PLAY WHAT’S NOT THERE PRODUCERS HealthPartners Institute for Medical Education has developed an innovative continuing medical education model that uses elements of theater to explore complex issues in health care and increase participant engagement. The model was recently used during a hospital medicine retreat. The learning event included a four-part monologue in which an actor portrayed a patient, interactive didactic sessions, a game show titled “Who Wants to be Hospitalized a Million Times,” computerized simulations, and a call for clinicians to help patients adopt healthier behaviors. Post-event evaluations demonstrated that participants gained valuable clinical knowledge and appreciated the combination of active learning and theater. Carl Patow, M.D., M.P.H., FACS is the president and executive director of HealthPartners Institute for Medical Education. He is responsible for the oversight of all medical students, residents and fellows, as well as nursing education, Continuing Medical Education (CME) and Continuing Education programs, allied health professional training, clinical simulation and the medical library. Dr. Patow is active in patient safety, clinical simulation, and quality initiatives and has served on the Board of the Accreditation Council for Graduate Medical Education. He is the recipient of a Bush Medical Fellowship for leadership advancement and studies related to innovation in graduate medical education. Prior to coming to Minnesota he was a member of the clinical faculty at the Johns Hopkins School of Medicine and spent several years as an officer in the U.S. Army. He is known as a highly creative innovator, who is able to move an organization towards its operational goals. Experienced in leading large complex multi-hospital initiatives in improving patient care. Member of national healthcare boards, particularly of accreditation and membership organizations. Interests include experiential learning, patient centered care, Institute for Health Care Improvement’s triple aim • To improve the health of the population; • To enhance the patient experience of care (including quality, access, and reliability); and • To reduce, or at least control, the per capita cost of care Debra Bryan, M.Ed. is Manager of Education Program Development at the HealthPartners Institute for Medical Education in Minneapolis, Minnesota. Debra has a M.Ed. in Adult Education and a B.S. in Business Administration both from the University of Minnesota. Debra has designed and developed many interactive programs for health professionals. She co-developed and managed a seminal year-long learning collaborative, called the EBAN Experience™, to create system-wide change to reduce health disparities for culturally specific populations in the Twin Cities. In this effort she facilitated the engagement of community members to partner with quality improvement teams to improve processes, behaviors, and systems of care. She is a HealthPartners Equitable Care Fellow, a James P. Shannon Leadership Alumni, and is committed to disseminating best practices in clinical care for patients of diverse cultures and patients with limited English proficiency. The center for Interactive Learning develops, produces, and provides consultation on innovative interactive learning experiences for the Institute for Medical Education (IME) through the use of imaginative learning environments that can lead to empathy, compassion, and ultimately better patient care. She serves on the board of Mixed Blood Theater. PLAYWRIGHT William Thomas, M.D. is an international authority on geriatric medicine and eldercare. A graduate of Harvard Medical School, he went on to graduate medical training in the Highland Hospital/University of Rochester Family Medicine Residency. While Dr. Thomas had planned on a career in Emergency Medicine, a part-time position as the medical director of a small rural nursing home turned into a full-time and life long passion for improving the wellbeing of older people. In the early 1990s he and his wife Judith Meyers-Thomas developed the Eden Alternative. In 2008, The Wall Street Journal named Thomas among the 12 most influential Americans shaping aging in the 21st century. “With his startling common-sense ideas and his ability to persuade others to take a risk, this creative and wildly exuberant 46-year-old country doctor has become something of a culture changer – reimagining how Americans will approach aging in the 21st century. He left full-time medical practice in 2004 but he continues to lecture at the SUNY Health Science Center’s Clinical Campus in Binghamton. In 2007, he was appointed as Professor of Aging Studies and Distinguished Fellow at the Erickson School in Baltimore, where he, amongst other things, led the development of the