His brand is chaos.

The other day I said to someone in the office, “You remember when we would say, on Friday, that something happened on Monday and it seemed like six months ago? Now something happens at 9 a.m. and by 3 p.m. something else has happened and it’s like, ‘oh, that’s so 9 a.m.'”

It’s about 9:30 p.m. now, and there are multiple scoops breaking all over Newsville, which makes yesterday’s astonishing press conferences seem like they happened a year ago, but come on, this picture is one for the ages:

I used to work with Chip Somodevilla. Great photographer.

Yeesh, what a week. The last 48 hours have been bananas, necessitating a drive to Goddamn Lansing in which it rained, hard, both ways. Welcome to fall, bitch, every drop seemed to say. I don’t mind an overcast, drizzly day from time to time, but it’s never fun to pass an 18-wheeler in that sort of weather. You just drive into the mist and hope the road is still under your tires as you do so. And it’s worse at night.

But never you mind that. Because anything I write now will be outdated in 15 minutes, some bloggage to take you into the weekend, then.

I read this piece by Gene Weingarten, an excerpt from his upcoming book, the other day, marveling at how well it’s written. It’s likely something you’ve read before, a story about an organ donor and organ recipient on their separate journeys, but it’s just So. Good. You want to know how to write about complex medicine? Watch and learn, kids. Here’s the moment where the donor heart is extracted from the chest:

If you’ve read about open-heart surgery or seen videos, you may have a mental image of what followed: hours of precise, delicate work on gossamer tissue and threadlike vessels, performed by beetle-browed people wearing those eyeglasses with little telescopes in them.

Discard everything but the furrowed foreheads and telescope glasses. Compared with other open-heart procedures in which Lefrak was already expert — say, coronary artery bypass — heart transplantation seems like butchery. The heart as a whole is a large, unsubtle organ, and those vessels feeding it that aren’t the circumference of a D battery are still as fat as thumbs. Edward Lefrak removed Mark Willey’s heart with a single tool: a pair of scissors not all that structurally different from what second-graders use on colored paper. There were no nurses beside him handing him tools or mopping his brow.

First he separated the superior and inferior venae cavae, the two large vessels that return blood from the body into the right atrium, and severed them. Then he lifted the organ with his left hand and cut behind it with his right, one snip on each of the four pulmonary veins that run lung to heart. He lowered it back into the chest. Below the clamp, he cut through the aorta and finally the pulmonary artery, which runs heart to lung. The heart was now in the doctor’s hands, free of the body. It felt cold, even through a latex glove.

All that detail, using both simple and specialized language, in images you can see in your mind’s eye – D batteries, a child’s scissors. And here’s the moment after it’s been attached to the recipient, before it’s brought back to life:

What happened next defied everything most people presume about the human heart. Lefrak lowered Eva’s head, cupped her new heart with his left hand and tilted the bottom of it up so it became the highest point in her body. Then he accepted from Dellinger a long 18-gauge hypodermic needle and stabbed it into the heart’s apex, clean through the muscle to the cavity of the left ventricle. From the plastic collet of the needle came a bloody froth. When that stopped, Lefrak withdrew the needle, then pushed it in again, a few millimeters away. More bubbles.

If a heart is sliced by the thrust of a knife, that is usually fatal. If it is pierced by a bullet, it is nearly always fatal. But the heart is, in the end, a muscle, and as anyone knows who has ever gotten a vaccination in the arm — or anyone familiar with the overdose scene in “Pulp Fiction” — muscles can withstand and survive a needle. They close back up and heal instantly. Lefrak repeated this unnerving stab of the needle more than a dozen times. The goal was to empty the heart of all air bubbles before reconnecting it to its prime source of blood, via the venae cavae. Air bubbles cause embolisms, and embolisms cause brain damage.

Satisfied all the air was gone — no more froth — Lefrak allowed the heart to fill with blood.

The magic phrase there is “anyone knows who has ever gotten a vaccination,” because it makes you understand immediately. Of course you can stab a heart with needles; it’s a muscle.

Alan used to be a medical writer in Fort Wayne, doing disease-of-the-week stories. He was good at this sort of explanation. Not this good.

OK, I’m going to bed. I’m going to nibble a quarter square of an indica edible, swallow a melatonin and go off to dreamland. Let’s hope we survive the weekend.

Posted at 9:59 pm in Current events |

51 responses to “His brand is chaos.”

