Thank you. Can you hear me, Mike? Can you hear me okay? So it's an honor to give this keynote to all of you. And I just want to thank all of you and thank all the students and special appreciation for my fellow faculty members and Michael and Bill and Elizabeth and everything that you do. So this is called Life on Mars. When I was growing up in the 1960s and early 70s, the exploration of outer space occupied my family's imagination. We huddled around a small television on the coast of Maine in 1969 as Neil Armstrong braved the lunar atmosphere peering out of the window of his circular helmet. One step for man, one giant leap for mankind, he famously mouthed over the crackling reception. As my father described for us each of those steps, the first space shuttles orbit the other attempts at space walks and the increasing number of satellites spinning around our Earth. That night, we dreamed of the cold puckered rock orbiting us in a far away planets in the deep, empty regions of space. My father was a chemist. My brother is a plant geneticist. My uncles and cousins are engineers and doctors. My mother was a naturalist. Early on, I distinguished myself in a family of scientists believing in the facts of the tangible world as someone who had little interest in data and could wander aimlessly for hours in her imagination. I was spaced out, and my father frequently prodded Earth to Karen, Earth to Karen. One of his favorite questions when I was caught staring out into nowhere when I came inside the house with a glint in my eyes after running for hours through the fields and woods behind our house was, how's life out there on Mars? Scientists of the natural world, including chemistry and biology, are passionately interested in knowing and understanding the things of this world. One year when there was a partial solar eclipse, my father hung black plastic, the polyurethane he was partly credited with inventing and developing, over the bathroom window and spent hours researching how to use pinholes in the plastic so we could view the exact progress of the eclipse on the bathroom mirror. When we took summer trips to Maine, my brother and I trailed behind him as he walked along the rocky coast classifying rocks. I searched especially for those large round geodes that revealed a cave of crystals when my father broke them apart with his hammer. The process of weather, carbonation, locomotion, and migratory patterns were explained and re-explained. Field guides littered the kitchen table along with lists naming the birds my parents had spotted in our yard and the plants and trees that grew in the fields and woods behind our house. Whenever we traveled, they added names to those lists cataloging the earth's objects. I spent my days roaming those fields and woods around my house in the nearby Niagara River running with a wild bunch of mainly boys. Writers have to court risk and I learned to do this early on. We tore up and down narrow roads on our bikes, rode off ramps that shot us high into the air and swung out on ropes over swollen, swiftly moving creeks that fed into the river, stretching out a foot or a hand to skim the muddy water. I didn't wonder what types of trees grew in the woods or ask about the many species of roses my father grew. I climbed high into trees and hung upside down on their branches just to see the sky as if it lay underneath me. I pilfered a kitchen knife and used it to cut entire cities out of the thick brush behind our house, forming tunnels that led into secret passages and rooms in the thickly packed brush. We lived on an island between the United States and Canada just north of Niagara Falls. The island became a place foreign and strange each winter when everything was covered with ice, including the frozen white fields purpled in late afternoon sun. Even the river froze over, massive chunks of ice crowding its banks. In summer, that same river was fathoms deep.  The river was full of life, including the squirming gray fish inside the fisherman's rope nets, but that river also killed my friend's brother when he tried to paddle a canoe across it. The natural world surrounding me was good fodder for the imagination, including the falls where great quantities of water fell from heights impossible to comprehend, even when seen over and over again. The imagination depends on the natural things of this world. William Carlos Williams famously wrote, no ideas but in things, declaring that poetry depends on concrete language. Like scientists, writers need to have a vast knowledge of and curiosity for the natural world. They need to know that oak trees are the last to drop their leaves and that the purple trillium grows so close to the ground in the woods, its intricate flower is easily missed. They need to know whether intimately, including how storms brew, what it feels like when the temperature drops and how lightning travels. They need to be curious about the habits of animals and the way in which a person's eye color might change depending on the lighting. They need to know the symptoms of physical ailments and understand the process of convection. This need for knowledge of the physical world aligns us with the scientist. But writing also demands a curiosity for things unseen. Just as the imagination needs the known world in order to create poetry or prose that is accessible, it needs the unknown world in order to produce something new. Writers travel back and forth between these two worlds. We have to possess language and wordlessness, things and non-things, sensation and emotion, the body and its essence, the seen world and the invisible one. I found it easy to travel back and forth between these dichotomies when I was growing up, slicing the branches of the thick brush to create tunnels that suggested the cities I saw in my mind or swinging on a rope across a wide creek to mimic flying. Mixing these two worlds becomes more difficult when writing fiction. I can touch the entire book inside my mind. I can see its contours, I know the sounds and rhythms of its prose and I can feel the characters' emotions. But finding the words to make these invisible things tangible can take months or years and sheet after sheet of paper. I get lost trying to navigate that landscape. Problems of discourse arise. The point of view I've chosen is too intrusive. The present tense telling becomes tiresome and artificial, sounding. Characters misbehave, strained from my plot and rendering any cohesive structure impossible. These difficulties stem directly from the wide space that exists between the intangible world of the imagination and the tangible world of the book. Languages of the vehicle we use to cross this wide space. I asked myself what making this trick requires and I came up with three things. The curiosity to ask questions, a vision large enough to hold both the known and the unknown world and the courage to proceed without being able to see where you are headed. Any piece of literature is a dialogue between a writer and a reader. In that way, it's also a work of inquiry. Good writers pose questions and active readers read to get answers. In fiction, the questions are often narrative. A version of what will happen next. Will the girl get the boy she's in love with? Will the earth come to an end because of the invasion of aliens? Will the Ramses make their trip to the lighthouse? The process of writing is driven by the questions we ask of our material and these questions often need to be the ones that are impossible to answer and that drive us crazy. What makes people fall in love? How are events and people's actions linked? What does it take to forgive someone or yourself? Can love last? Why? Why not? Study of the natural world produces many questions that can be answered. My father delighted in answering questions about the weather or solar system or the reactions produced by combining chemicals. He patiently explained how a fire had started in our kitchen and the reason why measurements for building a birdhouse had to be precise. I asked questions like, what makes the leaf swirl in the air as it falls? Not the wind, dad, it wasn't blowing. Why do we have to die? His answer to these questions was usually a perplexed shrug. Unanswerable questions couldn't produce profitable outcomes. We frequently spent Saturday afternoons in art galleries. I remember being with my father in a museum when I was about 10. He would stand in front of one painting for 20 minutes or more, silently gazing. This time the painting was a Monet of the Gardens of Givery. You can't explain why it's beautiful, I said after a while, but the question is important. He smiled. Of course you can explain it, and proceeded to tell me about the