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How is the ICSE essay checked?

lisen i have a treasure for you , please share it as much as you can it is top secret intelit is the exact rubics of icse board exam 2013 , through this rubics examinor has checked the answer sheet1. Evaluation of icse 2013 answer sheet2. COMPOSITION- GRADING Composition – 25 Marks Essays will be graded [A/B/C/D/E/F] by the Examiner Less than 200 words is a short script. No penalization is given for this. And also no penalization, if the student exceeds the limit. Deduct 2 Marks if the essay is not written in paragraphs3. Awarding of Grades for Essay Grade A An ‘A’ Grade Essay is awarded 21-25 marks. 84- 100% accuracy is expected. Qualities of an ‘A’ Grade Essay:  It should have very good language.  Matter should be original.  Sensitivity in the selection of language.  Fluency of expression.  Positive form of unity and arrangement.  Matter relevant to the topic.4. Grade B A ‘B’ Grade Essay is awarded 16-20 marks. 64-80% accuracy is expected. Qualities of an ‘A’ Grade Essay: Good linguistic ability. Usage of varied vocabulary. Arrangement clear and appropriate.5. Grade C A ‘C’ Grade Essay is awarded 12-15 marks. 48-60% accuracy is expected. Qualities of an ‘C’ Grade Essay: Fair language ability. Very few minor errors. Satisfactory treatment of subject.6. Grade D A ‘D’ Grade Essay is awarded 9-11marks. 36-44% accuracy is expected. Qualities of an ‘D’ Grade Essay: Monotonous and uncertain language. Subject not adequately developed. Communicates feelings at a simple level.7. Grade E A ‘E’ Grade Essay is awarded 6-8 marks. 24-32% accuracy is expected. Qualities of an ‘E’ Grade Essay:  Flat, faulty language.  Frequent gross errors.  Subject undeveloped.  Matter irrelevant and topic not focused upon.8. Grade F: 2-5/8-20% A ‘F’ Grade Essay is awarded 2-5 marks. 8- 20% accuracy is expected. Qualities of an ‘A’ Grade Essay:  Broken English.  Numerous and gross syntactical errors.  Subject distorted.  Faulty arrangement.  Garbled and continuous errors.  Makes no sense at all.9. Error Frequency – Criterion of Grading  The composition will be graded based on the frequency of simple and gross errors that occur within the first 200 words.  No penalization for errors after 200 words, but the examiner will give the highest or the lowest within the same grade depending upon the frequency of errors even after 200 words.  If the essay is improved after 200 words, the highest within the same grade will be awarded.10. Simple [SE] and Gross Errors [GE] What are Simple Errors?  Repetition of words by mistake and spelling mistakes.  Examples: 1. He said said that… 2. There/ their 3. Examinasion If one error is penalized once, [e.g.. Spelling error] the subsequent errors in the same fashion should not be penalized. [but in the case of tense, it should be penalized repeatedly.]11. Simple [SE] and Gross Errors [GE] What are Gross Errors?  All the other types of common errors. Capital and small letters. Punctuations and their omission. Wrong construction. Spoken language.12.  Unnecessary use of articles/ their omission.  Spelling errors that make changes in meaning.  Tense errors.  Subject verb agreement.  Wrong beginning of the sentence.  Wrong prepositions.  Incorrect vocabulary.13. A Few Examples for Gross Errors I prayed to god./ in spite of heavy traffic…/ I told Him… Thus we reached home late at 10 pm One flower was there.[There was a flower.] I asked, you have seen him? I told to the my friends/ Taj Mahal is one of the seven wonders…14. ◦ I was quarreling with my parents for my birth/berth. ◦ I had seen him tomorrow./ we all reach our destination and begin to enjoy. ◦ She do not know it./ I has bought a book. ◦ And we began chatting. ◦ He passed away a piece of cake to me. ◦ This is what effects you most…[ affects]15. What is Error Frequency? One point for one gross error. Half a point for one simple error. Each error to be underlined and indicated at the end of each line. Add up the points and mention the total error frequency where the first 200 words end.16.  Example:  10 gross errors and 5 simple errors within 200 words = Error Frequency is 12.5% [EF=13%] = D 11  Even the most creative composition may fetch a low grade if the error frequency within 200 words is more.  Depending upon the error frequency the examiners are to decide the grade as well as the marks.17. Counting the First Two Hundred Words Words in the First Line Number of Lines 5 40 6 33 7 29 8 25 9 22 10 20 11 18 12 16 13 15 14 14 15 1318. Grading Table Grade Marks % Error Frequency A 21-25 84-100 1-3 B 16-20 64-80 4-7 C 12-15 48-60 8-12 D 9-11 36-44 13-16 E 6-8 24-32 17-20 F 2-5 8-20 21+19. Question 1A. - Story Write an original short story that begins with the words: “In the background I could hear an awful commotion, men’s voices raised and women screaming.” The story must be original and must begin with the given sentence. The story may take any form but should convey why there was a commotion and what was making the men raise their voices and women scream. -2 if the story does not begin with the given sentence. -1 if only part of the sentence is used. Deduct 25% of the marks obtained if the story is blatantly unoriginal. Mention [not original] [e.g. Nirbhhaya’s case]20. B. Argumentative Composition “Boarding schools are far better than day schools for the all-round education of a child.” Express your views either for or against this statement.  views for or against the motion are to be accepted. The candidate should take a clear stand and give valid reasons for whatever stand he or she takes regarding the topic either for or against the statement. Deduct up to 25% of the marks obtained if no clear stand is taken. But be sure that no stand is taken before deducting. Mention [ No stand taken.]21. C. Descriptive Composition  You were on a school trip and were on your way back to the hotel late one night when your school bus, full of children, broke down in a lonely area. Describe what you saw and experienced as you looked around. How was the problem solved?  The events should be interesting and should be described in detail.  The fear, the night sights and sounds and the ultimate rescue or help should be described.  [What was seen and heard? How was the problem solved?]  [If onward journey is mentioned, do not penalize]22. D. Narrative Composition ◦ Teaching someone else how to do something can be a rewarding experience. Think of a skill that you have helped someone to develop. Perhaps you taught someone how to swim or to bake a cake, or helped someone learn how to study more effectively. Narrate the events that made up the process of teaching the skill and say what made the experience important and memorable for you.23. Marking Scheme A Personal experience- The particular event or situation in which the candidate taught another person how to do something or develop a skill must form the core of the essay. The candidate should focus on the events that made up the process of teaching the skill and clearly narrate what made the experience important and memorable for him or her. – How the person was taught? What made it rewarding?24. E. Picture Composition  Study the picture given. Write a story or a description or an account of what it suggests to you. Your composition may be about the subject of the picture or you may take suggestions from it; however, there must be a clear connection between the picture and your composition.  Accept a broad interpretation but keep in mind that there must be a clear connection between the picture and the composition.  There must be a reference to the elephant and the children on it.  Deduct 2 marks if no reference is made to the picture.25. Letter Writing – 10 Marks Format Content Expression Informal 2.5 2.5 5 Formal 3 2 526. Formal Letter – 3 for Format From Address Date To Address Salutation Subscription Signature27. Informal Letter – 2.5 for Format From Address Date Salutation Subscription Pet name/first name28. Note the following: Relevant points in the body [content] of the letter to be indicated by a tick and the marks for content to be shown in the right hand margin. Full range of marks to be used. No mark is to be deducted for lack of punctuation in the address. Incorrect punctuation in the subscription is to be penalized. [If comma not used, no marks] Informal letter: salutation: Dear Grandfather/My dear Grandfather = accepted. Formal letter: Salutation: Sir/ Dear Sir/ Madam/ Dear Madam = accepted.29.  Respected Sir/ Respected Madam = not accepted.  Month in the address should be written in full. No short forms accepted. No marks if year is not mentioned.  No Indian salutation to be accepted. [My dear dadaji, aunty etc…]  Your loving grandson, [not son or daughter as the letter is to the grandfather]/Yours lovingly,/ Your affectionate grandson,/ Yours affectionately, are the only subscriptions to be accepted in informal letters.30. Yours truly,/ Yours faithfully, are the only subscriptions to be accepted in formal letters. Incorrect subscription = 0 marks. If only one error occurs in the subscription and the name is written correctly, 0.5 marks can be given for signature. But if more than one error occurs in the subscription, no marks should be given for the signature even if the name is written correctly. Only first name for informal letters. First name and surname for formal letters. The subscription should be in the same side where the from address and the date is mentioned whatever may be the format one follows. No marks to be deducted even if the subject is not mentioned in the formal letter. The date, month and year can be any date in the past and not in the future. [reasonable = can not be 1950] Marks to be indicated in this manner : F+C+E = 2+1+3=631. Marking Scheme Informal letter: Question: You will soon have to make a decision about the subjects that you wish to study in classes XI and XII. Write a letter to your Grandfather telling him about the subjects that you plan to take up. Be sure to explain the reason for your choice and how you think these subjects would help you in the future. Ensure that the format is correct and the following points are clearly brought out.32. ◦ [format=2.5, content =2.5, Expression =5] 1. What? [specify the subject or group of subjects] = 1 2. Why? [ Reason/link why the subject(s) appeal to the candidate.] = 0.5 3. How will the choice help the candidate in future opportunities and career options? =1 4. [Marks for expression should correspond to the grade of the essay]33. Marking Scheme Formal Letter: Question: The children in your neighborhood are forced to play on the street for want of a proper play area. Write a letter to the editor of a popular newspaper, pointing out the need for a playground in your neighborhood. Give reasons why you think a play area is necessary and point out how it would benefit everyone who lives in that area. [Format= 3, Content = 2, Expression =5]34. Marking Scheme 1. WHY the park is necessary?: children need a safe place to play/would beautify the vicinity of the neighborhood/ trees and plants would help lessen environmental pollution etc. [any two reasons = 1 mark] 2. How it would benefit the neighborhood?: Foster interpersonal skills and encourage cooperation/ build a friendly family neighborhood/ would enable adults and children to pursue physical activities that would keep them fit. [any two reasons – 1 mark] Totally accept any four reasons but see that they are not repeated. Two for why and two for how. 2 marks totally.35. Expression [5 Marks] Both formal and informal letters : 5 marks. Ensure a correlation between essay grade and letter express based on the following criteria. Essay Grade Letter Expression A 4 B 3/3.5 C 2/2.5 D 1/1.5 E&F 0.5/136. Comprehension ◦ A] Give meaning of each of the following words as used in the passage. One word answers or short phrases will be accepted. 1. Agility= skillfulness/ skill/ acrobatic ability/ ease and flexibility/ quickness of movement/nimbleness/quick movement/ability to move quickly 2. Hailed = Greeted/said hello/wished/called out to/signaled/ hallooed 3. Villain = wicked/bad/evil person, rogue, miscreant, rascal, scoundrel [ not just adjective, noun i.e. person or man must be there.] 3x1=3 If two meanings are written, consider the wrong one. If both are correct, give mark.37. B:Answer the Following: 6X2=12 1. How was Chittru different from other boys? Answer: Chittru did not work like other boys, was lazy [1]/ fished in other people’s streams [0.5]/ and stole fruits [0.5]. 2. What was Bisnu’s Ambition? Answer: He wanted to read and write [1]/ had set his heart on receiving good scholarship, education or schooling[1]. 3. What information did Sarru give Bisnu? Answer: Sarru told Bisnu that a panther had come to the village [1]/ that night [1].38. Contd. 4. How did the information affect Bisnu? ANSWER: The information interested but did not excite him [1]/ because panthers were common in the hills [1]. 