“I don’t feel that I am a visitor in Ghana or in any part of Africa. I feel that I am at home. I’ve been away for four hundred years, but not of my own volition, not of my own will. Our people didn’t go to America on the Queen Mary, we didn’t go by Pan American, and we didn’t go to America on the Mayflower. We went in slave ships, we went in chains. We weren’t immigrants to America, we were cargo for purposes of a system that was bent upon making a profit…..When I was in Ibadan at the University of Ibadan last Friday night, the students there gave me a new name….. “Omowale,” which they say means in Yoruba…. ‘The child has returned'”.
– Malcolm X at the University of Ghana, Legon, on May 13, 1964
Malcolm X
Happy Birthday, Malcolm! You would be 91 today! Admire you for how you turned your life around!
We live in the era of big data. With the introduction of electronic medical records, big data is also alive and well in medicine. Mining that data can help establish therapies that are most effective in the majority of patients. The mined data plus results from large scale prospective, randomized studies then result in recommendations and protocols that are supposed to improve patient outcomes.
A majority of physicians have historically looked at medicine as an art. Each physician had his or her way of treating ailments, often tailoring them to fit individual patients.
Medicine however is moving in a direction where the “Medicine as an Art” crowd is on the edge of extinction.
Who is right? Should the practice of medicine be based on protocols or should it be practiced as an art?
I’ll start off the discussion with two examples:
Close to a million Americans suffer from strokes each year and it’s the number 4 killer in the US.
For years, different hospitals and physicians have managed patients with strokes differently. Studies show that if patients having ischemic strokes are given intravenous tissue plasminogen activator (tPA) to bust the clot causing the stroke within 60 min of arriving at a hospital, their chances of survival go up significantly. However, a study in 2014 showed that less than 30% of ischemic stroke patients were being treated this way. On the other hand, hospitals that had established protocols to facilitate this recommendation lowered the incidence of death and disability from stroke.
Another area of concern is that of medical errors. The “To Err is Human” report sounded the alarm bell in 1999. That in part led to the institution of the Surgical Safety Checklist and the “Time Out” for all surgical procedures. A 2009 study in the NEJM showed a drop in death from errors from 1.5% to 0.8% since institution of the checklist and “Time Out”. Inpatient complications dropped form 11% to 7%.
These two examples illustrate the fact that protocols based on science and solid evidence can positively affect outcomes.
Should this then be extrapolated to all of medicine? Should every decision we make be decided by protocols culled from studies and hard data?
Which brings me to the other side of the coin.
Say a study S looks at therapy for say, Prostate Cancer, in a 1000 men. if this therapy is effective in 86% of the men and it gets adopted, what happens to the 14% who do not benefit from the therapy.? if one extrapolates that to a million subjects, that 140,000 men who do not benefit from this new therapy. A good protocol has to allow a physician to cater to this group.
Recent recommendations about two tests that affect men and women have raised the ire of patients. The first is mammography to screen for breast cancer in women and the Prostate Specific Antigen (PSA)to screen for prostate cancer in men. In both cases, based on data, the opinion was that they led to an increase in the false positive diagnosis of a cancer. In other words, patients were thought to have cancer who did not. This led to further unnecessary testing and procedures. With the PSA, it is thought that a lot of small prostate cancers could be diagnosed, which left alone would not grow to be a problem. Now imagine telling a patient:
“You have cancer but it is so small we are going to leave it alone. You will outlive it.”
Sure, in a calm and reassuring manner, a doctor can try to make a patient understand but how many will bear to live with that uncertainty. Then there is also the probability that that small cluster of cells could get bigger….So why not get them out now?
Even if these cancers are small, isn’t it the smart thing to do to diagnose them and follow them? Doesn’t that make these screening tests then necessary? Doesn’t that give the patient a choice?
The point I am trying to make is, in spite of all the data, there are these people called Patients who we are supposed to serve. They are ruled by emotion and are not always as rational as the data and evidence. Is it part of “doctoring” to do whatever is possible, besides causing harm, to reassure these patients?
