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Member since Jun-04-08 · Last seen Apr-24-14
Good Day to All! Ma-ayong adlaw sa tanan. And my thanks to for this excellent website. Salamat Opinions:

1. World Chess Championship

The true Chess World Champions are the holders of the Traditional Title that originated with Steinitz & passed on in faithful succession to Lasker, Capablanca, Alekhine, Euwe, Botvinnik, Smyslov, Tal, Petrosian, Spassky, Fischer, Karpov, Kasparov, Kramnik, Anand, and Carlsen. The sacredness of this Title is what makes it so valuable.

And how does one become the true Chess World Champion? In general, by beating the previous Titleholder one on one in a Match! Matches are preferred over Tournaments because of the Tradition of the WC Succession & because the chance for pre-arranging a Tournament result is more likely. The only exceptions to this rule:

A. In case where the Candidates and World Champion participate in an event that all the participants agree to be a World Championship event because of extraordinary circumstances.

Thus, the 1948 World Championship Tournament was justifiable because of the death of the Title holder Alekhine.

Likewise, the 2007 WC Tournament was justifiable under the extraordinary circumstances of the Chessworld trying to heal its internal rift over the 1993 Kasparov Schism. Anand himself became the true World Champion in this 2007 Tournament & not in 2000 when he won a knock-out FIDE Tournament.

Karpov lost his Title to Kasparov in 1985, & never regained it in the 1990s events that FIDE labeled as 'world championships'. All solely FIDE Champions that emerged outside WC Traditional Succession elaborated on above, strong as they were, were not true World Champions (eg., Bogolyubov 1928, Khalifman 1999, Ponomariov 2002, Kasimdzhanov 2004, Topalov 2005).//

B. In case the previous Titleholder defaults an event that the Chessworld largely deems as a World Championship event in the Tradition of the World Championship Succession. Thus, Karpov was the true successor to Fischer who defaulted their WC Match in 1975.

2. The strongest chess events in different eras of chess history?

Because of the brain's limitations explained below, the best professional (amateurs don't matter much in top level chess) chess players of each generation beginning in the Lasker era have always played at a similar level - near the maximum allowed by human standards. Now there are larger cohorts of chess professionals post WW2 than preWW2 thanks to government state funding in the Soviet era and presently corporate funding. The result is that large preWW2 tournaments had numerous 'bunnies', relatively weak players. By the Kasparov era, super-tournaments that featured most of the top ten, and no bunnies, had became more common. However, the top 4 or 5 since Lasker's time have always been very strong.

Consequently the smaller the top-player-only tournament, the stronger it gets. For any era. If there was a double round robin tournament in 1914 featuring Lasker, Capablanca, Alekhine, and Rubinstein, and no other, it would be as strong as any present day super-tournament.

Now weed out everyone except the two strongest players in the world. What we (usually) get is the chess World Championship match.

There has been talk of elite tournaments, composed only of the strongest top masters and no weaker bunnies replacing the World Championship match in prestige, probably because of the assumption that they would be the strongest chess events possible. False assumption. The strongest chess events in chess history generally have been World Championship matches. Even the strongest masters in each generation usually do not match the world champion and challenger in chess strength. In a World Championship match, the contestant has to meet the monster champion or challenger over and over again, with no weaker master in between. Capablanca vs Lasker 1921 was just as strong a chess event as the recent Carlsen vs Anand 2013, and far stronger than Zurich 2014. (Imagine having to play 14 straight games with a computer-like errorless Capablanca at his peak.)

3. The strongest chess players in chess history?

IMO the 1919 version of Capablanca & the 1971 version of Fischer, both of whom played practically error-free chess, are it; updated in opening theory, they should beat anyone in a match.

If computers were self-aware, I have no doubt that they would unanimously choose the 1916 to 1924 Capablanca as the strongest chess player in history. And please no red herring remark that Capa played only 'simple' chess. This young Capablanca played some of the most complicated, sharp, double edged, and bizarre positions possible; and played them without making a single losing error (and by all accounts with unsurpassed quickness), something that has always befuddled my mind when I got to peruse through his games.

