Potpourri & Publishing

An interim miscellany of self-surgery, Talmudic sex, sphincters, limericks, humility, a mini book review, Greg vs. Leon, photos of Europe, a cocktail recipe...

Dear Subscribers,

My apologies for the slow turnaround time on articles recently. My caseload at the hospital has temporarily but significantly increased, and so my ability to write will be correspondingly reduced. The upside is that this is patient-care work, not busywork, so it will be time well spent nonetheless. I should be back up to speed in early November. I will pausing billing for those of you who are paying subscribers, and I’ll comp you longer subscriptions for the hassle.

In the meantime, here are a few items for you to peruse at your leisure.

If You’ve Had A Rough Day

If you’ve had a rough day, just remember Leonid Rogozov, the Russian doctor who, while on an Antarctic expedition, had to take out his own appendix. He was only two years out of training as a general practitioner and apparently hadn’t yet completed his surgical training. You can google the photos his comrades took of him performing the procedure. I think this is a story that every medical student hears at some point. From wikipedia:

On the morning of 29 April 1961, Rogozov experienced general weakness, nausea, and moderate fever, and later pain in the lower right portion of his abdomen. None of the possible conservative treatments helped. By 30 April signs of localised peritonitis became apparent, and his condition worsened considerably by the evening. Mirny, the nearest Soviet research station, was more than 1,000 miles from Novolazarevskaya. Antarctic research stations of other countries did not have an aircraft available. Severe blizzard conditions prevented aircraft landing in any case. Rogozov had no option but to perform an operation on himself.

The operation started at 02:00 local time on 1 May with the help of a driver and meteorologist, who provided instruments and held a mirror so Rogozov could observe areas not directly visible. Rogozov lay in a semi-reclining position, half-turned to his left side. A solution of 0.5% novocaine was used for local anesthesia of the abdominal wall. Rogozov made a 10–12 cm incision of the abdominal wall, but while opening the peritoneum he accidentally cut the cecum and had to suture it. Then he exposed the appendix. According to his report, the appendix was found to have a dark stain at its base, and Rogozov estimated it would have burst within a day. The appendix was resected and antibiotics were applied directly into the peritoneal cavity. General weakness and nausea developed about 30–40 minutes after the start of the operation so that short pauses for rest were repeatedly needed after that. By about 04:00 the operation was complete.

After the operation, gradual improvement occurred in the signs of peritonitis and in the general condition of Rogozov. Body temperature returned to normal after five days, and the stitches were removed seven days after the operation. He resumed his regular duties in about two weeks.

Talmudic Sex Law

I knew the Talmud got into the nitty gritty but this is truly impressive. The rabbis actually discuss the scenario of a man falling from the roof of a house and accidentally “inserting himself” into a woman upon landing. 

But there’s more.

The ancient tradition (Deuteronomy 25:5-10) says that if a man’s married brother dies childless, the widow must either re-marry the surviving brother, or avoid the marriage through performing a ritual (which involves her spitting in his face). If, as in the above example, the living brother falls off a roof and accidentally consummates the relationship with his deceased brother’s widow, it doesn’t count. Phew!

From Yevamot 54a:

But didn’t Rabba say: One who fell from a roof and was inserted into a woman due to the force of his fall is liable to pay four of the five types of indemnity that must be paid by one who damaged another: Injury, pain, medical costs, and loss of livelihood. However, he is not liable to pay for the shame he caused her, as he did not intend to perform the act, and if she is his yevama [his deceased brother’s widow whom he is obliged to marry], he has not [consummated their relationship] in this manner.

A Medical School Note

I was rummaging through old med school papers and found some notes from Anatomy class. Apparently this was the more important thing our professor said during one of our classes—

Today we’re going to talk about sphincters. Functioning sphincters are very important because they allow you to have a social life.

Three Bawdy Limericks

I’m as prone to getting sucked into current events as anyone else. There’s a time and a place for concentrating one’s attention on such things, and there’s a time and place for distraction. I wrote these limericks over the summer to take my mind off of some previous depressing news cycle (a news cycle that, by the way, I’ve totally forgotten about and probably wasn’t worth my time in the first place). The current Israel-Gaza conflict will of course not be forgotten soon, but occasional distraction even from serious and important events is healthy.