nation’s first emergency department designed for older adults. He is the winner of several national and international awards – not least of which is the Giraffe Award given to people who are willing to stick their necks out. Bill was honored for putting his own career at risk by redefining and recreating nursing homes as places for living, not dying. Today, his Eden Alternative approach is changing the face and heart of nursing homes everywhere. GUTHRIE EDUCATION DEPARTMENT Louise Chalfant, Director The Guthrie Theater, founded in 1963, is an American center for theater performance, production, education and professional training. By presenting both classical literature and new work from diverse cultures, the Guthrie illuminates the common humanity connecting Minnesota to the peoples of the world. Led by Director Joe Dowling since 1995, the Guthrie recently moved to their new three-theater home on the banks of the Mississippi River in Minneapolis. The Guthrie Education Department provides programs to serve schools, students, educators, the community at large, corporate professionals, and artists. These programs are designed to inspire imagination and creativity, to support arts education state-wide, to enhance the theater-going experience, and to create opportunities for the exchange of ideas in an environment embracing diversity and compassion” The Theater and the Healing Arts program in the Department of Education explores and facilitates the many ways in which theater arts are a conduit to healing the body, mind and spirit. Candace Barrett Birk, Theater and the Healing Arts lead teaching artist, is a nationally recognized expert on arts and culture. Candace has been involved in all facets of the arts community throughout her career as director, actress, teacher, designer and administrator. Candace is the former Executive Director of the Children’s Museum of Los Angeles and most recently the Director of Mythica, The Center for World Mythology in St. Paul, Minn. She has held many positions in the arts world Director of the Young Conservatory at the American Conservatory Theatre (San Francisco, Calif.), Founder and Director of The Academy of Theater and Media Arts (San Francisco, Calif.), Associate Professor of Theatre at Southern Methodist University (Dallas, Texas); Adjunct Professor of Theatre at the University of Southern California (Los Angeles, Calif.); and Assistant Professor of Acting and Directing at San Francisco State University. She has been a member of the acting companies of the Milwaukee Repertory Theatre, the Oregon Shakespeare Festival and the American Conservatory Theatre amongst others. Candace has also directed award-winning productions for the Reader’s Theatre Project, University of Southern California and the American Conservatory Theatre. Other projects have included serving on numerous boards and national panels including the National Endowment for the Arts, the Corporation for Public Broadcasting and the National Endowment for the Humanities; directing live entertainment for Disneyland, developing design and content for an equine theme park, developing the primary concept for a Peace Center in Korea and writing K–12 mythology curriculum for the Joseph Campbell Foundation. PLAY WHAT’S NOT THERE WORDS, NAMES, CONCEPTS p. 2 Excellent grades, President of AOA … Ordinarily … you would have been near the top of our list… AOA The Alpha Omega Alpha Honor Medical Society, commonly called Alpha Omega Alpha and abbreviated AΩA or AOA, is a national honor society for medical students, residents, scientists and physicians in the United States and Canada. The top 25 percent of a medical school class is eligible for nomination to the society, and up to 16 percent may be elected based on leadership, character, community service, and professionalism. p. 10 Decorations include several large format period posters, including one from the Woodstock music festival, and an iconic image of Miles Davis playing horn Woodstock Woodstock Music & Art Fair (informally, Woodstock or The Woodstock Festival) was a music festival, billed as “An Aquarian Exposition: 3 Days of Peace & Music”. It was held at Max Yasgur’s 600-acre dairy farm in the Catskills near the hamlet of White Lake in the town of Bethel, New York, from August 15 to August 18, 1969. Bethel, in Sullivan County, is 43 miles southwest of the town of Woodstock, New York, in adjoining Ulster County. Miles Davis An original, lyrical soloist and a demanding group leader, Miles Davis was the most consistently innovative musician in jazz from the late 1940s through the 1960s. Davis grew up in East St. Louis, and took up trumpet at the age of 13; two years later he was already playing professionally. He moved to New York in September 1944, ostensibly to enter the