So on one side are the those who preach a strict adherence to the evidence and on the other those who want to tailor things to the needs of the patient and the habits of the physician.
Into this fray drops Genomic Medicine. This is an emerging discipline that bases therapy on a patient’s genome. It is a well known fact that some drugs (e.g. Plavix) do not work in some patients because of lack of or too much of certain enzymes. Before a particular therapy is initiated, the genetic make-up of a patient is determined. It is now used extensively in psychiatry to get effective therapy.
This shows that in spite of the data or evidence, there are still individual variations.
All these arguments may not matter because of the Affordable Care Act.
The Affordable Care Act has decimated the private medical practice to the point where the majority of physicians are now employed by hospitals. The Act also rewards physicians whose practices are in line with the latest most effective therapy and management modalities. Hospital administrators are then going to compel their physicians to practice in accordance with protocol that fit the best recommendations. In that sense, the autonomy of the physician may already be a thing of the past and patients’ choice may be slowly narrowed to a few options.
All this makes me wonder what role the physician may play in medicine in the future. If every decision we make is based on a protocol, what will happen to the practice of medicine as we know it? Besides surgeons, are any other specialties even needed if all one needs is to follow a protocol? Protocols so simple that even a caveman can follow them? What are we then good for?
Exactly 50 years ago today, on May 16, 1966, the Chinese Communist Party, under the influence of Chairman Mao Zedong, released what came to be known as the May 16 Notification:
“Those representatives of the bourgeoisie who have sneaked into the Party, the government, the army, and various spheres of culture are a bunch of counter-revolutionary revisionists. Once conditions are ripe, they will seize political power and turn the dictatorship of the proletariat into a dictatorship of the bourgeoisie.”
This statement is seen by historians as the words that justified and ushered in the subsequent ten-year period of terror, death and anarchy in China known as a the Cultural Revolution.
Mao Zedong and the communist swept into power in China after WWII. In the 1950’s, his Great Leap Forward program, seeking to organize farmers into communes, was a total disaster leading to a famine and the death of about 45 million people between 1958-61. This led to Mao loosing power in the party.
Away from the limelight, he plotted how to regain power and bring his pure brand of communism or Maoism to the fore. His plan was to use young people to force societal change. Even though the opening salvoes of the Cultural Revolution were fired with the May 16 Notification, the violence really started in August of 1966.
He empowered teenagers and students, who came to be known as the Red Guard to go after “the Four Olds” – Ideas, Customs, Culture and Habits. Armed with a book of Mao quotes called “the Little Red Book” and lots of zeal, what followed till Mao died in 1976 was hordes of young people attacking anyone who they deemed as being bourgeoisie. They went after university professors, then party officials and then “class enemies”. Some even turned on their own parents. There were mass killings. Sometimes gangs of Red Guards battled each other. They destroyed historical sites and cultural relics. Even cats, seen as pets of the bourgeoisie, were not spared. It looked like they sought to remove the spirit of Confucius from the collective psyche of the Chinese society.
Mao let the Red Guards run amok until the atrocities got too much. In 1968, he sent the army after them, further escalating a terrible situation. Millions were killed. Some were rounded up and sent to work in the fields in the country (the sent-down youth).
The cultural revolution ended in 1976 when Mao died. In an effort not to discredit Mao, scapegoats were sought for the debacle. They turned out to be the Gang of Four – Mao’s wife and three other men. They underwent sham trials and were imprisoned.
The ten years of terror achieved the opposite effect that Mao sought – the Chinese became disillusioned with communism. When Deng Xiaoping, who had been purged twice by the Red Guards during the Cultural Revolution came into power 7 years later, his push towards reforms that pushed China towards capitalism were widely embraced.
Myriad lessons can be learnt from this period in history – the negatives of communism, the results of dictatorship, the risks of brainwashing the youth and so on.