relationship between visual beauty and proportion. I tore off on a search of a gallery and landed in front of a Jackson Pollock. When he found me, he said, it doesn't fit the theory because it's not beautiful. It was years later before we agreed that the nature of beauty is its elusiveness. The more one tries to grasp why or how something is beautiful, the more it escapes one's hold. The same way the bands of color that form a rainbow dissolve into the sky when we try to see them. Because we can't name what makes a work of art or literature beautiful, the work remains alive. Maybe because being alive and the feeling of being alive is ultimately just as mysterious. I often compare the art of explicating a piece of literature to the opening of Chinese boxes. There needs to always be another box. If you open the last one, or convince yourself that you can open the last one, you reduce the work. Each insight should lead to another question, and the questions should be endless. The same thing is true when we write, and this process of answering questions and finding other questions inside the answer can be maddening. For several months while writing The River Road, I was driven crazy by questions concerning one of the main characters. What would make someone accuse a possibly innocent bystander of a crime? And if she was found guilty, would her accuser be satisfied? What would satisfy him, and what tortured him? As soon as I arrived at an answer, he was tortured by his knowledge that his wife had had an affair with her neighbor. I saw that it wasn't really an answer. Something else would have gotten under his skin, even if his wife hadn't had the affair. These questions that can't be answered in a work of fiction become just as important as those that can be answered, even in a good mystery or a whodunit. Richard Dillard describes the necessity for ambiguity using an analogy of shooting rabbits.  By the end of a novel, we need to have shot them. I always loved his dictum about this, which was, don't shoot all the rabbits. Besides being driven by active pressing questions, those that can be answered and those that can't be answered, we must possess a wide enough vision to hold both what is known and unknown in our view. Those rabbits that can be seen, and the ones out there somewhere in trees and bushes, the ones we're not even sure actually exist. In a recent article in the New York Times magazine, Breeding In vs. Spacing Out, Dan Hurley describes meditation or mindfulness to coin John Kevitt's Zen's word for it as the quote, simple, non-judgmental observation of a person's breath, body, or just about anything else, claiming that this act of meditation is the opposite of spacing out or what he calls quote also, spacing out in quotes or mind wandering. Both physicists and writers, he claims, come up with their most insightful ideas while spacing out. I found this distinction both puzzling and interesting, and it begs the question, what is spacing out and what happens in the minds of writers when they are spacing out? I would describe this activity as a loosening of attention. For example, when I'm in the midst of writing out a dialogue between two characters, the moment of invention happens if I let go of my knowledge of where I think the conversation is going or what each character is about to say. The release of expectations that occurs because I have loosened my mind's grip creates a sense of floating within the dialogue. The conversation is already present, separate from myself, and I'm merely listening. I'm like the net that gradually closes around it. If the net pulls too tightly or closes too quickly, it will miss many of the fish. The trick is to suspend the urge to grab hold of the thing, in this case the dialogue and where it's headed. Inevitably, if I gradually gather the strings of this net, I would be surprised by something within the dialogue, a turn of phrase or an insistence of voice that reveals a character is gay. This happened to me recently, where the realization that two characters I was convinced would love each other will also betray one another. What is the mind doing when it's released its hold in order to wander? I recognize this state is the same one I experienced as a child wandering the woods or fields that ran along the river. When I had no destination in mind, I came across a bird caught within a palace of ice. I saw the purple pools of a sunset forming on the snow. I heard the rush of the river's rapids. While this state of mind seems the opposite of focusing one's attention on a single point, or awareness on a single point of attention, say the breath, it's actually paradoxically similar. Spacing out happens when the mind is empty of judgments and expectations, when awareness resembles an empty field. The writer watches that field with a sense of heightened curiosity or playfulness or arousal or excitement. There's life within that field. But one has to release one's grip on the story or the poem or the character or even language itself in order to perceive it. I look for this process when I read. It can be felt in moments when a poem or story comes suddenly and inexplicably alive. I sense that process in Galway Canal's well-known poem, The Bear. When the narrator hunter finally comes upon the bear he has killed from within by enticing it with a piece of blubber that hid a sharply whittled bone meant to tear open its insides. Up until this point in the poem, the narrator acts as a hunter following the bear's tracks, dragging his bear knives. Some of the early details begin to suggest a different, unexpected and more imaginative direction for the poem. The narrator becomes hungry enough that he eats a bear turd, socked in blood, for example. But in the fifth and sixth section of the poem shifts course and no one who reads it will forget the image of the human being wrapping himself inside the bear's skin against the cold, dreaming himself into the bear's body. There is a similar moment in Frost's poem after apple picking, which I heard Baron Wormster refer to as a slice of dreaming. In a moment of daydreaming, the narrator sees the apples he's been picking and simultaneously sees the sleep that will disable his ability to harvest those apples and perhaps even his ability to desire them. This conundrum lies at the heart of the poem. Neither the sleep nor the harvest and our abundant desire for it can be explained away. Questions lie inside of questions. Why is his desire endless? What is sleep? What is dreaming? What is consciousness? And what is the absence of consciousness? Mystery lies inside of mystery and in order to experience the astounding resonance of those questions we have to suspend our reasoning and our pretense that we can know or understand anything. Curiously, I find myself writing a portion of this talk while in bed with the flu. I want some of this last spring. I can't resist sharing the irony of my delirium. I had a pretty good fever. As I lie here wondering about dreaming and imaginative moments. Good fiction is full of these moments. Often an unexpected reversal lies at their heart. There's a very short story called The Continuity of Parks by Julio Cortesar in which we seem to be entering the experience of reading a highly suspenseful and dramatic mystery when suddenly we realize it's the person who's reading the story in his green armchair with his slippers who is about to be murdered. That victim lies inside us. As readers, we are victims to the heart of suspense as part of the unending architecture of boxes within boxes. A similarly affecting reversal occurs at the end of Chekhov's story, Sleepy, in which a young girl forced to labor for a family not her own is expected to quiet a crying baby throughout the night so that everyone else in the house can sleep. Repeatedly she no sooner falls asleep and begins to dream than she's forced awake again by the baby's cries. The moment we don't see coming but perhaps sense within our own lucid dreaming within the story is the girl's final action of smothering the baby. That accomplished she sinks down at last into her own sleep and we feel to our shock complete relief that the baby is silenced. Inside our relief lies a feeling of horror at the brutality of the girl's actions and inside the feeling of horror lies our knowledge of what will happen once the girl's actions are discovered. I sometimes pretend I wrote something I admire. By this I mean I try to imagine the process of writing it. Recently I reread the great Gatsby wondering how much Fitzgerald knew in advance about his ending. I hypothesized that he knew Gatsby would die. The image of Gatsby at the end of the book floating in his pool is an image you can feel everything heading toward and it feels linked to that early image of Gatsby looking seaward at the single green light minute and far away. We sense that he won't get that light which he longs for and that the sea or the water will somehow overpower him. Gatsby's death is the inevitable event that creates the book's forward momentum.  