We have to take this question in the context of the limits of the human Anatomy and Physiology. A concrete example would be the one hundred meter dash. The human body is designed such that the limit it can run is about 9 seconds. In order for a human being to run faster, we would have to redesign the human anatomy into that of say a cheetah. One can rev up the human Anatomy and Physiology, say with steroids, but this regimen would hit an eventual Stonewall too; the same way that we could rev up human proficiency to learn openings with computer assistance.

Since the Nervous System has physiological limits (example of a limit- neuronal action potential speed don't go up much more than 100 m/s) and so limits the human chess playing ability, increasing the number human chess players, thus expanding the normal curve of players, simply creates more possibilities of players playing like a Fischer in his prime, but will not create a mental superman who plays chess at computer levels. This explains why human and computer analysis indicate that Lasker was playing on a qualitatively similar level as more recent WCs.

'Worse' in chess, any computer assistance ends once the opening is over. After a computer-assisted opening prep, every GM today has to play the game the way Lasker did a hundred years ago, relying on himself alone, with the same fundamental chess rules and chess clock. An Encyclopedic opening repertoire is not a necessity to be a top player. In fact, there are World Champions who did not do deep opening prep; they just played quiet but sound openings that got them into playable middlegames and then beat their opponents in the midlegame or endgame. Just look at Capablanca, Spassky, Karpov, and now Carlsen.

Because of subconscious adherence to the narcissistic generation syndrome, the belief that everything that is the best can only exist in the here and now, many kibitzers would not agree to the above theses. While it is true that there have been more active chess professionals and consequently larger cohorts of top chess masters on a yearly basis since WW2 thanks to Soviet state funding and present corporate funding, the very top chess masters since Lasker's time have always played at a similar level- within the limits imposed by the human brain. There is no physical law that bars a pre-WW2 chess master from playing chess as well as today's generation. The human brain has not changed in any fundamental manner in the past tens of thousands of years.

4. The greatest chess players in history?

A related question is who is the greatest chess player in history. The answer depends on the criteria one uses. Since I place great emphasis on the ability to play world class chess for the longest period of time, Lasker would be it. He was playing at peak form from 1890 age 22 (when he began a remarkable run of match victories over Bird, Mieses, Blackburne, Showalter, and culminating in his two massacres of Steinitz) until 1925 at age 57 (when he nearly won Moscow after winning new York 1924). Kasparov (high plateau from 1980 to 2005) and Karpov (high plateau from 1972 to 1996) would follow. (At their very peak though, I believe that Kasparov was stronger than Karpov, and both were stronger than Lasker; and the peak Capablanca and Fischer were stronger than any of them.)

5. Computers vs Humans, who is stronger?

Another related question is how history's top masters would fare against computers. It's obvious from Kasparov's time that computers would totally crush them all. Opening knowledge would not matter much. Computers swamp human opponents in the middle game, simply by calculating more variations more rapidly by several orders of magnitude. Peak Capablanca probably would have the best score among humans. Talk about another level of playing is fans' subjective and IMO wrong words for their favorite players, unless one talks about chess computers. Chess computers do play at a higher level.

6. On the game and chess players young and old, past and present:

The proposition that an older player would not be able to adjust to the openings and methods of a younger generation is false, as evidenced by the observation of strong masters whose careers happened to span generations beating the tar out of weaker masters of the next generations. Lasker provides a classic example; he was beating Mieses, Blackburne, and Steinitz in the 1890s, and crushing masters versed in the hyper-modern teaching of controlling the center indirectly- Reti, Bogolyubov, and Euwe in the 1920s. In more recent times, we have Victor the Terrible, who learned most of his chess in the 1940s and 1950s, whom we have seen competing successfully with the so-called computer generation even at an advanced age.

The notion that computers are more advantageous to younger players IMO is not quite right. Younger players should have more energy and stamina in studying chess openings and endgames for long hours everyday compared to older players without computers, but the use of computers would tend to make the learning process easier for every one including the older ones.

As a corollary, computers also make it easier today for very young players in their early teens to peak at a younger age than in past eras, although they tend to level off in their early 20s to their high plateau, defined by their inborn talents and determination.

In brief. computers tend to level chess learning for everyone, young and old.