For me, it brings to fore the importance of the Four Olds – ideas, customs, culture and habits. These four factors underpin any society. Without them, a society has no character and cohesiveness. Sure, one or more of these can be a drag on development. This is seen especially in a lot of developing countries where cultural practices and centuries-old habits seem to hinder modern development sometimes. However, a drastic societal uprooting of any of these leaves a vacuum that is often not easily filled and can lead to anarchy. Maybe instead of aiming for a dramatic removal, one should target modification. Maybe one should tailor policies to include some of these ideas, customs, culture and habits.
Keep resting in peace, Robert Nesta Marley! It’s been 35 years since you up and left and your music still has so much spirit, the lyrics so prescient. Prince is up there now. Have you two hooked up yet?
Like I said:
It’s been 35 years since you walked out of that door,
And the pain sure does knock more:
Ooh Bob, ooh Bob, is it feasible?
We wanna know now, for the pain to knock some more.
Ya see, in life we know there’s lots of grief,
But your music was our relief:
Tears in our eyes burn – tears in our eyes burn
While we’re waiting – while we’re waiting for the Jah Man,
See!
We don’t wanna wait in vain for Jah Man;
We don’t wanna wait in vain for Jah Man;
We don’t wanna wait in vain for Jah Man;
We don’t wanna wait in vain for Jah Man;
We don’t wanna wait in vain for Jah Man, oh!
We don’t wanna – We don’t wanna – We don’t wanna – We don’t wanna -We don’t wanna wait in vain.
“All the companies in the United States and Europe and Japan, they have experts, and the experts are surgeons and they said it is absolutely not possible. We would kill the patients on the table.” – Alain Cribier, Cardiologist, Innovator of the TAVR Procedure
On April 9, 2002, a 57-year old man presented at the Cardiology Clinic of L’Hôpital Charles Nicolle, in Rouen, France. He had severe aortic stenosis with a valve area of 0.6 sq cm (normal is 4 – 6 sq cm), a mean gradient of 30 mmHg (normal < 5 mm Hg), was in cardiogenic shock (systolic blood pressure was 80) and had a left ventricular ejection fraction of 14% (normal 55 – 60%). Due to all his co-morbidities – chronic pancreatitis, severe vascular disease, silicosis, history of lung cancer – he had been refused surgery at several centers.
A cardiologist at the hospital, Alain Cribier, had in 1985, successfully used a ballon to open up stenotic aortic valves, a procedure termed ballon valvuloplasty.
That day in April of 2002, Dr Cribier performed balloon valvuloplasty on the aortic valve of the patient. He improved initially with the gradient falling to 13 mm Hg and the area increasing to 1.07 sq cm. However over the next week, the patient’s condition steadily declined. By about the 6th day after the valvuloplasty, his ejection fraction was 8 – 12% and in spite of support with medications, his systolic blood pressure was only 70.
A week after his valvuloplasty, on April 16, 2002, Alain Cribber made a decision that made history and is disrupting cardiac care like not seen since the introduction of cardiac stents about 10 years earlier.
After obtaining permission from the hospital’s Institutional Ethics Committee, he took the patient to the cardiac cath lab where, by accessing the femoral vein in the patient’s groin, he introduced an investigational heart valve to replace the stenotic aortic valve of the sick 57-year-old man. He didn’t open the patient’s chest like was the norm. He did everything from outside the body! The patient’s condition improved significantly. He however died 4 months later from unrelated issues.
Dr Alain Cribber had just performed the first percutaneous valve replacement in a human! The rest, like they say, is history.
In 2004, Edwards bought the company Dr Cribier had started to make the valves and the equipment to deploy it for $125 million.
That procedure, now called Transcatheter Aortic Valve Replacement (TAVR), has been approved by the FDA for patients with aortic stenosis (NOT regurgitation) who are terrible surgical candidates. These are patients not expected to survive surgery. It is presently performed in about 400 centers in the US. As I write, approval is pending for the use in patients with intermediate risk and it is quite possible that TAVR will replace the surgical approach in the next few years. In Europe, TAVR is used 60% of the time for the treatment of aortic stenosis.