I imagine that the surprising plot turn was Myrtle Wilson's death. It comes out of left field, out of the subplots spun by Tom Buchanan's desire. The fact that Myrtle's death lies inside of Gatsby's death and that conversely Gatsby's death lies inside of Myrtle's death forms a long string of questions inside of questions most of which can't be answered and end up echoing long after one has finished the novel. Because of course inside of Gatsby's pure idealized desire for that green light lies Tom's desire for Myrtle which includes the brutal desire for power and control and ravaging betrayal. Desire spins both outcomes in the complicated plot such that even the strictly narrative questions that's been out from this inventive connection are endless. Did Wilson suspect his wife was having an affair? How could Tom have convinced Daisy to leave? How and when did Daisy learn of Gatsby's death? Did she feel anything? Loss, remorse, love? I've demonstrated how I read because it's so important to how I write. In a good novel story or poem we can never arrive at definitive meaning. This makes the act of reading feel alive. The same is true for the writing process. Chekhov once said that we aren't psychologists. I think what he meant is that it's not our job as writers to explain characters. Instead our job is to dream them into being. This dream has to be concrete and specific but it also has to retain a sense of the mysterious. The more we dream our characters into being the more they should paradoxically disappear under our pens or computer keys. What we know about them is as important as what we don't or can't know. Some characters appear suddenly, full blown and real. I experienced this with one of the sisters in Patchwork. An older neighbor of mine who had worked in the cotton mills of Norris, South Carolina told me about sitting outside the mill, leaning up against the building and feeling the vibrations of the looms while nursing her baby on a work break. Quote, giving it the titty. I saw that young woman in a flash and it was only later as I fleshed out many scenes that I saw what I hadn't known about her. That faith and humor allowed her to confront hardship. Other times a character comes more slowly to life slowly through torturous detours. So I start out knowing nothing and every detail I invent feels false. As writers we are constantly synthesizing what we know with what we don't know. Invention is the mechanism that makes this synthesis possible. As writers we have to find the language for wordless truths and invent whole worlds by stumbling upon surprises, along with using sensory details and thinking hard about a plot or a character. These requirements form the central paradox of the writer's trade expressed by Emily Dickinson, the spreading wide of my narrow hands to gather paradise. Poetry is sometimes divided into two impulses, the narrative and the lyric. The narrative or storyline made up of characters, actions, speech, setting, the things of this world, and the lyric or song consisting of what can't be seen or known or explained. I was taught these strands separately. Emily Dickinson an example of a lyric poet, Walt Whitman or Robert Frost examples of narrative poets. In much of the best poetry however, the two impulses twine together. The known world converses with the unknown world. In Frost after apple picking, the action of harvesting apples becomes the dream, both waking and sleeping, both human and inhuman, dreamt by the apple picker and ultimately by the reader. In A Favorite Calm Mind of Fish by Elizabeth Bishop, it's the images of the brown skin hung in strips, the barnacles and that lip with its old pieces of broken fish line that turn the enormous fish that's hauled up onto the boat into an unknown creature that exists beyond the imagination's grasp. These two strands, song and story, exist also in fiction. We're more used to identifying narrative elements, setting, characterization, dialogue, plot, point of view, but we can sympathize ourselves to notice the other element as well. In The Great Gatsby, it's there in the glitter that winds through Gatsby's mansion and parties and in Daisy's laughter, which turns money, greed and power into something akin to a fairy palace. In Virginia Woolf's To The Lighthouse, it's felt in the snatches of lives that drift through the summer house, similar to the winds that sweep everything away when summer is over and the years are passing. A good story often juxtaposes a mysterious world with a concrete world of things and people and houses. In Gusev, another of Chekhov's stories, a man lies dying in an infirmary ship, returning from a far away military duty to Russia. In his delirium, his bad fever is contracted, he drifts between dreams of his family back in Russia and the conversations going on around him in the ship. This swaying back and forth between dream and reality becomes the central conflict of the story, more important than his fight to live. At the end of the story, he is wrapped in a sail. His body, resembling a large carrot or turnip, is dumped overboard and we watch as the fish approach him, swimming round and round this strange package.  The mysteriousness of the world opens up and just like that, death and its meaning lies beyond us, even while that world is imagined by us. Viewing a construct of boxes, nestling inside of boxes from the perspective of the writer who must sit down to produce them is much harder. One can't build those boxes deliberately the way one might construct a house. A good floor plan, while important, will only take us so far. In workshops, we are often mostly concerned with the narrative or story elements of fiction, setting, characterization, dialogue, plot, point of view. It's harder to know how to talk about elements that are mercurial. I sometimes ask where the story comes alive or where the heart of a story is. These sorts of misnomers are the closest I can get and it can feel almost sacrilegious to talk about the life of a story at all. In my own work, I get spooked about paying too much conscious attention to these unnameable elements which can disappear upon examination. The process of writing both poetry and fiction often begins with observation which recalls the child's curiosity. I was forbidden to go to the marina, probably because there was a seedy bar in the back. I would stand in the trees just beyond the parking lot and watch the women come out on the porch, leaning against the railing of the steps in their flimsy dressings. One of these women wore a thick coating of makeup and I couldn't tell that she was old until she came out into the parking lot and stood under the lights. I heard the low laughter of a man who walked her to his car and I watched her stumble. When would she notice that she left her high heeled shoe behind in the gravel parking lot? What were they saying to each other? Sitting, pressed together on the front seat of his car. There was an abandoned house in the woods near the marina said to be haunted. One evening after exploring it, I sat in the upstairs hallway determined to see if there was actually a ghost. I never saw one appear, but as I watched the muddy lights that fell through the windows fade, the old cabinets turned into lurking shapes. Chandelier in the front hallway creaked with movement. The house I realized was just as mysterious as it would have been if a ghost had inhabited it. Finding those moments in my writing requires watching for places where the story is not the one I thought I was telling. Those moments unnerve me because the story isn't in my control anymore.  