  1. Jakash said on October 3, 2019 at 11:23 pm

    Today was pretty sporting of Trump, really. He knows many of his supporters can’t or won’t read *anything*, so he went to the trouble of putting the impeachable offense right on TV, where they can see it for themselves. The hard-core 35 – 40% might not care, but, at long last, have Republican legislators left no sense of decency? Oh, right…

    “CNN contacted the offices of 64 Republican lawmakers in the House & Senate today to see if any had concerns with Trump’s public call for China to investigate Biden. Only a few responded, not a single one said yes.”


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  2. MarkH said on October 4, 2019 at 1:13 am

    Meantime, FLOTUS landed here today with only 24 hours notice. Solo, thank God. Part of her national parks tour and spreading the ‘Be Best’ word.


    She’ll be in Yellowstone Friday, hopefully not pulling rank to wander off the boardwalk around Old Faithful.

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  3. beb said on October 4, 2019 at 1:16 am

    I just drove from far eastern Detroit to the Franklin Mill and back in the rain. That was bad enough. I’m glad I didn’t have to go to Lansing. The fight between Gov. Witmer and the Republican legislation ought to be national news. I don’t think it’s making local news because of the 12-year old in the WH.

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  4. Dexter Friend said on October 4, 2019 at 2:50 am

    Whoa, yeah, great descriptive text. Yeah, I was stabbed by the blood draw lab on Friday, I stabbed myself with an IM needle for my bi-monthly B-12 shot today, while Tuesday I got stabbed for a senior flu shot. The senior flu shot is more high-powered than the regular one. My arm ached for 36 hours and I was listless for the same time period. I thought of Nance and Alan Tuesday as I was blasting along on US 24, the 70 mph freeway where I clip along at 79 mph , and I blew by a big-ass truck with very high sides, peaked to damn-nearly spilling-over, heading for Campbell’s Napoleon soup factory. Jammed to max with tomatoes from up around Ida, Michigan, where that commuter plane crashed about 24 years ago. I live near tomato fields, too, just a little NE, around rural Stryker. My son-in-law is 43 today…now the kids are middle-aged.

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  5. Connie said on October 4, 2019 at 6:02 am

    4dbirds, I answered your question about implants in last comment yesterday.

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  6. alex said on October 4, 2019 at 7:47 am

    Lost in the raucous news cycle is this bit of political drama from Indiana, where the right-wingers are suing to restore Pence’s “religious liberty” law as it was originally written.

    And here’s Dahlia on how the Trump spin cycle works and how a small load just wrecked his machine.

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  7. Suzanne said on October 4, 2019 at 8:13 am

    We can all rest assured that the tide is turning against Trump because Ben Sasse has made a statement that “Americans don’t look to Chinese commies for the truth.”
    Does this mean he is merely concerned or very concerned?

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  8. Dorothy said on October 4, 2019 at 9:17 am

    I saw your tweet about the Weingarten piece the other day and read the entire article during a slow afternoon at work. Just WOW. Great work. I love those kinds of stories.

    The dog woke me at 3:10 – she does this maybe once every other month. “I’m thirsty! I need to pee!” So of course I had to take her outside quickly. I checked Twitter and started to read Adam Schiff’s tweet/link about the letter he composed yesterday, and the attached long list of text messages, etc. between Volker and a bunch of other people. Then I noticed that it was 25 pages long, so I closed my iPad and tried to get back to sleep at 3:45.
    (Didn’t work) This will be today’s reading for quiet times of the day. I don’t know why I’m stunned that Dumpy’s base are blind and deaf to all of this information. Talk about living in denial….

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  9. Sherri said on October 4, 2019 at 9:24 am

    My brother had heart surgery a couple of days ago, fortunately not an open procedure. He has a leaky aortic valve that started causing problems, so he just got it replaced. Because his arteries were all fine, they didn’t have to crack his chest and fix anything else, but even with the less invasive procedure, they have to put the heart on bypass. So he’s in CICU for a few days while his heart rhythm stabilizes, and will be in the hospital up to a week.

    Apparently in the genetic lottery, he drew the leaky aortic valve while I drew high blood pressure.

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  10. 4dbirds said on October 4, 2019 at 9:25 am


    Thanks, I saw your answer. As an army brat and later as a soldier, I received excellent dental care but my years of grinding my teeth has taken its toll now that I’m in my 60s. My daughter, who is my dependent, needs an implant for a front tooth and that is our priority right now. She doesn’t have dental insurance so we are out the 4K for the cost. I’ll just be careful eating and hope I can get into next year before replacing my bridges or doing an implant. With insurance, the cost of each implant will be around 2K. No wonder people die from dental issues. How can people of modest means afford it?