A disruptive technology is one that displaces an established technology and shakes up the industry or a ground-breaking product that creates a completely new industry. Disruptive technologies are innovations often seen in the Tech world – like what Netflix did to Blockbuster or what the iPad did to personal computing or what the DVD did to the VHS.
The percutaneous approach to replacing the aortic valve is one such disruptive innovation.
For years, the only way to replace a stenotic aortic valve was to open the patient’s sternum while under general anesthesia, place him or her on cardiopulmonary bypass, open the aorta, excise out the old valve and sew in a new one. That demanded a team made up of the surgeon, anesthesiologist who acted also as the echocardiographer and a perfusionist.
For a TAVR, the cardiologist of surgeon punctures the femoral artery in the groin, introduces a wire with a ballon at the tip into the aorta and feeds the valve, in a collapsed state, all the way up into the aorta where the valve is, over this wire. The new valve is then inflated with the ballon. The new valve squishes the old valve against the wall of the aorta and in the process, takes it’s place. In most centers now, only a cardiologist or a surgeon performs the procedure!
If this becomes the dominant way of doing aortic valve replacements, tell me it’s not disruptive.
Years of accepted surgical practice will all of a sudden be made almost archaic. Why almost? Well, there will always be conditions where TAVR might not work and surgery is the only way (eg Endocarditis) or the patients may need other procedures. However it is possible that the majority of the estimated 1.5 million patients with aortic stenosis will undergo percutaneous and not surgical replacement.
Also, what this approach has done is spawn attempts to develop percutaneous approaches to replace or repair other heart valves. The Melody valve is already available to replace the pulmonary valve, a procedure often needed in children. There are also several percutaneous mitral valves in the works. The mitral clip is used to treat severe mitral regurgitation in the severely ill.
TAVR is not without it’s complications but it provides an alternative way of providing a needed service.
The history of cardiac care is marked with disruptive innovation. By the 1970’s, coronary artery bypass graft surgery (CABG) was the main way to treat coronary artery disease. Then Gruentzig developed percutaneous transluminal coronary angioplasty (PTCA) in the 1980’s and brought about an exciting new dimension in the treatment of coronary artery disease (CAD). (Gruentzig later migrated to the US and joined the faculty at Emory!) Then followed the development of stents. These developments were also very disruptive and dislodged the grip surgeons had on the treatment of coronary artery disease.
These very stents were what planted the idea of percutaneous valves in the mind of the Danish cardiologist, Henning Rud Andersen of Aarhus University in Jutland. Even though Cribber was the first to perform a percutaneous implantation in a human, Andersen was the first try this out in pigs.
And now we are seeing a tomorrow of percutaneous valves.
In 1995, Clayton M. Christensen coined the term, “Disruptive Innovation”, in his book “The Innovator’s Dilemma”. He defined it as:
“An innovation that creates a new market and value network and eventually disrupts an existing market and value network, displacing established market leaders and alliances.”
I argue that the TAVR is doing just that.
Human nature…..a very interesting thing indeed.
After working with people for a while, one starts noticing little things that tend to be intriguing and interesting.
Who we are is a function of a lot of things including our character, upbringing and environment. However, is there also the chance that we are what we do?
Let me explain by asking a question:
Would the stern demeanor a teacher has to assume around rowdy elementary school children every single day soon translate into a stern bearing?
In dealing with patients, I tend to notice certain tendencies that are peculiar to certain professions. Now, the following descriptions are purely observational and are not backed by any kind of science. These observations are also in no way a form a profiling because they do not have any bearing on how I treat them. I just wonder if they somehow support the claim that you are what you do.