Institute of Musical Art but actually to locate his idol, Charlie Parker. He joined Parker in live appearances and recording sessions (1945-8), at the same time playing in other groups and touring in the big bands led by Benny Carter and Billy Eckstine. In 1948 he began to lead his own bop groups, and he participated in an experimental workshop centered on the arranger Gil Evans. Their collaborations with Gerry Mulligan, John Lewis, and Johnny Carisi culminated in a series of nonet recordings for Capitol under Davis’ name and later collected and reissued as Birth of the Cool. In 1949 Davis performed with Sonny Rollins and Art Blakey, and with Tadd Dameron, until heroin addiction interrupted his public career intermittently from mid-1949 to 1953. Although he continued to record with famous bop musicians, including Parker, Rollins, Blakey, J. J. Johnson, Horace Silver, and members of the Modern Jazz Quartet, he worked in clubs infrequently and with inferior accompanists until 1954. In 1955 Davis appeared informally at the Newport Jazz Festival. His sensational improvisations there brought him widespread publicity and sufficient engagements to establish a quintet (1955-7) with Red Garland, Paul Chambers, Philly Joe Jones, and John Coltrane, who in 1956 was joined and later replaced by Rollins. In May 1957 Davis made the first of several remarkable solo recordings on trumpet and flugelhorn against unusual jazz orchestrations by Gil Evans. In the autumn he organized a quintet, later joined by Cannonball Adderley, that proved short-lived; in the same year he wrote and recorded music in Paris for Louis Malle’s film Ascenseur pour l’echafaud. Upon his return to the USA he re-formed his original quintet of 1955 with Adderley as a sixth member. For the next five years Davis drew the rhythm sections of his various sextets and quintets from a small pool of players: the pianists Garland, Bill Evans (1958-9), and Wynton Kelly, the drummers Jones and Jimmy Cobb, and bass player Chambers. Personnel changes increased in early 1963, and finally Davis engaged a new rhythm section as the nucleus of another quintet: Herbie Hancock (1963-8), Ron Carter (1963-8), and Tony Williams (1963-9). To replace Coltrane, who had left in 1960, Davis tried a succession of saxophonists, including Sonny Stitt, Jimmy Heath, Hank Mobley (1961), George Coleman (1963-4), and Sam Rivers; ultimately he settled on Wayne Shorter (1964-70). Because of his irascible temperament and his need for frequent periods of inactivity, these sidemen were by no means entirely faithful to Davis. Nevertheless, the groups of 1955-68 were more stable than his later ones of 1969-75. Often the instrumentation and style of his ever-changing recording ensembles (up to 14 players) diverged considerably from that of his working groups (generally sextets or septets). Influential new members joined him in the late 1960s and early 1970s: Chick Corea, Joe Zawinul, Keith Jarrett, John McLaughlin, Dave Holland, Jack DeJohnette, Bill Cobham, Al Foster, and Airto Moreira. As with Davis’s previous colleagues, the excellence of these sidemen bore eloquent witness to his stature among jazz musicians. For years Davis, who trained as a boxer, had always been physically equal to the exertions of playing jazz trumpet; however, in the mid-1970s serious ailments and the effects of an automobile accident obliged him to retire. He suffered for five years from pneumonia and other afflictions. But in 1980 he made new recordings, and in the summer of 1981 began to tour extensively with new quintets and sextets. Although he was incapacitated by a stroke in February 1982, he resumed an active career in the spring of that year. Only Foster remained with Davis, serving as a sideman to 1975 and again from 1980 to 1985. New young members of his groups have included Bill Evans (1980-84), Branford Marsalis (1984-5), Bob Berg (from 1985), John Scofield (1982-5), and the synthesizer player Robert (Bobby) Irving III (1980, from 1983). In the 1980s Davis was described as a “living legend,” a title he detested because it went against his continuing inclination to be associated with new popular music and energetic youthful activities, but one that was nonetheless accurate, reflecting his position as the former partner of both Parker and Coltrane. He received an honorary Doctorate of Music from the New England Conservatory in 1986 in honor of his longstanding achievements. The New Grove Dictionary of Jazz, Oxford University Press. MILES DAVIS IS QUOTED AS SAYING OF THE CREATIVE PROCESS OF PERFORMANCE, “DON’T PLAY WHAT’S THERE, PLAY WHAT’S NOT THERE.” TREADMILL ROUNDS [Spoken as a rhythmic chant.] DM, HTN, MI, CVA Hepatitis, Cystitis, Myositis, Arthritis IV, PCN, PO, ABX Hematoma, Blastoma, Angioma, Sarcoma PO, IVP, IM, PRN