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  11. Bitter Scribe said on October 4, 2019 at 10:47 am

    Even assuming for the sake of argument that I could handle the academic work, I could never be a surgeon (or any kind of doctor, really), because this sort of thing squicks me out. Unless I went into robotic surgery or something like that. There’s a fascinating profile in the current New Yorker about an Italian surgeon who got woozy as a medical student over icky surgical procedures and is now a pioneer in minimally invasive surgery done with robots, where it’s all like a video game.

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  12. Julie Robinson said on October 4, 2019 at 11:11 am

    I read the Weingarten piece when it came out, and there were details I hadn’t known, even though my dad had a heart transplant. It was indeed beautifully written.

    Sherri, hope your brother has a speedy recovery. Cracking open the chest is a whole ‘nother thing to get healed up from. Big sis had a quadruple bypass, and after staying with her through the aftermath, I believe I would decline surgery and simply live out my days.

    I haven’t looked at the news in 15 minutes, so I’ve probably missed three or four new developments. Stranger than fiction, isn’t it?

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  13. basset said on October 4, 2019 at 11:18 am

    Mrs. B was a surgical tech for many years before retiring and helped on many surgeries with the DaVinci robot… amazing what they can do through a few relatively small punctures. And we hear you on the dental stuff, her latest bridge is gonna be $3700 after insurance.

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  14. Alan Stamm said on October 4, 2019 at 11:29 am

    Shoo-whee, Gene has language artistry at such a head-spinning level. Thanks for today’s vivid reconfirmation.

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  15. Deborah said on October 4, 2019 at 12:44 pm

    There’s a great scene in the movie Vice where Cheney is undergoing his heart removal, they focus on a deep black bloody hole which perfectly symbolized Cheney himself, a heartless man.

    My spine surgery was robotic, the incision was tiny. My dad had surgery on his spine for the same reason back in the 80s, his was full blown invasive and afterwards the incision became infected, a nurse had to come and administer a shot once a week, which back then cost $1,000 per shot. He had to have it for months.

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  16. David C. said on October 4, 2019 at 2:06 pm

    If the purpose if insurance is to cover things beyond what I could cover myself, then dental insurance hardly fits the description. I could cover cleanings and the occasional filling. Things like bridges and crowns, I can cover those too, but it’s damned difficult. So the insurance covers what I can take care of 100% and the other stuff is covered 50% up to a $1500 maximum. It’s completely ass backwards.

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  17. Jenine said on October 4, 2019 at 2:20 pm

    Today’s comment by T&Lo on Timothee Chalamet’s red carpet outfit:
    ‘A Louis Vuitton hoodie embroidered with Swarovski crystals and sequins. Liberace is smiling down from heaven and muttering “Damn, son.”’
    Love it.

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  18. Deborah said on October 4, 2019 at 3:46 pm

    Jenine, I’m not sure if that particular hoodie was designed by him but Virgil Abloh is the head designer for mens wear at Louis Vuitton. He’s from the town in Illinois where my husband’s uncle (the one with Alzheimers) lives and a couple of his grandkids went to high school with Abloh and his sister. Also he was a student of my husband’s at IIT a while back. Abloh decided to be in the fashion world instead of the architecture world. My husband said he wasn’t a great student, so maybe that’s why. Abloh got his break when he worked with Kanye West in Europe I think. Also they just had a show at the Museum of Contemporary Art in Chicago about Abloh, that just finished up last weekend. It was such a popular show, they extended it for a month. I wanted to go, but I never got around to it. I have no excuse the museum is a couple of blocks away and I pass by it almost every single day.

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  19. Colleen said on October 4, 2019 at 5:26 pm

    I just finished reading “Teeth”, about how we got where we are with dental care being considered separate from health care, when it’s really not.

    I had a robotic hysterectomy a few years ago. I was surprised how easy my recovery was. I was walking around an outdoor antique show three days later. Not very fast, and not for very long, but I was up and going far more quickly than I would have been with an open procedure.

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  20. Sherri said on October 4, 2019 at 9:13 pm

    My brother is doing well, much better two days out from the surgery. His heart rate, rhythm, and BP have all normalized, and he was up and walking easily today, according to my mom. He had originally hoped to put the surgery off until December, but started having chest pains and the shortness of breath was getting worse, so they moved the surgery up.

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  21. alex said on October 4, 2019 at 9:33 pm

    Saw the Linda Ronstadt documentary tonight and loved it.