So let’s get started:
I have noticed that patients who are teachers still maintain that stern demeanor even when facing surgery and anesthesia. Facing a teacher, I always feel like I forgot my homework. They seem to have assumed control and I come across as being there to do their bidding. Even when they are asleep, they still look and exude that teacher look! It is an interesting dynamic.
Accountants offer a very straightforward kind of affect. Much like, “You are the doctor, I am the patient. You have the obligation to take care of me, so do your job already and stop the chit-chat!” If they are nervous, they never show it. It’s almost like business as usual. I have had a few auditors as patients as well and they seem to be even a level more intense.
With lawyers, one always has the feeling like they are circling the wagons, looking, sniffing, ready to pounce. Almost like, “A-ha!, I’ll see you in court!’ (Kojo Ace, I greet you!????) Everything one says to them is weighted, compared and balanced against the scales of something unseen.
Veterans are an amazing bunch. (The few left from WW II and the Korean War are in a special class of awesome!) Describing them as stoic is an understatement. (Obie, greetings!) Most times, I expect them to say, “Doc, I don’t need anesthesia for that amputation. Give me a shot of bourbon and a bullet to bite on!” If one ever asked, I wouldn’t know where to get a bullet at the hospital. I wonder if the pharmacy stocks them.
Staying with the military, drill sergeants are a special breed. They cannot help just instilling fear wherever they are. At least in me they do. I always feel like I have to drop and give them fifty.
Cops, firemen and soldiers are sort of stoic to a level too, but not as much as veterans. They almost exude the feeling, “I need to be out there so please hurry up!”
Probably the most challenging group to take care of are patients who are in the medical field. Those who do not work in the perioperative setting are the most interesting. A short read-up on the kinds of anesthetics and practices out there 24 hours prior to surgery is often enough for these colleagues to dub themselves specialists in anesthetic care. Some demands are, well, interesting.
“Are you going to do a spinal for my thyroidectomy?”
“Huh?”
Most of us in medicine tend to be attentive to detail and want to be in charge. Well, we seem not to be able to let go in the perioperative phase too.
So what do my unscientific and probably biased observations really show? Do they support my initial claim that we are what we do? Probably not but these observations show that humans are a diverse bunch and hence the reactions to the same set of conditions will vary widely. Whether what someone does affects how they react may well be true but a real study may be needed to figure that out.
In the mean time, I’ll keep adding to my observational sample size by listening to my patients, calming down their fears and giving them the best care I can.
Don’t we all?
I am intrigued by what I call the Frisome Women (Friggin’ Awesome Women). I was raised by one who was raised by one, married to one, have a sibling who is one and may be raising one. Smart, focused, pragmatic, creative and tough, they have a certain sixth sense for what works! They don’t mince words, don’t suffer fools, and want to get things done. I am intrigued by what makes them tick. You all know one or may even be one.
Bertha Ringer was a Frisome. She was born into a wealthy family in Pforzheim, Germany, on May 3, 1849 (167 years ago today). Her dad wanted a son and wrote in the family Bible: “Unfortunately only a girl again”! Bertha, however, was an intelligent girl who at an early age was very interested in technical things like the locomotive. When she was allowed to attend school at the age of 9, her interest was in the Natural Sciences. However, in that era, women were not allowed into institutions of higher education. It was the scientific belief that the lighter brain of women was logically unable to absorb and process as much information. Moreover, too much thinking was thought to be harmful to their reproductive abilities!
The beliefs of the day irked her greatly. It didn’t help when she read what her dad wrote in the family Bible. These factors might have lit up her subsequent determination to show her dad and the world that women could be great too.
On June 27, 1869, while on a trip with her mother, a poor young engineer joined them in their coach. They soon started talking and he told her about his dream of building a driverless carriage. She was hooked. By the next year, they were engaged. The man’s name was Karl Benz.
In 1870, Karl owned an iron construction company. His business partner was irresponsible and the company was failing. Karl was also a terrible businessman. As a single woman at that time, Bertha was allowed by law to invest in a company and so she rescued Karl’s business using funds from her substantial dowry.