This is not a rigid rule. The best games I have ever seen played by a 12-13 year old are Capablanca's; and Tal, Karpov, and Kasparov reached their high plateau in their early 20s in a computer-less era, similar to computer age Carlsen. However let it be noted that Carlsen reached his peak sidestepping intensive computer-prepped tactical openings and beating his competitors in the old fashioned way in the middlegame and endgame. These masters peaked early not because of computers by because of their immense chess talent. Perhaps normal rules do not apply to these geniuses.

Another false notion is that the nature of the middlegame today is somehow different from the middlegame in the past. The easiest way to prove the wrongness of this proposition is by observing CG's daily puzzles. Do not peek at the names of the players that played these puzzles, and don't look at the dates. Can you glean from the middlegame play and combinations in the puzzles the date they were played? You can't. You would not know if it was played in 2014, 2000, 1950, or 1900. Chess combinations don't just suddenly change their stripes just because a hundred years have passed.

Another observation is that when the best masters of the past, Lasker and Capablanca met the occasional 'modern' structures of the Sicilian Scheveningen and Dragon, KID, Modern Benoni, Benko Gambit, they played strategically perfectly, in just the way these opening structures should be played. So how did these masters play openings and the resulting middlegame structures that are deemed incomprehensible to them by some of today's dogmatically 'modern' kibitzers? The answer is that chess rules and principles have not changed. Center, rapid development, open files and diagonals, holes, weak pawns, piece activity, initiative and attack, positional sacrifices and all types of combinations were as familiar to them as to us.

Instead, it is the frequencies of a few middlegame pawn structures have changed since WW2. Not the Ruy Lopez or QGD, but obviously Sicilians and KIDs are much more common post-WW2. Since so many games nowadays begin with the Sicilian and KID, people associate these with being 'modern' (which is a rather vague undefined term IMO). But certainly Lasker and Capablanca understood the middlegame principles behind them and when they did get these positions they played them excellently, like the top masters they are.

7. On ratings:

Elo ratings reflect relative and not absolute chess strength.

Chessplayers are naturally arranged in populations partitioned by geopolitical regions & time periods that have infrequent contacts with one another. Within such a population, players get to play each other more frequently, thus forming a quasi-equilibrium group wherein individual ratings would tend to equilibrate quickly; but not with outside groups. With caveats & in the proper context, FIDE/Elo ratings are simply fallible descriptors & predictors of an active player's near-past & near-future performances against other rated players, & only within the same quasi-equilibrium group.

As corollaries: the best way to evaluate a player's strength is to analyze his games & not his ratings; one cannot use ratings to accurately compare the quality of play of players from the past and present, or even the same player say a decade ago and today; & care should be taken in the use of ratings as a criterion in choosing which players to seed into the upper levels of the WC cycle. All the above often entail comparisons between players from different quasi-equilibrium groups separated by space and/or time.

Regarding inflation deniers, they imply that Elo ratings reflect absolute and not relative chess strength. Professor Elo himself would condemn their view. If the top 20 players were to suffer a serious brain injury and begin playing like patzers, but play no one else for the next decade, they would more or less retain their 2700s ratings, although they would be playing terrible patzerish chess.

8. Best Qualifiers?

The credible, fair, tried & tested Zonals - Interzonals - Candidates (with known strong players directly seeded into the Interzonals & Candidates; & here ratings may be used with caveats) over the random World Cup and the elitist Grand Prix. If possible long Candidate matches and 16 to 24 game World Championship matches. However, with the passing of the state-funded chess era of Soviet times, I begin to doubt if the strict money guzzling qualification process above can be re-installed.

9. The 1993 Chess Rift and Kramnik:

Regarding the Rift in the chessworld after Kasparov split in 1993, I believe that Kramnik has done more than any other individual in helping heal it by concrete actions - agreeing to a WC Match with Topalov in 2006 & not walking out when he could have done so with the support of most of the world's top GMs after getting accused of cheating; & agreeing to Defend his Title in a WC Tournament in 2007, the first time a living Titleholder has agreed to do so in chess history. My eternal gratitude to him.

