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“Hippocampus” is the greek word for “seahorse” اللي هوَ حصان البحر مدري شسمه “Hippos” meaning horse “Kampos” meaning sea monster

Valles Marineris is a 4000-km long, and 7 km deep valley in Mars. It's the largest valley in the solar system.

Valles Marineris, Battle Scar of Mars

تعذيب وعلي

— The Checklist Manifesto, by Atul Gawande

Expertise is the mantra of modern medicine. In the early twentieth century, you needed only a high school diploma and a one-year medical degree to practice medicine. By the century’s end, all doctors had to have a college degree, a four-year medical degree, and an additional three to seven years of residency training in an individual field of practice—pediatrics, surgery, neurology, or the like. In recent years, though, even this level of preparation has not been enough for the new complexity of medicine. After their residencies, most young doctors today are going on to do fellowships, adding one to three further years of training in, say, laparoscopic surgery, or pediatric metabolic disorders, or breast radiology, or critical care. A young doctor is not so young nowadays; you typically don’t start in independent practice until your midthirties.

There is perhaps no field that has taken specialization further than surgery. Surgeons are so absurdly ultraspecialized that when we joke about right ear surgeons and left ear surgeons, we have to check to be sure they don’t exist. I am trained as a general surgeon but, except in the most rural places, there is no such thing. You really can’t do everything anymore. I decided to center my practice on surgical oncology— cancer surgery—but even this proved too broad. So, although I have done all I can to hang on to a broad span of general surgical skills, especially for emergencies, I’ve developed a particular expertise in removing cancers of endocrine glands.

— The Checklist Manifesto, by Atul Gawande

Such failures carry an emotional valence that seems to cloud how we think about them. Failures of ignorance we can forgive. If the knowledge of the best thing to do in a given situation does not exist, we are happy to have people simply make their best effort. But if the knowledge exists and is not applied correctly, it is difficult not to be infuriated. What do you mean half of heart attack patients don’t get their treatment on time? What do you mean that two-thirds of death penalty cases are overturned because of errors? It is not for nothing that the philosophers gave these failures so unmerciful a name—ineptitude. Those on the receiving end use other words, like negligence or even heartlessness. I have been trying for some time to understand the source of our greatest difficulties and stresses in medicine. It is not money or government or the threat of malpractice lawsuits or insurance company hassles—although they all play their role. It is the complexity that science has dropped upon us and the enormous strains we are encountering in making good on its promise. The problem is not uniquely American; I have seen it everywhere—in Europe, in Asia, in rich countries and poor. Moreover, I have found to my surprise that the challenge is not limited to medicine.

Careful studies have shown, for example, that heart attack patients undergoing cardiac balloon therapy should have it done within ninety minutes of arrival at a hospital. After that, survival falls off sharply. In practical terms this means that, within ninety minutes, medical teams must complete all their testing for every patient who turns up in an emergency room with chest pain, make a correct diagnosis and plan, discuss the decision with the patient, obtain his or her agreement to proceed, confirm there are no allergies or medical problems that have to be accounted for, ready a cath lab and team, transport the patient, and get started. What is the likelihood that all this will actually occur within ninety minutes in an average hospital? In 2006, it was less than 50 percent. This is not an unusual example. These kinds of failures are routine in medicine. Studies have found that at least 30 percent of patients with stroke receive incomplete or inappropriate care from their doctors, as do 45 percent of patients with asthma and 60 percent of patients with pneumonia. Getting the steps right is proving brutally hard, even if you know them.

By David Dubnitskiy

The Lovers, By Émile Friant

الشَّمول: إسمٌ للخمر. تُرُنج، أو الأترُج: نوع من الحمضيات (يسمونه بالعامية كبّاد، طرنج). قِيلي: قَولي.

الشَّمول: إسمٌ للخمر. تُرُنج، أو الأترُج: نوع من الحمضيات (يسمونه بالعامية كبّاد، طرنج). قِيلي: قَولي.

يكلك فد يوم راح المتنبي لمجلس سيف الدولة وشاف عنده أَترُج وطَلع النخيل، وثنينهن جانن مزة ياكلوها وية الشرب، بس مع ذلك، ما راد يسيء الظن بسيف الدولة. فأثناء ما هو كاعد يمه، واحد من الحاضرين كله: لا تتوهم، ترة هاي علمود الشرب... هنا أبو الطيب رد عليهم بهاي الأبيات بس همين ما سكتوا، ف رد عليهم بالأبيات اللي مطلعها "أتيتُ بمَنطِقِ العربِ الأصيلِ."

يكلك فد يوم راح المتنبي لمجلس سيف الدولة، ف شاف عنده أَترُج وطَلع النخيل، وثنينهن جانن مزة ياكلوهن وية الشرب بس هو ما راد يسيء الظن بسيف الدولة. فأثناء ما هو كاعد يمه، واحد من الحاضرين كله: لا تتوهم، ترة هاي علمود الشرب... هنا أبو الطيب رد عليهم بهاي الأبيات بس هم ما سكتوا، ف رد عليهم بالأبيات اللي مطلعها "أتيتُ بمَنطِقِ العربِ الأصيلِ."