Head towards the thing that scares you. There is no list of instructions. While we can help each other by noticing a place in the story or the poem that feels full of mystery or life by saying go into that. Follow that image or trust that voice. I think that ultimately you as a writer have to stumble off the map. Feeling hopelessly lost can be a good thing. I've worked on a novel for months, sensing that there's something exciting somewhere underneath all my words before finding it. Oh, I realized recently, it's right there in the contrast between what my character thought she wanted and what she really wanted. Quick, I thought, write that down. Yet when I went back to that insight later, the resonance it held for me had slipped away. I knew I'd have to stumble on it again in a new way. Last one, stumble. I did not know where this talk was going when I began with the idea of two worlds, that of the scientist, naturalist, and that of the writer's imagination. But the more I asked questions about the writer's access to imagination, the more the two seemingly opposing worlds converge. It's the observable world that leads to the imagined one. We can see this process in any good poem. For example, the other worldliness of a sudden appearance of the moose in Elizabeth Bishop's poem, The Moose, depends on the very ordinary images that preceded of cabbage roses and rubber boots. The feeling that we can't comprehend what we're looking at when we see the strange looming image of the moose comes from first looking closely at the interior of the bus and the landscape outside it. Paradoxically, if we pursue the concrete aspects of craft, including a careful observation of the physical world, that otherness, the intangible, unnameable quality will emerge. This is, I think, what's meant by faith as it relates to writing. One has to trust that in creating a tangible world, the otherness, which is the opposite twin, will reveal itself. The farther one goes into the creating of that world through concrete sensory details and the sorts of specifics found in field guides, the more likely it is that the unknown will well up and make its presence felt. My brother once told me that the world becomes more real when we quantify it. I might claim the opposite, which is that the more we identify and quantify the things of the world, the more they disappear into an unknown vastness. My first semester of graduate school, I was called into James Whitehead's office. I need to pause for a minute and say that James Whitehead, who was a great poet, novelist, and really great teacher, was also incredibly intimidating. He was something like 6'5", and had played football at Vanderbilt. He was a massive man and body, mind, and spirit, and he had a booming voice. His office was down at the end of the hall, and he would stand in the doorway and shout your name if he wanted to talk to you. I was always Osborn, get down here. He could also explicate a piece of literature like no one I've ever known. He called me into his office to talk about a poem I'd written. I saw the poem as a narrative scene, but he was arguing the poem was a lyric. The poem described a group of old women seen by the narrator through her window when they walked into the woods to collect flowers, moving one behind the other like a line of poplars. Osborn, he said, tell me what the poem is about. I don't know, I replied, and in hindsight that was my best answer. Then I went on to say, I supposed it was a dream moment. I had been taken with the image of the women moving across the field toward the trees, one of them pausing, holding onto a fence post while she tied her laces. When they disappeared, I knew they'd eventually come back with the flowers. It's not about the old women, he said, smiling, enjoying the fact that I was dense about my own poem. It's about the narrator, the woman watching the old women. It's the knowledge that she'll be pulled across that field also. He said something about time and its relentless progression, and I remember thinking that he was trying to make the poem into something it was not. I was in my 20s and had no thought of myself aging when I wrote it. He was telling me that the poem was not entirely mine, and it took me a long time to learn that lesson. The poem had become larger than my conception because I'd been so intent on seeing the women and making them real. They're heavy legs rolling under their skirts, the folds of their dark cotton clothes like shadows, and that empty field after they'd gone into the woods with the rush of wind on it. The concrete particulars yielded from my observations had produced something I couldn't entirely comprehend and hadn't conceived. Whitehead was suggesting that as writers we are not just craftsmen moving our characters through actions or fleshing at a scene or a metaphor. We are creators, which implies that we are inipotent, but our power is actually in reverse. When our creations come to life, it's in spite of us. We become absorbed with the particulars of language or imagery or detail, and those particulars do the work of transforming our limited vision into something we couldn't have imagined. We have to loosen the reins if we ever held them, trust the narrative or the language, and watch to see what they reveal. Those revelations will be the truths that can later be opened by a reader, not the points or thoughts or messages we intended. In fiction for me, it's often in dialogue where I have to let go the reins, and when you think about it, dialogue is a place in fiction where conflicts or problems in the story are pinned down and quantified. In Hemingway's famous short story, it was like white elephants. A man and a woman argue about the abortion he wants her to have. We'll be fine afterwards, he tells her, just like we were before, I know we will. You don't have to be afraid. I know lots of people who have done it. He pushes her in this way until she finally says, I'll do it, because I don't care about me. This elevates the argument to another level. More is at stake, including an unspoken specter of guilt. The man says, I don't want you to do it if you feel that way. Seeing could have stopped there, but Hemingway makes us listen to every last piece of this argument because he's able to listen to it. The word choice is deceptively simple and direct, including a simple shift in tense that produces an unnameable but very palpable sense of dread. And finality and sin and loss and regret, she says, we could have everything, referring to the child she carries. He says, we can have everything, referring to their ability to be free of responsibility to continue on as before after the abortion. Right there, in between the very tangible conditional and present tense, the world of the story opens up.  A world that contains the future, which will be utterly different depending on the choice decided on right now. I thought about that passage when I was writing difficult scenes in Centerville between a minister and killer. I completed many drafts before I could erase my assumptions of where I thought the scene would go and hear the simple spoken words one by one that would reveal everything. How can we cultivate that strand of greater knowledge or insight that leads us to the heart of the story or center of the poem? How can we lead the life of the imagination? How can we experience a productive dreaminess or spaced out wandering of the mind? I'm big on mapping a plot and making lists of setting details. I use field guides and research, historical incidents, and the reasons for whether. These activities address the very necessary concrete aspects of writing. But dreaming the story is just as important and doing that requires descending into the mysterious and sometimes dark world of the self. The images that carry me to this place often involve large bodies of water. The feeling of a story lives right inside the feeling I had when I stood on the banks of the Niagara, watching the steady flow of its swift current. It's inside the feeling I had when I worked all afternoon with a kitchen knife, cutting out a city inside a thick patch of brush. The rhythm of the language I need exists in the physical rhythm of running through the woods. These archetypes deliver me into the world of the story or poem and sometimes they carry me into the center of disturbing emotions or insights. The knowledge that people create acts of violence or betrayal or theft for unknown reasons that love exists side by side with cruelty. That our actions have consequences we can't avoid or imagine and that any life is both finite and infinite.  