10. Finances of a would-be Challenger:

Regarding all kinds of problems chessplayers outside of Europe & the USA face in their quest for the Title, Capablanca & Anand have proven it's possible for a non-European non-USA chessplayer to be World Champion; but apparently only if you have the chess talent of a Capablanca or Anand! For others, I guess they would have to try to get monetary support & good seconds somewhere to have some hope for a Title shot.

11. Ducking a World Championship re-match:

Alekhine vs. Capablanca - Not definitively resolved. If pushed, I would tend to favor Capablanca given that pre-WW 2, there was no definitive cycle to choose the Challenger &, after all is said and done, it was the Champion who set the conditions & who chose his Challenger. AAA could & should have chosen Capa; & there was ample time, more than a decade, to do so before WW2. On the other hand, Capa's pride may have caused him to behave arrogantly & thus offend AAA. The issue is very much debatable. //

Kramnik vs. Kasparov - For me, it's resolved. Kudos to Kramnik for trying his best to install a decent Qualifying Event. Kasparov for his reasons clearly did not want to go through the Qualifying Event that he himself had pledged before losing his Title; & did not even seem serious in playing the solely FIDE champions. Why? I can only speculate that Kasparov would rather retire than risk a loss in a Qualifier or a match to either a FIDE champion or to Kramnik. If he regained his Title, he would be the greatest Champion in history, but there was risk involved. If he retired, he would still be the greatest Champion in history, but there would be no risk involved. Kasparov chose the latter & no one should blame him for that decision; & more so don't blame Kramnik!

12. Predictions for Hypothetical World Championship Matches:

Lasker vs. Pillsbury, Rubinstein, Maroczy - Lasker wins 2, loses 1 match //

Lasker vs. Capablanca (inexperienced) 1914 - Lasker close win //

Capablanca (not overconfident & not having TIAs) 1929 to 1937 vs. Alekhine or any other master - Capa win //

Alekhine (sober & prepared) vs. Capablanca (w/ severe HPN & numerous past strokes), Botvinnik, Keres, Fine, Reshevsky, Flohr 1939 - Alekhine win //

Alekhine (alcoholic, ill, & depressed) vs. Botvinnik 1946 - Botvinnik win //

Fischer (inactive for 3 years) vs. Karpov 1975 - Karpov win//

Kasparov vs. Shirov 2000 - Kasparov win. (But GKK should still have given it to Shirov. And don't blame Kramnik. Had Kramnik declined, GKK would have chosen another; & Shirov would still be frustrated.)


I have opened a <'multi-experimental' forum> below. Its nature is that of several secret social and psychological experiments, whose objectives and parameters, and the rules that follow, are strictly defined and which I may or may not reveal. Readers of this forum might be able to deduce some of these rules. Accordingly messages shall be retained or removed with or without explanation, even those from my dear friends here in CG, although I am making it clear here that absolutely no offense is intended to any one in this experiment. I may or may not respond to certain questions and messages, also according to the rules. To my friends: Please bear with me in this matter. There can be a certain amount of disinformation and propaganda in the messages that are retained.

The title of this <'multi-experimental' forum> is:

Biased Journal of a Fourth World Brain Operator

Some abbreviations

CiH = the public City Hospital

PrvH = Private Hospital. There are three main ones. So PrvH 1, PrvH 2, PrvH 3.

ProvH = the public Provincial Hospital

SOL = Space Occupying Lesion

SQ = Subcutaneous tissue layer of the skin or scalp

CVA = Cerebrovascular accident = stroke

EDH = Epidural Hematoma, blood above the dura mater, the outer covering of the brain, and beneath the skull.

SDH = Subdural Hematoma, blood beneath the dura mater.

CSF = Cerebrospinal Fluid

CNS = Central Nervous System

CAB = Continuous ambubagging

ETT = Endotracheal tube (for airway purposes)

NGT = Nasogastric tube (for feeding purposes)

NOD = Nurse on duty

The Oracle = personification of the CT (computed tomography) scan.

Magic mirror = the computer monitor where one can see CT scan images.

Witching Hour Admissions or Referrals = 12 midnight to 5am

Uneventful day = Most likely still a busy day, making daily rounds in the hospitals, following up post-op patients, seeing patients in the OPD, answering referrals, admitting all kinds of patients in the hospitals; nevertheless a day in which nothing interesting has caught my attention.