5. Why did the panther become a cattle-lifter? ANSWER: A panther if wounded can not hunt [1]/ so it attacks cattle and people [1]. 6. What joke does Sarru make? ANSWER: Sarru jokes that the panther poisoned itself [1]/ when it ate the headman of the village [1].39. Précis Writing C(i): In not more than 60 words describe what the narrator tells us about the behavior of the langoors. [8] MAIN POINTS TO BE MENTIONED IN THE SUMMARY: 1. Langoors lived in the forest. 2. Fed on oak leaves, acorns and other green things. 3. remained in trees. 4. Played or sunned themselves. 5. Leapt from tree to tree. 6. Young ones wrestled like boys.40. 1. Were dignified, not cheeky or dishonest. 2. Did not approach dogs or humans. 3. Grown used to Bisnu’s coming and goings/ did not fear him. 4. Older ones would watch him quietly- puzzled. 5. Did not go near towns. 6. All the food they got from the forest.41. Key Words 1. Lived 2. Fed 3. Remained 4. Played 5. Leapt 6. Wrestled 7. Were dignified 8. Not approach 9. Not fear/Grown used to 10. Watch 11. Not go 12. Got from 12x0.5=6+2 for Expression [ Total =8]42. Marks for Expression Marks for Points Marks for Expression 1.5 0.5 3 1 4.5 1.5 6 243. Note: ◦ If the candidate exceeds 65 words and has mentioned all the points, award only 0.5 mark for expression. ◦ Do not correct beyond 60 words. ◦ C (II) = Give a title to your summary in 3(c). Give a reason to justify your choice. ◦ Any apt title pertaining to the behavior of langoors [1] ◦ A valid reason to justify the choice [1] ◦ If the title is correct and the reason is lame, do not award marks for justification. ◦ If the title is wrong, automatically the justification also must be wrong. So no marks. ◦ It is mandatory that the summary should be written in grids. But no penalization is required even if grid is not used by the candidate.44. Question 4 ◦ A) Fill in each of the numbered blanks with correct form of the word given in brackets. Do not copy the passage, but write in correct serial order the word or phrase appropriate to the blank space. ◦ See the Q.P. 1. Hunted 2. Bought 3. Was engrossed 4. Munched 5. Got/was getting 6. Would blacken 7. Took 8. Had tried/tried/was trying/had been trying45. Question 4 ◦ B) Fill in the blanks with an appropriate word. ◦ See the Q.P. 1. Over/with 2. To 3. In 4. Into 5. For 6. Behind/inside/under/in 7. Of 8. Among/Amongst46. Question 4 ◦ C) Join the following sentences to make one complete sentence without using and, but or so. 1. We had better get ready now. We may not have time to reach the airport.  We had better get ready now otherwise/or/or else we may not have time to reach the airport.  Unless we get ready now we may not have time to reach the airport.  If we do not get ready now, we may not have time to reach the airport.47. Question 4 2. Mr. Liew has been sick. He has been so since he came back from Japan. Mr. Liew has been sick since/ever since coming back/returning from Japan. Mr. Liew has been sick since/ever since he came back/ returned from Japan. [returned back = wrong]48. Question 4 ◦ 3. The debating teams were very happy. Both were declared joint-champions. The debating teams were very happy as/since both were declared joint- champions. The debating teams were very happy because they both were declared joint- champions.49. Question 4 ◦ 4. He escaped from the prison. He looked for a place where he could hide. Escaping from the prison, he looked for a place where he could hide. After escaping from the prison, he looked for a place where he could hide. Having escaped from the prison, he looked for a place where he could hide. After having escaped from the prison, he looked for a place where he could hide. [Accept several alternatives as long as the rubric is followed, meaning remains the same and the answer grammatically correct.]50. Question 4 ◦ D) Rewrite the following sentences according to the instructions given after each. Make other changes that may be necessary, but do not change the meaning of each sentence. 1. These windows need cleaning again. [Begin: These windows will ………….]  These windows will have/need to be cleaned again. [Do not accept ‘require’.]51. Contd. 2. My mother said I could go with you only if I returned home by five o’clock. [Use: As long as] [Notice that the conjunction “that” is omitted and it is in indirect speech.] My mother says I can go with you as long as I return home by 5 o’clock. My mother said I could go with you as long as I returned home by 5 o’clock. [accept 5a.m. and 5 p.m.]52. Contd. 3. It doesn’t matter which chemical you put into the mixture first, the results will be the same. [Use: Difference] It makes no difference which chemical you put into the mixture first, the results will be the same. [The word “difference” should be used at the beginning i.e. in the first clause only]53. Contd. 5. Heavy rain has caused the cancellation of the outdoor garden party. [Begin: Due…] Due to the heavy rain, the outdoor garden party has been cancelled.54. Contd. 4. Who does this pen belong to? [ Begin: Do you know…….] Do you know whose pen this is? Do you know to whom this pen belongs? Do you know who/whom this pen belongs to? [Deduct 0.5 mark if there is no question mark.]55. Contd. 6. I’ve never seen so many people in this building before. [ Begin: This is ………..] This is the first time I have seen so many people in this building. [ Do not accept Present Continuous Tense.]56. Contd. 7. If we light the fire, the rescuers will see us. [Begin: We will…] We will be seen by the rescuers if we light the fire.57. Contd. 8. Only a few books were remaining on the shelf when we left. [Begin: Most…] Most of the books had been sold by the time we left. Most of the books were gone by the time we left. Most of the books on the shelf had been taken away by the time we left. Most of the books had been removed by the time we left. Most of the books were not on the shelf when we left. Most of the books were not remaining on the shelf when we left. [Not in the key but given marks]58. Final Analysis  Very difficult to score in Language paper. But whatever the student loses in Language paper will be compensated in the literature paper. Presence of mind is required. [ question to be analyzed] Answers to be specific. Apply technical mind. Essay writing skills to be developed. Aim at perfection. [make your answers error free] Only practice makes you perfect. If ready for hard work, centum accomplishment is certain

Who can give me a simple formula for using who and whom correctly, especially in the middle of the sentence?