Follow rituals, allow for superstitions, say a prayer, meditate on a phrase, or read a passage from a book you love over and over. My father had a rye sense of humor when he was dying about his inability to explain anything that was happening to him. While growing up in the tenements of New York City, he'd been one of those young boys of eight or nine standing on street corners selling newspapers. When it was cold and he stood in the doorway of a store or business to catch a little warmth, he might get caught or thrown out on the street. His papers scattered, but if it was really cold or he had a cough, he'd stand in that bit of warmth and he'd whistle as if he knew everything would come out. On the morning when he was about to undergo a dangerous surgery from which he sensed he wouldn't recover, he was told to walk up and down the hospital hallway. He did this, leaning on my sister for support and singing snatches of snow tunes. The sun will come out tomorrow, bet your bottom dollar. It only occurred to me later that he was whistling in the cold again. That is my final directive, whistle. When you don't know where and how your plot is going or if the language of a poem or paragraph feels empty, or if there is no piece of emotion or invention to be felt anywhere inside the dozens of pages you've written, pretend it's there. Move forward as if you're certain the entirety of your creation is just about to reveal itself. Well, certain fear or uncertainty with its opposite and write another page. Trust that ultimately the known things of the world of your creation are the same as the mysterious otherness of that world. And trust that all of it is in the end amazing. I've written these pages in an upstairs room of my house that sits high in the treetops. Through the open window I can hear two birds crawling back and forth to one another. One cheeks quick short trills, the other has a low pitched who what. When I look out my window all I see are the trunks and branches of the trees fleshed out with thick dark oak leaves. I have to spend several minutes peering through the depth of greens and browns before I find the birds. But finally when I've forgotten about the speech I have to write, when I've stopped noticing how long everything is taking me, I see the white head of a downy tiny downy woodpecker on the silvery trunk of a beech tree not 10 feet from my house. A pale purple finch in the nearby branches of the oak is joined by a second one and the song changes. What is life like on Mars in this mysterious illogical world where stories don't have clear or predictable outcomes and a disturbing sense of otherness can suddenly rise up inside of the known presence of trees, bushes, rivers and houses. It can be maddening and scary but it's also breathtaking, it's a worthy journey. This is that important as long as I'm like in that fly room. But I write on hand so I write first. I do eventually do a lot of work on the computer. Sometimes I will like, especially if I've already got a couple of drafts of something, sometimes I will be working more on the computer, but I first drafts as long as I can. I think that kind of is different for everybody. I think for me, yeah, the rhythm is different. I write on hand and I feel the rhythms of the words. The mic's up there. Sorry. Oops. Yeah? I mean, how do I balance getting everything moving and the story itself? Oh yeah, that's a good question. Well, I mean, I think I'm doing different things at different times, although you must mix. I mean, sometimes I am specifically thinking about a character and I might be trying to either puzzle them out or I might have a scene. Often what it is is I'll start with a scene that I have in mind. So I like to write in the morning when I first get up, I tend to get wake up early.  And so often as I'm waking up, or I might have seen from the day before that I'm going to write, like, I can't wait to write the scene. And I'm sort of visualizing it in my mind. And so as I start writing out the scene in terms of it's the first draft, for me, seeing it is really important in my mind and feeling it and so using that whole thing of experiencing it with five senses. But the other thing that's important to me, and this is, I don't know, this is probably kind of odd, and maybe it does come from having, you know, from also writing poetry. But I, voice is really, is really crucial. If I get the voice right, I can write the whole scene. And so I will often have lists and lists, sometimes pages of words that don't fit together, that are just the sound, I like the sounds of them or whatever. And then I just start pulling from the list. Like, you know, I'm sort of thinking of words in my own, in my mind as I go along, but then I'm also pulling from the list. I mean, it sounds weird. I'm crazy, but what it does, I think what it does, I don't really know what it does, but I think what it does is I think it keeps me off balance a little bit so that that whole thing of, you know, of things going in unexpected directions can happen and that details come up that I, if I was consciously trying to think of these details, I wouldn't have thought of them. So I guess that that's a way in which, another way to think about it might be, it's a way in which I'm trying to use both the, or access both the conscious and the unconscious mind maybe. Yeah. How do you achieve that state and if that's possible, how do you recognize it? And then you also... I'm unfortunately just in it a lot. I seem to have no choice. Quite the same way. So it seems inherently elusive. How do you manage that? Yeah, it does. But yeah, I don't know if I have an answer because this is sort of just frustrating. I don't know that I'm able to do that always. I mean, I think that I just always have been sort of, I was always spaced out as a child. And now it's not always a good thing. I can tell you, driving down a road is not a good time to be spaced out. But yeah, you know, when you're riding it's perfect to be spaced out. So it's kind of the natural thing.  I walk around with post-its lately, which is probably not the best thing. And then I write down, if I think of something, I write it down. Sometimes if you write it down, then it's there later on. Yeah. Yes. I don't know if I'm supposed to, but this is something about, like, writing about ultimately not really coming to any conclusion or knowing anything. I don't know if that's a point or not. But I think that's, like, when you have to usually apply it, of course, you may be trying to apply it to something. But a lot more times it's usually like, it's made out of that in a way. Because if that's all it's about, you know, I guess it's just double-edged means, like, that's what it's about me. Writing has got that openness, sort of, like, by knowing more about research. But then on the flip side, a lot of times it makes me very optimistic. I think it's like, why am I even doing this? Because nothing can be known. Well, the thing is, is that I think what I was trying to say is that things can be known and that you do, there are answers. I think in any good piece of literature, and then when you're writing the same thing happens, is that you do answer questions. You answer questions about your characters, you find out about an event that you thought you didn't understand, and all of a sudden you can see the whole event. So you are getting answers, but that those answers open up other questions. And then you might get an answer to that question, but there's always another question behind the answer. So that you can't ever know everything, I guess is what I would say. Which I'm ultimately really glad about. Any other questions? Alright, thank you.


In an exam, what you'll be given is a slip of paper. Please do this, Primaelda, or the Primaelda, and one more to testing. So, C and one. As usual, check the patency of the nostril. Both sides, occlude one, breathe through the other, see the patency, occlude the other, breathe, see the patency. First, you confirm the patency. Second step, occlude one, put a strong smelling substance, coffee, peppermint, globe, or anything. Ask the patient to close his or her eyes. I'll be watching for this. So please close your eyes. Can you smell something? Let's say yes. Smell cigarettes. Yes. Smell this rice. No. I do. And then you close the other nostril. And can you smell something? If so, what it is. OK, fine. I'll keep an eye on that what you said just now. So that's C and one testing over. No. Come on. It's weird because I got a stronger sense of smell when I close my eyes. Everybody does. But remember, whenever you're doing any sensory testing, patients, I have to be closed. Point number one. Point number two, you have to test both the sides. So these are the two things which people miss out on during the exams, so be careful about that. C and one, over. Come to C and two, please. OK, this is the important one. This has got several components. One, the vision testing. That's called the visual acuity. I'm going to show it to you how it's done. Second one will be the ophthalmoscopy. And the third will be the visual field testing by confrontation methods. These three components are part of C and two. Color vision, we don't do. OK, now come here, please. This is our stainless chart. It is at a standardized distance. I've got a blue line here. What it is. I think we'll draw it again. It's just like a long distance. This line is approximately 24. This is not a long distance. Can you please put your signature here? OK, so you're going to show that? You're supposed to know that. This is 20 feet. This