Recently we have a case of cerebrospinal fluid-cutaneous fistula following spinal anesthesia used for indirect inguinal hernia repair. But we couldn't see any comment in the textbook about the management of cerebrospinal fluid fistula from inthratecal space to skin due to postdural puncture for purpose of spinal (intrathecal) anesthesia.
Cutaneous cerebrospinal fluid (CSF) fistula are known to occur rarely under spinal puncture during spinal anesthesia, and CSF leaks via that fistula. This complication is often self-limiting but sometimes needed some treatment procedures such as intravenous fluid restruction, patient prone position, strecth dressing of wound, epidural injection of autologous blood patche or fibrin glue, or uncommonly use of CSF drainage system.
We think that if this complication and its' management is included in new edition of the textbook it will be better.
With our regards,
Hakan Erbay, M.D. Assisstant Professor of Anesthesiology Pamukkale University, Medical Faculty Department of Anesthesiology and Intensive Care, Denizli, Turkey
Erkan Tomatir, M.D. Associated Professor of Anesthesiology Pamukkale University, Medical Faculty Department of Anesthesiology and Intensive Care, Denizli, Turkey
With our regards,
Hakan Erbay, M.D. Assisstant Professor of Anesthesiology Pamukkale University, Medical Faculty Department of Anesthesiology and Intensive Care, Denizli, Turkey
Erkan Tomatir, M.D. Associated Professor of Anesthesiology Pamukkale University, Medical Faculty Department of Anesthesiology and Intensive Care, Denizli, Turkey
List price: $15.95 (that's 30% off!)
And do I need to mention this is a damn good play? But, as I said, you'll get the same play regardless of which version you pick up (at least, I would hope...).
Real vs. Virtual American Dream
By Kevin Biederer
Arthur Miller's 1949 drama basically revolves around the American dream of a father who makes many mental errors that lead to his downfall.
The inner life of the father, Willy, is presented by the use of monologs in his head. He is a washed up salesman that does not realize it, and tries to rub off his overwhelming cockiness on his two sons.
Biff, one of his sons, transforms from a cocky, young football player into a doubtful, young man. Biff understands the reality of life through the falseness of the American dream, which ultimately, destroys his father who is living a virtual American dream. If Biff had listened to his father his whole life, he would still just be a cocky, young football player. Instead Biff realizes what a, 'ridiculous lie [his] life has been!' (104). He
Death of a Salesman
By Arthur Miller
139 pages
realizes he does not want to follow in his father's footsteps and become a washed up salesman. Biff just wants to live a normal life where Willy is not pressuring him about everything. Willy is one of those fathers who think their child is the greatest at everything no matter what. That is good in some cases, but not when Willy sets unrealistic goals for his child.
This drama portrays how many parents treat their children. Most parents try to push their children, but some go over the line, as seen in this drama. But what Willy has truly failed in is his family life and his married life. That is the corruption of the true American dream.
This drama deserves five stars because it always keeps you on your feet just waiting to see what will happen next. Brooks Atkinson of the New York Times says, 'this is one of the finest dramas in the whole range of the American theater.'
The theme of this drama is seen in the mental approaches Willy has in his life. You have to think about what you say to certain individuals and spot errors. Could Willy Loman's downfall have been avoided or not?
This drama has a tragic but far-fetched ending that puts a twist on the entire novel. Willy does something drastic, which he thinks is best for his children. We will leave that for you to decide if this decision was the best one he could have made.
Like, The Brady Bunch, Leave it to Beaver, or Seventh Heaven. All these shows displayed
the perfect American families: happy, secure, no problems or conflicts, and all these
dreams that came true. These types of shows were composed of illusions. These shows
were far from reality. These illusions are a lot like the ones Willy Loman from Death of a Salesman, by Arthur
Miller,experiences. Throughout the whole play Willy seems to have a hard time distinguishing these
two. The author does a good job at describing the journey of Willy and his problem
dealing with these two concepts.
The play starts out when Willy returns home from a failed sales trip. Finding out
his son Biff is home he criticizes him for not living up to his full potential. After feeling
really depressed he immerses himself in a flashback. These flashbacks happen quite
frequently throughout the play and are very confusing. On the contrary, the author's
placement of these flashbacks help represent the theme. His flashbacks are examples of
his illusions. Willy looks back on better times when his life becomes unsatisfactory to
him. He surrounds himself in these illusions so he does not have to face reality.
His flashbacks are only one of his types of illusions. Another illusion of Willy's
deals with his definition of a good salesman. He thinks that if there is a 'man who makes
an appearance in the business world, [a] man who creates personal interest, is [a] man
who gets ahead' (33).Willy feels that success in the business world is based on looks and
response from others around them. Hard work has no merit at all. This is an illusion as
well. This illusion replaced the little reality that Willy had left in his mind. It was this
illusion that explained the affair he had. He felt that if he was well liked and attractive
someone would want to have an affair with him. After this point Willy's mind only falls
deeper and deeper into his illusions.
By the end of the play Willy's sense of reality was so far gone he ended up
committing suicide. He could not handle what was really going on in his life. His inability
to distinguish reality from illusion is what led to his downfall. This was the point that
Arthur Miller expressed exquisitely.
This play is excellent at showing the affects of a life surrounded by illusion. It was
clearly stated that a life immersed in illusion leads a person to their ultimate downfall.
This play gives a dramatic look at this concept. It was probably very easy for Arthur
Miller to write this play because he said that he relates and understands, '[Willy
Loman's] longing for immortality, Willy's writing his name in a cake of ice on a hot day,
but he wishes he were writing in stone'(Miller). He understands the reason for Willy's
illusions. It is this understanding that helps the play be the masterpiece it is. These
illusions that Willy experiences are similar to the ones that television watchers can have
everyday. The television families that they thought were real were a lot like Willy's
flashbacks. Miller's play taps into that concept through a dramatic and tragic drama. A
drama that is good for anyone and everyone to read.
The story is about a broken-hearted salesman, Willy Loman. He is a man no longer living in the real world but is mostly trapped in his own delusional world. He can't let go of the past no matter how hard he tries, and it's eating him up inside. He wants to believe that his family is a shoe-in for greatness, no matter how lonely and sad his wife is, or how much of a player/swinger his youngest son is, or how confused and anti-business his oldest son is. You put all of this together and you get a glimpse of an American tragedy that is so powerful and sad that it makes you think these things happen all the time. From Page 1 you know it's not going to end on a happy note, but you decide to take the path anyways. And a path worth taking it is.
I admit that I was confused at certain points, because through the text alone it is very hard to separate Willy's reality from his imagination. There are places where Willy departs from reality and goes back to the past and it makes it very hard for us to figure out what is going on if we're only reading it. When I saw the movie version after reading this, I was able to appreciate the play more. I understood what confused me and I was able to figure out what was happening. Despite some confusing moments it is still a tremendous play that is very involving from start to finish. You are able to sympathize with the main character, and with the rest of the characters as well. You know a writer has done the job right when you are able to feel or care for every single character (or at least almost all of them, being there will be a few minor characters you're really not supposed to care for that much. This is something that always happens in the world of fiction and is to be expected). Arthur Miller did an amazing job of writing such a realistic and emotionally driven play. The characters were realistic as well as the dialogue.
"Death of a Salesman" is more than just simply a stunning play; it is a beautiful portrait of a family dealing with hardships and troubles. As soon as I began the play I was unable to put it down until it was finished. If you want to read a great play and are interested in great works of drama, this is the one for you.
(Note: If you are confused by the play, see the movie afterwards. It really helps.)