Since the question regarding "who" and "whom" is listed as "7" in your list in the Question Details, I will follow the list and answer it when I get to "7."With regard to "may" and "might," it is important to know that "might" is also the subjunctive form of "may" (in addition to being the past tense form). The subjunctive form is a form of the verb that shows an imagined or hypothetical state of affairs. It is used in a variety of situations, but especially in imaginary conditional clauses (with "if"). So, for example, we might say (here I am imagining the action of saying, so I use "might") something like: "If I were in your situation, I might not be so calm." The example sentence means two things: (1) I am not sure how calm I would be; (2) I am imagining myself in your situation. A similar subjunctive force is present in the sentence: "If you hadn't pulled me out of the way, I might have been hit." The possibility of being hit is imagined in the imaginary scenario in which you did not pull me out of the way.There is another difference between "may" and "might" that is important to know: "might" is used to indicate low probability. "May" indicates possibility, that is, a 50-50 chance either way, or higher than 50 percent in favour of something happening. If we want to decrease the likelihood to something less than 50 percent, we use "might." So, if we say "It might rain today," we think that it probably will not, but there is a small probability that it will. If we say "It may rain today," we think that the chances of it raining are pretty good—certainly 50 percent or more.1. There is no difference between "anyone" and "anybody."2. "Fill in the form" means "write something in the blank spaces." "Fill out the form" means "complete the form." Both are used and you can choose either one. "Fill in" is more common in British English. "Fill out" is used in American English. "Fill the form" is not used by native English speakers, as far as I am aware.3. "The" is not needed, since the sentence is making a general statement. If we are talking about a specific group of people that we belong to and we are dividing that group into two subgroups, then we would say: "They're the doers [in our group], we are the intellectuals." If we say: "They're doers, we're intellectuals" (without "the"), we imply that "they" are not part of our group.4. "Met him" suggests that the meeting happened by chance or that it was an informal meeting. "Met with him" means "had a prearranged meeting with him" and it suggests that the meeting was arranged to discuss some matter of common interest in some formal setting.5. There is no need for "a," since "wastage" is an uncountable noun. By the way, it is also abstract rather than concrete, and that reinforces its uncountability. Therefore, the indefinite article is not needed.6. "More quickly" is the comparative form of the adverb "quickly." ("Quicker" is the comparative form of the adjective "quick.") If you are comparing the speed of two actions, use "more quickly"—for example, "She ate more quickly than her sister.""Maturer" is the official comparative form of "mature," and this is the form given in most dictionaries. However, "more mature" is the commonly used form these days. My advice is: Use "more mature."7. "Who" is the subject form; "whom" is the object form. The best way to remember this is to connect it as follows: "he/they/who" and "him/them/whom." Use "who" where you would use "he/they" and "whom" where you would use "him/them."In your example sentence, we would say: "You are aiming them at him," or "You are aiming them at them." Therefore, it should be "whom you are aiming them at." (Him/them/whom is the object of the preposition "at," so we need the object form.)In the second occurrence, we would say: "They think otherwise" or "he thinks otherwise." Therefore, it should be "who you believe think otherwise." (He/They/Who is the subject of the verb "think," so we need the subject form.)So, "Curse words are cuss words, regardless of whom you are aiming them at, and damn those men who you believe think otherwise."

What is a week in the life of a neurosurgeon like?

Q. What is a week in the life of a neurosurgeon like?A2A. Two neurosurgeons describe their lifework.Before I Go: A Stanford neurosurgeon’s parting wisdom about life and timeLife as a brain surgeonBefore I Go: A Stanford neurosurgeon’s parting wisdom about life and timeBy Paul Kalanithi March 12, 2015 (Washington Post)Paul Kalanithi savors a moment with his daughter, Cady/ Photo by Mark HanlonIn residency, there’s a saying: The days are long, but the years are short. In neurosurgical training, the day usually began a little before 6 a.m., and lasted until the operating was done, which depended, in part, on how quick you were in the OR.A resident’s surgical skill is judged by his technique and his speed. You can’t be sloppy and you can’t be slow. From your first wound closure onward, spend too much time being precise and the scrub tech will announce, “Looks like we’ve got a plastic surgeon on our hands!” Or say: “I get your strategy — by the time you finish sewing the top half of the wound, the bottom will have healed on its own. Half the work — smart!” A chief resident will advise a junior: “Learn to be fast now — you can learn to be good later.” Everyone’s eyes are always on the clock. For the patient’s sake: How long has the patient been under anesthesia? During long procedures, nerves can get damaged, muscles can break down, even causing kidney failure. For everyone else’s sake: What time are we getting out of here tonight?There are two strategies to cutting the time short, like the tortoise and the hare. The hare moves as fast as possible, hands a blur, instruments clattering, falling to the floor; the skin slips open like a curtain, the skull flap is on the tray before the bone dust settles. But the opening might need to be expanded a centimeter here or there because it’s not optimally placed. The tortoise proceeds deliberately, with no wasted movements, measuring twice, cutting once. No step of the operation needs revisiting; everything proceeds in orderly fashion. If the hare makes too many minor missteps and has to keep adjusting, the tortoise wins. If the tortoise spends too much time planning each step, the hare wins.The funny thing about time in the OR, whether you frenetically race or steadily proceed, is that you have no sense of it passing. If boredom is, as Heidegger argued, the awareness of time passing, this is the opposite: The intense focus makes the arms of the clock seem arbitrarily placed. Two hours can feel like a minute. Once the final stitch is placed and the wound is dressed, normal time suddenly restarts. You can almost hear an audible whoosh. Then you start wondering: How long till the patient wakes up? How long till the next case gets started? How many patients do I need to see before then? What time will I get home tonight?It’s not until the last case finishes that you feel the length of the day, the drag in your step. Those last few administrative tasks before leaving the hospital, however far post-meridian you stood, felt like anvils. Could they wait till tomorrow? No. A sigh, and Earth continued to rotate back toward the sun.But the years did, as promised, fly by. Six years passed in a flash, but then, heading into chief residency, I developed a classic constellation of symptoms — weight loss, fevers, night sweats, unremitting back pain, cough — indicating a diagnosis quickly confirmed: metastatic lung cancer. The gears of time ground down. While able to limp through the end of residency on treatment, I relapsed, underwent chemo and endured a prolonged hospitalization.I emerged from the hospital weakened, with thin limbs and thinned hair. Now unable to work, I was left at home to convalesce. Getting up from a chair or lifting a glass of water took concentration and effort. If time dilates when one moves at high speeds, does it contract when one moves barely at all? It must: The day shortened considerably. A full