They got married in 1872 and Bertha Ringer became Bertha Benz. They moved to Mannheim where she helped her husband start the Benz Gasmotoren-Fabrik – a company that manufactured internal combustion engines. Problems with the banks led to the closure of that business after a year.
In 1883, Bertha helped Karl Benz start another company – Benz & Cie. They made industrial parts. That business venture thrived. This allowed Karl to turn his attention to his lifelong dream – the invention of a driverless carriage powered by an internal combustion engine, in other words, an automobile. History then was full of several engineers before who had built versions of a driverless carriage but hadn’t been able to market them with any success.
After several failed attempts, Karl finally finished work on his first horseless carriage in December 1885 and received a patent for it in 1886. It was powered by a four-stroke, single-cylinder, 0.67 horsepower engine and had three wheels – one in front and two in the back. It was the Patent-Motorwagen No.1. For fuel it used the solvent ligroin that you bought from a pharmacy. It had no gear system and had brakes and wheels made out of wood!
By 1888, he had built 2 more – the No.2 and No.3. The No.3 was much improved with a 2 hp engine and max speed of 10 mph (16 km/h).
He showed the Model 3 at the Paris expo in 1887. In late summer of 1888, it went on sale as the Benz Patent Motorwagen.
Well, Karl like most great inventors was also terrible at marketing and couldn’t find any buyers or get anyone interested in his invention. Bertha had seen him build his Motorwagen and believed in the product. She thought it was ready for prime time and needed publicity. She had invested a lot of money in the venture and she needed to see some returns. Moreover, not too far away was a gentleman called Gottlieb Daimler, who together with his partner Wilhelm Maybach, were trying to build a driverless carriage too.
So one early morning in August of 1888 (may have been the 5th or the 12th), she left her husband a note, packed her two sons, Richard who was 13 and Eugen who was 15 into the Patent Motorwagen No.3 and drove off to visit her mum in her hometown of Pforzheim which was 66 miles (106 km) away!
Now let that go through your heads for a minute! 66 miles in a contraption that had never been tested before over more than a few miles in town! In 1888! On roads meant for horses and carriages! By a 39-year-old woman with 2 teenage boys! Now isn’t that just friggin’ awesome?
Now the big idea wasn’t really to visit her mum. It was to prove to her husband that his invention was great and ready for prime time and to give the car publicity.
The journey took her just over 11 hours. She stopped at several pharmacies to buy ligroin as fuel. The motorwagen used a surface carburetor which doubled as a reservoir for 1.5 liters of fuel. (Subsequent models had a fuel tank and also, her experience probably birthed the concept of the gas station). At one point, she had to repair the car’s ignition and she improvised with her garter. When the fuel line became clogged, Bertha cleared it using her hairpin! When the wooden brakes began to fail, she got a shoemaker to make leather pads for them, thus coming up with the idea of brake pads. At one point, she had to get two young boys to help her sons push the car up a hill (that bore the idea for a gear system).
The arrived in Pforzheim tired and dirty but in safely. Once in Pforzeim, she sent her husband a telegram to let him know they had arrived safely. Can you imagine him freaking out?
She stayed for 3 days with her mum and then made the return trip to Mannheim using a different route. This way, she was able to introduce the car to even more people. The reception ranged from wonder to frank fear of the “Smoking Monster”.
Benz Patent Motorwagen Typ III
Beside getting a lot of publicity for the Motorwagen, she had also undertaken the first test drive of a car!
Her 120 mile trip was the catalyst Benz & Cie needed. Karl Benz became credited with inventing the predecessor of the modern car. By 1899, Benz & Cie was the world’s largest automobile company with a staff that had grown from 50 to 430. That year, they sold 572 vehicles!
Karl and Bertha, along with sons Eugen and Richard, also formed a new family-owned car company, Benz & Sons in 1906. The cars they made became popular in London as taxis because of their quality and reliability. It closed its doors in 1924.