Galileo, the renowned astronomer
Saw a bella who upped his barometer,
So he ditched his eclipses 
For her supple ellipses,
But was so old he could only yawn at her.

Euclid drew proofs with great intellection,
Yet his wife soon felt starved for affection.
Her fine angles as bait,
She then sought to inflate
The volume of his conic section. 

Meet the prude French philosopher Blaise, 
Who from ladies averted his gaze,
Lest one thought of their pleasures
Corrupt his endeavors,
And give rein to his filthy Pensées. 

Two Thoughts re: Humility

“The test of humility is your attitude to subordinates.”

—Orchot Tzaddikim, Chapter 2

and From The Path of the Just—

It is self-evident that, being aware of his shortcomings, a man should be humble. It is impossible for any man to be altogether without faults which may be due to nature, to heredity, to accidents, or to his own doings…Such faults leave no room whatsoever for haughtiness. There is no one so sagelike that he does not make mistakes, or who is not in need of learning from his peers, and often even from his students. How, then, shall a man dare to boast of his wisdom?

The man of understanding will, upon reflection, realize that there is no justification for haughtiness and pride even if he was privileged to become very learned. A man of great intelligence who has acquired more knowledge than the average person, has accomplished nothing more than what his nature impelled him to do, as it is the nature of the bird to fly, or of the ox to pull with all its strength. Hence if a man is intelligent, learned, or wise, he is indebted to natural gifts which he happens to possess. But for another person who is currently not as wise as him, if he had possessed natural gifts like him, would also have become just as wise. Hence, there is no room to pride oneself in this.

Rather, if he possesses great wisdom, he is under duty to teach it to those in need of it…

If he is wealthy, he may rejoice in his lot, but it is incumbent upon him to help those who do not have. If he is strong, he must help those who are weak and rescue the oppressed.

To what is this similar? To servants in a household where each one is charged with a matter and it is incumbent on each to stand on his appointed position to uphold the affairs and needs of the house. In truth, there is no place for pride here. 

Behold, this is the type of examination and contemplation proper for every person whose intellect is straight and true. When all this becomes clear to him in his heart, he may be called a truly humble person.

Observations on Character

From The Armed Forces Officer: Edition of 1950—

Excerpt p. 16:

1. A man has honor if he holds himself to a course of conduct, because of a conviction that it is in the general interest, even though he is well aware that it may lead to inconvenience, personal loss, humiliation or grave physical risk. 2. He has veracity if, having studied a question to the limit of his ability, he says and believes what he thinks to be true, even though it would be the path of least resistance to deceive others and himself. 3. He has justice if he acknowledges the interests of all concerned in any particular transaction rather than serving his own apparent interest. 4. He has graciousness if he acts and speaks forthrightly, agrees warmly, disagrees fairly and respectfully, participates enthusiastically, refrains from harboring grudges, takes his reverses in stride, and does not complain or ask for help in the face of trifling calamities. 5. He has integrity if his interest in the good of the service is at all times greater than his personal pride, and when he holds himself to the same line of duty when unobserved as he would follow if all of his superiors were present.

One of my favorites, from chapter eight, Getting Along With People, p. 62 (emphasis mine):

If you like people, if you seek contact with them rather than hiding yourself in a corner, if you study your fellow men sympathetically, if you try consistently to contribute something to their success and happiness, if you are reasonably generous with your thoughts and your time, if you have a partial reserve with everyone but a seeming reserve with no one, if you work to be interesting rather than spend to be a good fellow, you will get along with your superiors, your subordinates, your orderly, your roommate and the human race.

It is easy enough to chart a course for the individual who is wise enough to make human relationships his main concern. But getting the knack of it is sufficiently more difficult that it is safe to say more talk has been devoted to this subject than to any other topic of conversation since Noah quit the Ark. From Confucius down to Emily Post, greater and lesser minds have worked at gentling the human race. By the scores of thousands, precepts and platitudes have been written for the guidance of personal conduct. The odd part of it is that despite all of this labor, most of the frictions in modern society arise from the individual's feeling of inferiority, his false pride, his vanity, his unwillingness to yield space to any other man, and his consequent urge to throw his own weight around. Goethe said that the quality which best enables a man to renew his own life, in his relation to others, is that he will become capable of renouncing particular things at the right moment in order warmly to embrace something new in the next.