day’s activity might be a medical appointment, or a visit from a friend. The rest of the time was rest.With little to distinguish one day from the next, time began to feel static. In English, we use the word time in different ways, “the time is 2:45” versus “I’m going through a tough time.” Time began to feel less like the ticking clock, and more like the state of being. Languor settled in. Focused in the OR, the position of the clock’s hands might seem arbitrary, but never meaningless. Now the time of day meant nothing, the day of the week scarcely more so.Verb conjugation became muddled. Which was correct? “I am a neurosurgeon,” “I was a neurosurgeon,” “I had been a neurosurgeon before and will be again”? Graham Greene felt life was lived in the first 20 years and the remainder was just reflection. What tense was I living in? Had I proceeded, like a burned-out Greene character, beyond the present tense and into the past perfect? The future tense seemed vacant and, on others’ lips, jarring. I recently celebrated my 15th college reunion; it seemed rude to respond to parting promises from old friends, “We’ll see you at the 25th!” with “Probably not!”Yet there is dynamism in our house. Our daughter was born days after I was released from the hospital. Week to week, she blossoms: a first grasp, a first smile, a first laugh. Her pediatrician regularly records her growth on charts, tick marks of her progress over time. A brightening newness surrounds her. As she sits in my lap smiling, enthralled by my tuneless singing, an incandescence lights the room.Time for me is double-edged: Every day brings me further from the low of my last cancer relapse, but every day also brings me closer to the next cancer recurrence — and eventually, death. Perhaps later than I think, but certainly sooner than I desire. There are, I imagine, two responses to that realization. The most obvious might be an impulse to frantic activity: to “live life to its fullest,” to travel, to dine, to achieve a host of neglected ambitions. Part of the cruelty of cancer, though, is not only that it limits your time, it also limits your energy, vastly reducing the amount you can squeeze into a day. It is a tired hare who now races. But even if I had the energy, I prefer a more tortoiselike approach. I plod, I ponder, some days I simply persist.Everyone succumbs to finitude. I suspect I am not the only one who reaches this pluperfect state. Most ambitions are either achieved or abandoned; either way, they belong to the past. The future, instead of the ladder toward the goals of life, flattens out into a perpetual present. Money, status, all the vanities the preacher of Ecclesiastes described, hold so little interest: a chasing after wind, indeed.Yet one thing cannot be robbed of her futurity: my daughter, Cady. I hope I’ll live long enough that she has some memory of me. Words have a longevity I do not. I had thought I could leave her a series of letters — but what would they really say? I don’t know what this girl will be like when she is 15; I don’t even know if she’ll take to the nickname we’ve given her. There is perhaps only one thing to say to this infant, who is all future, overlapping briefly with me, whose life, barring the improbable, is all but past.That message is simple: When you come to one of the many moments in life when you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more, but rests, satisfied. In this time, right now, that is an enormous thing.This article is republished with the permission of Stanford Medicine magazine. Its author, Stanford University neurosurgeon Paul Kalanithi, died Monday night at the age of 37. Here is his obituary.Below is a video of Kalanithi speaking about the importance of time:8:39Days are long, years are shortPaul Kalanithi reflects on being a physician and a patient, the human experience of facing death, and the joy he found despite terminal illness. (Stanford/YouTube)Life as a brain surgeonSunday 22 October 2017 5:05PMBrain surgery is bloody, messy, and dangerous. Britain’s foremost neurosurgeon Henry Marsh likens it to a blood sport—such as tiger hunting, and after 40 years of getting inside people’s brains, he reflects on the exhilarating highs and devastating lows. But his love for the practice of neurosurgery has never wavered and he shares with us his victories, mistakes, and musings on consciousness and death.NEUROSURGEON HENRY MARSH (ALEX MACKWORTH-PRAED)Lynne Malcolm: Can you imagine a lifetime of slicing through people's thoughts, feelings, dreams and memories? In brain surgery there's blood, noise and bone dust, and the stakes are high.Henry Marsh: And when you're operating and looking at the surface of the brain or the major blood vessels around it, and you're anxious and nervous and it's like, I'd imagine, tiger hunting, but I don't hunt and I certainly wouldn't hunt a tiger but…Lynne Malcolm: You've called it a blood sport.Henry Marsh: Well, it is a blood sport and I say that deliberately and provocatively, and you become a surgeon, certainly a neurosurgeon, because it's exciting, but what makes it exciting is the fact you are actually very anxious the patient should do well.Lynne Malcolm: It's All in the Mind on RN, I'm Lynne Malcolm. Today I'm speaking with one of Britain's foremost brain surgeons, Henry Marsh.His first memoir Do No Harm gave a rich human insight into the sometimes mysterious field of neurosurgery. The book became an international best seller in 2014.Now he's reaching the end of his 40-year career as a neurosurgeon and reflects more deeply about what getting inside people's heads has meant to him. In his latest memoir, Admissions: A Life in Brain Surgery, he's scathingly honest about his failures and misjudgements, as well as his triumphs.Henry Marsh's medical career began as an operating theatre porter at a hospital in a mining town in the north of England. At the time, he says, he was very lonely, writing incredibly bad second-rate poetry. But after watching a few operations he decided to become a doctor.Henry Marsh: So I didn't actually become a doctor until I was almost 30 years old. And then when I was a junior houseman and I was seeing surgery, I didn't really like it, and I didn't really like surgeons very much. I was in a bit of a quandary, became a bit depressed. And then more of less by chance a year, a half after I had actually qualified as a doctor I saw a brain operation, something called an aneurysm pure oration which involves making a small opening in the side of somebody's head and then using a microscope to fiddle around with blood vessels more or less in the middle of the brain. And it's terribly dangerous, it's terribly exciting, very exquisite and very, very serious. And I just loved it. It was love…it was an epiphanic experience.Having said that, a year before that my infant son had had a brain tumour, which hadn't exactly turned me on to neurosurgery but maybe it influenced me a bit. But I immediately knew what I wanted to do and I came back and said to my first wife, I said, 'I'm going to be a brain surgeon.' And she said all right, and all my family and friends said, 'Henry is a brain surgeon, yes,' I think on the grounds it suited my rather…not exactly megalomaniac but rather self-important aura. And although I think my view of brain surgery has changed profoundly since then, I've never regretted it. I can't for myself imagine a more interesting, more fascinating, more complex work. But it's not the operating, the operating is easy. I mean, it sounds crazy, but the operating is the easy bit. And I like to say, well, actually brain surgery is quite easy.Lynne Malcolm: It's not brain surgery.Henry Marsh: Exactly. But it's the decision-making which is so critical, because what is special about brain surgery is it's very dangerous. Every time you operate, basically we are going to damage the brain. The brain does not…although it has some some powers of recovery, it's not like operating on bone or muscle or other tissues which actually heal. You stitch them together