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  22. Jeff (the mild-mannered one) said on October 4, 2019 at 11:07 pm

    Congrats, Sherri.

    I learned something in Niles, Michigan I was not expecting, as well as did not know:


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  23. Connie said on October 5, 2019 at 6:32 am

    So Jefftmmo, if you head a few miles south and east from there to central city Elkhart you can be surprised by a historical marker denoting that Ambrose Bierce lived and worked here.

    Whose death place is unknown, other than that he disappeared in Mexico.

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  24. alex said on October 5, 2019 at 8:48 am

    Jefftmmo, we just got a new historical marker in Auburn, Indiana, in front of the childhood home of Will Cuppy. I forget whether there’s a marker in front of his grandparents’ house but it was known to be a stop on the Underground Railroad.

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  25. Suzanne said on October 5, 2019 at 10:49 am

    For those of you in a bubble, this is what an acquaintance of mine, a Lutheran pastor’s wife, posted of Facebook this morning:

    And old Jim Banks is posting all sorts of Breitbart garbage on Twitter about how Adam Schiff is a liar.

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  26. Deborah said on October 5, 2019 at 11:46 am

    Suzanne, that screed was hilarious. Wow, I was laughing so hard I almost peed my pants. What a bunch of weirdos. I couldn’t finish it, it was such crazy nonsense.

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  27. Suzanne said on October 5, 2019 at 11:54 am

    The thing is, Deborah, this woman who posted it doesn’t find it funny but truly believes this crazy non-sense. Totally 100% buys into it. And I know plenty of others with this same apocalyptic mindset.
    This is why I do worry about gun toting maniacs roaming the countryside when Trump gets thrown out of office.

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  28. Deborah said on October 5, 2019 at 1:16 pm

    Unfortunately there are extremist types who want to scare the bejesus out of people with their ridiculous screeds, they need to be ignored and belittled. That pastor’s wife who falls for that crap is befuddled if anything. Is she old?

    Do I think there will be protests no matter who wins the election? Maybe. Will they be widespread and violent? Doubtful. I refuse to be frightened by that kind of rhetoric.

    At this rate though Trump won’t even make it to the election.

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  29. Deborah said on October 5, 2019 at 1:50 pm

    No, Deborah, she’s not old, probably mid-40s, college educated (Mich State U) She & her husband have several kids, lives in Maryland, and while I haven’t seen her in years, she seemed perfectly normal and sensible back when I knew her.
    I guess my point is that there are more of these kinds of people out here than most realize if you don’t rub noses with them everyday.

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  30. Jeff (the mild-mannered one) said on October 5, 2019 at 2:02 pm

    Bierce, I knew. Cuppy will have to wait — got to enjoy a nice if chilly sunrise over Lake Michigan this am and watched the sun catch the Chicago skyline before it lit up my stretch of the Dunes. 45 degrees keeps the crowds down, let alone 6:45 am, but it’s got me feeling the autumnal vibe finally.

    Homecoming in Athens next Saturday, Bobcats.

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  31. Jeff (the mild-mannered one) said on October 5, 2019 at 2:14 pm

    Meanwhile, back home, the rumbling is going to get too pronounced for local media to ignore much longer . . .


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  32. Julie Robinson said on October 5, 2019 at 2:39 pm

    While I’m not a betting woman, I would absolutely bet that my Missouri Synod Lutheran uncle in Iowa has read the American “Thinker” article and agrees with it 100%. Although I doubt he personally owns guns, I bet my cousins do.

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  33. Brian stouder said on October 5, 2019 at 3:01 pm

    I didn’t make it past the opening canard about ‘the left will never accept’ anything less than socialism…!!? Let’s think about that one for even just a few seconds. What do we take for ‘granted’, every single day? Streets and roads – well maintained and augmented, leaps to mind. Clean, plentiful water at our demand; responsible waste management, 24-7 police, fire, and emergency first responders on-demand; edible food (thanks FDA!) and trustworthy meters and scales (at gas stations and markets), and so on and so forth. Oh, and a publically financed military establishment, second-to-none on Earth…I’d call each of these examples of socialism, and I love them all

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  34. Deborah said on October 5, 2019 at 3:17 pm

    Whenever I have looked up old college (Lutheran Church Missouri Synod) friends that I completely lost track of over the years I’m always appalled at how many of their Facebook pages spout Fox News crap. Many of these people were absolutely normal in college and in fact some of them were even liberal back then. It’s amazing how people can be so gullible when they’re fed a steady diet of propaganda. It really works, unfortunately. I stopped looking them up after a while and I certainly don’t send them friend requests. It creeps me out.

    Suzanne, I feel for you, having to be surrounded by all of that. I don’t think I could stand it.

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  35. Suzanne said on October 5, 2019 at 4:13 pm

    “But in Trump’s America—where Greenland is for sale, weather is changed with the swish of a Sharpie, and tanks roll down Pennsylvania Avenue on July 4—they should know that crazy people are seriously contemplating these questions, and looking to the books they’ve spent a lifetime reading and sharing for prophecy, if not instructions. We so-called normies must be prepared to answer.”


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  36. Julie Robinson said on October 5, 2019 at 4:21 pm

    My college church was LC-MS, and with one exception, my old friends from then are similarly right wing now. They were all very open and intelligent people back then, and we spent hours discussing topics of faith and politics. I never saw it coming.

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  37. David C. said on October 5, 2019 at 6:04 pm

    Didn’t tRump go to a wingnut retirement community in FLA this week to tell the wrinklies that he was going to save Medicare from socialism? WTF is all you can say. Those morons probably lapped it up with a spoon.

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  38. Deborah said on October 5, 2019 at 6:55 pm

    We’re leaving for the opera in about an hour, The Barber of Seville at the Lyric, it’s supposed to be funny. I hope so because otherwise I might fall asleep, given my penchant to do so before 8pm these days.

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  39. Joe Kobiela said on October 5, 2019 at 7:06 pm

    I bet Bugs Bunny’s version of the Barber of Seville is funnier.
    Pilot Joe

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  40. Jeff (the mild-mannered one) said on October 5, 2019 at 7:43 pm

    I hear the Lyric Opera’s rendition has a nod or two to Bugs and Elmer.

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  41. susan said on October 5, 2019 at 11:04 pm

    Have you ever heard Ana Russell do the “Ring Cycle,” in 25 minutes? The whole thing in 25 minutes. That’s really all it needs to be.

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  42. beb said on October 5, 2019 at 11:53 pm

    Yes, I remember hearing Ana Russel explaining the Ring Cycle. The woman was hilarious in part because the story is so wildly improbable.

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  43. Deborah said on October 6, 2019 at 1:24 am

    The opera was delightful, very entertaining. Good voices, good sets and very good acting. We had seats closer than any other seats I’ve ever had at an opera and it’s the first time I got a good look at the performers faces. Since it’s a comic opera the exaggerated expressions were hysterical.

    We walked home and my feet are killing me because I was wearing a pair of boots that have a 2 1/2 inch heel. I haven’t worn them since about a year or so ago. Ouch. It’s hard to get a cab outside around the Lyric right after the opera and once we started walking it was cool and pleasant so we kept going, it was 2 miles. I had already walked my normal 4 mile walk earlier in the day. I’m tired but the opera left me wired.

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  44. Deborah said on October 6, 2019 at 10:19 am

    I watched a clip of the SNL opening from last night. The way Steven Miller was depicted was hilariously spot on.

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  45. LAMary said on October 6, 2019 at 12:28 pm

    The Anna Russell account of the Ring Cycle is wonderful. It’s so much better than the actual opera.

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  46. Joe Kobiela said on October 6, 2019 at 12:58 pm

    Last Christmas it was elf on a shelf, this year may be Bernie on a gurney.
    Don’t forget to tip your waitress
    Pilot Joe

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  47. Brian stouder said on October 6, 2019 at 1:37 pm

    100 years ago, the Republican president indicated one should ‘speak softly and carry a big stick’ and nowadays the Republican president seems to advocate ‘whine and natter incessantly (and in writing, too), while you have hold of the big stick’

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  48. Brian stouder said on October 6, 2019 at 1:50 pm

    Oh – by the way – my fine young son and daughter and I caught ‘Joker’ at the movie house last night, and it struck me as unsettling – and unsatisfactorily incomplete. Indeed, I get that it’s a backstory in what is intended as another ‘franchise’ series of movies (ala-Star Wars, et al); but the effect on me was like reading an unpleasant news article; you know there’s lots more to come, and much of it will also be unpleasant. So indeed, not my cup of tea

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  49. Deborah said on October 6, 2019 at 2:18 pm

    Ignore Ignore Ignore ignore ignore ignore ignore ignore. But damn it’s hard.

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  50. susan said on October 6, 2019 at 7:49 pm

    You don’t want to get a hook caught in your lip…don’t rise.

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  51. alex said on October 6, 2019 at 8:46 pm

    Last year it was elf on a shelf. This year it’s troll on a roll. With spellcheck.

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