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