From p. 68, same chapter. :

Nobody likes to be bored, but fully half of boredom comes from lack of the habit of careful listening. The man who will not listen never develops wits enough to distinguish between a bore and a sage and therefore cannot pick the best company.

From pp. 77-78

'Quiet resolution. The hardihood to take risks. The will to take full responsibility for decision. The readiness to share its rewards with subordinates. An equal readiness to take the blame when things go adversely. The nerve to survive storm and disappointment and to face toward each new day with the scoresheet wiped clean, neither dwelling on one's successes nor accepting discouragement from one's failures.' In these things lie a great part of the essence of leadership, for they are the constituents of that kind of moral courage which has enabled one man to draw many others to him in any age.

Favorite Curb Your Enthusiasm Supporting Character?

Greg the flamboyant kid:

or Leon:

Bite-sized Book Review

The Practicing Stoic: A Philosophical User’s Manual, by Ward Farnsworth

The mind turns around every hindrance to its activity and converts it to further its purpose. The impediment to action becomes part of the action; the obstacle in our way becomes the way forward. —Marcus Aurelius, p. 195, from Meditations 5.20

Many books on Stoicism have been written for popular consumption in the last two decades. The successful ones tend to take the style of a guidebook, journal, calendar, or some other form meant to be amenable to integrating Stoic practices into one’s life. The results are mixed; a few manage to do justice to the philosophical problems posed by Stoicism and grapple with them accordingly, while many end up a superficial hodgepodge of warmed-over CBT and standard motivational self-help, often with some pseudo-Buddhist mindfulness sprinkled on for good measure. They may or may not contain useful life advice, but they often stretch the meaning of Stoicism to the point that it means nothing other than having basic psychological stability and common sense.

If you are genuinely interested in Stoicism as a philosophy, you should ditch the popular books and first read the original texts: the Discourses of Epictetus, the works of Seneca, particularly his essays and letters, Marcus Aurelius’ Meditations, as well as some selections from Cicero and the collected fragments of early Stoic philosophers. If you are serious about Stoicism, you should be broadly familiar with the other Hellenistic philosophies, Greek philosophy prior to the Stoics—Plato and Aristotle in particular—as well as some pre-Socratics like Democritus and Heraclitus. A passing familiarity with the increasingly cosmopolitan social-cultural milieu of the Hellenistic and early Imperial Roman periods will provide the context necessary to understand why and how Stoicism emerged when it did. Collections of source material on Stoicism are essential, and those edited by Anthony Long and Brad Inwood, among others, are worth the investment.

Most people, however, have neither the time nor inclination to get into that kind of minutiae. The modern interest in Stoicism is focused, for better or worse, almost exclusively on its more accessible psychological and ethical dimensions. Because of this, it is all too easy for an approachable book on Stoicism to veer headlong into Hallmark-card style motivational pablum. Ward Farnsworth’s The Practicing Stoic is one of the few books that manages to capture the ethical and psychological dimension of Stoicism while avoiding shallow self-helpism. Aside from the original sources themselves, this is one of the few books on Stoicism that I return to with any regularity.

The Practicing Stoic is divided into thirteen chapters, each centered around a theme: Judgement, Externals, Perspective, Death, Desire, Wealth and Pleasure, What Others Think, Valuation, Emotion, Adversity, Virtue, Learning, and Stoicism and Its Critics. The book need not be read in sequence, as each chapter can be profitably read as a standalone. Each chapter is divided into numbered subsections elaborating various aspects of the theme. One of Farnsworth’s great strengths is that he lets the philosophers speak for themselves, as more than half the book is consists of quoted source material with the citations placed accessibly, yet unobtrusively, in the margins.

While drawing primarily on the Holy Trinity of Stoicism: Epictetus, Seneca, and Marcus Aurelius, Farnsworth enlists auxiliary ancient and modern luminaries whose thought, at least in places, aligns with the Stoics. Epicurus, Plutarch, Cicero, Montaigne, Samuel Johnson, Adam Smith, Arthur Schopenhauer, and a handful of other philosophers all make welcome cameos that ultimately add to, rather than detract from, the thematic treatment he aims for.