is standard. It is not random. Ask the patient to stand 20 feet away from the stainless chart. Please stand here. Want it? No, I'm looking at the chart. At 20 feet. You can come up with the feet touching the 20 feet. Now let me explain this chart to you. Imagine when you are asking the patient to do all these things. So that is a standardized patient. I'm the physician, and you are being tested. I mean, I'm watching you doing it. Explain to the patient, stand 20 feet away. Close one eye with the palm of your hand. Not with the fingers, because people will try to beep through the fingers. So close one eye with the palm of your hand, please. With the palm of your hand. If the patient has got glasses, keep asking to keep the glasses on. There are several levels here of different sizes, starting from largest to smallest. And when you come here, you will see next to this figure, a figure is written on your. If you don't want the video, just let me know. 200 feet, 100 feet, 70 feet, 50 feet. That is the figure which we want. Please follow me closely. Patient is standing very feet away. You will indicate to the patient just with your finger, and the patient will read that line. Then go to the next one, then to the next one, and to the next one. Till the patient can read one line and cannot read most of the letters of the last line. When the patient cannot read most of the letters, then you go back to the previous line where the patient had read all the letters. That line, whatever figure is written here, will be mentioned in your denominator. The numerator of your value will be 20 always. The denominator will be what is mentioned here. So now let's demonstrate how it is done. Please close one eye with your palm of your hand. So now we are testing her visual equity of her right eye. Please read this one. E, F, P, T, O, Z, L, P, E, D, P, E, C, F, D, E, D, F, B, Z, P. Even if the patient misses out one letter, it doesn't matter. One or two letters, it doesn't matter. Most of the letters they should be able to read. F, E, L, O, P, Z, D, P, E, D, E, F, P, G, E, G, L, E, F, D, E, G, F. I don't know. That one's hard to read. Oh, I definitely can't read. OK. So she read most of the letters in this slide. Against this is written here, 15 feet. So I will record her visual equity as on the right eye, B, A, right eye, 20 divided by 15. That brings me to the interpretation of this value. Come on, please. You're over 15 now? 15, 15. It means that she had read this line from 20 feet, which another normal person would have read from 15 feet. So you're super normal. Oh, OK. Suppose she had read only up to this line. Suppose this I'm saying just for the sake of demonstration. Against here is written 70 feet. So what would have been my interpretation? Visual equity right eye would have been 20 divided by 7. Meaning? Some other 7. She read it from 20 feet away. What a normal person would have read from? 75 feet away. Are we clear? Suppose she had read up to this line. What would have been written here 40 feet? What would have been my interpretation? 20 by 40. This is what I need from you. Meaning what? She has read from 20 feet, because this 20 is constant. Numerator is constant. She has read from 20 feet. What a normal person would have read from? 40 feet. 40 feet away. That means the patient's eyesight is poor. Did we get that? So in her case, it was other way round. It was 20 by 15. Meaning a normal person would have had to come at 15 feet to read this. She managed to read from 20 feet away. So you're 20 by 15. So this is the first part of the test, visual activity, BA. The similar component of this test in the next slide, please, is the sense, near vision, but we don't do it. Similar chart is held at 14 inches away, and you are asked to read from top to bottom. But we don't do that. That is the counterpart to the near vision. This was the distant vision test. Did we understand how to interpret this? Because in the exam, you will be asked to do this test, and you'll be asked to interpretation of it. Come to the next slide, please. Next is the visual field. Please come here. We don't do the instruments. We don't do the Lister's Perimeter, how pre-golden, and we don't do all this. Those who came here, please put your signature. We do only the visual field by the confrontation method. So stand appropriate distance away from the patient. When you see my fingers moving, please tell me. Ideally, if we start with both the hands, can you just keep looking straight? Patient's right eye, your left eye, patient's left eye, your right eye. Keep looking at my eyes. Can you see anything? Not moving at all. Can you see anything? You can? Can you? OK. OK, so this is the place, the limit, this vision. Keep moving inwards till the patient can identify what you are moving. You have to be able to think how many. Yes, that's what I'm saying. You first saw the movement. That's the limit. Keep looking straight till you can identify. Don't look sideways, please look straight. OK. So this is the middle. Similarly, start from the top. Keep looking straight, please. Tell me when you start seeing. OK. Start from the bottom. Keep looking straight. Can you see anything? So this is the starting from the limit and this is where she can identify. So lateral limit, inferior limit, superior limit, media limit. If there's a visual problem, then you do each eye. This is called the confrontation method. Fingers should be moving. So this is the visual field by confrontation. Please put a signature. The next test, please. I'm sorry. Yes? You find a problem when you're doing your room. Then suppose she says that she couldn't see the side. When you came very close, then only she saw it. That means there's a problem. Then you ask her to close her right eye and see the visual field of the left eye. So then that's when you do it? Absolutely. That's what I'm going to tell you how many fingers you have because it's very hard. Yes, I know. Tell you can identify the number of fingers. Initially, you'll see the movement and after that, you'll be able to identify the fingers. But the patient should keep looking. Right eye, left eye, left eye, right eye. Looking straight at you. This is the visual field by confrontation method. These are the instruments, but we don't do them in the lab. The next slide, please. Now we come to the ophthalmoscopic part of it. Again, this is something which you need to know. All of you'll have to do. So let me demonstrate the first parts of the ophthalmoscope for you and then how to do it. First thing, switch on. See the light there. Control for the light is here. Behind, those of you who can't see, please come. Make sure you see it. The control for the light is here, watch. When I turn this, I get different, different grids. Those are for various special tests. This is a slit-like examination. This is a blue color. You can see it's a blue color. This is a pinpoint light. This is a brighter light. This is an even bigger light and so on and so forth. You can keep turning it in either direction. What we do is we usually use this one. So first, determine which type of light you want. Yellow light is the one which we use. Then look at the intensity of the light on the palm of your hand. Again, by turning, till you get the right intensity. If it is too bright, it will produce spasm of the pupil, which is known as hippus. So we have to adjust the intensity. Step number two. Step number three, again with my index finger, you'll see there's a wheel here on the side. If the wheel normally, and when you're rotating the wheel, there's a small window here, where right now it is showing zero. This is the diopteric power of the ophthalmoscope. Diopter is the power of the eye, the refractive index of the eye. I just briefly mentioned it in the class. If I rotate it clockwise, I'll see a green figure coming here, one, two, three, green figure. This means that the diopteric power is going in a positive direction. If I rotate it anti-clockwise, I'll see a red figure coming here, one, two, three, and so on and so forth. That means it is negative. Minus one, minus two, minus three. What is the significance of this? Suppose let's say the patient has got, what is your power? Do you know your power? You don't know your number. Oh, it's like negative 4.5. It's minus 4.5, I think. OK. Let's put it, round it off, to minus 4, minus 5. Let's say minus power is 0. That means her eyeball is slightly bigger. So we have to put it at minus 5. Did we get it? Suppose she had said her power is plus 3, and I'm 0. Then we put it at plus 3. That means eyeball is a little smaller. So this is how you adjust it. So this is the meaning of this adjustment. But for all practical, for our FCM lab, we will keep it at 0. But you don't know their power. Keep it at 0.  