and it heals. You can't stitch the brain together. So every time you operate, to a greater or lesser extent you would inflict some damage. So it's all about balancing the risk of causing damage against the risk of not operating. And looking back on my career, which is now 38 years of neurosurgery, and looking at colleagues, it is clear to me where the mistakes get made is in the decision-making. The public have this totally mistaken idea it's all about exquisite manual dexterity. It's not, and in fact the dexterity required manually for brain surgery is no more or less than many other branches of surgery. But the problem is the consequences of what you do, and in human terms that is often terrible and very, very difficult.Lynne Malcolm: We'll talk a little bit more about that and some of the examples that you've had to face in that way. But, as you say, brain surgery, it's dangerous and it's quite confronting, there's blood and there's dust and there's noise, it's a very physical thing.Henry Marsh: It is. I mean, the blood, dust and noise is when you're opening the skull, that's not brain surgery, that's sort of carpentry. But yes, there are many different sorts of brain operation, not all necessarily operating within the brain itself, although my main specialty in recent years is removing tumours from within the brain itself rather than things outside the brain pressing on it. And it is of course one of these extraordinary fascinating things that thought and feeling is a physical process. It doesn't feel like it.The way I like to illustrate this, because I specialise in operating with patients awake, for certain tumours it helps to have a patient awake so that it basically gives you early warning if you're actually going to start causing disability of some sort. This is done with a microscope, in effect in crude terms you take the top of the patient's head off and you have the brain exposed and you actually can see the patient's face and talk to the patient at the same time. At least that's the way I do it.But anyway, I remember one particular case I was operating on the back of the brain, the left occipital lobe which is responsible for vision on the right side because everything in the brain is crossed over. The left side of the brain moves the right side of the body and perceives the right side of the world. And since I have a camera attached to the microscope there's a TV monitor, basically so the nurses and my assistants can see what I'm doing. But I'll say to the patient, 'Would you like to see your own brain?' And most say no but some of them say yes. And I then say, 'Well, you're now one of the few people in the history of not just the human race but of planet Earth who have seen their own brain.' And I had one patient where I was operating on the visual area and the television monitor was on the right side at the end of the operating table, so the left occipital lobe was looking at itself. And you feel there should be the philosophical equivalent of acoustic feedback, there should be a metaphysical explosion. There's not, and it's just crazy. And there is something profoundly crazy and incomprehensible about the fact everything you and I are thinking and feeling at the moment is the electrochemical activity of nerve cells.Lynne Malcolm: So do you actually think about that when you're cutting into the brain or you are dabbling around in the brain, about dreams and memories…?Henry Marsh: No, you get used to it. When I started doing brain surgery as a junior trainee years ago, I got a certain thrill thinking about that. But the brain, although an intact living brain viewed from the outside is rather attractive, particularly down a microscope it shines very brightly because it's covered in cerebrospinal fluid, and all these blood vessels, it's rather like looking down from space on a river estuary or something, if you actually open the brain and you're in the brain itself chasing a tumour, say, it's like being inside cream cheese more or less, and that's not particularly impressive.In my books I try to describe the occasional tremendous beauty of brain surgery, particularly when you are operating down a microscope. It's like with a really good pair of binoculars the world looks somehow more real than with normal vision. And when you are operating and looking at the surface of the brain or the major blood vessels around it which are often something you operate on and you are anxious and nervous, and it's like, I'd imagine, tiger hunting, but I don't hunt and I certainly wouldn't hunt a tiger but…Lynne Malcolm: You've called it a blood sport.Henry Marsh: Well, it is a blood sport and I say that deliberately and provocatively, but the point is of course…and you become a surgeon, certainly a neurosurgeon, because it's exciting, but what makes it exciting is the fact you are actually very anxious the patient should do well. If you're a true psychopath, as some people like to think surgeons are…and I know one or two surgeons who certainly have a psychopathic bent, which means they don't actually care for their patients very much, then it wouldn't be so exciting.The problem with brain surgery is however good you are, some patients are going to do badly. Sometimes because an operation goes wrong for no obvious reason…I was doing an operation like that in fact two weeks ago in London where it all went perfectly and then went horribly wrong at the end and I just don't know why. And the problem is then you're left with a totally disabled patient. I mean, it's awful. But other times the operation has gone wrong because you made a bad decision, and it may be it was understandable, it wasn't a mistake as such, but the fact of the matter is you are a human being and you will make mistakes, and this is something obviously doctors find very difficult to talk about.But the memoirs written by doctors of my seniority usually are celebrations of triumph and success, and my book is rather unusual, both my books are rather unusual because I'm much more interested in writing about things going wrong. And obviously people find that interesting.Lynne Malcolm: You're with All in the Mind on RN, I'm Lynne Malcolm, and with me is renowned British neurosurgeon Henry Marsh. In his latest memoir called Admissionshe reflects on some of the experiences he's had working over many years in poverty stricken countries such Nepal and the Ukraine. One little girl patient there, Tanya, really touched his heart.Henry Marsh: Well, it was a 12-year-old girl with a huge benign brain tumour, and because although the Ukraine has changed a lot over the 25 years I've been working there…I don't go on holidays, I go and do operations in funny countries. My first wife finally got fed up with it, my second wife is very understanding. And diagnosis is late because the availability…there are fewer brain scanners, this was now almost 20 years ago. And I saw this girl, a tremendously big brain tumour. In a sense I think it was a mistake. Although there is this Jewish saviour saying he who saves a life saves the world, we live in a world of limited resources.Anyway, to make a long story shorter I brought her to London because I couldn't really do the operation in the Ukraine and financed it charitably, and it all went very badly, and she ended up stuck in London for six months in intensive care for ages. Eventually went back to the Ukraine a lot worse than she…although she was going to die without surgery sooner or later, she went back to the Ukraine after six months much more disabled than when she arrived. And in fact she then died subsequently a year later in the Ukraine.And the moral of the story is sometimes you have to be a bad Samaritan. If you're going to work in these poor countries you have to actually be pretty realistic and careful about which cases to take on because if you bite off more than you can chew it reduces your ability to do all sorts of problems. On the other hand, the mother still I think is immensely grateful because I tried to save her child's life, although