Cytosis, Sarcoidosis, Halitosis, Cirrhosis Afib, NSR, V Tach, PVCs Duodenitis, Arteritis, Retinitis, Glossitis NG, NPO, BP, ESR Hepatitis, Cystitis, Myositis, Arthritis AP, MRI, PA, IVP Hematoma, Blastoma, Angioma, Sarcoma THE MEDICAL SHORTHAND DM diabetes mellitus HTNHypertension MI Myocardial Infarction CVA Cerebral Vascular Accident IVIntravenous PCN Penicillin PO“By Mouth” (from the Latin Per Os). To administer orally ABXAntibiotics IVP Intravenous pyleogram IMintramuscular PRN As needed Afib atrial fibrilation NSR Normal sinus rhythm V TACH Ventricular tachycardia PVCs Premature cardiac ventricular contractions NGnasogastric NPO Nothing by mouth BP Blood pressure ESR Erythrocyte sedimentation rate AP ante partum, before childbirth MRI Magnetic Resonance Imaging PA Pulmonary Artery THE “DISEASES” Hepatitis is swelling and inflammation of the liver. It is not a condition, but is often used to refer to a viral infection of the liver. Cystitis is the medical term for inflammation of the bladder. Most of the time, the inflammation is caused by a bacterial infection, in which case it may be referred to as a urinary tract infection (UTI). A bladder infection can be painful and annoying, and can become a serious health problem if the infection spreads to your kidneys. Myositis is inflammation of your skeletal muscles, which are also called the voluntary muscles. These are the muscles you consciously control that help you move your body. An injury, infection or autoimmune disease can cause myositis. Arthritis is inflammation of one or more joints. A joint is the area where two bones meet. There are over 100 different types of arthritis. Arthritis involves the breakdown of cartilage. Cartilage normally protects a joint, allowing it to move smoothly. Cartilage also absorbs shock when pressure is placed on the joint, such as when you walk. Without the normal amount of cartilage, the bones rub together, causing pain, swelling (inflammation), and stiffness. Joint inflammation may result from: • An autoimmune disease (the body’s immune system mistakenly attacks healthy tissue) • Broken bone • General “wear and tear” on joints • Infection, usually by bacteria or virus Usually the joint inflammation goes away after the cause goes away or is treated. Sometimes it does not. When this happens, you have chronic arthritis. Arthritis may occur in men or women. Osteoarthritis is the most common type. Hematoma a mass of usually clotted blood that forms in a tissue, organ, or body space as a result of a broken blood vessel Blastoma A type of tumor that originates from precursor cells or blasts (immature or embryonic tissue). The symptoms can vary greatly and are determined by the part of the body that is affected. Blastomas can occur in parts of the body such as the brain, liver, kidneys, nervous system, bones and the retina. AngiomaAngiomas are benign tumors derived from cells of the vascular or lymphatic vessel walls (epithelium) or derived from cells of the tissues surrounding these vessels. Angiomas are a frequent occurrence as patients age, but they might be an indicator of systemic problems such as liver disease. They are not commonly associated with malignancy. Sarcoma A sarcoma (from the Greek sarx meaning “flesh”) is a cancer that arises from transformed cells of mesenchymal origin. Thus, malignant tumors made of cancerous bone, cartilage, fat, muscle, vascular or hematopoietic tissues are, by definition, considered sarcomas. This is in contrast to a malignant tumor originating from epithelial cells, which are termed carcinoma. Sarcomas are quite rare - common malignancies, such as breast, colon and lung cancer, are almost always carcinoma. Cytosis (1) A condition in which there is more than the usual number of cells, as in the cytosis of spinal fluid in acute leptomeningitis. (2) Frequently used with a prefixed combining form as a means of describing certain features pertaining to cells; e.g., isocytosis, equality in size; polycytosis, abnormal increase in number. Sarcoidosis is a disease in which inflammation occurs in the lymph nodes, lungs, liver, eyes, skin, or other tissues. The cause of the disease is unknown. In sarcoidosis, tiny clumps of abnormal tissue (granulomas) form in certain organs of the body. Granulomas are clusters of immune cells. The disease can affect almost any organ of the body, but it most commonly affects the lungs. HalitosisHalitosis is an oral health condition characterized by consistently odorous breath. Cirrhosis is scarring of the liver and poor liver function. It is the final phase of chronic liver disease. Cirrhosis is the end result of chronic liver damage caused by chronic liver diseases. Duodenitis is swelling in the duodenum, or the upper segment of the small intestine. This inflammation