Benz & Cie on the other hand stayed in business until 1926 when it merged with it’s main competitor, Daimler Motoren Gesellschaft (DMG) to form the Daimler-Benz AG. The rest, as they say, is history!
Karl Benz among other inventions went on to build the first truck and also to invent the flat or boxer engine that is still used in Porsches and other racing cars. Among some of his honors was a doctorate from his alma mater, the Technical University of Karlsruhe. He died in 1929.
On her 95th birthday on May 3, 1944, Bertha was honored by the Technical University of Karlsruhe, her husband’s alma mater, with the title of Honorary Senator. Two days later, she died.
Among her many honors is also the Bertha Benz Memorial route. The route traces her path during the world’s first long-distance journey by automobile in 1888 from Mannheim to Pforzheim and back.
What a woman! A mother, investor, test driver, mechanic and inventor! Now tell me Bertha Benz was not a Frisome!
Can you imagine what she might have achieved if she had been allowed to study at a university? Can you imagine what Karl Benz would have done without her?
So as you speed off in your AMGs, G-wagons and SLs, spare a minute to wish her “Herzlichen Geburtstag” on the other side.
What is the saying again? Behind every successful man, is a friggin’ awesome woman!
Frau Bertha Benz, you were friggin awesome!
Watched Beyonce’s Lemonade….
Wow!
A quote:
“I tried to change. Closed my mouth more. Tried to be softer, prettier, less awake. Plugged my menses with pages from the Holy Book but still coiled inside me was the need to know: Are you cheating on me?”
A 60 min blend of poetry, dance, sultry vocals, beats and eye-catching visuals! An Ode to the Woman!
The poetry was written by a Somalian-British poet called Warsan Shire. Cool poet!…. already named Poet Laureate of London at age 25 in 2014! Below is a snippet from her poem “what they did yesterday afternoon”:
later that night
i held an atlas in my lap
ran my fingers across the whole world
and whispered
where does it hurt?
it answered
I know, I know……boring!…so what?.. he inspires me!……400 years ago today, April 23, 1616, poet and playwright, William Shakespeare died in his home in Stratford-upon-Avon. He was just 52……wrote 37 plays and 154 sonnets! 154 sonnets! Dang!..So I wanted to share two of my favorite quotes from all his works. The first is from Julius Caesar:
Brutus:
There is a tide in the affairs of men.
Which, taken at the flood, leads on to fortune;
Omitted, all the voyage of their life
Is bound in shallows and in miseries.
On such a full sea are we now afloat,
And we must take the current when it serves,
Or lose our ventures.
Julius Caesar Act 4, scene 3, 218–224
The second is from Macbeth:
Macbeth:
Life’s but a walking shadow, a poor player
That struts and frets his hour upon the stage
And then is heard no more. It is a tale
Told by an idiot, full of sound and fury
Signifying nothing.
That Lady in the Red Corvette
One Sexy MF she was
Looks that made you never forget
A body that caused a buzz
Said, “My name is Prince.
I Wanna Be Your Lover”.
Looked at me with a wince
Said, “No go in The Holy River”.
The Most Beautiful Girl in the World
Donned in Diamonds and Pearls
As a Sexy Dancer she twirled
Raspberry Beret off, showing those curls
Said, “Money Don’t Matter 2 Night
So come and let us Kiss”.
For just a minute I thought she might
Just then came the hiss.
Said, “Let’s Pretend we’re Married”.
“Get Off!”, she said with a sneer
My world she just totally buried
Standing there in her Pink Cashmere.
I wanted to party like it’s 1999
Over at Paisley Park with her
With Peach, Cream and wine
Now that will never ever occur.
Betcha Golly Wow!
You did it without an apology
I guess now you take that bow
Leaving us your Musicology
As you walk into the Purple Rain
We understand When Doves Cry
It’s surely to hide the pain
When those they love leave for the sky.