I failed, although for me it was a failure. So again, it's the example of the way the doctor/patient relationship is terribly asymmetrical and very different points of view from family and the surgeon sometimes.Lynne Malcolm: So you've had many situations where you've had to tell somebody that they are going to die or tell somebody that their child is going to die, and actually there's no hope. How do you do that and how do you manage it?Henry Marsh: Well, the first thing to say, and I think it's something many doctors and the public don't understand, is it's very difficult to learn how to talk to patients because we never get any feedback. If I have to tell somebody they or their child have a cancerous brain tumour which ultimately will be fatal, they don't ring me up the next day and say, Mr Marsh, you did that very well or very badly. So you kind of learn floundering around in the dark. And I suspect most doctors, including myself, have a very rose-tinted view of how good we are at talking to patients when probably actually if you could record the patient and their family's conversation in the corridor as they walk away, you might get a very different idea. So it is very difficult to learn how to have these very difficult conversations.I mean, if an operation goes well, it doesn't matter how rude you are with the patient, they'll still think you are wonderful. And if it goes badly you often don't get to hear about how you actually handled it in terms of communication. So in some ways being a doctor, particularly a surgeon, is potentially terribly corrupting, you can end up terribly pleased with yourself when it's not really justified. But at the same time you have to be confident and have quite high self-esteem to do the work, and to get that balance right is very difficult.I don't know what sort of doctor I would have been if I hadn't had the experience of my son. It's all hypothetical, but it probably made me a little bit better than perhaps I would have been otherwise, because having been…at one point it looked as though he'd die and he was only three months old. And having known what it's like to be a relative, a parent of a child, absolutely devastated and terrified, is quite a useful experience, because even though anxious relatives are a burden all doctors have to bear, and many doctors really resent relatives, just call them 'rellies' and hate them and think they are all a complete nuisance, but I've never been able to feel that because I always think, well actually, I've been there myself.And it's one of the sad aspects of healthcare, is most of it is handed out by young doctors and nurses who have minimal personal experience of what it's like to be ill, what it's like to be a patient in hospital. I'm always telling my trainees, you think you're this sort of philanthropic, wonderful, nice doctor. Your patients are frightened of you. They just don't understand that because they haven't been there themselves.Lynne Malcolm: You say that your life as a neurosurgeon has taught you that the distinction between the brain and the body is false. What do you mean by that?Henry Marsh: Well, in the sense that mind and matter are not separate entities, that there is no reason in terms of science why states of mind should not have physical consequences, and I don't think psychological treatment cures cancer, but I think there's no reason in principle why many what we call physical conditions will not be helped by paying attention to the patient's psychological state, and vice versa.Doctors…hopefully they are better at it nowadays than in the past, but have always been rather dismissive of what's called non-organic illness, pains in the mind. All medical specialties have a large part of outpatient practice which has a very strong stress psychological component to it, and in neurosurgery it's backache and in general surgery it's tummy ache, in neurology it's headache, and it's very easy for doctors to dismiss this on the grounds of…well, you haven't got a brain tumour, go away.I'm amazed when I'm doing outpatient clinics in Kathmandu in Nepal, almost the entire population of Nepal seems to have headaches and it's very difficult to deal with it. But ultimately mind and matter are the same thing. In these days of increasingly specialised medicine, it is very easy, particularly with ill patients in hospital, to lose sight of the patient as a person. And again, a particular concern of mine which is the physical environment in hospitals in terms of design and the environment, whereas my second wife, who was a social anthropologist and has Crohn's disease and has a lot of experience at being in hospital and she is a trained observer as an anthropologist, and I hadn't really appreciated until I met her almost 20 years ago, the one thing you never get in hospital is peace, rest or quiet. And yet common-sense tells us if you are ill or recovering from an operation, that's what you need. There's this huge blind-spot in the mentality of both doctors and nurses where we just disregard this fundamental truth, that people need peace, rest and quiet when they are ill.Lynne Malcolm: You also note though that we still don't have much of an idea of how physical matter gives rise to consciousness, thoughts and feelings.Henry Marsh: We've no idea at all. Although there is a vast amount of neuroscience research going on, we really understand very little about the brain and that's because it is so complicated and so microscopic. The most accurate ways of looking into it, which is MRI scanning or magnetoencephalography or electroencephalography, it's like looking at the starry sky through a very cheap pair of dirty binoculars. I'm all for neuroscience research, I think it's fascinating, but we really understand very little. And the interesting thing is what is a thought, how do we think, how does consciousness arise? We haven't a clue.Lynne Malcolm: And so you've talked a bit about quite a famous experiment by American neuroscientist Benjamin Libet. Tell us about that.Henry Marsh: Well, it is extraordinary, and nobody really has been able to explain this, and it's been confirmed subsequently. It was a very simple experiment. You get people to sit in front of a clock face with a moving arm and they have a button to press. And you have electrodes on their scalp recording activity in the brain, particularly in the movement areas and particularly an area called the supplementary motor area. And you tell people just look at the clock and just record the time when you decide to move your finger and press the button.As you'd expect, there is a slight delay between the decision (as you say, when they note the clock hand, what the time is, in milliseconds), and when you actually physically press the button. But if you look at the electrical record from the electrical activity of the brain, the supplementary motor area becomes active 0.05 of a millisecond before the conscious decision to move the hand. That's been repeated again, and it opens up a whole almost incomprehensible area of…well, it's called epi-phenomenalism, that is to say the consciousness is like the sound of the clock ticking, and is our consciousness just an epiphenomenon, basically everything is unconscious activity of our minds.Philosophers and neuroscientists write books and books and books about this, and other people say, well, consciousness wouldn't have evolved (if you are a strict Darwinist, as most scientists are) if it didn't have some sort of function or purpose. But we all know that we don't choose our feelings, and it's something I try to allude to a bit in my second book, is our conscious self is somehow like a ball on a pinball machine, so bouncing between all these different motives and feelings, many of which are subconscious. And again, like dreaming. Why do we have these weird dreams, what they mean? It is evidence of how little we understand.When I'm a bit jetlagged, as I am at the moment, flying around the world, I sleep in a very interrupted sort of way, and I was doing this last night, so I do a lot of lucid dreaming, when I know I'm dreaming. So I am actually aware of all these extraordinary images that suddenly appear in my mind, and they are completely bizarre. It's not as if there is any connection. I can actually sort of analyse them because I'm half awake. And it is extraordinary. It's almost as though the brain is constantly active unconsciously, generating all this stuff all the time. And when we are actually conscious we are just actually…it's a bit like if you pressed all the keys on a keyboard at once you'll get a sort of crazy noise. And then to write a piece of music you have to introduce time gaps between the notes. We don't know why people dream. We know dreaming is very important, there is some recent mouse work suggesting it's actually very important for memory, and it confirms potentially, probably the most popular view of dreaming is it's a sort of garbage disposal process, it's clearing more space so you can remember more the next day. Dreaming and sleep is essential to all animals with brains. But the fact we can't even explain that shows how little we know.Lynne Malcolm: So how are you reacting to retirement? I know you're still doing some work, but you are heading towards retirement. How are you reacting to retirement and to your own ageing?Henry Marsh: Well, with reluctance is the answer. In fact I am busier now than I was when I was still working full-time in London, partly because I continue to work in both Nepal and Ukraine. I'm going back to Nepal later this year, but I suspect I will stop that, for various reasons. I've got a fairly major commitment in the Ukraine, and I still do one day a week in London, that's mainly teaching, which I like doing. With surgery…for most of us, not everybody, teaching is a hugely important part of it because it's a practical skill, like master and apprentice, and you have an enormous responsibility to train the next generation of surgeons. It's also immensely rewarding. The prospect of retirement fills me with dread in many ways because psychologically I'm a bit of a gyroscope. If I stop spinning I'm worried I'll fall over. And also the problem is as a surgeon you're used to being very important in your patient's lives and so the idea of not being important I find rather frightening. I've also become quite a well-known writer as well. But at the same time I know it's essential to leave too early rather than too late. It's like going to a dinner party or life itself, the problem is knowing when.Lynne Malcolm: As a neurosurgeon over four decades, Henry Marsh has been confronted almost every day with the concept of death. But in his own words he says he's 'deprived of the consolation of belief in any kind of life after death'. And as you'll hear shortly, he's open to the idea of euthanasia for himself. He acknowledges that having no belief in life after death is not very helpful as you get older.Henry Marsh: Well, no, because death is nothing. Fear of death is not rational unless you believe in heaven and hell. In America everybody believes in heaven, nobody believes in hell any longer. So you ought to look forward to dying, which of course we don't. But if you see people, as I do, at work with frontal brain damage, it's usually after head injuries, and the front of the brain is the bit of the brain responsible for social behaviour, moral behaviour, planning, our relationships to other people, and these people can be intellectually intact, they're not paralysed, they can see, they can think, they can reason, but they are no longer the people they were. They don't know it. This is what is so grotesque about it, they don't realise. And the change usually is a change very much for the worse, they become selfish, impulsive, irritable, temper tantrums, and almost invariably the marriage breaks down in time, they lose their work, and then you get a lot of secondary depression.But if you see somebody who has what we would consider to be their fundamental human moral nature changed by physical damage to the brain and the brain scan showing all these little areas of haemorrhage in the frontal lobes, it's very hard to feel there is some kind of essential human being who continues beyond the brain. So taking that into conjunction with all the suffering you see as a doctor, particularly of children, and I see children dying from malignant brain tumours, to me that's not consistent with a benign deity, unless you say God is a bastard, and that's consistent with the evidence. Because the only way you can justify this terrible suffering you see of children…or like those people killed in Manchester a few days ago, one sweet little girl, I wept when I saw the picture and I'm sure many other people did, you could only justify that in a theological way if you say there is an afterlife and everything is going to be corrected afterwards. You can't, not if you have some basic neuroscientific understanding.So death is nothing. But the problem is dying of course, and dementia above all. And in my new book I discuss that because my father, as do many of us, my father died from Alzheimer's and I didn't really cope with it very well I don't think. But these are the realities of life in the modern world and our society where we all live longer and longer, and the two great diseases of old age are cancer and dementia. And that does worry me. It also worries me because of course if you are dementing you will lose insight into it or there may be a period when you realise you are starting to lose your memory, and there is no effective treatment for it at the moment. And despite the huge amount of research into Alzheimer's and the other dementias there's minimal therapeutic progress. So the irony if you're going to kill yourself…and I start my book joking about my suicide kit, which is real, it's a serious joke…Lynne Malcolm: So you have the drugs all ready?Henry Marsh: I have the drugs at home, as I joke in the books they don't come with a 'best by' or 'best before' date, so I'm a worried they might not work, then I'd have the embarrassment of having my stomach pumped out in hospital, which I don't want. You need to in theory get out ahead of the game, but then of course you won't do that because I'm fine, why should I kill myself today when everything is all right. So slowly we compromise and compromise and compromise when it comes to dementia. Obviously if you have motor neuron disease or a malignant brain tumour then it's a bit different. But as a doctor you see this on a daily basis and it's harder I think as a doctor to run away from these problems perhaps, and I try to write about this and share this with the public.Lynne Malcolm: So, overall what has 40 years of working so closely and intensively on the human brain taught you about life?Henry Marsh: Nothing at all, other than to be appalled by its fragility and the fragility of thought and reason. Neurosurgery is really very crude. But you see a lot of illness, and again you learn about your own fallibility, you learn a lot of psychological lessons. But understanding that the brain is a physical process doesn't tell you anything. And that is actually very important because a lot of people resent the idea maybe that thought is a physical process, they think it's reductionist, that it means we are just automata. It doesn't mean that at all. What it does is it elevates matter, it elevates the matter into something we really don't understand, even though you have these amazing descriptions of quantum mechanics and the Big Bang and quantum entanglement and this weird and in a sense incomprehensible world of modern physics, but we don't understand how it gives rise to consciousness. And we shouldn't see it as a threat in any way.Lynne Malcolm: Henry Marsh, neurosurgeon and author. His latest memoir is called Admissions: A Life in Brain Surgery. Henry Marsh was a guest of the Sydney Writers Festival.A look into neurosurgeon NIH funding from 1991-2015 - 7 observations

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