"You can do the case," Dr. Blanchard said.

Nothing in his voice indicated he was kidding.

He drew a large, backward question mark on the shaved scalp. "Cut down to the skull on a 90 degree angle on this line."

"Knife," I called, and, unbelievably, the scrub tech put the knife in my hand. I was 25 years old and about to do a craniotomy. I provided traction on the skin with my left hand and inserted the knife. The first cut was like butter. I followed the smooth curve.

"Slow down, it's not a race."

But this guy is dying. He might already be brain dead.

When I was finished, Blanchard pulled at the large flap I'd made. It separated easily from the skull. Everything turned red; the scalp really bleeds. He undermined the skin surrounding the wound and called for the hemoclip.

"Just push in on the skin edge and click." When he pulled the trigger a little plastic clip, about 1/4-inch wide, shot forward and grabbed the skin edge, pinching the blood vessels closed. He handed me the hemoclip and away I went. Clip, clip, clip until the cartridge emptied, then a reload and more clipping. After about 20 clips, hemostasis was achieved.

"Great," he said as I finished. "Drill."

The drill was placed in his outstretched hand.

"See this? It turns at 7,000 rpm, so only put it on something you want it to go through. The pedal is by your foot." He looped the cord around my forearm and handed me the drill.

I was a little kid again, playing with Dad's power tools. But the stakes were much higher now.

He marked off the four corners where I was supposed to make holes. "As soon as you're through, stop. The goal is to not drill the brain."

This is all a dream. This is a game. It's all make-believe. We're just playing doctor.

I couldn't even see a body under all the drapes, just a square of skull with some blood. The only evidence of a live patient was the beeping of the anesthesiologist's heart monitor.

I hit the pedal and the drill whirled to life. It had its own mission: to skip across the smooth skull. But my determination to not mess up prevailed—that, and brute strength. The drill sank into the skull. Blanchard kept the drilling area wet with saline. I pulled up a few times to check my progress. I pulled up once more when the resistance changed. There was a clean, 3-millimeter-wide hole in the skull.

"You're doing great. Next hole."

This time I didn't pull up so often. After I'd made the other two holes, Blanchard called for the Medical Electric Saw.

"If you angle it properly, it will cut through the skull like air; otherwise it's work."

He handed me the Medical Electric Drill.

A Medical Electric Saw & Drill in my inexperienced hand sounds risky, but it was one of the safer tools at my disposal. It has a guard that prevents it from going too deep.

"Connect the outsides of the holes."

"Ho hum, just sawing the skull. I'm sawing a human skull. I'm sawing a living human's skull!"

"What type of work do you do?"

"I saw human skulls; live people only, of course."

"Really? That must require a lot of training."

"Well, I went to medical school for four years, but I don't remember any lectures about skull-sawing. In fact, I don't remember any neurosurgery lectures whatsoever."

"How do you know what you're doing?"

"See the guy next to me? He's my mentor. When he's quiet, I can assume I'm doing things correctly."

But I didn't think I was. My angle must have been off. My hand was getting sore from trying to cut out the square.

When I finished, Blanchard took a small pick and lifted the cut square of bone. It came right off.

"That's what I like about young skulls. They're so easy to open."

Hmm. I'd never had that thought.

The dura mater, a protective sheath just inside the skull—"dura" meaning hard and "mater" meaning mother—is the only thing separating us from the brain. Blanchard poked a small hole in it with a scalpel.

"Take the scissors and cut out a flap."

"Scissors," I called. The dura wasn't so tough. It felt like I was cutting an al dente mostaccioli noodle.

We folded back the flap. I couldn't see the brain through the dark red clot. Again I thought of food: It looked like cherry Jell-O.

"Be careful with that sucker. Hold it like this," Blanchard ordered. He showed me the proper grip.

"Never use full suction. It will suck up the clot and the brain with it."

I remembered reading that the human brain is the same color and consistency as vanilla custard. Fresh brains are nothing like the stage props I was used to.

We started sucking away the clot with a coffee-stirrer-sized vacuum. I was glad machines are available for that. We went through 1.5 centimeters of clot before we uncovered the brain's mysterious folds. I wished I could have taken a picture. There was something mesmerizing about the spider web of veins covering the pale yellow brain.

It's hard to accept that such an ambiguous-shaped organ has so many functions. The brain is nothing like the stomach. You can look at the stomach and say the food comes in here and goes out there; the muscles jostle food and the glands secrete digestive chemicals. Straightforward and logical. The brain is just a squishy blob. You can't look at a wrinkle and deduce that the area controls leg movements. It would be like looking at the grooves of a record and trying to figure out what sounds are encoded.

"Brain retractor," Blanchard called. "If you use this you can put your sucker right on top of it. Then you know you won't be sucking brain."

He slapped it into my hand. It was a flat paddle of metal, like a steel tongue depressor. I slowly slid it under a clot and sucked above it.

"Go ahead, you don't have to be so gentle. It's soft. It's a brain retractor." He politely omitted the "duh."

I suddenly realized how quiet the room was. The anesthesiologist, scrub tech, scrub nurse, and neurosurgeon were watching me remove a clot from the brain.

"What are the chances of survival for a patient is in this condition?"

"About one in 500."

Well, at least there was a chance. I got a huge chunk of the clot under the retractor and lifted it out. Just below the patient's head was a plastic brain bag, used to catch the dripping blood. I dumped the clot into it, missed, and got some on my shoes. I wished I had put on shoe covers.

Fresh blood poured from under the edge of the clot. I couldn't see the source. It kept bleeding and I kept sucking. Some dripped onto the floor, a bit more onto my shoes.

When I finished we flushed the brain with warm saline. The bleeding stopped.

"Let's get out of here before the brain swells too large," said Blanchard. If that happens you won't be able to put the bone back.

He told me to sew the dura closed. After I did that with a baseball stitch we put the chunk of skull back on. We attached little metal brackets to hold it in place.

Blanchard inserted a long probe through one of the drill holes into the dura and one of the ventricles of the brain. This allowed the extra cerebrospinal fluid to drain as intracranial pressure increased from the swelling.

To close the deep layer of skin, Blanchard used interrupted stitches and I tied them. We closed the outside layer with staples, which hold the skin together with greater strength than stitches. At least that's what they told me in eighth grade when I had to get the back of my head stapled shut. I thought the Frankenstein look was cool.

Does the list look OK to start me off? and if something i dont need or left off please let me know.This question has been bugging me for awhile.lol
Thanks!

Every company is ‘A Leading Company‘. Leading whom in what? Leading a pack of liars in the most broken marketing promises? Hardly ever is specified exactly how a company is leading. Well, some do specify it, but then the outcomes of statistics are what they are chosen to be. And what if a company truly is leading the market with the biggest revenue? Is that really a good sign? In this case Microsoft would be the best IT company there is and it certainly isn‘t. Is stock market share value really an indicator of what this company can do for you? No. It is trader expectations and nothing more. Is a large user base really everything you need? No, because the more users there are, the more requests for changes the vendor has to juggle.

Buying name brand software seems a safe bet for the buyer but is not safe for the business. Name recognition and brands are important but they come at a hefty price tag and have nothing to do with the functionality of the product. With public companies it is easy to see how much money a company is spending for cost of sales. You will find that it is mostly above forty percent of revenue and therefore when you buy a product from this company you obviously pay for its effort to market and sell it. IBM spent billions in 2000 and 2001 to become recognized as a leading e-business solution provider, when they had no product at the time but simply renamed a few old products to the newly created WebSphere brand.

What does actually the term Best-Of-Breed tell you? We used it for a little while too until I felt that it did not describe a functional benefit. It is in fact an admission that all the software of all the vendors of one breed is the same. No wonder that you decide to buy the cheapest.

Open, standard, non-propriatory and plug-and-play software is not desirable, because these properties are of no benefit to you. Open means that you can interface with it, which means a lot of work in coding dependencies. Standard means the software is years old and the vendor had no ideas of his own to sell. Non-proprietary means that everyone else they interface with has the same lack of new ideas. Plug-and-play means that the software can not be adapted to your needs.

Companies that boast huge service departments and consultancy teams are of no benefit to you. These departments are there because you need them and means the software cannot be used without a huge service expenditure. If a software company starts to grow in services more than in software revenue then their software is at the end of its life-cycle.

A long list of partners is a reason to be cautious. Companies that partner with every Tom, Dick and Harry can not stand on their own. Their software is so limited in its solution scope that it brings no benefit if you don‘t buy all the other stuff as well.

The claim of SOA compliant software - don't get me started on that. It is such a poorly defined term that anyone can claim to be SOA. The idea is good but see my other articles on SOA drawbacks.

The word AGILE should be prohibited when even a single line of Java code has to be used. If you involve a programmer there is no agility.

XML standards are always claimed but a pain in the neck. What is so great about two triangle brackets and a slash? XML is a huge problem because of data size and processing time. I was told by some companies that more than 70% of server time is used for XML validation alone. XML is a monster because of its lack of a metadata concept. You do need many other definition structures to make XML work and once you do that the flexibility that seems so cool when you can read the file goes out the window. If you manage metadata the right way, then message formats are irrelevant.

WebServices is right up there with SOA ...

Easily customized, pre-configured and out-of-box is pretty good if it is true. That should mean that the software can be installed and set up in a few days. Don‘t believe it but try it. Once installed ask for certain aspects to be changed to your needs. If that requires programmers to come in then get rid of it as fast as you can.

I have now tried for years to truly understand what IT sells with On-Demand exactly. Sometimes it is a flexible licensing model or charging per use rather than per install. Sometimes it means a flexible deployment model or an outsourced ASP approach. Sometimes it means nothing.

Full Life-cycle is an often misused term as well. It should only be used in terms of application change management. A full life-cycle must provide a complete roundtrip from analysis, modeling, coding, documentation, version controlled deployment, tuning and maintenance without loosing control in intermediate stages or being unable to feed later changes back into the model stage. I have not yet seen a full life-cycle tool that uses Java and XML where intermediate coding is fully reloaded into the model stage and managed there. The same applies to most BPM tools. The models have to be encoded with a lot of Java code that remains separate.

The misuse of the words knowledge and intelligence in IT is appalling: Proactive intelligence alerts, enterprise knowledge databases, and real-time predictive intelligence are no more than pure BS. Knowledge systems are text databases and Business Intelligence is no more than statistical data collection. Knowledge still means nothing else than knowing what-to-do in a given situation and intelligence is clearly defined as the ability to learn by itself. Maybe the intelligence agencies had to reduce that meaning for good reason ...

‚We have a repository to store all documents.‘ A repository is not an archive. A repository is an application development tool that more than anything else has to version-control metadata and related source code, ideally over the full life-cycle. A registry on the other hand is just that. A queriable list of entries without further functionality.

I think that this is enough for now. I propose for vendors to be more accurate in what they claim and for buyers to be more prudent. They call me jaded, but I am still standing and fighting.

http://www.babble.com/CS/blogs/strollerderby/2008/01/01-07/stupid-people.jpg

http://happybunny.orbitearthstores.com/images/loserLarge.jpg