usually appears with other conditions in the abdomen, such as hepatitis, dyspepsia, or gastritis. Dyspepsia is abdominal pain after eating and gastritis is swelling in the lining of the stomach. Symptoms of duodenitis include abdominal pain, bloating, vomiting, indigestion, bloody vomit, black stools, diarrhea, and other abdominal symptoms that might accompany associated abdominal disorders. Inflammation of the intestine can occur for several reasons and is treated according to the cause. Arteritis Not to be confused with arthritis. Arteritis is inflammation of the walls of arteries, usually as a result of infection or auto-immune response. RetinitisRetinitis is inflammation of the retina in the eye. Glossitis Glossitis is a condition in which the tongue is swollen and changes color, often making the surface of the tongue appear smooth. p. 18Oh it’s bad. Massive anterior wall … Huge CPK spill … Don’t know how he’s hanging on … You won’t believe this … He’s DNR! ‘No heroic measures …’ …ridiculous. Hard to imagine him surviving this … Terrible of course … Just terrible … CPK spill Creatine phosphokinase (CPK) is an enzyme found primarily in the heart, skeletal muscles and brain. This enzyme’s primary function is to convert the creatine into phosphate, which then gets consumed or burned up as a quick energy source by the cells of the body. In healthy adults, CPK blood test normal levels are somewhere around 12-80 ml (30 degrees) or 55-170 ml (37 degrees). In women these levels are slightly lower. However, when there occurs any kind of muscle damage, the levels of CPK enzyme shoot up. This is because when the muscle gets injured, the muscle cells burst open and spill out their contents into the bloodstream. Since a large amount of the CPK enzyme is present in the muscle cells, their splitting open results in spilling of CPK into the blood, thereby raising the levels of CPK present in the blood. A CPK test checks for the level of this enzyme in the blood. Elevated CPK blood test levels reveal that there has been some muscle damage in the body or there is some muscle damage currently taking place in the body. It is therefore an indicator of muscle injury, muscle dystrophy, malignant hyperthermia, myocarditis, myocardial infarction, rhabdomyolysis or myositis. DNR do not resuscitate p. 20He admitted that Sklepios is an FMG, from Greece! … for god’s sake. FMG Foreign Medical Graduate (more currently IMG, International Medical Graduate) p. 21 I’ll be the Chief! Mmmmmh, jaaneman, I knew I could count on you. Jaaneman my soul, beloved p. 22That was a nice bit of doctoring … Nephrolithiasis, your diagnosis is correct. Nephrolithiasis kidney stones MI/AMI myocardial infarction/acute myocardial infarction anterior wall The sternocostal surface of the heart (anterior surface of the heart) is directed forward, upward, and to the left. Myocardial infarction (MI) or acute myocardial infarction (AMI), commonly known as a heart attack, results from the interruption of blood supply to a part of the heart (in this case the anterior wall), causing heart cells to die. INCUBATION p. 31 – ASKLEPIOS, also known as Asklapios (Gr.) and Aesculapius (Lat.), was the ancient Greek god of healing. The etymology of the name Asklepios is uncertain, it may mean “to cut out” based on the story of his birth or it may also derive from ēpiotēs, meaning “gentleness.” MYTHOLOGY Asklepios was apparently more successful than other mortal healers such as Amphiaraos or Trophonios. Nevertheless, knowledge about these two figures is invaluable in our reconstruction of the cult of Asklepios. After proving himself a healer of extraordinary success, serving for instance as genius loci (“guardian spirit”) at the oracle of Tricca and curing the most hopeless illnesses, Asklepios went so far as to resurrect the dead, a display of pride or hubris that greatly angered Zeus. Zeus then cast a thunderbolt at the physician, but instead of killing him, the shock rendered him immortal by way of apotheosis. The history of the divine Asklepios is found in both Pindar’s Pythian Ode and Ovid’s Metamorphoses 11, in which the mortal woman Coronis becomes pregnant with Asklepios, fathered by Apollo. She wants to marry one Ischys in order to legitimatize the birth of the child, but Apollo gets jealous and causes her to be burned to death. While the mother dies on a funeral pyre, Apollo rescues his child by cutting him out of the womb, and entrusts the infant to the centaur Chiron. Chiron teaches the child the art of healing, and Asklepios grows into his role as a god-man (theios anēr). Additional knowledge about the healer is derived, for the most part, from tales about the cures he effected, especially through the process called incubation. The cult of Asklepios is hardly documented, whereas