What will I put it as? Suppose I am plus 1, and she's plus 3. Yes, we'll put it at plus 2. Because the difference between the two of us. So this is how we will adjust so that we can get a good vision. Because remember, when you're doing the ophthalmoscopy, you're looking at the fullness. You're looking at the inside of her eyeball. So this is the meaning of this directory power. So these are the two adjustments. We will see through this upper opening. This is the place where we see through. Now we will show you how to do the procedure. Can you come closer to this? I need this now. For this, I'll have to ask you to remove your glasses. And I'll have to remove my glasses also. So I'm just giving it at 0. Doesn't matter. I need you to be closer because this will not come so far away. Does it matter if I have contact lens? It doesn't matter. The glasses will obstruct the vision. Step number one. As I told you, my right eye, her right eye, my right hand. My left eye, her left eye, my left hand. Room should be ideally dark so that the pupils will be dilated. So I'm going to do the left. But I'll use the right hand. But I'll tell you the procedure for it. Yeah, it's all right. You can keep it like that so that people can see. First step. Adjust everything. Handle of the ophthalmoscope tilted 20 degrees laterally. First thing. Handle of the ophthalmoscope tilted 20 degrees laterally. And ask the patient to look over your shoulder. Can you look at Rachel? I'm so blind. OK, she's there somewhere. I see her. Keep looking at her. Patient should be looking over your shoulder at a mid-distance away. That way the pupil is slightly in a dilated position. This is the line of sight. We go 15 degrees lateral to the line of sight. Handle 20 degrees laterally. 15 degrees directed lateral to the line of sight. I'm going to use my left eye to see her left eye. Please keep looking there. OK. There's a ridge here. This one hitches against my eyebrow. There's a ridge here. Please follow. This one hitches against my medial side of my orbital margin. So I hitch this. Keep looking straight. Yes, yes, yes, yes, yes, yes, yes. I'm doing it right hand, but because I find it more convenient. Yes, I can see her optic disc beautifully. I can see the blood vessels. Keep looking straight. So after you identify the optic disc, keep looking straight, please. Don't look here and there. After you've seen the optic disc, keep looking straight, please. There you go. There you go. I can see the artery. I can see the vein. I can see the retina. So this is how you will do. You will do it.  See the retina. If possible, come to the macular. So these are the four things we look for. Optic disc, retina, blood vessels, macular. Is my normal? Is it normal? Yeah, till now it's normal. Whatever little I saw. So these are the procedures. You will do them and as you have problems, I'll explain it to you. OK, after we have done that, we switch it off. So this is the third part of the test. I agree. I should have used my left hand, but I followed all the steps. So this is 20 degrees, handle tilted, and 15 degrees lateral to the line of vision. Remember, line of vision.  Remember, optic disc is of the temporal field. Yes. When you tell it, it looks like it's looking forward. If you're looking at a certain angle. No, she's looking straight at it. That is the line of sight. So your blade of your ophthalmoscope will be tilted 15 degrees lateral to her line of sight. Handle tilted 20 degrees away. This one fitted against my eyebrow, and I go straight into her pupil, and I start looking till almost the eyebrow touches the eyebrow. That is the reason we said left eye, left eye, right eye, right eye. Otherwise, eyebrows won't touch. Something else will touch, right? So that is the whole purpose of doing this. So these are the three parts of the visual testing. What did we do? Visual equity testing, visual field by confrontation, and ophthalmoscope. So these are the three parts. Come to the next slide, please. The next, yeah, this is the fundus. Same thing, the fundus of the findings. Colour vision we don't do. This was just for your interest, I put that. So we don't do the colour vision testing for FCM. Now, see, 3, 4, 6. Here again, we have a specific number of tests which are required for FCM, the first and foremost test, the edge test, so-called edge test. We combine, check, 3, 4, 6 together. That is the version testing, that both eyes together. Look straight at me. Follow my fingers. Right side, straight right. Keep following my fingers. We have to explain to the vision. Keep following my fingers. Up, down, back, straight left. Up, down. So what did we do? Right, up, down, left, up, down. This is called the so-called edge test, which is shown in the next slide, please. There, the first figure. You can see the full sequence of moments are shown. Can you come back to the? Yes, so this picture is the individual eye, but we did the shown in the one next slide. Yes, so this is the first test that we do, 3, 4, 6. The next test we do is the convergence test. We look for the convergence of the eyes. Start with a pen or pencil, a tip from a distance. As they move this closer to your face, please keep looking at the tip. And when the patient follows the tip of the pencil, look for the convergence of the eyes. You look for the convergence. Bring it up to, if necessary, up to five centimeters close to the eyes. I can visibly see the pupil's eyes converging. So this is the convergence test. So these are the two tests that we need to do. We don't test for the superior oblique and inferior oblique, but you know them. Superior oblique is, with eyes converged, look down. If you oblique eyes converged, look up, et cetera. And late-lag also we don't do. But if you're asked, you should be able to answer that. But these are the two tests that we do for 3, 3, 4, 6. The muscle testing. But remember, there's also a parasympathetic testing. Can we go to the next slide, please? In the parasympathetic component, again, we have two tests. Does anybody have a torch? Wonderful. So this, again, is done in a dark room with a bright light. So the patient should keep looking straight. Torch light. Torch light brought from the lateral aspect. Please keep looking straight. Torch light should be brought from the lateral aspect. In this case, I would like to ask you to remove your glasses. Bring the torch light from the lateral aspect and shine it on the pupil. There. When I shine it on the pupil, I saw the pupil constricting on that side. And I also saw the pupil constricting on the opposite side. So this was a direct light response that was a consensual light ripple response. Two points to be noted here. Dark room, bright light. The torch should not come too close to the eyes because then the near response will kick in. Did you understand that? We don't want the near response. We want the light response. Similarly, do it with the other side. Again, bring from the lateral side. Don't bring from the medial side because when you bring from the medial side, you've already stimulated the other eye, isn't it? So that we don't want. So bring from the lateral aspect and don't bring the torch too close to the eyes because then the near response may mislead your findings. So do it with the other side also. There, I can see both the pupils constricting. This is the near response. This is the light response. Can you have to light that, please? This is the first part of the parasympathetic testing. The second part of the parasympathetic testing is the near response. How do we go about it? Again, I'd like to see her pupils soon. I'm going to keep this tip of this pencil 10 centimeters from our nose and I'll keep it fixed there. This is done in normal light or bright light. So this way we have got the normal light on. You will ask the patient to alternately look at the tip and then look far away. Look at the tip, look far away. Look at the tip, look far away. And when the patient is doing that, look at the pupil. What do we see? When the patient looks here, the pupil's constrict. When the patient looks there, pupils dilate. First look at this eye, then ask the patient to continue doing the same thing and look at the other eye. So you look at the pupil of each eye when the patient is doing this job, looking at this and looking far away, looking at this and looking far away. Keep it constant at 10 centimeters. It is written there clearly and shown there. If you have any problems, please look at the pictures. So I'm going to hold this at a particular distance away from your face. I would ask you to look at this and immediately look far away. And then