it is a lesson on many levels.

    As a writer, Le Guin has a lot to say, and uses inspiration from her own family background:

    My father was an ethnologist, who learned from the Indians of California that California could be inhabited in a very different way from how we inhabit it—many different ways. I send imaginary people to imaginary planets to learn other ways in which we might inhabit our own.
    Her mother, Theodora Kroeber, wrote the classic anthropological biography, "Ishi," about the last survivor of a California native tribe who made contact with the modern world in 1911. On her personal webpage, Le Guin comments about her family's contact with Ishi:

    The only useful thing I can tell people is about his name. Since his people didn't tell other people their name and there was no one to do it for him, he and my father Alfred Kroeber and the other people working with him agreed to use a word which they understood to mean, in Ishi's language, simply "Man."
    Ishi passed away many years before Ursula LeGuin was born, so she never had the opportunity to meet him. Nonetheless, her parents' experiences as anthropologists clearly seeped into her imagination to inform her writing.

    Books by Ursula LeGuin and her family members
    My pile of books by Ursula Le Guin (as well as "Ishi," her mother's book)
    Not only does Le Guin have plenty to write about, she is a masterful writer by the standards of any literary genre. I mentioned her book on writing, "Steering the Craft" in an earlier post, but I wanted to praise it again and in more detail.

    "Steering the Craft" is a beyond-the-basics lesson in the contents of a writer's toolkit. While it's aimed at fiction writers, it has much to offer nonfiction writers as well. Chapter topics include pacing, voice, point of view (POV), punctuation, and the potential of indirect narration -- all to the purpose of "show, don't tell."

    Concepts are illustrated with examples from classic literature or brief passages of her own invention. I never fully understood the power of altering POV to control a reader's experience until seeing how the same paragraph, about a young princess entering a room, changes when simply rendered through various eyes.

    An appendix on verb forms is way more interesting and useful than many might think. A lot of people talk about "passive voice," without actually understanding what it is or when or why to avoid it. All of us use imperative, indicative, subjunctive, and potential moods in spoken English naturally, without a second thought, but not many of us could write:

    The people in this book might be going to have lived a long, long time from now in Northern California.


    Thursday, August 07, 2014

    "The Coming Plague," and "Betrayal of Trust," by Laurie Garrett: Ebola and other emerging diseases

    The current Ebola epidemic in West Africa, and the tragic death of Dr. Sheik Humarr Khan, serve as reminders of how the real monsters in our world are far too small for the naked eye to see. I enjoy a good horror story, but Pulitzer Prize winning science journalist Laurie Garrett's book, "The Coming Plague; Newly Emerging Diseases in a World Out of Balance," is the scariest book I've ever read. It's also an excellent and gripping read -- don't be discouraged by its doorstop dimensions (my trade paperback version has 750 pages). Each chapter covers topics only an epidemiologist or a glutton for dread could love, including: Marburg virus, Lassa fever, Ebola, Aids, Hantavirus, and (my personal "favorite" because we are creating them by sheer stupidity) multi-drug resistant pathogens.

    I recently went back to re-read her chapter on the first identified Ebola outbreak in Yambuku Zaire, during the summer and fall of 1976. The initial cases appeared in August of that year; by mid-October, when the WHO released a warning bulletin, 137 cases with 59 deaths had been documented. Despite the remote location, and very basic facilities, work began quickly to obtain samples and identify the pathogen. The October WHO bulletin was able to clarify that the new deadly "hemorrhagic fever of viral origin" was similar, but not antigenically identically to Marburg. In other words, they knew it was something never seen before and eventually gave it the name Ebola -- after a river near the stricken village of Yambuku.

    In her follow-up book from 2000, "Betrayal of Trust; the Collapse of Global Public Health," Garrett addresses a world-wide decline in commitment to public health and the detrimental effect this has on battling emerging diseases. Mobutu's Zaire left doctors and nurses unpaid, and medical facilities stripped of salable supplies. The country was no more ready for a fresh Ebola outbreak in 1995 than it had been in 1976.
    Contributing then, as now, to the spread of Ebola:
    • Crowded and under-equipped medical facilities reusing needles, and unable to effectively isolate infectious patients, sterilize equipment, sanitize bedding, or provide protective gear for their own staff members
    • Unprotected family members caring for their sick loved ones, or preparing remains for burial
    • Difficulty in distinguishing initial cases of Ebola from other -- too common -- diseases presenting similar symptoms such as high fever and bloody diarrhea (such as malaria, AIDS, TB, dysentery) 
    "Outbreak News Today" recently interviewed Laurie Garrett about the current Ebola outbreak, and when asked about the new experimental serum used to treat two Americans, she replied:
    “I would caution everybody to recall that there is no statistical power whatsoever in an N of 1. One person does well on a drug. That equals one person might have done well because they were a healthy individual to begin with, might have been sheer shake of the dice.
    As she goes on to point out, even if both Americans recover, it's far from establishing that the serum is a cure.

    To learn more about the current Ebola outbreak, check out this article in the open access online journal, "PLOS, Neglected Tropical Diseases": Bausch DG, Schwarz L (2014) Outbreak of Ebola Virus Disease in Guinea: Where Ecology Meets Economy. PLoS Negl Trop Dis 8(7): e3056. doi:10.1371/journal.pntd.0003056