>> Click here to see visayanbraindoctor's game collections. Full Member

   visayanbraindoctor has kibitzed 6304 times to chessgames   [more...]
   Apr-24-14 visayanbraindoctor chessforum
visayanbraindoctor: 24 April 2014. Entry 1. <7 March 2014. Entry 1. Unusual case. 60F had a two-week history of headache and progressive left hemiparesis. The Oracle shows a large right temporo-parietal intra-cerebral hypodense lesion, that had already caused subfalcial herniation to the ...
   Apr-16-14 Berlin (1928)
visayanbraindoctor: <Petrosianic: Yes, because they've proven themselves.> While I am not disputing this, it's also true that some who have also proven themselves have historically never been awarded the GM title, or ended their lives untitled or undertitled. In some cases it's also ...
   Apr-11-14 Reti vs Spielmann, 1928
visayanbraindoctor: 35. Rdd4 followed by 36. Rxe4 Right after the exchange of Queens, Reti decides to do an exchange sac. Or perhaps he was already was planning on it upon 33. Qc4, trying to liquidate into the above position. It's not a forced win, but could do well as a daily puzzle, ...
   Apr-11-14 twinlark chessforum (replies)
visayanbraindoctor: <hms123: I am implying that methods are <theory-laden> and thus old methods that worked in the context of old theories may or may not work in the context of new theories.> That sounds to me as implying that other methods superior to the scientific method may ...
   Apr-09-14 Reti vs Capablanca, 1928 (replies)
visayanbraindoctor: Reti is known for his 'hypermodern' idea of controlling the center indirectly by pieces, and not necessarily by occupying it with pawns. In my view, this is the last great positional idea 'discovered' in chess. The importance of center, open files and diagonals, tempo, ...
   Apr-02-14 Garry Kasparov (replies)
visayanbraindoctor: I have never read OMGP. I got surprised after reading these critiques linked to in posts above. It seems that there are a lot of factual errors in the books when it comes to history. OMGP is an excellent chess book but not a history ...
   Apr-02-14 Annie K. chessforum (replies)
visayanbraindoctor: Elephant giving birth, and behaving in a typical mammalian way when her baby does not wake up.
   Mar-31-14 World Chess Championship Candidates (2014) (replies)
visayanbraindoctor: Lasker and Capablanca were so good that it's my notion that, with all due respect, anyone who innocently claims they would not be able to comprehend today's openings or compete with the post WW2 masters probably simply have not studied their games. Regarding modern ...
   Mar-30-14 Levon Aronian (replies)
visayanbraindoctor: Aronian is a great player. At his best his games dazzle and awe. Yet I feel that he is weaker compared to his great Armenian predecessor Petrosian. If he had lived in the 70s and 80s, he would never have made it past Fischer, Korchnoi, Karpov and later on Kasparov. In the
   Mar-30-14 Karjakin vs Anand, 2014 (replies)
visayanbraindoctor: <devere: If Anand tries this sort of ending against Carlsen he is unlikely to achieve a draw.> I think you are right. Carlsen tries to create and exploit every weakness possible and thoroughly plays out endings until there is nothing left to play for. The only ...
(replies) indicates a reply to the comment.

Kibitzer's Corner
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Premium Chessgames Member
  visayanbraindoctor: 9 April 2014. Entry 2. After operating on 38F above, I followed up with 21M. another motorcycle fall patient. Peculiarly so, his nose almost got torn off. I repaired his left frontal scalp laceration and, although ENT doctors are supposed to do it, tried to repair his nose as well. There is no ENT doctor in the public CiH. I had to discard part of the avulsed skin covering the left alar cartilages because it had necrosed. I hope he does not begin resembling one of those noseless aliens seen in the movies.
Premium Chessgames Member

I was curious about the back story of that awful picture. Ugly, ugly, ugly.