literary evidence of his cures is abundant. Extant are more than seventy case histories from the sanctuaries at Epidaurus, Kos, and the Tiber Island at Rome. Edited with care by priests, the texts have been carved on stone slabs, or stelae. Each gives the identity of the patient, the diagnosis of the illness, and the dream experienced during incubation in the holy precincts. The dream was believed to have been the therapeutic experience resulting in the cure. Upon arriving in the hieron, the sacred precinct, the patient was lodged in a guest house and came under the care of the priests. A series of lustrations for purification, followed by sacrifices, were performed by the patient as preparation for the ritual cure. Baths, in particular cold baths, were always required of the patients. Abundant springs existed in the sanctuaries of Asklepios, but because they were cold rather than warm or mineral baths, the Asklepieia never degenerated into mere spas for pleasure. The preferred sacrificial animal was the cock, as witnessed by Plato (Phaedo 118a), who tells how Socrates, having taken his lethal drink, asks his friends to offer a cock to Asklepios for having cured him of the sickness of life. The patient reported his dreams to the priest and, as soon as he had a propitious dream, was taken the following night to the abaton (or aduton), that is, to the “place forbidden to the ‘unbidden’ ones.” There the patient had to lie on a cot, or klinē (from which our word clinic derives), in order to await the healing experience, which came either during sleep or while he was yet awake from excitement, in other words, by means of a dream or a vision. During this night the patient nearly always had a decisive dream; called the enupnion enarges (“effective dream”), it was considered to constitute the cure. Indeed, a patient not healed at this time was deemed incurable. A small offering of thanksgiving was required at this point; should the patient forget, the god would surely send a relapse. We learn a great deal more about the god Asklepios through the records (iamata) of the healing dreams themselves. If the god manifested himself, he appeared as a tall, bearded man with a white cloak (much like the modern physician) and a serpent staff (the emblem of the healer even today), possibly accompanied by a dog. He was often accompanied as well by his wife or daughters: Hygieia (“health,” whence our word hygiene), Panakeia (“panacea”), Iaso (“healing”), and Epione (“the gentle-handed”). The serpent, the dog, or Asklepios himself by means of his digitus medicinalis (“healing finger”) would touch the diseased part of the incubant’s body and disappear. Such is the pattern of the typical miraculous cure, but many variations were witnessed. Some of the dreams were prophetic (revealing the location of lost property, or the mending of a broken object, for instance), and showed Asklepios to be the true son of Apollo, the god of prophecy. Additional cases are known, however, where the god refused to effect an immediate cure and instead prescribed a specific therapy: the taking of cold baths, attending the theater, making music (analogous to Socrates’ daemon), or writing poetry (as in the case of Aelius Aristides). In yet other cases, he prescribed a certain medicine or applied shock therapy. Rumor had it that Hippocrates learned his art of medicine from the dreams of the patients of the Asklepieion at Kos, the activity of which he tried nevertheless to suppress in favor of his so-called scientific method. After Hippocrates’ death, however, the Asklepieion was further enlarged, and theurgic medicine flourished there all the more, with the result that the Hippocratic physicians, claiming a scientific tradition, were unable to eliminate the cult altogether. Thus, a period followed during which physicians and priests coexisted in the treatment of disease to the benefit of the patients. HISTORY On account of his spectacular successes in healing, Asklepios soon became the most popular deity of the Hellenistic world. His shrines multiplied until no large settlement existed without one. Well over two hundred shrines are known today, and still more are being discovered from time to time. The radius of this explosion was considerable: even today it is possible to find his snakes (elaphē longissima) at the German spa Schlangenbad (“snake bath”). With the rise of Christianity, Asklepios, because of his gentleness and willingness to aid suffering people, came into rather serious competition with Christ, so that the Christian bishops, Theophilus in particular, found themselves compelled to eradicate his temples. At this point, it may be useful to examine the history of the Asklepieion on the Tiber Island in Rome. In 291 BCE a devastating plague ravaged