All things considered, if you’re looking for a contemporary book on “practical” Stoicism that is heavy on primary source material and avoids the more shallow contemporary trends, I would recommend The Practicing Stoic.

Photos From My “Grand Tour” Through Central Europe

On the one hand, one of my great regrets is that I’m not more well travelled. On the other hand, there’s that saying about how travel is overrated because you always bring your problems with you. On balance, though, I think I need to travel more. I was lucky to be able to travel Europe for four weeks before medical school, the longest time I’ve spent abroad. The trip was “all expenses paid” in the sense that every penny I spent was from a travel fund I built up with the savings from quitting smoking over the previous year and a half or so. I don’t have the receipts handy, but it was on the order of $3,500-$4,000.

I spent a week each in Munich, Vienna, Prague, and Budapest. The locals were unfailingly courteous hosts, and I have distinctly fond memories of each city. Here’s just a few of the many photos I took—

Munich, and the Dachau concentration camp

At Dachau

“Work will set you free”

Vienna

Breakfast of champions

Attention to detail

For the record, I did not place the Heineken can in the statue’s hand, but I applaud whoever did.

Prague & Budapest

Riverwalk in Budapest

The Oxley South Side

Please enjoy the following summer autumn cocktail, with recipe below. I originally posted this for paid subscribers a few months ago, but thought I’d share it.

Here is a medicinal¹, nutritional², prohibitional³ beverage to help you stay cool as summer heats up [update 10/19/2023: this beverage is perfect for all seasons and will also warm you up this autumn]. The Oxley South Side is my favorite cocktail both to make and to drink, which I stumbled upon after moving to Chicago for medical school. About ten years ago, at my then-favorite cocktail bar in the city, I asked a bartender for the recipe, which he gave me only because I was there to celebrate my birthday.

Ingredients:

• 1.5 gin (theoretically Oxley London Dry Gin but most high quality gin will do)

• 1 oz lemon juice, fresh squeezed⁴

• 1 oz simple syrup, infuse with rosemary and/or thyme if herb-forward is your thing

• 1 egg white

• ice

• 5-10 mint leaves or to taste

• grapefruit bitters (optional)

Prep:

1. Combine gin, lemon juice, simple syrup, and egg white in a cocktail shaker. Shake vigorously for 30 seconds.

2. Add mint leaves and ice. Shake for another ~15 seconds. Adjust shaking time for more or less minty taste.

3. Double strain into a coupe glass (fit a Hawthorne strainer over the shaker and pour through a fine mesh strainer to filter out the now-shredded mint).

4. Garnish with a mint leaf. Add grapefruit bitters if desired.

I realized I only have a photo of an egg white whiskey sour (with grapefruit bitters). The Oxley South Side looks exactly like this except it has a mint garnish and the liquid is a slightly radioactive-green color, depending on how much mint you add.

From A Letter

This is an excerpt from a letter by Yoni Netanyahu to his younger sister, written May 23, 1963. The last paragraph is one I come back to frequently, and have placed in my commonplace book:

Why am I writing all this to you? Perhaps to protest against your failure to realize that with every passing day you acquire a complete world. Now, this very moment, you’ve gained something. From every mistake you make you gain a little. Every single moment of your life is a whole epoch.

Do you remember Rudyard Kipling’s poem “If”? In one of the stanzas, he says:

If you can fill the unforgiven minute
With sixty seconds worth of distance run,
Yours is the earth . . .

Because each and every minute is made up of seconds and of even briefer fragments of time, and every tiny fragment ought not to be allowed to pass in vain. I must feel certain that not only at the moment of my death shall I be able to account for the time I have lived; I ought to be ready at every moment of my life to confront myself and say—This is what I’ve done.

1. “Medicinal” in the spiritual sense, not in terms of taste.

2. “Nutritional” also in the spiritual sense, not in the actual nutritional sense.

3. So I’ve heard from various bartenders. The internet sometimes agrees and sometimes doesn’t.

4. I’ve since found recipes online that call for lime juice instead of lemon. At the end of the day, to each his own, although I think lime juice basically turns this into a gin mojito. A fine drink, but not an Oxley South Side.