Premium Chessgames Member
  WannaBe: Definitely a very sad chapter of (U.S.) history. Very interesting how the European (Irish) and fellow European (Greek) were involved.
Premium Chessgames Member
  visayanbraindoctor: 10 April 2014. Entry 1. Uneventful day.
Premium Chessgames Member
  visayanbraindoctor: 11 April 2014. Entry 1. Uneventful day.
Premium Chessgames Member
  visayanbraindoctor: 12 April 2014. Entry 1. A near midnight admission (7M who got hit by a van) caused me to defer sleeping for a couple of hours.
Premium Chessgames Member
  visayanbraindoctor: 13 April 2014. Entry 1. My uneventful days are not as uneventful anymore since repairs to the old bridge in my locality started last week. In order to go to the CiH which is more than 6 kilometers away from the city proper, the PUVs I take (and all other vehicles) have to use the new bridge near the circumferential road, which adds an extra 4 kilometers to the ride, and makes me more tired at the end of the day.
Premium Chessgames Member
  visayanbraindoctor: 14 April 2014. Entry 1. There was an earthquake yesterday at round 6am, followed by a weaker aftershock about an hour later. I was waiting for more Earth tremors today, but none occurred.
Premium Chessgames Member
  visayanbraindoctor: 15 April 2014. Entry 1. The awaited after shock occurred at around 11am this morning, relatively weaker.

I was wondering why there has been an anomalous quantity of rain in the past couple of days, thereby flooding parts of the city. It has stranded me at times, so I could not make my rounds. Turns out there's another typhoon that weakened into a tropical depression.

Premium Chessgames Member
  visayanbraindoctor: 16 April 2014. Entry 1. Uneventful day.
Premium Chessgames Member
  visayanbraindoctor: 17 April 2014. Entry 1. Not many people and vehicles in the streets as it's Holy Thursday.
Premium Chessgames Member
  visayanbraindoctor: 18 April 2014. Entry 1. Good Friday. Again not many people and vehicles in the streets. I heard from an acquaintance who attended the Stations of the Cross march that it took nearly 6 hours, walking from one church-station to another all over the city.
Premium Chessgames Member
  visayanbraindoctor: 19 April 2014. Entry 1. Black Saturday. In the local culture, for some reason while people hardly go out in the last two days, they do so now.
Apr-20-14  Everett: <Do you think there's any chance the pneumonia factor could be reduced if these patients were kept in much warmer conditions? If yes, would it be possible to try putting those at worst pneumonia risk in one highly heated room?>

I think pneumonia/sepsis is brought on by being bedridden with absolutely no movement. The diaphragm likely fatigues and no longer pumps as well. All the crucial mechanical pumps from walking and general movement, etc., are not present.

It is like the body becomes a stagnant pool, which in turn collects bacteria.

I believe this is why when one becomes bedridden with cancer, intense pain, and the above listed operable conditions, many get hit and die from complications from pneumonia before death from the other condition.

Premium Chessgames Member
  visayanbraindoctor: <Everett> You are generally correct. Nice way of putting it.
Premium Chessgames Member
  visayanbraindoctor: 20 April 2014. Entry 1. Easter Sunday, and parts of the city were alive even at midnight with people on their way for the Easter vigil. After answering a midnight referral I heard church bells pealing.
Premium Chessgames Member
  visayanbraindoctor: 21 April 2014. Entry 1. 61F incurred a huge (more than 100 cc) epidural hematoma this morning after falling off a motorcycle. The accident occurred in a neighboring province, and when she arrived in PrvH2 ER at night, she was already decorticate and with mid-dilated pupils.

For me that's boundary case. Most EDH cases wake up immediately after the operation because the only brain problem is the pressure produced by the blood clot. Remove the EDH, remove the pressure, and the patient wakes up. On the other hand, dilated pupils indicate that the supratentorial brain might be irremediably damaged or dead. I decided take a chance and operate. After I informed the relatives of the situation, they still remained aggressive. Post-op the patient did not wake up and the pupils were still dilated. Means she won't make it.

Apr-21-14  Everett: Oh no. That is terrible.

Regarding your leg pain, and your knowledge of the brain, you may be amenable to checking out a company called Z-Health, led by a chiro in the States named Eric Cobb. He specifically targets the brain, via joint mobility, eye drills, and specific manipulation to get people out of pain and functioning better.