Latium, and neither medicine nor sacrifice had any effect. The Roman authorities sent a delegation to Epidaurus to ask Asklepios for help. The god accepted their invitation and boarded the Roman boat in the guise of a huge snake. When the boat arrived at Ostia and was being drawn up the river Tiber, the snake jumped onto an island (Isola Tiberina) and insisted on dwelling there. A temple was built and dedicated to Asklepios, and the plague subsided. This Asklepieion flourished for centuries, and the island was enclosed with slabs of travertine (a light-colored limestone) in the shape of a ship, the stern of which was adorned with a portrait of Asklepios and his serpent staff. Later, an Egyptian obelisk was erected in the middle of the island to represent the ship’s mast. The temple has since been turned into a Christian church, San Bartolomeo, which is still adorned by fourteen splendid columns from the Hellenistic temple. In front of the altar is a deep well that contains the water of life so indispensable to Asklepios. Still more striking is the fact that, to this day, the Tiber Island remains a center of healing: the hospital of the Fatebenefratelli (trans. The brothers hospitallers, or “do-good” brothers), the best of all the clinics in modern Rome, is located right across from the church. ARCHAEOLOGY Because the Christian bishops were so thorough in destroying the temples of Asklepios, architectural remains are very scanty. However, three things associated with the shrines are worth noting: the theater, the rotunda, and numerous statues. Drama and music were essential elements in the treatments of Asklepios. The theater at Epidaurus is the largest and finest of the ancient world. The rotunda there was the most beautiful and most expensive building of antiquity and was under construction for twenty-one years. Its foundation is a classical labyrinth, and the cupola is covered with Pausias’s paintings of Sober Drunkenness (methē nēphalias) and Eros, the latter having thrown away his bow and arrows to hold instead the lyre. We can only guess at the function of this building. Several of the statues of Asklepios have been preserved, and the best one (from the Tiber Island) is now in the Museo Nazionale in Naples (see photograph). Reliefs illustrating memorable dream events from the abaton are also on view there. The statues of Asklepios are often accompanied by the dwarfish figure of Telesphoros (“bringer of the goal”), a hooded boy who is associated with mystery cults like the one at Eleusis. From Pausanias we know that Asklepios was eventually assimilated into the Eleusinia. ORIGIN OF THE CULT Asklepios’s cult seems to have originated at Tricca (modern Trikkala in Thessaly), where he must have been consulted as a hērōs iatros (“hero physician”). Though excavated, his site there has yielded no further information about his cult. From Tricca, Asklepios traveled in the form of a baby in swaddling clothes to Titane on the Peloponnese. His fame as a healer grew, and he came to settle at nearby Epidaurus. There he ranked already as a god and was recognized by the state cult (as was also the case later in Kos, Athens, Rome, and Pergamum). Epidaurus maintained the cult and the rites associated with it; furthermore, the city founded numerous sanctuaries elsewhere that were dedicated to the god. Two hundred are known to have existed throughout the Greco-Roman world. Migrations of the cult were always effected by transporting one of Asklepios’s sacred snakes from the sanctuary in Epidaurus. The snake was the god in his theriomorphic manifestation, for Asklepios was an essentially chthonic deity (one having origins in the earth), as his epithets “snake” and “dog” amply testify. The snake embodies the capacity for renewal of life and rebirth in health, whereas the dog, with its reliable instinct for following a scent, represents a healthy invulnerability to both illusion and sham. Asklepios probably inherited his dog aspect from his father Apollo Kunegetes (“patron of dogs”). p. 49Reginald Davis’ heart is as good as new. In fact, I believe, his ejection fraction is now 87 percent with a cardiac output of … About … 7.2 liters per minute. Ejection fraction Ejection fraction is a measurement of the percentage of blood leaving the heart each time it contracts. During each heartbeat cycle, the heart contracts and relaxes. When the heart contracts, it ejects blood from the two pumping chambers (ventricles). When the heart relaxes, the ventricles refill with blood. No matter how forceful the contraction, it doesn’t empty all of the blood out of a ventricle. The term “ejection fraction” refers to the percentage of blood that’s pumped out of a filled ventricle with each heartbeat.
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