look at this and look at far away. Just keep doing that for a few times. Look at this, look far away. Look at this, look far away. Look at this, look far away. Look at this, look at far away. When the patient is doing that, you look for the pupil of constriction. When the patient looks far away, look at that. That is the near-response. So we have tested the pupil of constriction with light. We have tested the pupil of constriction with near-response, clear? So these are the two components. Yes, Josh? Yeah, they just look far away, that's all. They immediate to the pupil there. Same line of patient. That's why you have kept it right in the middle. Patient looks here, patient looks far away. Patient looks here far. So when the patient focuses here, the pupil is constricted. And when the patient looks far away, that's what you see in the mirror. But this is done in a normal light. The previous one was done in a dark room with a bright light. So these are the two components of CN3, parasympathetic and the motor component. Can we have the next slide please? CN5 testing. Again, two components, motor sensory. Let's do the motor first. I'll ask you to clench your teeth hard. When the patient is clenched his or her teeth hard, you palpate the meseta and palpate the temporalis, both the sides. Motor done. Sensory. Light touch, pain, temperature. If you're given a toothpick or if you're given a pin, you can do pin prick. But for all practical purposes, you will not be given the pin prick. You will be not given the temperature. Even though some of you would like to do the caloric test, you will not be given that. You will be given only the cotton wool. There's a stick with the cotton wool or you'll be given the cotton wool. This is the light touch. Again, the same two policies. Ask the patient to close his or her eyes and test both the sides. Don't forget this.  Okay, next slide to the patient. Please close your eyes. Actually, your hair should be out of the way. You know why? Because the hair itself is giving you that sensation. So the three representative areas are V1, V2, V3. It's shown there in the circle form in that third picture there. Do you feel the same on both the sides? Now? No. Sure? Okay. So just to test, you need not touch and ask, do you feel anything or not? So this is the sensory testing and the motor testing of CN5. Remember, I'll see whether you're asking the patient to close her eyes and whether you're testing both the sides or not. Sensory testing is always done with these two caveats. Next slide, please. We do not do the corneal reflex. Even in clinical skills assessment and even in CS, step two CS, you are not expected to do, but you must know it. Ask the patient to look immediately and bring the cornea, light touch, cotton wool from the lateral aspect and touch the cornea. You will be asked to explain it, but not do it. The first picture is the correct one, the second picture is the wrong one. You will not do this, but you may be asked to demonstrate what other means of testing you have. So we'll come to the next slide, please. CN7. Look up, please. Look surprised. Look surprised. Rinkly of forehead. Rinkly of forehead. There, look at the corrugated, corrugations of the- Wrinkles? Wrinkles of the forehead. Corrugations.  There. There. Okay, frown at him. Frown at, whoever is your- Can I put my glasses on? Yes, whoever you want to frown at. There, look at the vertical ridges of the forehead. Number one. Number two. I'll have to ask you to remove your glasses again. Close your eyes tightly. Tightly. And try to open them apart. Price them apart. There's a third rest. Fourth one. Bloody cheek, please. Try to puncture it. Number five. Keep your face normal, please. Look at the nasolabial furrow. Look at the angle of the mouth. Symmetry. Number six. Just show your teeth. Look at the symmetry. Equal number of teeth should be visible on either side. Mind you, in the previous group or the other semesters, I noticed people get confused between clenching your teeth and showing your teeth. What is the difference? I will look for these things in the exam. Clenching your teeth, you're testing CN five. Showing your teeth, you're testing for CN seven. Are we clear about this difference? So I just asked you to do, I didn't ask you to clench your teeth. I said, just show me your teeth. Or just smile. Just say a smile, that's all. Lift up the skin of your, do this. This, this. There. That is smile. So we have tested for CN seven. Again, we do not test for taste, but you may be asked. So you should say, I will test with salt, sweet, bitter, or this thing, something, salt. What is it, other one? Umami. Sour. On anterior two-thirds of the tongue, either side. But we don't do it. So we are done with CN seven. Next slide, please. CN eight. The good news is for FCM, we do not do vestibular testing. So we won't do the caloric test. We won't do the ocular cephalic reflex test. We will not do the bad knees chair test. We will do only the tunic bone test. And I'm going to quickly demonstrate what I've already shown to you. We do the renails and the Weber's test. I'm going to put this on behind your ear.    Thank you. It's okay. I think you'll have to hold it there with your other hand. Yes, that's better. I guess it's tight. Make sure when you're doing the tap, don't tap it on the heart, sir, object. Tap it on something firm or relatively soft. And make sure, yes, I saw somebody holding like this. This is also a mistake because you're dampening the vibrations.  So this is renails positive. Air conduction is better than bone conduction. It's very important to explain to the patient so that you get a good correct response. Next, I'm going to do the same thing. I'm going to put it here. Tell me whether you hear it equally on both the sides or you hear it more on one side or the other side. This is Weber's test equally lateralized both sides. So these are the two tiny four tests that you'll be especially to prove. Can I have the next slide, please? So we have done all these. We have done this one. We have done. It's all from your glass. Yes? Air conduction is better than bone. Test is negative. That means bone conduction is better than air conduction. We raise negative. So positive is air conduction is better than bone, which is normal or sensory neural. And Weber's is lateralization, conductive deafness, opposite side sensory neural deafness. Nine and 10 together. Now what I'm going to do is can you just open your mouth? Again, I may need the torch. Sometimes you cannot see inside, so you have to shine the torch. And just, I know you have that. Just open your mouth. And just say, ah. Yes, please say softly, ah. Say again, ah. OK. You ask the patient to say ah softly, or you on. We look for three things. One, movement of both the soft palate, arching up, symmetrically. Movement of the uvula back in the midline. Three, movement of the pharyngeal wall closes the medial. Again, please say ah. Ah. Say again. Ah. Look for these three things. You will not do the gag reflex, but you will be asked. So you say, I'll take a tongue depressor or a spatula, wooden spatula, and I'm going to stimulate the posterior one-third of the tongue, or the posterior pharyngeal wall on one side, and I will look for the movement of the pharyngeal wall on both the sides. Clear? You won't do it, but you'll ask the patient. And the third part of the test will be, ask the patient to say some hard words, like guh, and look for the sound, quality of the sound. So can you say guh? Guh. Say guh, please. Guh. Sorry, my gum. I don't want to fly on you. I'm sorry. Guh. Yes. Look for the quality of the sound, hoarseness, and nasal quality. Say a nine-ten over. Next slide, please. C-11. I'll ask you to turn your head to one side. Please look at Abed and keep looking at him. I'm going to try to prevent you from looking at him, but you will insist on looking at him. So what did I test? Right side. Similarly, I'm going to ask you to look at Fadi. You will insist on looking at him, and I'll try to prevent you from looking at him. What did I test? SCM. Which one? Left. Next, please try to touch your chin to your chest.  Yes, look down, please. Try to touch your chin. Yes. I tested both sides, I'm against you. Can I ask you to stand up, please? Even though the picture says from the front, I prefer it, and it is better to do the trapezius test from behind. Can you turn around, please? Look at the symmetry of the shoulder. If it's that side, it's more horizontal or flattened out. We test only the supia fibers. If we don't test the media fibers, we then test the inferior fibers. I'm going to ask you to lift your shoulders up, and I'm going to press down. See the resistance. So, