text:
THE SQUEAKY WHEEL- Missing Mall music: Please just jiggle the handle
Sometimes all it takes to solve a water flow problem is to jiggle a handle. Getting the Downtown Mall fountains working again wasn′t quite that simple. All four Mall fountains have been dry much of the time since spring 2006. These fountains are my favorite Mall sites, and they all seemed to be calling for attention. I contacted Mike Svetz, Charlottesville Department of Parks and Recreation Director, to see if he could get the water flowing again.
Svetz explained that the fountains' water pumps are as old as the Mall, are worn out, and repair parts are hard to obtain and replace. Only one member of the city staff can do the repairs. He promised to expedite repairs as best he could and provided me frequent progress updates.
Partial Success:
In mid-July, just after the Downtown Mall's 30th anniversary celebration, the fountain at Central Place spewed water for the first time in many months. Several weeks later, the fountain at Miller′s awakened. A few weeks after that, the fountain at Chaps started flowing. The fountain at the Nook didn't come alive before winter shutdown. I was disappointed, but three of the four did work for the latter part of the season.
Prognosis for Spring 2007:
I telephoned Svetz again recently to find out the chances of all four fountains operating this spring. He boldly promised that it's not a matter of "if"– he pledged they all will be working!
I don′t generally toss coins into fountains for luck, but I might toss some in this spring and ask for luck in keeping these fountains flowing. I also look forward to thanking Mike Svetz for jiggling the handles– or whatever he did to get the fountains working again.
That is, if I hear the refreshing tinkling of splashing water once the warm weather arrives.
Dry fountains may soon tinkle again.


text:
- July 1: Ford Recalls F-250, F-350 and F-550 Diesel Trucks recalls | 5 days ago
- July 1: Ford Expeditions and Lincoln Navigators Recalled recalls | 5 days ago
- June 11: Ford F-150 Master Cylinder Recall Issued After Crashes recalls | 25 days ago
- June 10: Ford Door Latch Recall Says Pawl Spring Tabs Crack recalls | 26 days ago
- June 4: Ford Mustang Transmission Problems Cause Lawsuit news | 32 days ago
Ford Recall : Wheelchair Lift - Platform Cracking
2013 Ford E-350
If the platform side plates crack, the lift platform can separate from the lift and come to rest against the vehicle's lift door. When the doors are opened, the platform may fall out, increasing the risk of injury to the lift operator. Additionally, if the bearings move out of position, the stowed platform may have excessive movement resulting in failure of the platform mounting. This failure could cause the wheel chair lift platform to fall out of the vehicle when the doors are opened, increasing the risk of injury for the lift operator.
Equipment Adaptive
- Summary
- Mobility Specialists, Inc. (Mobility Specialists) is recalling certain model year 2006-2014 Ford E-250, and E-350 vehicles modified to be equipped with certain model S2005, S2010, S5005, S5010, S5505, and S5510 wheelchair lifts manufactured by Ricon Corporation. The platform side plate of the affected wheelchair lifts may crack. Additionally, the affected lifts are equipped with folding link arms that may have pivot holes that are too big, allowing the bearings to move out of position.
- Actions
- Mobility Specialists will notify owners to take their vehicles to a Ricon dealer or service center who will install supplemental platform support bumpers. Any platform that has already started cracking will be replaced, free of charge. The recall began on November 13, 2015. Owners may contact Mobility Specialists customer service at 1-877-777-5438, or Ricon customer service at 1-800-322-2884.
- Documents (4)
Click a tab for more information.

subset: commoncrawl


text:
Hello everyone,
I wrote most of this post in a specific topic, but as I said there, this isn't something that I want to single out a particular LCCer for, but something that I'd like to bring to the attention of everyone.
As I said there, the Classic-Castle staff is glad to see activity in the MOCs Forum and we certainly don't want to discourage either creating or posting new castle creations...
It takes all of an extra 30 seconds longer to write a new post for the MOCs Forum rather than copying whatever you write for the LCC threads. Bear in mind that the MOCs Forum is intended to showcase the MOCs themselves. This doesn't mean you can't give us the context to understand what is going on--that usually helps the viewer appreciate your MOC--but when things get lengthy or when they get LCC technical, sometimes it's better to link to things rather than include them completely.
So, before you repost something in the MOCs Forum that you've already put in an LCC thread (or that you're about to put there), ask yourself a couple things about the post:
1.) Does the text in my post make sense to any reader or just to an LCC reader?
2.) Could I link to this instead?
As I said before, we're glad to see that the LCC has taken off and given us so many excellent new MOCs to look at, and we do enjoy seeing them--but not all the LCC-specific information is going to make the general reader more interesting in your LEGO building and could in fact discourage them from commenting. Remember that when you post in the MOCs Forum, you're asking for general MOCing/Building comments. LCC-specific comments come from the LCC threads and when there is a lot of LCC information, it should mostly be found only there.
~Formendacil - Moderator


text:
Friday, June 09, 2017 - 1 comment
Winter's Work (Sabbatical Part 1)
There's a famous story told around these parts involving me, a plant with pretty purple flowers, and a pair of scissors. One late summer's day, many moons ago, my roommate told me it would be a good time to harvest the basil from the plant out on the balcony. So with visions of pesto and a well-sprinkled salad dancing in my head, I grabbed the scissors and went outside. A few minutes later, my roommate came into the kitchen and gasped in horror as she saw me rinsing a colander-full of leaves from the one plant the gardener hadn't killed while we were gone over the summer. The basil, with its slightly lighter purple flowers (and, I now know, rather different-shaped leaves) was still sitting happily in one piece in its pot on the balcony. And all I wanted to know was, "Can I still use these leaves in the salad?"
My point? I am not a gardener. Not by any stretch of the imagination.
And yet, despite my uncanny ability - by overactive scissors or watering cans- to kill green things, pretty much alllll the revelations I've had in the last year have involved plants. Well, trees, mostly. Roots and leaves and rings and sap. Buds and blossoms, too. So I've taken to reading articles about pruning and photosynthesis and forest growth just to understand what's being spoken to my own heart.
Last year was a rough year, to put it mildly. An extended summer at home due to wanting to be with my mom through a difficult season of health problems had allowed for a degree of rest, but as I prepared to return to Turkey in November, I felt like I was returning having only "come up to zero." The thought of trying to jump back into life and somehow muster up vision and energy was a tiring one. I felt about like this pathetic little branch - desperately wanting to bear fruit, but lacking any sort of life in my empty hands.
It was then - through some conversations with some wise friends - that I started to sense a call to dormancy. To winter. To a season where this little tree could hunker down, cease all activity, and rest as unto coming back to life.
Dormancy, I learned, is when trees shed their leaves and use all the energy they would have spent "feeding them" for what's happening inside and underground. "It's similar to hibernation, since most animals who hibernate store food as fat, and then use it to run their essential systems during the winter, rather than grow any more. The tree's metabolism also slows down during dormancy... Since it has to conserve the food it has stored, it's best if the tree uses it up slowly, and only for essential functions."
One article talked about the danger of forcing a plant to "skip its period of dormancy" by controlling the temperature and light in its environment. But this dramatically shortens its lifespan and is bad for the overall health of the plant. I realized that by not giving myself the chance to rest and refuel that I so desperately needed, I was doing something that might seem "productive" in the immediate future, but would seriously hinder my ability to make it over the long haul.
So I started to make plans for a sabbatical.
In the time between getting the "invitation" to come away for winter and actually leaving for my sabbatical in Scotland, I would notice bare, leafless trees whose branches had been cut back to stubs and think, "I can't wait to be just like you." While winter often sounds "bleak and depressing", I craved its ruthless stillness.
In its portrayal of the seasons our souls go through, Mark Buchanan's book "Spiritual Rhythm" perfectly captured what I was after:
"Pruning is another winter's work. A tree's dormancy strips the thing to bony nakedness, fruitless, leafless, ugly. A tree in winter is useless and unsightly. But it has this one advantage: you can cut the wood deep, right back to its trunk if you must, and the tree will survive. If it's done right, the tree will be better for it come springtime: stronger, shaplier, more vigorous. Above all, more fruitful."
"Pruning strengthens our core. It takes energy that is dissipated over a wide span, branching every which way, and distills it into the trunk and a few solid arms. That means spring will find you lean and strong, ready to bear much fruit."
"Winter is when you submit to the vinedresser's pruning shears. Winter's not for adding things, but for cutting things. It's the best season - the safest one, actually - to look closely at all the tangled branches of your life - the travel, the committee work, the various projects, the hobbies that have become burdens or obsessions, the trivial pursuits, the diversions; or the ingrown snarl of things, the lists in your head of people and situations to worry about, the proliferation of responsibilities that aren't really yours - and ask honestly if those are bearing fruit or just sapping energy. And then, without apology or even caution, cut to nothing all that gives nothing."
That was my goal.
The end of January was the beginning of my "winter season." It found me in Scotland, on the wind-whipped, rain-drenched, and occasionally (if only for five minutes) snow-graced Ayrshire coast. My spacious, bookshelf-lined room was the perfect introvert's haven, and the bare trees in the glen just a few steps outside my door were the ideal backdrop to my season of being "cut back to nothing." Things might have looked bleak on the surface...but I knew that a deep work was going on underground.
My winter was one of long, bundled-up tromps on the beach, pounding my questions out over miles of dark sand and receiving the peace that came with each wave that lapped at my Wellies. It was strolls through the glen, feeling a sense of kinship with the wintering trees, seeing my own heart in their stripped-bare branches. It was steaming mugs of coffee and rain streaming down window panes and page upon page of untwisting my heart and mind in my journal. It was a table covered in pencil shaving and eraser bits, brush pens and a watercolour palette as I explored new creative ways of expressing what was going on inside of me. It was times of going deep with people who were like assistant gardeners, aiding the Vinedresser as He chopped and pruned, extracting unhealthy thought patterns and beliefs, and getting rid of dead branches so the living ones had space to flourish. It was breathing deeply of fresh, clean air and feeling the tingle of sap flowing through my veins once again.
It was a long stretch of dormancy as unto coming back to life.


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SADNESS AFTER POSTMODERNISM: MOOD IN CONTEMPORARY FICTION by Marija Cetinic A Dissertation Presented to the FACULTY OF THE USC GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY (COMPARATIVE LITERATURE) August 2010 Copyright 2010 Marija Cetinic
Object Description
|Sadness after postmodernism: mood in contemporary fiction
|Cetinic, Marija
|Author email
|firstname.lastname@example.com; email@example.com
|Doctor of Philosophy
|Document type
|Degree program
|Comparative Literature
|College of Letters, Arts and Sciences
|Date defended/completed
|Date submitted
|Restricted until
|Restricted until 02 Aug. 2012.
|Date published
|Advisor (committee chair)
|Lippit, Akira Mizuta
|Advisor (committee member)
Lloyd, David
Norindr, Panivong
|My dissertation project is a comparative study of very recent Anglo-American and post-Yugoslav literary texts that address traumatic experience through experimental forms. What interests me in these texts is the manner in which they treat affect as a form of circulation, rather than as the emotional experience of a particular character. By "affect as a form of circulation," I mean that the feeling of emotions is detached from individuals and thereby becomes the basis of an impersonal distribution of collective experience. The texts that I am studying—including works by Dubravka Ugrešić, David Markson, Salvador Plascencia, Ben Marcus, and Aleksandar Hemon—are characterized by an ambiguous atmosphere of diffuse and unlocatable "sadness"—a tonal quality that emerges as much from their formal properties as from their content. I argue that the new forms and narrative procedures by which these texts transmit the emotional residue of traumatic experience break down the constitution of individual characters and privilege the circulation of affect as a form of exchange and of community.; The dissertation is particularly invested in the politics and the ethics of these experimental literary texts. Trauma theory—as a way of engaging personal and collective experiences of historical catastrophe—has traditionally operated within a psychoanalytic framework that stresses the pathology of the individual subject. Taking up recent work in political theory, my project aims to transform this framework in order to address the contemporary political conditions of globalization, attempting to account for the new forms of transmission and relationality that transnational capitalism has created. My argument is that an adequate understanding of how historical catastrophe functions in this political climate requires a study of how the affective flows that trauma opens create collectivities that are not predicated upon identity categories, and which resist the hegemony of global capitalism even as they are enabled by it. If the operations of capitalism break down national boundaries in order to facilitate the exchange of commodities, my project explores how this opening of transnationality enables other forms of transaction that are not subsumed by the imperatives of the market.; The texts that I study foreground "sadness" as a global condition that circulates as an obstruction underneath or alongside the networks of capital. Sadness is, I argue, the mood of the contemporary fiction I study here. Each chapter of my dissertation focuses on a different mode of such circulation in these texts: archivization, technological connectivity, narration, and the ethics of passivity. The theoretical framework of the study engages extensively with the work of numerous philosophers and theorists, including Jean-Luc Nancy, Gilles Deleuze, Baruch Spinoza, Brian Massumi, Fredric Jameson, and Jacques Derrida. Overall, "Sadness After Postmodernism" aims to make a significant intervention in the manner in which we think about the relation between literature and affect in the context of contemporary politics.
|affect; trauma; mood; contemporary fiction
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|University of Southern California dissertations and theses
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|University of Southern California
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|Los Angeles, California
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|University of Southern California
|Cetinic, Marija
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|Libraries, University of Southern California
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|University of Southern California
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|SADNESS AFTER POSTMODERNISM: MOOD IN CONTEMPORARY FICTION by Marija Cetinic A Dissertation Presented to the FACULTY OF THE USC GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY (COMPARATIVE LITERATURE) August 2010 Copyright 2010 Marija Cetinic


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American English Grammar Review
By Bill Green
Billgreen54 has created this refresher podcast just for you. American English Grammar Review is all about studying English again. Do you remember what verbs do? What about nouns? Do you remember all of your pronouns? What is an interjection? Billgreen54 is an ESL teacher. He has taught over 15,000 hours of English. In this podcast, he shares English in an understandable way. Have fun learning English again!
Listen on
Where to listen
Correlative Conjunctions Explained American English Billgreen54
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July 8, 2020
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Abstract nouns are easy once you understand the basics.
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American English Common Expressions x11 Billgreen54
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July 5, 2020
Ten Common English Expressions Explained Billgreen54
Bill explains ten common expressions with examples in American English.
July 4, 2020
American English Twelve Everyday Expressions Billgreen54
American use expressions in everyday speech. Here are 12 that are extremely useful.
July 3, 2020
American English Six Everyday Expressions Billgreen54
There are countless expressions used daily in the English language. Bill explains a few of the most common.
July 2, 2020
Partitives & Quantifiers American English Grammar Review Billgreen54
Partitives are all about counting the uncountable in English.
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Some & Any Quantifiers American English Grammar Review Billgreen54
Some and any are quantifiers. Used to help refer to how much and how many.
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Last & Ago Adverbs American English Grammar Review Billgreen54
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Time Prepositions & Adverbs American English Grammar Review Billgreen54
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Have & Have Got American English Grammar Review Billgreen54
Have and have got are extremely common in English. Both American and British English use these verbs many ways. Have fun learning American English with Billgreen54!
June 26, 2020
Actions, States, Feelings Explained Billgreen54
Most teachers tell students that verbs are just actions. While that is true, it is not the entire truth. Find out why in this episode with Billgreen54 ESL teacher!
September 16, 2019
Arbitrary Collocations Explained American English Billgreen54
Bill started using the term "Arbitrary collocation" in 2008. This term is extremely useful when teaching English. Bill explains why in this American English lesson!
September 15, 2019
The Adverb "How" Explained American English
Billgreen54 explains why we use the adverb "how." How is just one of the many question words in English. It is also used in positives and interjections!
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Conjunction Review American English Billgreen54
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September 13, 2019
The Job Interview Explained American English Billgreen54
The Job Interview is all about what to say when you need to answer a few simple questions. Bill explains why you should keep things simple!
September 12, 2019
Adverbs and The Perfect Tense Explained Billgreen54
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WH Question Words Review American English Billgreen54
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Modal Verbs of Probability Explained Billgreen54
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Definite Article Explained American English Billgreen54
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September 7, 2019
Present Simple Six Ways American English Billgreen54
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Indefinite Article Review American English Billgreen54
The indefinite article is one of the eight parts of English. The indefinite article can be used for one of something and uncountable nouns. Find out how and why in this easy to understand American English lesson by Billgreen54.
September 5, 2019
Polite Conversation at The Cafe Explained Billgreen54
Polite conversation is always important. This podcast explains with just a few simple words, how to be more polite. Billgreen54 has taught over 15,000 English lessons and created hundreds of videos, podcasts, books all in American English.
September 5, 2019
American English Politeness at The Dinner Table Billgreen54
Do you know the difference between give and hand? They are both verbs, right? Learn why we should use hand instead of give in this podcast episode. Table manners are always a good thing.
September 5, 2019
Modal Verbs at The Cafe American English Billgreen54
Do you know the difference between can and could? Why use one or the other? Billgreen54 explains how to use modal verbs at the cafe in easy to understand American English! Have fun with this episode!
September 5, 2019
American English Comparative and Superlative Adjectives
Comparatives are all about comparing two of something. Superlatives are something else. Find out why we use adjectives in these forms. Billgreen54 explains grammar in easy to understand lessons.
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Superlative Adjectives Explained English Lesson
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Comparative Adjectives Review American English Lesson
Comparative adjectives are used to compare two things, two people and more! In this special podcast, Billgreen54 explains how to create comparatives.
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"How Often" Adverbs American English Lesson
Always, everyday, daily, never... These adverbs and more are all part of the adverb family. Billgreen54 explains with examples how we use adverbs.
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"How Much?" Adverbs Explained Billgreen54 California English
The eight parts of English is the foundation to the English language. How do we ask for something? Why do we use a certain word? Bill offers his insights in this special podcast episode.
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Adverb "When" Explained Billgreen54 American English
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Adverbs and How? California American English with Billgreen54
Adverbs are explained in this episode with Billgreen54. Adverbs are just one part of English. This episode will teach you why we use the word "How!"
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Adjective Vocabulary Explained Two Billgreen54
Podcast English lessons are a great way to study anywhere! Adjectives describe nouns, feelings and pronouns. Study with Bill and learn how to speak California English.
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Adjectives Vocabulary and Pronunciation 1 American English
Adjectives are describing words. Adjectives are just one of the eight essential parts of English. Did you know that the most common adjectives are actually verbs? Have fun with this important American English lesson with Billgreen54!
September 4, 2019
Nouns Are Verbs Lesson Six American English Billgreen54
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Nouns Are Verbs Explained Five American English Lesson.
American English Lesson number five "Nouns are Verbs" is just for students of English. Study the eight parts of English and you are well on your way to speaking English fluently!
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Part Four Nouns Are Verbs Explained Billgreen California English
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Nouns Are Verbs Lesson Three Billgreen54 California English
A run or to run? Verb or noun? Find out in this six part lesson.
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September 4, 2019
Nouns Are Verbs Review One Billgreen54
American English is often difficult to understand. Most teachers fail to explain to students that most nouns are also verbs. Study this podcast for Bill's thoughts and examples. This podcast English lesson is the first in a six part lesson.
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Plural Nouns Explained American English Third Part
Plural nouns explained three is the last in a three part lesson. Billgreen54 offers his thoughts and many spelling examples for plural nouns. Have fun with this podcast lesson.
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Plural Nouns Explained Lesson Two Billgreen54
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Plural Nouns Review One California American English
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Lesson Six Oxymorons Explained American English
Lesson six completes this extended lesson created by Billgreen54 ESL teacher from California. Oxymorons are used a number of ways in English. You can compare oxymorons to phrases with different meanings too!
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Episode five of this six part lesson offers insights and examples in California American English. Look for all six episodes.
September 4, 2019
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Prepositions of Movement Review One Billgreen54
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September 4, 2019
Time Prepositions Explained American English
Time prepositions are limitless in American English. Learn the most common and you will be well on your way to English fluency! Billgreen54 ESL Teacher explains English in simple terms. There are a few basic rules but, most of the time, it is better to learn common English by heart! Have fun with this episode!
September 4, 2019
On In At Time Prepositions American English
Time Prepositions are another fun part of English. There are so many variants. Students often ask me why? Why do we do what we do in English? Where do time prepositions come from? Find out why we use certain word combinations in this episode! Billgreen54 ESL Teacher!
September 4, 2019
Prohibition Words Explained American English
To prohibit is a verb. There are just a few words you need to know in English. Have fun with this simple to understand lesson.
March 29, 2019
Obligation Words Review American English
Obligation words are not difficult with this lesson. Have fun as Billgreen54 explains English!
March 28, 2019
Permission Words Review American English
How do we ask for permission? How do we know we have permission without asking? Bill explains English in simple to understand English!
March 27, 2019
Common Verbs with Infinitive Review
I enjoy travel, traveling or to travel? Which is correct and why? Bill helps explain a few common word combinations.
March 26, 2019
Past, Present, Future, So, Neither, Too Review
Adverbs and conjunctions are used in all tenses. Why and how we do that is explained in this episode!
March 25, 2019
So, Neither, Too Present Tense Explained
So, neither and too come from different parts of English. It is important to understand how they are used. Bill explains in simple to understand English!
March 24, 2019
Quantifiers & Comparative Adjectives Review
What are quantifiers? What are adjectives? How do we talk about things understandably? English is a step by step, day by day adventure! Let Bill help you understand and speak great English!
March 23, 2019
Comparative Adjectives Negative As & As Review
Adjectives describe nouns and feelings. Comparatives are all about two! Comparing two objects with as & as is another way to do it!
March 22, 2019
Present Perfect Simple & Continuous Review 3
Study your adverbs and participle two if you want to communicate in English! The perfect tenses are usually a challenge for most students. Bill explains English in simple English.
March 21, 2019
Present Perfect Simple & Continuous Review 2
Listen again and again to this second in a two part lesson. Present perfect is not difficult if you have studied third form and adverbs!
March 20, 2019
Present Perfect Simple & Continuous Review 1
Present Perfect is usually the last tense studied by ESL students. That is in part because there are many elements that must be learned before! Bill helps explain in this episode.
March 19, 2019
Present Perfect Time Adverbs American English
Adverbs are essential in the English language. Do we need adverbs to form a sentence? No... Do we need adverbs at clearly communicate? Yes...
March 18, 2019
Past Simple & Past Continuous Explained
Past simple and past continuous are often used together. How do we do that? Bill explains in simple to understand English!
March 17, 2019
Irregular Verb Review Three American English
There are something close to 150 irregular verbs used in everyday English! This is the third part of this subject! Have fun with English!
March 16, 2019
Irregular Verb Review Two American English
Verbs are needed to create a sentence in English. Every sentence in English must have a verb to be grammatically correct. Billgreen54 explains English in simple and understandable ways.
March 15, 2019
Irregular Verb Review One American English
How many irregular verbs are used in everyday English? Find out when Bill explains irregular verbs in the first of a two part lesson.
March 14, 2019
Contrasting Linking Words Explained
There are many linking words in English. Knowing how to use them will help you better communicate! Have fun with this episode!
March 13, 2019
Organize & Summarize Linking Words
Bill explains linking words in easy to understand American English. Have fun with this episode!
March 12, 2019
Adding Information Linking Words
How can we add information to our statements. Find out more with Bill as he explains linking words.
March 11, 2019
Linking Words and Results Explained
Linking words and how they are used explained in simple terms by Billgreen54 ESL Tutor!
March 10, 2019
Linking Words Reasons and Why!
Linking words connect other words! That is a simple thought! Learn more with Bill in this episode!
March 9, 2019
"Will and Going to" Tenses Explained
"Will" is a modal auxiliary verb and "Going to" is a phrase. They are used to refer to the same time and more! Bill explains just for you!
March 8, 2019
Present Continuous For The Future Explained
Tenses are used many more ways than most students learn at the early stages of English. Bill explains how to use present continuous for the future!
March 7, 2019
Work Out, Set Up, Take Up Phrasal Verbs
"Take up" has several meanings including "Learn". Bill explains why in this episode!
March 6, 2019
Come On, Come In, Go Down Phrasal Verbs
Phrasal Verbs are always a fun part of English! It's just the way people speak! Bill explains in simple American English!
March 5, 2019
Make Up, Take Over, Come Out Phrasal Verbs
Make up? Is it a phrasal verb or noun? Of course, it's both! Find out more with Billgreen54!
March 4, 2019
Go Out, Point Out, Find Out Phrasal Verbs
Lets go out! What does that mean and how many other ways can we use this phrasal verb?
March 3, 2019
Pick Up, Go Back, Come Back Phrasal Verbs
Pick up can be literal and idiomatic! What does that mean? Find out when Bill explains!
March 2, 2019
Go On, Carry Out, Set Up Phrasal Verbs
Phrasal verbs are all about everyday English. They can be idiomatic or literal and sometimes both! Find out more with Billgreen54!
March 1, 2019
Fourteen Everyday American English Expressions
Literal or idiomatic? Can you see it happening? It's literal! Can't see it happening? It's idiomatic! Have fun with this episode!
February 28, 2019
Thirteen English Expressions Review
No matter what a person says or does, the main idea is to communicate. Bill explains English in simple terms!
February 27, 2019
Eight English Expressions Grammar Review
There are so many ways to communicate in all languages! Expressions are just one!
February 26, 2019
Nine American English Expressions Review
English is always fun to study and learn. The basics start with A, B, C! From there, anything goes! The main idea is to learn how people communicate!
February 25, 2019
Eleven American English Expressions Review
Countless English expressions are spoken every second of every day! Have fun with this episode!
February 24, 2019
Ten English Expressions Grammar Review
English expressions are everywhere! Learn more with Billgreen54!
February 23, 2019
Twelve American English Expressions
To the advanced speaker, expressions are used in everyday speech. Do you need to study common English expressions? Simple answer... Yes! Bill explains a few English expressions that will help you understand others!
February 22, 2019
Six Everyday English Expressions
Phrases, idioms, expressions... These are just a small part of the English language! Why do we need to know expressions in English? Bill explains why and how to use them!
February 21, 2019
Past Simple Verb Grammar Review
The verbs be, do, go, have, are all commonly used in English. Find out why when Billgreen54 explains American English!
February 20, 2019
Past Simple Tense Grammar Review
What is past simple? It is a tense in the English language! Which verbs are commonly used with this tense? Billgreen54 explains grammar in simple to understand ways!
February 19, 2019
Present Simple Verb Tense Review
Present simple? Infinitive? First form? What are the most common verbs used and why? Find out in this episode!
February 18, 2019
Present Simple Tense Review
Now, actions, the past, schedules are different ways we use present simple. Find out more in the episode with Billgreen54!
February 17, 2019
Days & Months Grammar Review
Just seven days in the week and twelve months in the year! What about that pronunciation? Billgreen54 explains with a little grammar and California accent!
February 16, 2019
Ordinal Numbers Grammar Review
Ordinal numbers are all about "first, second, third". Learn more with this grammar review!
February 15, 2019
Cardinal Numbers Grammar Review
Cardinal? Ordinal? Which is which? Find out when Billgreen54 explains numbers!
February 14, 2019
The Alphabet Grammar Review
The alphabet is just the beginning to your language learning journey. Have fun as Billgreen54 uses his California English to help you with your pronunciation!
February 13, 2019
"No Way & Oops" Interjections Grammar Review
Interjections are another fun part of English! Billgreen54 explains English so you understand it!
February 12, 2019
"Ouch & Bravo" Interjections Grammar Review
Positive or negative? Bill explains in the episode!
February 11, 2019
"Alrighty & Okay" Interjections Grammar Review
Did you know that Interjections stand alone! Study English with Billgreen54 ESL Teacher!
February 10, 2019
"My God & Darn It" Interjections Grammar Review
Oh Oh! My Gosh! There are many interjections in English! Study English with Billgreen54!
February 9, 2019
"What & Wow" Interjections Grammar Review
What is much more than a question word! Study English with Billgreen54 ESL Teacher!
February 8, 2019
"Oh Dear & I Never" Interjections Grammar Review
Interjections can be positive, negative and more! Billgreen54 explains English understandably!
February 7, 2019
"No" Interjection Grammar Review
How to use the word "No" as an interjection? Bill explains American English!
February 6, 2019
"Hello" Interjection Grammar Review
Hello:) Hi:) How do they work and why? Billgreen54 explains how to use Interjections!
February 5, 2019
Interjections Grammar Review
What are interjections? How do they work? Billgreen54 explains in this easy to understand audio lesson!
February 4, 2019
Intensive Pronouns Grammar Review
Intensive pronouns! What are they? How do they work? Billgreen54 ESL teacher explains!
February 3, 2019
Reflexive Pronouns Grammar Review
Pronouns replace nouns. That sounds easy. Let Billgreen54 help you with your English!
February 2, 2019
Relative Pronouns Grammar Review
Billgreen54 teaches English in easy to understand ways!
February 1, 2019
Reciprocal Pronouns Grammar Review
Study American English with Billgreen54 ESL Teacher!
January 31, 2019
Possessive Pronouns Grammar Review
Pronouns replace nouns! That's simple! What do Possessive pronouns do? Let Billgreen54 help with your English!
January 30, 2019
Indefinite Pronouns Grammar Review
Indefinite pronouns don't refer to any one thing. Study English with Bill.
January 29, 2019
Interrogative Pronouns Grammar Review
Interrogative pronouns are easy to learn with Billgreen54!
January 28, 2019
Demonstrative Pronoun Grammar Review
Bill explains in easy to understand English. Study demonstrative pronouns with Billgreen54!
January 27, 2019
Personal Pronouns Grammar Review
Personal pronouns are easy when Billgreen54 explains in simple terms!
January 26, 2019
"Pronouns" Explained American English Grammar Review
Latest episode of American English Grammar Review
January 25, 2019
"Recently/Already" Adverbs Grammar Review
Already is used in past simple and perfect!
January 24, 2019
"Quickly/Fast" Adverbs Grammar Review
Fast is both an adjective and adverb!
January 23, 2019
"Slowly/Carefully" Adverbs Grammar Review
Slowly and carefully are used in everyday speech!
January 22, 2019
"Rarely/Seldom" Adverbs Grammar Review
Some adverbs are often used the same way in English!
January 20, 2019
"Usually/Hardly" Adverbs Grammar Review
Adverbs are used in everyday speech!
January 19, 2019
"Always/Never" Adverbs Grammar Review
Always is used in present simple and perfect tenses!
January 18, 2019
"Still/Lately" Adverbs Grammar Review
Adverbs are one of the most important parts of English!
January 17, 2019
"Since/For" Adverbs Grammar Review
Since is used for a point in time and more!
January 16, 2019
"Just/Yet" Adverbs Grammar Review
Just and yet are used in the perfect tenses and more!
January 15, 2019
"Ever/Never" Adverbs Grammar Review
Adverbs are one of the eight parts of English!
January 14, 2019
"Both/And" Correlative Conjunctions
Correlative conjunctions are words used in combination with each other.
January 13, 2019
"Not only/But also" Correlative Conjunctions
Correlative conjunctions are used in pairs!
January 12, 2019
"Either/Or" Correlative Conjunctions
Correlative conjunctions are all about more than one!
January 11, 2019
"For" Conjunction Grammar Review
What is a conjunction?
January 10, 2019
"So" Conjunction Grammar Review
Conjunctions are just one of the eight parts of speech!
January 9, 2019
"Or" Conjunction Grammar Review
Conjunctions are always a fun subject!
January 8, 2019
"And/But Conjunctions Grammar Review
Study conjunctions and understand English faster!
January 7, 2019
Correlative Conjunctions Grammar Review
Correlative Conjunctions are always an interesting subject!
January 6, 2019
Subordinating Conjunctions Grammar Review
What are subordinating conjunctions?
January 5, 2019
Coordinating Conjunctions Grammar Review
How to use coordinating conjunctions?
January 4, 2019
Preposition "In" Grammar Review
The preposition "In" is a place preposition.
January 3, 2019
Preposition "On" Grammar Review
The preposition "On" is a place preposition.
January 2, 2019
Preposition "At" Grammar Review
The preposition "At" is a place preposition.
January 1, 2019
American British English Grammar Review
What's the difference between British and American English?
December 31, 2018
Movement Prepositions Grammar Review
Movement prepositions are all about actions.
December 30, 2018
Place Prepositions Grammar Review
The most common place prepositions are "In, On, At".
December 29, 2018
Time Prepositions Grammar Review
Time prepositions are all about collocations from the past!
December 28, 2018
By, Next to, Beside Preposition Grammar Review
By, next to, and beside can be used interchangeably.
December 27, 2018
Arbitrary Collocations Grammar Review
What are arbitrary collocations? Actually, I created this term!
December 26, 2018
Prepositions Grammar Review
Prepositions are all about "place, movement and time".
December 25, 2018
Adverb Adjective Grammar Review
How are adverbs and adjectives connected? Many adverbs are created using an adjective. Like or likely? High or highly? Slow or slowly? Which is which and why? Speak fast with better English!
December 24, 2018
Superlative Adjective Grammar Review
The biggest! The coldest! The prettiest! These are all superlative adjectives to learn. Compare more than one, two or more with superlatives! Study with Billgreen54!
December 23, 2018
Possesive Adjective Grammar Review
Here is a short and simple explanation by Bill to refresh your memory or maybe help with a part of English you didn't know! Have fun with English!
December 22, 2018
Feelings Adjective Grammar Review
How to describe feelings? He is sad:( She is happy:) They are kind! Feelings are easily describes with a few simple adjectives! Learn more with Billgreen54!
December 21, 2018
Personality Adjective Grammar Review
She is artistic! He is creative! They are intelligent! These are all personality adjectives. Adjectives are describing words. Have fun with English!
December 20, 2018
Noun Adjective Grammar Review
What is a noun adjective? It's a noun that describes another noun! Remember that a word is just a word until we give it a job!
December 19, 2018
Comparative Adjective Grammar Review
How do we compare things in English? This one is bigger! That one is better! Hers' is prettier than his! Adjectives are describing words. Compare two and now you know how! Learn English with Billgreen54!
December 18, 2018
Demonstrative Adjective Grammar Review
This and that are two of the most used demonstrative adjectives. This grammar review will help remind you of what adjectives do. Have fun with this one!
December 17, 2018
Noun Modifier Grammar Review
A noun modifier is a word that changes another word. This could be an adjective, an adverb. Words that modify a noun to help better understand or describe. Learn more with Billgreen54!
December 16, 2018
Predicate Noun Grammar Review
Nouns are always an interesting subject! Predicate nouns are no exception! A predicate noun is a word that renames or provides more information. Learn more with Billgreen54!
December 15, 2018
Proper Noun Grammar review
Mr. Jones, Bill, Larisa, Chicago, Florida... These are all proper nouns. There are many rules and examples! En easy way to remember a proper noun is to know that there is usually just "One"! Speak more with Billgreen54!
December 14, 2018
Collective Noun Grammar Review
Collectives represent a group! They are uncountable! In other words, we can't use an "S" to form a plural! Furniture, money, electronics, fruit, vegetables are all collective nouns. Have fun with Billgreen54!
December 13, 2018
Abstract Noun Grammar Review
Abstract nouns are all about a quality, idea or state! They are just the opposite of concrete nouns! In other words, we can't touch, smell or taste abstract nouns! Learn more with Billgreen54!
December 12, 2018
Count Noun Grammar Review
Count nouns are just what it sounds like. We can count "count nouns"! Chair, table, book, pencil are all count nouns. Study more with Billgreen54!
December 11, 2018
Gerund Grammar Review
Gerunds are verbs that act like nouns! We do this by adding "ing" to a verb after a state verb! An example would be "I like walking with Larisa" Like is a state verb while walking is now a noun known as a gerund!
December 10, 2018
Mass Noun Grammar Review
Mass or uncountable nouns are nouns we can't technically count! Sugar, rice, water, coffee are all mass nouns. Learn more with Billgreen54!
December 9, 2018
Compound Noun Grammar Review
Nouns are just nouns, right? Not really! There are many types of nouns. A compound noun is two nouns put together. A compound noun can also be a word created with a noun and adjective! Learn more with Billgreen54!
December 8, 2018
Concrete Noun Grammar Review
Concrete nouns refer to things we can touch, see, hear, smell! The five senses play an important role here. Can you touch it? It is a concrete noun. Learn more with Billgreen54!
December 7, 2018
Common Noun Grammar Review
Nouns are all about "People, Place, Thing" right? Well, maybe:) Nouns can be used many different ways. Common nouns are usually easy for most students. Have fun with This subject!
December 6, 2018
Action Verb Grammar Review
Run, jump, dance, walk... are all action verbs! In English, there are many different types of verbs. Action verbs are usually one of the easiest parts of English to learn! Learn more with Billgreen54!
December 5, 2018
Present Participle Grammar Review
Most ESL students never learn the term "Present Participle". Why is that? Teachers just don't think of teaching English grammar terminology most of the time. Present participle is simply "ing". Speak more with Billgreen54!
December 4, 2018
Stative Verb Grammar Review
Think, see, listen, hear, smell, have! These are all stative verbs! State verbs are all about facts as opposed to actions! Learn more with Billgreen54!
December 3, 2018
Infinitive Verb Grammar Review
Verbs in the first form or infinitive verbs? What are they? Actually, they are both the same. Questions, negatives, positives! When do we use them? Find out more with Billgreen54!
December 2, 2018
Past Simple Grammar Review
Regular or irregular verbs? Present simple or past simple? Which is correct and why? Here are simple answers to these questions! Learn more with Billgreen54!
December 1, 2018
Past Participle Grammar Review
Infinitive, past simple, past participle! What are they? They are the three verb forms in English! Past participle is important for many reasons. Did you know that many past participle verbs are also adjectives? Have fun with this subject! Study more with Billgreen54!
November 30, 2018
Auxiliary Verb Grammar Review
What are auxiliary verbs? They are words that help other verbs. All continuous tense use at least two verbs. Auxiliary verbs help with time and full verbs help with the action or state!
November 29, 2018
Verb Too Grammar Review
Verbs are used so many ways in English! Most nouns are verbs and many verbs are nouns. Remember that a word is just a word until you decide how to use it. Is it an action? Is it a thing? Billgreen54 teaches more!
November 28, 2018
Empty Verb Grammar Review
What is an empty verb? It is a verb that has no single definition. Empty verbs are used many different ways. They often replace natural verbs! Learn more with Billgreen54!
November 27, 2018
Modal Verb Grammar Review
Modal Auxiliary verbs are used many ways in the English language. Why are they called auxiliary verbs? Because they are always used with another verb! Lets find out more with Billgreen54!
November 26, 2018
Negative Question Grammar Review
Negative questions are one of the most polite ways to learn more about someone or something. There are many ways to ask for something in English. This is just one! Study with Billgreen54!
November 25, 2018
Partitives Grammar Review
One can of soda! One pound of sugar! Two gallons of water! Five bottles of milk! These are all partitives. It is another way we determine how much or how many!
November 24, 2018
Indirect Request Grammar Review
Why would someone ask for something indirectly? Good question, right? Find out why we ask questions in so many ways. Study English with Billgreen54.
November 23, 2018
Passive Voice Grammar Review
Passive voice is when we reverse the object and subject. Bill wrote that book! or That book was written by Bill! Which is more common and why!
November 22, 2018
Indirect Question Grammar Review
Direct or indirect? Which is better? Actually, speakers of English use both. It is possible that indirect might be a little more polite! Have fun with this lesson!
November 21, 2018
Meeting and Hello Grammar Review
Meeting someone for the first time should be easy in English. As an ESL student, it may not be so easy without a little practice! Join Billgreen54 for this simple lesson!
November 20, 2018
Determiners 2 Grammar Review
Determiners come from many parts of the English language. What is a determiner? Find out with the detailed grammar review!
November 19, 2018
Question Tag Grammar Review
Question tags are another fun part of English to study. This grammar is normally taught at the intermediate level. I like teaching it at the elementary level for a number of reasons! Study English with Billgreen54!
November 18, 2018
Goodbye Grammar Review
Goodbye! So long! Bye for now! See you! These are all ways to depart from someone. Are they all polite? How common is the word "Goodbye" in American English? Billgreen54 explains!
November 17, 2018
Time Adverbs Grammar Review
Time adverbs are just one part of the English language. Adverbs and how they are used is one of the most important pieces of the English language puzzle.
November 16, 2018
Quantifier & Partitive Grammar Review
Quantifiers help use determine how much, how many and more! Partitives are all about a glass of, a bottle of and more! Have fun studying with Billgreen54!
November 15, 2018
Determiner Grammar Review
Determiners are another interesting subject! Determiners are words that help use know what noun we are talking about. Study English with Billgreen54!
November 14, 2018
Active & Passive Voice Grammar Review
Passive voice is often a mystery to most students of a second language. Why? Because most students who study English as a foreign language stop studying at the elementary level.
November 13, 2018
Interjection Grammar Review
Interjections are always fun to study! Just about any word in English can be an interjection! Did you know the word "Yes" is an adverb? Did you know that it is also an interjection?
November 12, 2018
Adverbs Grammar Review
Adverbs are probably the most important part of the English language. Adverbs do so many things. Adverbs modify verbs, adjectives, phrases and other adverbs!
November 11, 2018
Verb Grammar Review
Verbs are easy once you get the hang of it! Did you know that most verbs are nouns and are other parts of English too!
November 10, 2018
Pronoun Grammar Review
So, what is a pronoun? Pronouns relace nouns! There are many different pronouns in English. Study English with Bill! Have fun!
November 9, 2018
Adjective Grammar Review
Why do we need adjectives? There are many reasons! Adjectives are describing words. Take the time to learn adjectives again with Billgreen54 ESL Teacher!
November 5, 2018
Preposition Grammar Review
Prepositions are an interesting part of English. Place prepositions "in, at, on" are used in countless ways. Study English again with Billgreen54. Have fun with prepositions!
November 5, 2018
Conjunction Grammar Review
Conjunctions explained in understandable American English by Billgreen54! What are conjunctions? What do they do? Study English again with Bill. Have fun with conjunctions!
November 5, 2018
Noun Grammar Review
What is a noun? People, place, thing! Easy right? Well maybe for some. For others who studied English in grade school, have fun studying the basics again with Billgreen54 ESL teacher!
November 5, 2018
Prefix, Suffix, Affix Grammar Review
Join Billgreen54 ESL teacher for this interesting and informative review of affixes. Bill shares grammar in a simple and understandable way!
November 5, 2018


text:
Monday, March 19, 2007
Knot Really
Of all the strongly-held beliefs imparted to me in training (and the list is long, indeed), using which suture under what circumstance may be at the top of the list. Emphasis on "strongly" as the operative criterion. That various surgeons had widely divergent views on the matter didn't diminish the near religious intensity of those beliefs. Woe be to the trainee who even questioned it: and forget about actually making up your own mind. If you were working with Doctor X, you used his/her preferred suture. At some point, it's likely you'd hear each one's reasons. Everyone had an understandable basis, I suppose. It's just that it turns out most of them were wrong. Some stuff never really made any sense; other things changed as materials improved, so I guess the old guys should get a pass.
Before getting to the meat of the matter (I could make it a pretty long and ultimately boring post if I enumerated all the examples), here's one thing I'd bet each surgeon has had etched deeply into his/her sensibility: how long the "tails" ought to be when cutting suture. As if giving the most precious of gifts, generous beyond the call, the senior surgeon would allow a new intern to cut the suture he'd just tied. In tern, the young fellow/fellowette would tremulously apply the scissor beyond the knot and snip, knowing with near-certainty that the move would be followed by the loudly-declared "That's too long!" or "That's too short!!" In fairness, too short could lead to a knot untying itself (at least if poorly tied and/or finished off with too few throws [another imprint: how many throws is just right?]). The result, over time, is a stone-carved sense of proper appearance of those two little ends, variation from which can cause a physical sense of unease. It took me many years to realize: the suture may have been placed, for example, around a munch of muscle in closing an incision such that its entire length is well over an inch, maybe two. What possible difference can it make if the ends are a couple of millimeters "too long?" And now, I can tell you, tying and cutting knots laparoscopically -- which gives a very close and magnified view -- can distort one's sense of proportion beyond repair. But enough of minutiae.
The only time I've used wire suture on my own patients was on the trauma service at the county hospital. There, our chief of service insisted on it: wire suture was strong as hell and, more importantly for traumatic and therefore typically contaminated wounds, it was highly unlikely to become a nidus for infection. Despite the fact that tying it many times a day literally rubbed the ulnar aspect of our palms raw and often bloody, and that the knots tended to be uncomfortable (even though we carefully bent them downward) under the skin of the patients and frequently required later removal, it's what we used. Period. Embedded in my brain, the need to close such incisions with wire extended briefly into my early practice days until I was convinced (didn't take much) that the new strong-as-steel but soft and comfortable dissolving materials worked just fine. To his credit, the chief (one of my heroes!) later published a paper confirming the efficacy and he abandoned wire.
At our weekly conference wherein the chief residents on all the various surgical services presented their data, including all complications, one of my friends was profoundly excoriated for brazenly flaunting the party line and closing a long midline abdominal incision with a single running suture in the muscle layer. With no exceptions -- no matter the size and material of the sutures -- no one, NO ONE, closed that layer in any way but with single interrupted stitches, placed and tied one at a time, laboriously, plentifully. Having read some papers on continuous closure, Jerry thought it made sense and gave it a go. Sadly, being at the VA hospital, he unwittingly used nylon material that had been sitting around in storage, left there by George Washington not long after he'd crossed the Delaware River. Brittle and aged, it broke, resulting in a rather dramatic (but ultimately devoid of long-term consequences) reappearance of the man's innards, not in the operating room but in his bed. Yuck. The professors, on hearing the report, went ballistic: the stupidest thing they'd ever heard of. Reckless, idiotic, no understanding of wound healing. Righteous yada yada, indignant. Poor Jerry. Now an internationally respected and universally admired and loved academic surgeon, that was a bad day for him. Suffice it to say, very shortly after finishing training I came to close nearly all of my major incisions with a running suture and never -- not once -- had a reason to regret it. Not only does it save significant time, studies have shown healing is facilitated and pain is less. Who knew?
Wounds heal between sutures. In other words, the tissue actually grasped by the stitch, being squeezed, often doesn't get adequate circulation. More so, the tighter the stitch, the smaller the bite, the more closely placed to the neighboring one. Individually placed and tied sutures, in other words, potentially provide innumerable micro-zones of ischemia. With a running suture, there's essentially no crimped zone. You can, of course, screw anything up. The important thing, in my opinion, is to take larger bites than most people take, and to cinch up the suture gently, getting the edges just together. Otherwise, if I were letting an intern do it, I'd holler "too loose," or "too tight!!"
(Only the very hip will get the photo-pun. And I'm nothing, if not hip.)
14 comments:
- Lynn Price said...
As always, you throw out an interesting post. I'm in the middle of writing a chapter where the doc is teaching med students how to do stitches on chicken legs - really happened when we were in the Amazon jungle - and find your comments helpful in giving me added reality.
As an old seamstress from another age, I always feared the running stitch because if one end came undone, bango, my daughter's prom dress could be in a heap on the dance floor. A lovely sight for her date, agonizing hell for Daughter. Even more agonizing hell for Mother. I assume that the surgeon's running stitch is far stronger and less likely to unravel than a seamstress', yes? If so, how?
Another question: Why do docs call it "throwing down" a stitch? Makes it sound like you have a bag of them and you reach in and toss one into an organ.
"(Only the very hip will get the photo-pun. And I'm nothing, if not hip.)"
God, I'm so uhip. I give. What's the pun?
- Sid Schwab said...
lynn: the suture material I used for running closure was big and strong. #1 vicryl, to be specific. It's absorbable, meaning it entirely disappears, but only after at least a couple of months, by which time it's all healed. It's impossible to break the stuff, and it's quite thick so it won't pull through. Barring manufacturing defect (which I've never seen or heard of), and assumint the initial and final knots are well-tied, ain't no way it'll come loose.
"Throwing down" (not a universally used phrase, I'd say) refers, I think, to the act of tying each knot, as opposed to place the stitch in the first place. When tying one-handed, the loop is made and sort of thrown down to the knot with the index (or sometimes the middle) finger. Sling, push, pop.
And I'm waiting until I see if anyone gets it before explaining the pun.
Here's a hint: right click on the image and then go to [save image as]...
ps Dr. Schwab, I loved your book (I think I read it all in one sitting - couldn't put it down)... please keep your illuminating posts coming.
- Lynn Price said...
"Here's a hint: right click on the image and then go to [save image as]..."
I got that when I clicked directly on the photo. I figured the guy was a rapper named Too Short. Being an old broad, I don't do rap, so I can only guess.
Thanks for the explanations, Sid. I've heard that term "throwing down" from any number of places.
Still loving your book. Wish I could just sit and eat it up in one sitting like Anon did. Lucky stiff!
on suturing: approximate, don't strangulate
I was told that there were two ways that the medical student can cut a suture: too long and too short. This is true.
One fellow student was set on getting things exactly right and was allowed by an attending doc to close. True to form, Dr. Attending yelled, "Too short! Too long! I want them one centimeter [pronounced the bizarro-surgeon way as "sahnnimeeter"], exactly!" He called for a sterile ruler. Still, the sutures ran 1.2cm, 0.9cm, 1.1cm... Student sees his surgical career fading incrementally with each millimeter (the sutures were plentiful, as Dr. Schwab notes, and the running commentary was interminable). At the end, the surgeon said "Good job!" and walked out laughing. Don't know what specialty the student ended up in.
Don't know what specialty the student ended up in.
Malpractice attorney.
- Bongi said...
one thing i've learned in the blogosphere is that the surgical world is small. our old (very old) professor used to say centimeter in that same way, "sahnnimeeter". i just thought he was old and perculiar. once again i see there is nothing unique to us but rather a constant thread that binds us all together.
i feel a tear welling up in my eye...
- Bard-Parker said...
I myself am a big fan of the double-stranded #1 PDS. The loop eliminates the need to tie in the corners and you can start one from either end and tie in the middle.
Of course if all else fails there is the old retention closure with the "dead man's stitch" of #2 nylon with cut up red rubber catheters.
- Sid Schwab said...
Yep, been there, done those!
It must be a surgeon thing:
English speaking surgeons using the French pronunciation for "centimeter";
another favourite, of course, is "debridement".
My ortho surgeon used staples to close the wound. Because of a planned trip I had to ask him to remove them several days before it was scheduled. Have to say each snip (fourteen) smarted but was not unbearable! Now, nine months later, there's hardly a visible scar.
I finished your book in one setting, also! It was great. Love your blog and hope you write another book!
- Dr. Rob Oliver Jr. said...
Sorry Sid, but Vicryl & other short-acting absorbables for closing laparotomy incisions have substancially higher hernia rates then PDS, Dexon, or the permanent sutures (steel, nylon, polyester). Your other comments I agree with 100%.
- Sid Schwab said...
Hmm. I always thought of dexon and vicryl as interchangeable: both polyglycolic acid. Our hospital bought vicryl. I used #1 vicryl for running closure, and had no problems with it.


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Photo on Flickr by Night Owl City
That's why I find those first classes very important for the rest of the course. Ideally, by the end of the first two weeks, everyone will have relaxed. In order for this to happen, everybody should get to know everybody else. The students should get to know each other and some sort of group spirit should emerge. The teacher should get to know the students and adapt the course to their interests and learning styles. Last but not least, the students should get to know the teacher. Students will relate better to your subject if they get to know the real you.
In no particular order, I am going to share some of the activities I use during the first two weeks.
When I attended CRELL two years ago I learnt the following two warmers that I have been using ever since:
Here is the original description of the activity from the CRELL lesson plan:
1. Tell students they are going to introduce themselves by sharing something about their first, middle, or last name. If you have a large group, you may want to have students work in small groups to share the story of their names. Begin the activity by modeling it and sharing something about your first, middle, or last name.
2. After each student has shared with the group, lead a whole class discussion using some or all of the following questions.
This is what I shared in the CRELL forum:
"My name is Natasa. The name was derived from Latin "Dies Natalis", which means Christmas Day. It is really strange, but my maiden name, Bozic, means exactly the same thing, only in Serbian. So my name and my surname are synonyms. I like the idea of being protected by these Nativity symbols. I was named after my maternal grandmother. Her name was Natalia, but my parents shortened it to Natasa, which was more popular at the time. When I was a little girl, I didn't like my name (I guess that's usual for little girls), but now I am glad I was called after my grandmother. She died when I was nine and she was an important figure in my childhood. She was a truly good person. When I got married, I added my husband's surname to my maiden name. I wanted to keep "Christmas" with me and I felt that by that time the surname was a part of who I was. I also did it because I am an only child and my father was no longer alive. My married name is very rare – I have never met anyone outside my husband's family called Grojic. We believe that somebody made a mistake at the Registry Office a long time ago and wrote Grojic instead of the very common Grujic. I always have to spell it to people and they usually get it wrong – they write u instead of o. My husband says that with time I'll stop paying attention and let them write whatever they want."
I always share this story with the students first before I ask them to do the same. It helps them understand what I want them to do. It is a great way for everybody to learn everybody else's name.
Here is what the CRELL lesson plan says:
"In this activity we would like you to think of a way to represent yourself to the other participants in our session by drawing a symbol. You can use Word Drawing or another program to draw your symbol. You can also hand draw your symbol and scan your picture, then download it to the correct folder. Please create an original drawing instead of downloading clip art or a photo. Below your symbol, please provide a brief explanation of how this symbol represents you."
This is what I did:
"I chose the candle as my symbol. When I was a student, I used to draw candlesticks on the margin of my books. Maybe it had something to do with burning midnight oil, or maybe (and I prefer this second explanation) it had something to do with the quest for knowledge. Candle represents light, as opposed to darkness. It represents knowledge and wisdom. It shows us directions when we are lost and, if we leave a candle in the window, our dear ones will find us. We light candles to remember both the living and the dead. Our lives might be "like candles in the wind", but if we live them with passion and if we bring some light into the lives of others, we will live forever. The flame is eternal."
Again, I would share the story with the students first, maybe even try to draw my symbol on the board. Then I would ask them to do the same. I teach adults so I usually wouldn't ask them to draw their own symbol in one of our first classes (they are scared enough even without me asking them to draw). I usually share a ready-made lesson plan instead. It is a lovely little lesson plan from the Inside Out website and it is called You In Pictures. A whole collection of these plans can be found here and You In Pictures is the first one. Please allow the time for the booklet to download.
I learnt this activity from my colleague Zorana who teaches German at my school. Students sit opposite each other in pairs and they have five minutes to talk to each other. After the time is up, everybody moves one seat to their left, so that they talk to somebody else. The goal is similar to speed dating - to find out as much as possible about their partner. Before the students start talking to each other, I ask them to write down five or six questions that they are going to ask everybody in the class, although, of course, improvising additional questions on the spot is most welcome. At the end of the activity, I ask each student to share the most interesting question they were asked.
Photo on Flickr by Rocket Ship
Students are given some time to prepare a one-minute talk about something they are passionate about. It can be a hobby or simply a topic they are very interested in. After each student has delivered the speech, others ask follow-up questions. At least three questions should be asked.
In pairs, students talk about what sort of questions they hate being asked, then they share the questions with the rest of the class and they explain why they hate talking about the topic. Those can be typical 'taboo questions' like asking about somebody's weight, or simply the questions the students find boring or intrusive. Very useful feedback for the teacher.
This is a writing exercise. Students are asked to write something about themselves in 150 words. I would share my own Twitter bio (mother, wife, EFL teacher, Webhead, blogger, writer lifelong learner, daydreamer, geek, insomniac) as an example.
I borrowed this from a blogging challenge I participated in. Here is my original post on what an elevator pitch is. An elevator pitch is similar to a Twitter bio, but it should be delivered orally. Students should introduce themselves to others in no more than 150 words.
I like to do this as a mingle activity. Students circle around, delivering their elevator pitches to each other. They should listen to other elevator pitches carefully, but they shouldn't write anything down. Afterwards, I ask them to recall anything they can remember about the people they talked to.
One of my favourite photocopiables is Group Work Intermediate. Activity 2 (Get to know your group) contains 64 great icebreaker questions that can be exploited in different ways. I often use those during the first two or three weeks of the course.
I could go on and on, but I am going to stop here for the moment. This post is very long as it is.
Please let me know what you think. Your opinion is, as always, very important to me.


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axiUm is the dental school's clinic management system. It integrates multiple functions and processes across a wide range of departments within the dental clinics, as well as the dental school as a whole. axiUm has transformed and updated many aspects of how the dental school functions through the use of new hardware, electronic patient records, and more.
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Jon Hamm looked bummed out when Mad Men won for Best Drama. Jon Hamm also has a man-crush on Coach Taylor. This is why we love Jon Hamm. Who looked, as usual, very handsome last night. And very chivalrously helped several ladies up on stage. And he loves his lady so much, Jennifer Westfeldt, which is why I wish, I wish so much, she would stop with the nonsense all up in her face. Because whatever she's trying to fix with all that sh-t, it cannot be fixed with a needle or a filler, and this was the perhaps too-subtle point I was trying to make last week: she is too smart to be fighting it this hard; but a girl who is fighting it this hard, well, that's a girl who's probably holding on really, really too tight, right?
One day a few years ago, Antonio Banderas looked at his wife Melanie Griffith and he told her, "I love you so much, only you, and this is why I cannot accept any more plastic surgery because you don't need it, I will still love you when you stop, I will always love you so please stop."
Supposedly she did.
I wonder if Jon Hamm will say the same to Jennifer Westfeldt. I wonder if he will tell her that she is bright and talented, that she can write and create, that she is more than just a witless starlet running around pretending to be 25 forever, and that as such she doesn't have to paralyse her face anymore, because it's so much more interesting when it moves.
I hope he tells her that every day and she listens. I hope she listens and they make it.
Westfeldt's Friends With Kids which screened at TIFF last week was just acquired yesterday by Lionsgate. I didn't get a chance to see it but several of my colleagues did, and LOVED it.
September 19, 2011 at 4:37 AM
He turned out to be the cliché


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