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Table of context

A Conversation

Sudden Onset Maddnes

A Tomb for Anatole

Spoken and Written Ferdinand de Saussure

Voicemail StoryShort stories

SourDough RyeTimeline

David Foster Wallace

s,

s,

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‘I don’t get how you couldn’t feel like you believed, today, out there. It was so right there. You moved like you totally believed.’

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Sudden-Onset MadnessʻʻGet me out of here!ʼʼ the middle-aged man shouted to his sister from his hospital bed. ʻʻTheyʼre coming to get me.ʼʼ His eyes darted from side to side as if searching for someone who was after him. His arms and legs shook. She had never seen him like this. He looked terrified.

A CRY FOR HELP

Three months earlier, the patient, a 55-year-old man who suffered from depres-sion and alcoholism, was admitted to the same hospital after falling down the stairs in his home. He wasnʼt found for twodays. Because of his injuries and this delay, when he was discovered, he was close to death. His kidneys had stopped working, and his body chemistry was com-pletely out of whack. On the way to the hospital, his heart stopped, and he had to be shocked back to

A TERRIBLE FALL

THE PRESENTING PROBLEM:What could be driving this man crazy ?

The patient remained in Waterbury

weeks (where I was one of his doctors), three of them in intensive care. Even after these weeks of care, the toll of his injury was terrible: hiskidneys were still not working, so he required hemodialysis three times a week; his arms and legs were so weak that he could not even lift them. He was unable to swallow and had to be fed through a tube. When his sister visited him there, she barely recognized him. His slender body was bloated. Hehad tubes everywhere. He could do little more than whisper. Still, she saw that he was slowly improving. He had started to smile and make jokes despite his many disabilities.

was transferred to a short-term rehabilitation facility.

A SLOW RECOVERY

After two weeks in rehab, some-thing changed. He started talking to people no one else could see. He feared they wanted to harm him. When the hallucinations persisted for a second day, he was sent to theemergency room at Waterbury.The patient told the E.R. psychiatrist that he was seeing people he knew couldn’t be there. Despite thehallucinations, he was calm and clear. He told the doctor that he thought the visions began after herecently started taking a new sleeping pill. That made sense to the doctor. Delirium is an unusual

sleep medication and returned him to rehab.

SEEING THINGS

life.

DELIRIUMTwo days later he was back. He was still seeing people who weren’t there, but now he was also frantic and confused. He knew his name but little more. All he was certain of was that he was in danger. Because of his confusion, Dr. Brian Linde, the intern on call, couldn’t rely on the patient to tell his own story. Instead the doctor had to depend on the patient’s records to make sense of the situation in front of him: the hospital notes provided an outline of the patient’s earlier admissions. The rehab-center records showed some details of his recovery from the serious injury. It also included a long list of the medications he was taking and reported that he had been confused for the past four days. On examination, the patient had a fever. His heart was racing, and his blood pressure was high. His arms and legs were weak and swollen. His legs were shaking, and his muscles were hyperreactive

TEST RESULTSBlood count: Anemic but unchanged from previous tests.

Blood chemistry: Abnormal because of the kidney failure, but unchanged from previous tests.

Urine test: Abnormal, with white blood cells and bacteria sugges-tive of an infection.

Head CT: Unremarkable.

Chest X-ray: Unremarkable.

INFECTION AND CONFUSIONDr. Donna Windish, the attending physician,

the next morning. She stood with her team outside the patient’s room as Linde described a man recovering from a severe injury who had suddenly begun seeing things. The cause wasn’t clear, Linde told Windish. It wasn’t from the sleeping pill, because eliminating it didn’t help. Tests indicated that the patient had a urinary-tract infection. Could that be the cause of the patient’s delirium? Although disorientation linked to an infection is more common in the elderly, Linde said he thought that this patient’s weakened state might make him more susceptible. If they treated the infection, the confusion shouldclear.

WORSE AND WORSEThe next day the patient’s sister arrived and was greeted with his paranoid entreaty for help. She wasbewildered; he had been improving. She demanded to know what was going on with her brother. But no one knew. Windish was also worried. Patients usually improve rapidly when urinary infections are treated with antibi-otics. But he was no better than he was the day before. Windish told her team that she didn’t think this confusion was caused by his infection. She had another idea. He was on two antidepressants at the time of his admission. These medications help allay depression by increasing the amount of serotonin, a neurotransmitter, in the brain. But too much serotonin can confuse the mind and hurt the body.

Sudden-Onset MadnessʻʻGet me out of here!ʼʼ the middle-aged man shouted to his sister from his hospital bed. ʻʻTheyʼre coming to get me.ʼʼ His eyes darted from side to side as if searching for someone who was after him. His arms and legs shook. She had never seen him like this. He looked terrified.

A CRY FOR HELP

Three months earlier, the patient, a 55-year-old man who suffered from depres-sion and alcoholism, was admitted to the same hospital after falling down the stairs in his home. He wasnʼt found for twodays. Because of his injuries and this delay, when he was discovered, he was close to death. His kidneys had stopped working, and his body chemistry was com-pletely out of whack. On the way to the hospital, his heart stopped, and he had to be shocked back to

A TERRIBLE FALL

THE PRESENTING PROBLEM:What could be driving this man crazy ?

The patient remained in Waterbury

weeks (where I was one of his doctors), three of them in intensive care. Even after these weeks of care, the toll of his injury was terrible: hiskidneys were still not working, so he required hemodialysis three times a week; his arms and legs were so weak that he could not even lift them. He was unable to swallow and had to be fed through a tube. When his sister visited him there, she barely recognized him. His slender body was bloated. Hehad tubes everywhere. He could do little more than whisper. Still, she saw that he was slowly improving. He had started to smile and make jokes despite his many disabilities.

was transferred to a short-term rehabilitation facility.

A SLOW RECOVERY

After two weeks in rehab, some-thing changed. He started talking to people no one else could see. He feared they wanted to harm him. When the hallucinations persisted for a second day, he was sent to theemergency room at Waterbury.The patient told the E.R. psychiatrist that he was seeing people he knew couldn’t be there. Despite thehallucinations, he was calm and clear. He told the doctor that he thought the visions began after herecently started taking a new sleeping pill. That made sense to the doctor. Delirium is an unusual

sleep medication and returned him to rehab.

SEEING THINGS

life.

DELIRIUMTwo days later he was back. He was still seeing people who weren’t there, but now he was also frantic and confused. He knew his name but little more. All he was certain of was that he was in danger. Because of his confusion, Dr. Brian Linde, the intern on call, couldn’t rely on the patient to tell his own story. Instead the doctor had to depend on the patient’s records to make sense of the situation in front of him: the hospital notes provided an outline of the patient’s earlier admissions. The rehab-center records showed some details of his recovery from the serious injury. It also included a long list of the medications he was taking and reported that he had been confused for the past four days. On examination, the patient had a fever. His heart was racing, and his blood pressure was high. His arms and legs were weak and swollen. His legs were shaking, and his muscles were hyperreactive

TEST RESULTSBlood count: Anemic but unchanged from previous tests.

Blood chemistry: Abnormal because of the kidney failure, but unchanged from previous tests.

Urine test: Abnormal, with white blood cells and bacteria sugges-tive of an infection.

Head CT: Unremarkable.

Chest X-ray: Unremarkable.

INFECTION AND CONFUSIONDr. Donna Windish, the attending physician,

the next morning. She stood with her team outside the patient’s room as Linde described a man recovering from a severe injury who had suddenly begun seeing things. The cause wasn’t clear, Linde told Windish. It wasn’t from the sleeping pill, because eliminating it didn’t help. Tests indicated that the patient had a urinary-tract infection. Could that be the cause of the patient’s delirium? Although disorientation linked to an infection is more common in the elderly, Linde said he thought that this patient’s weakened state might make him more susceptible. If they treated the infection, the confusion shouldclear.

WORSE AND WORSEThe next day the patient’s sister arrived and was greeted with his paranoid entreaty for help. She wasbewildered; he had been improving. She demanded to know what was going on with her brother. But no one knew. Windish was also worried. Patients usually improve rapidly when urinary infections are treated with antibi-otics. But he was no better than he was the day before. Windish told her team that she didn’t think this confusion was caused by his infection. She had another idea. He was on two antidepressants at the time of his admission. These medications help allay depression by increasing the amount of serotonin, a neurotransmitter, in the brain. But too much serotonin can confuse the mind and hurt the body.

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But the written word is so closely bound up with the spoken, whose image it isUltimately the point is reachedwhere more importance is attached to representation of the spoken sign It’s like thinking that to know someone,It is better to look at his photograph than his face.

Language and writing are two different systems of signs;the only purpose of the latter is to represent the former. Lin guistics is not concernedwith the connection between the written and spoken word its sole object is the latter: the spoken word.

yp pBut the written word is so closely bound up with the spokenBut the written word is so closely bound up with the spoken,, whose image it iswhose iUltimately the point is reachedUltimately the point is reachedUltimately the point is reachedwp cs cd ps sp sgwhere more importance is attached to representation of the spoken sign where more importance is attached to representation of the spoken sign ItItIt s like thinking that to know someones like thinking that to know someones like thinking that to know someone,,,It is better to look at his photograph than his faceIt is better to look at his photograph than his faceIt is better to look at his photograph than his face.

But the writte iilh ii hd

hi ih dit’s like thinking that to know someone

kh ih

written word is so closely bound up with the spokenBut the written word is so closely bound up with the spokenBut the written word is so closely bound up with the spoken,,, gwhose image it iswhose image it isypmately the point is reachedmately the point is reached

ppwhere more importance is attached to representationwhere more importance is attached to representatitIt’’’s like thinking that to know someones like thinking that to know someon

ook at his photook at his pho

e it is, that it is increasingly arrogating the main role to itself

than to this sign itself.

. Lin guistics is not concernedith the connection between the written and spoken word –

e it is,,, that it is increasingly arrogating the main role to itself that it is increasingly arrogating the main role to itselfincreasingly arrogating the main role to itself

ss gs than to this sign itself than to this sign itselff.

hi ii il ih il il

il f.

gy ggthat it is increasingly arrogating the main role to itsethat it is increasingly arrogating the main role to it

gsign itselfsign itselfff

ii , e it ise it is,,

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your dreams or me. WI don

't blame yl

eaving me. I wthough

you'

feel your genes in me. I hear the ocean calto me in my sthe scent o

fu

nderstand wh

ave a

d

au

hs

oon, too. I caI

wi

ll

b

e

h

eater is o

ld

er, I k

now s

h

e wi

ll

ams or me. What an age to be f ree.me you

for running away an

d

g me. I want to run away too. Evenou re not here and

you never were

I

ur genes in me. I hear the ocean call

to me in my s

l

eep, as it call

ed

you. I smell

the wild the same wa

y

y

ou did. I

tand why I couldn

'

t come with you;

I

aug

h

ter now too. I t

h

in

k

I wi

ll

l

eav

e

. I can

'

t stop thinking about the li

fe

ea

d

ing towar

d

s. W

h

en my

d

aug

h-

er, I

k

now s

h

e wi

ll

un

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erstan

d

.

I

e wi

ll

b

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. Just

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.

Hi Mom, it's me, I guess you're out. I know I should hate you for leaving me but I don't. I did for a long time but now I understand. You

were so beautiful in the picture I have of you; Dad said you were twenty-one. You were forced to choose between your dreams or me. What

an age to be free. I don't blame you for running away and leaving me. I want to run away too. Even though you're not here and you never

were I feel your genes in me. I hear the ocean call to me in my sleep, as it called you. I smell the scent of the wild the same way you did. I

understand why I couldn't come with you; I have a daughter now too. I think I will leave soon, too. I can't stop thinking about the life I will be heading towards. When my daughter is older, I know she will understand. I know she will be okay. Just like I am.

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T. S. Eliot

T. S. Eliot

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2002Middle School

2003First ConcertFirstC oncert

2006Death In the Famly

I Loved HerDeathI nt he Famly

2007High School

VALLEY HIGHVIKING PRIDE

High School

2008OBAMAOBAMA

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"Beauty is truth, truth beauty, – t at is aYe know on earth, and all ye nee to now."Beauty is truth, truth beauty," – that is allYe know on earth, and all ye need to know.

18th Birthday

Lots going on this Year

Oh and college things, apps, ACTS, Stress and acceptance

18th Birthday

GraduationGraduation

Osama bin Laden Killed Osamab in LadenK illed

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2013Sophomore yearSophomorey ear

Bahamas and tanningSchool, work and intern

Moving and living in SRQ

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YIELD2 loaves

TOTAL TIME

FOR THE SOURDOUGH STARTER

Pinch instant yeast

FOR THE DOUGHSourdough starter

1 tablespoon kosher salt

1.To make the starter: In a tall, narrow, nonmetal contain-

1/2 cup water, along with the tiniest pinch of instant yeast — less than 1/16 teaspoon. Cover and let sit for about 24 hours, then add the same amount of both

24-hour intervals; 24 hours after the fourth addition, you have your starter. (From now on, keep it in the refrigera-tor; you don’t need to proceed with the recipe for a day or two if you don’t want to. Before making the dough, take a ladleful — 1/2 to 3/4 cup — of the starter and put

cup water, mix well, cover and refrigerate. This starter will keep for a couple of weeks. If you don’t use it during that time and you wish to keep it alive, add 1/2 cup each

-card a portion of it if it becomes too voluminous.)

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5.Pour and scrape it into two 8-by-4-inch nonstick loaf pans. The batter should come to within an inch of the top, no higher.

Remove loaves from the pans anin plastic and let sit for a da

6.Cover (an improvised dome is better than plastic wrap; the dough will stick to whatever it touches) and let rest until it reaches the rim of the pans, about 2 to 3 hours, usually. Preheat the oven to 325 and bake until a skewer comes out almost clean; the internal temperature will

measure between 190 and 200. This will take about 1 1/2 hours or a little longer.

e pans and cool on a rack. Wrap day before slicing, if you can

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