eight texts

plumber’sbible

the

BUFFALO BILL’S .......... 5e.e. cummings

DIAGNOSIS: MADNESS .......... 11dr. lisa sanders, m.d.

POUR UN TOMBEAU D’ANATOLE .......... 21stéphame mallarmé

IT’S NOT OK TO ACT THIS WAY .......... 35 kama brown

SPOKEN & WRITTEN .......... 53 ferdinand de saussure

A HISTORY .......... 61leah lauber

YIELD: 2 LOAVES .......... 71mark bittman

A CONVERSATION .......... 79david foster wallace

TABLE OF CONTENTS

5

Buffalo Bill’se.e. cummings

6

Buffalo Bill’s

watersmooth-silver

defunctwho used to

and break

ride astallion

11

Diagnosis: Madnessdr. lisa sanders, m.d.

12

Sudden

What could be driving this man crazy?

13

OnsetA CRY FOR HELP

A TERRIBLE FALL

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

Three months earlier, the patient, a 55-year-old man who suffered from depression and alcoholism, was admited to the same hospital after falling down the stairs in his home. He wasn’t found for two, possibly three days. Because of his injuries and this delay, when he was discovered, he was close to death. His kidneys had stopped working, and his body chemistry was completely out of whack. On the way to the hospital, his heart stopped, and he had to be shocked back to life.

The patient remained in Waterbury Hospital in Connecticut for five weeks (where I was one of his doctors), three of them in intensive care. Even after these weeks of care, the toll of his injury was terrible: his kidneys were still not working, so he required hemodialysis three times a week; his arms and legs were so weak that he could not even lift them. He was unable to swal-low and had to be fed through a tube. When his sister visited him there, she barely recognized him. His slender body was bloated. He had tubes everywhere. He could do little more than whisper. Still, she saw that he was slowly improving. He had to started to smile and make jokes despite his many disabilities. After five weeks in the hospital, he was transferred to a short-term rehab facility.

A SLOW RECOVERY

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After two weeks in rehab, something changed. He started talking to people no one else could see. He feared they wanted to harm him. When the hallucinations persisted for a second day, he was sent to the emergency room at Waterbury. The patient told the E.R. psychiatrist that he was seeing people he knew couldn’t be there. Despite the hallucinations, he was calm and clear. He told the doctor that he thought the visions began after he recently started taking a new sleeping pill. That made sense to the doctor. Delirium is an un-usual but known side effect of that drug. He put the patient on a different sleep medication and returned him to rehab.

DELIRIUM

SEEING THINGS

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

BLOOD COUNT: Anemic but unchanged from previous tests

Abnormal because of the kidney failure, but unchanged from previous tests

Abnormal, with white blood cells and bacteria suggestive of an infection

Unremarkable

Unremarkable

TEST RESULTS

BLOOD CHEMISTRY:

URINE TEST:

HEAD CT:

CHEST X-RAY:

15

INFECTION & CONFUSION

WORSE & WORSE

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

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

TOO MUCH OF A GOOD THING

High serotonin levels can lead to something called serotonin syndrome. This rare, potentially life-threatening disorder is characterized by increased body temperature, increased heart rate and blood pressure and muscle hyperreactivity. Windish had never seen a case of it. She and the team read up on it, and while the diagnosis seemed to fit, there was no definitive test. She stopped the antidepressants and asked the neurologist on duty to double check the diagnosis. He agreed, and they put the patient on a drug that blocks serotonin. The response was remarkable and immediate. Within 24 hours the patient was alert and talking. His hallucinations were gone, his heart rate and blood pressure normal, and tremors resolving.

16

UNRAVELING THE MYSTERY

KEEPING THE RECORD STRAIGHT

How had this patient developed serotonin syndrome? When he was sent to the Waterbury emergency room, he was taking two antidepressants. He was on one for years, but no one, including the patient, knew when he started the other. A phone call to the rehabilitation center resolved the mystery. The patient was seen by a psychiatrist there two days before his E.R. visit and was given a second antidepressant and the sleeping pill. The patient was also taking a heartburn medication that raised his serotonin level. After one dose of the new antidepressant, he began to have hallu-cinations and his blood pressure and heart rate went up. No one in the rehab center connected these symptoms to the new antidepressant. And when he went to the E.R., no one knew that he had been given a new serotonin-increasing medication.

Effectively conveying medical information is essential. Yet, as patient care is shared with more providers and institutions, this basic necessity has be-come more difficult to manage. The electronic medical record was sup-posed to help. Waterbury Hospital uses electronic records, but the rehab facility does not. And even if it did, electronic sharing between institutions is rare. This patient is recovering. He’s walking - although with a cane. The hospital psychiatrist didn’t think he was depressed, so he’s not taking any antidepressants, and he feels just fine.

17

A SELECTION OF READERS’ RESPONSESMore than 200 readers commented on this case after it was posted on The Times’s Wellblog on Feb. 7.The first person to come up with the correct diagnosis was Thea Grendahl Christou of Chicago, a writer and musician married to a physician. Here are some other responses:

Mara - Somerville, Mass.Neurosyphillis associated with latent stage syphilis

02.07.13 @ 13:24

T.W. - CaliforniaHe has been in hospitals for too long. Patients, especially old ones, lose contact with reality, get very confused and have hallucinations. I have seen it happen to an older friend of mine.

02.07.13 @ 11:21

Elizabeth - VirginiaSinus infection that spread to his brain

02.07.13 @ 11:21

Naomi Utgoff - Silver Spring, Md.Bipolar disorder. He was self-medicating with alcohol all those years.

02.07.13 @ 10:35

Jonathan - MassachusettsI wonder if withdrawal from the sleep medication could present with psychosis/confusion, hypertension, tachycardia and clonus?

02.07.13 @ 3:43

21

POUR UN TOMBEAU D’ANATOLEstéphame mallarmé

22

Avec le don de la paroleWith the gift of words

J’aurais pu vousI could have made you

vousyourself

le roiking

a fait de vousmade of you

23

des enfants du travailchild of the work

24

Non, tristeno, sad

--

du filsof the son

--de

of

tâchetask

25

en nousin us

--

Vous faitesmade you

plutôtinstead

26

no --no

mais ilyet he

prouveproves

27

rappeler leremember the

qu’ilthat he

28

bad days

jouéplayed

bouche ferméemouth closed

mauvais jours --

29

bouche ferméemouth closed

was suchétait telle -

-

ce rôle!that role!

30

originairenative

discours -speech -

oubliéforgotten

c’est moi qui aiit is I who have

31

speech

vous aidé depuisaided you since

33

confusion.

he read his

obituarywith

-steven meretzky

35

It’s Not OK To Act This Way

kama brown

36

Hi Mom

37

it’s me,

I guess you’re

out.

38

I know I should hate you for leaving me but I don’t.

39

I did for a long time

40

but now I understand.

42

What an age to be free.

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

43

What an age to be free.I don’t blame you for running away and leaving me.

44

I want to run away too.

45

Even though you’re not here and you never were I feel your genes in me. I hear the ocean call me in my sleep, as it called you. I smell the scent of the wild the same way you did. I understand why I couldn’t come with you;

I have a daughter now too.

46

I think I will leave soon, too. I can’t stop thinking about the life I will be heading towards.

47

When my daughter is older, I know she will understand.

48

I know she will be okay.

49

Just like I am.

51

swear.Please,

this iseverything, I

-orson scott card

53

Spoken & Writtenferdinand de saussure

54

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

55

But the written word is so closely bound up with the spoken, whose image it is, that it is inceasingly arrogating the main role to itself/Ultimately the point is reachedwhere more importance is attached to representation of the spoken signthan to this sign itself.

56

It’s like thinking that to know someone,

57

it is better to look at his photograph

than his face.

58

help!in atext adventure

- marc laidlaw

trapped

59

help!in a

trapped

61

A Historyleah lauber

63

19881987

1986hello, world

sister born

The hospital asked my parents why they waited so long to get there. Dad was making himself a sandwich.

I don’t remember this at all, and I’m okay with that.

That’s enough children, my parents decided. We don’t want them out-numbering us.

move to new jersey

november

september

july

1990move to florida

july

I don’t remember the move, but I do remember playing Barbies with my sister at our first house. It had a terrazzo floor.

64

1992

1991

start kindergarten

start pre-k

I would be with the same kids through high school.

My parents were told it was a non-demoninational school, but got suspicious when my sister and I started bringing home dreidels and declaring we were Jewish. We’re not.

august

august

1998x-press teamI was accepted to be a reporter for a kids’ section of The St. Petersburg Times, my local newspaper.

july

65

1998

1999first concert

women’s world cup

*N SYNC, because it couldn’t get any more teenage girly than that.

With help from my X-Press Team editor, I obtained credentials and was the youngest reporter in the press tent after the final game.

november

july

2001first day of high school

august

2002driver’s licenseGood thing I didn’t have to parallel park.

november

66

2005high school graduation

may

2005start florida stateOnce a Seminole, always a Seminole.

august

2007transfer to usfMy best friend used to crash at my dorm, and I would read her A Clockwork Orange as a bedtime story.

august

2007twenty-first birthdayLearned to never drink (multiple) Irish Car Bombs on an empty stomach again.

november

67

transfer to usf

2008first apartmentMy landlord’s mother lived below, and I’m pretty sure she spied on us. We partied any-way, and my landlord awkwardly asked to buy weed from me.

july

2009college graduationEntirely unsure what I wanted to do with my life. Lots of reflection (via partying) ensued.

may

2011start ringling

august

2013last day of classI’m going to sleep until August.

april

69

mind of its own.damnlawnmower.

- david brin

71

Yield: 2 Loavesmark bittman

SourdoughRyeTotal Time5 days the first time;

overnight subsequentlyYield

2 loaves

Sourdough Starter:

Dough:

For the

For the

2 2/3 cups rye flourPinch instant yeast

Sourdough starter2 cups rye flour2 cups whole-wheat or white flour1 tablespoon kosher salt1 1/2 cups cracked rye or rye flour

Sourdough

73

Starter:To make the

In a tall, narrow, nonmetal contain-er, mix 2/3 cup rye flour with 1/2 cup water, along with the tiniest pinch of instant yeast - less than 1/16 teaspoon.

and let sit for about 24 hours, then add the same amount of both flour and water (no more yeast).

twice more, at 24-hour intervals; 24 hours after the fourth addition, you have your starter.

(From now on, keep it in the refrigerator; you don’t need to proceed with the recipe for a day or two if you don’t want to. Before making the dough, take a ladleful - 1/2 to 3/4 cup - of the starter and put it in a container; stir in 1/2 cup rye flour and a scant 1/2 cup water, mix well, cover and refriger-ate. This starter will keep for a couple of weeks. If you don’t use it during that time and wish to keep it alive, add 1/2 cup each flour and water every week or so and stir; you can discard a portion of it if it becomes too voluminous.)

Cover

Repeat

74

Dough:To make the

the starter in a big bowl with the rye flour and the whole-wheat or white flour.

then cover with plastic wrap and let sit overnight, up to 12 hours.

The next morning, the dough should be bubbly and lovely. Add the salt, the cracked rye and 1 cup water - it will be more of a thick batter than a dough and should be pretty much pourable.

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

Combine

Mix well

Pour & scrape

75

Dough:To make the

(an improvised dome is better than plastic wrap; the dough will stick to whatever it touches) and let rest until it reaches the rim of the pans, about 2 to 3 hours, usually.

the oven to 325 and bake until a skewer comes out almost clean; the internal temperature will measure between 190 and 200. This will take about 1 1/2 hours or a little longer.

loaves from the pans and cool on a rack. Wrap in plastic and let sit for a day before slicing, if you can manage that; the texture is definitely better the next day.

Cover

Preheat

Remove

76

Bang postponed.

77

Bignot

Reboot.- david brin

enough.

79

A Conversationfrom Infinite Jest

david foster wallace

80

Hal?

Hey Hal?

...

Yes Mario?

81

Yes Mario?

Are you asleep?

82

Booboo, we’ve been over this. I can’t be asleep if we’re talking.

That’s what I thought.

83

Happy to reassure you.

84

Boy were you on today. Boy did

you ever make that guy look sick.

When he hit that one down the line

and you got it and fell down and hit

that drop-volley Pemulis said the

guy looked like he was going to be

sick all over the net, he said.

Boo, I kicked a kid’s ass is all. End of story. I don’t think it’s good to rehash it when I’ve kicked somebody’s ass.

It’s like a dignity thing. I think we should just let it sort of lie in state, quietly.

Speaking of which.

87

Hey Hal?

Hey Hal?

...

88

It’s late, Mario. It’s sleepy-time. Close

your eyes and think fuzzy thoughts.

Always worked for me, Boo.

That’s what the Moms

always say, too.

You think I think fuzzy

thoughts all the time. You let

me room with you because

you feel sorry for me.

Booboo I’m not even going to dignify

that. I’ll regard it as a warning sign. You

always get petulant when you don’t get

enough sleep. And here we are seeing

petulance already on the western

horizon, right here.

90

...

...

When I asked if you were

asleep I was going to ask if

you felt like you believed in

God, today, out there, when

you were so on, making that

guy look sick.

91

...

This again?

92

Really don’t think midnight in a

totally dark room with me so tired

my hair hurts and drills in six short

hours is the time and place to get

into this, Mario.

You ask me this once a week.

...

You never say, is why.

93

So tonight to shush you how about

if I say I have administrative bones

to pick with God, Boo. I’ll say God

seems to have a kind of laid-back

management style I’m not crazy

about. I’m pretty much anti-death.

God looks by all accounts to be

pro-death. I’m not seeing how we

can get together on this issue, he

and I, Boo.

94

...

I do too. I just did.

I just didn’t happen to say what you wanted to hear, is all.

You’re talking about since Himself passed away.

See? You never say.

...

95

There’s a difference.

I don’t get how you couldn’t

feel like you believed, today,

out there. It was so right

there. You moved like you

totally believed.

...

96

...

How do you feel inside, now?

Mario, you and I are mysterious to each other. We countenance each other from either side of

unbridgeable differences on this issue. Let’s lie very quietly and

ponder this.

98

Hal?

Hey Hal?

...

99

I’m going to propose that I tell you a joke, Boo, on the

condition that afterward you shush and let me sleep.

100

Is it a good one?

I give.

Mario, what do you get when you cross

an insomniac, an unwilling agnostic,

and a dyslexic?

You get somebody who stays up all night torturing himself mentally over the

question of whether or not there’s a dog.

That’s a good one!

101

Shush.

102

...

...

Hey Hal? What’s

an insomniac?

Somebody who rooms with you, kid, that’s for sure.

103

Hey Hal?

...

104

How come Moms never cried when

Himself passed away? I cried, and

you, even C.T. cried. I personally

saw him cry.

You listened to Tosca over and over

and cried and cried and said you

were sad. We all were.

...

105

Hey Hal, did the Moms seem like

she got happier after Himself

passed away, to you?

...

106

...

It seems like she got happier. She even

seems taller. She stopped travelling

everywhere all the time for this and that

thing. The corporate-grammar thing. The

library-protest thing.

Now she never goes anywhere,

Boo. Now she’s got the

Headmaster’s House and her

office and the tunnel in between,

and never leaves the grounds.

She’s a worse workaholic than

she ever was. And more obses-

sive-compulsive. When’s the last

time you saw a dust-mite in

that house?

107

Now she’s just a

agoraphobic workaholic and

obsessive-compulsive. That

strikes you as happification?

Hey Hal?

108

Her eyes are better. They don’t

seem as sunk in. They look better.

She laughs at C.T. way more than

she laughed at Himself. She laughs

from lower down inside. She laughs

more. Her jokes she tells are better

ones than yours, even, now, a lot of

the time.

109

How come she never got sad?

...

110

She did get sad, Booboo. She

just got sad in her way instead of

yours and mine. She got sad, I’m

pretty sure.

You remember how the staff

lowered the flag to half-mast out

front by the portcullis here after

it happened? Do you remember

that? And it goes half-mast every

year at Convocation? Remember

the flag, Boo?

Hal?

111

Hey Hal?

112

Don’t cry, Booboo. Remember

the flag only halfway up the pole?

Booboo, there are two ways to

lower a flag at half-mast. Are you

listening? Because no shit I really

have to sleep here in a second. So

listen - one way to lower the flag

to half-mast is just to lower the

flag. There’s another way though.

You can also raise the pole. You

can also just raise the pole. You

can raise the pole to like twice its

original height. You get me? You

understand what I mean, Mario?

113

She’s plenty sad, I bet.

Hal?

114

wasted day.wasted life.

115

dessert, please.- steven meretzky

FONTS USEDAMERICAN TYPEWRITER

BASKERVILLE

BEMBO

BODONI

DIDOT

GARAMOND

GEORGIA

GILL SANS

QUAN

ROCHESTER

ROCKWELL

SANSATION

LEAH LAUBERSPRING 2013CLASS: TYPOGRAPHY 2EDWIN UTERMOHLEN

eight texts

Design