Premium Chessgames Member
  visayanbraindoctor: 22 April 2014. Entry 1. 61F is now brain dead. I had to let the relatives know.
Premium Chessgames Member
  visayanbraindoctor: 22 April 2014. Entry 2. The poor man's transportation of choice here, meaning it's quite common, is the motorcycle. One can see whole families zooming around the roads- father, mother, one to three children- on these unstable two-wheeled contraptions. It's always a tragedy when one crashes.

And one did two days ago. The two year old boy in between his parents got thrown off and severely contused his brain, as indicated by the Oracle and his decerebrate posturing. He had also aspirated, a sure ticket to the pneumonia-sepsis roller coaster ride. Before it could go much further, 2M died tonight.

Apr-22-14  savagerules: Interesting articles. I was wondering do you ever get depressed? Or maybe wonder what life is all about or what is the purpose of life after treating some of the hopeless accidental patients and then dealing with the distraught families? I know I couldn't handle it.
Apr-23-14  SugarDom: Doc, so time is the essence? If 61f was operated on earlier, she could have survived?
Premium Chessgames Member
  visayanbraindoctor: <savagerules: I was wondering do you ever get depressed?> Yes, if I make a mistake and a patient that I expected to live dies. Oh no, did I kill the patient? Occasionally it can get nightmarish. Maybe that's what some soldiers feel after they accidentally kill some civilians who were not supposed to die. I try to make up for any bad karma by operating on all charity cases that needs operating on, even if they don't pay up. Other doctors probably have different coping mechanisms, the most common of which is compartmentalization of events that happen in the hospitals from their ordinary daily lives.

<SugarDom: Doc, so time is the essence? If 61f was operated on earlier, she could have survived?> Yes. In surgically critical patients, an early even if bungled operation is usually way better than a perfect but late one.

Premium Chessgames Member
  visayanbraindoctor: 23 April 2014. Entry 1. A borderline case, 31M fell off a motorcycle 4 days ago and developed a small epidural hematoma on top of his left temporal lobe. Normally there is no need to remove this. However, he also had bitemporal contusions, and a swelling brain. In these cases, I usually observe them for a week, and operate only if deterioration occurs. In 31M's case, he developed bradycardia, heart rate lower than 60, which indicates significant intracranial pressure. I operated on him this morning.
Premium Chessgames Member
  visayanbraindoctor: 24 April 2014. Entry 1. <7 March 2014. Entry 1. Unusual case. 60F had a two-week history of headache and progressive left hemiparesis. The Oracle shows a large right temporo-parietal intra-cerebral hypodense lesion, that had already caused subfalcial herniation to the left. I was not sure if it is a cystic brain tumor, and abscess, TB, or some parasite (cerebral cysticercosis and schistosomiasis occur in my locality). So I placed 60F on Mannitol and a steroid (to decrease the brain swelling) for three days and opened up the brain this morning. If one immediately opens up the brain without prior decompression, it tends to pop out and bleed.

I do a cortisectomy on the posterior part of the superior temporal gyrus and find a walled fluid collection just beneath the cortex. I aspirate it with a needle and syringe. The fluid looks slightly brownish and has the feel and consistency of thick mucus.>

<20 March 2014. Entry 1. I heard from the doctor-relative of 60F that the histopath result for 60F is adenocarcinoma.>

I met one of the doctor relatives of 60F, and he told me the whole body CT scan could not locate any other tumor except the suspicious lung mass. So the brain tumor I excised is probably a metastasis from a lung adenocarcinoma.

Notice that in my first entry above, I had already noted that the tumor was secreting mucus. Come to think of it, mucus in the brain? Pretty unusual since it's the GIT and respiratory tract that normally secrete mucus.

Cancerous tumors resemble death dealing cannibalistic zombies of the sci-fi and horror world that retain memories of their human origins. The zombie has a vague sense of the human it once was, but morbidly goes on to kill and cannibalize normal humans. A tumor may still retain a genetic memory of what it once was, and dutifully continues to secrete mucus as it once did when it was normal tissue in the lungs or GIT. Yet it proceeds to kill and grow at the expense of surrounding normal tissues.

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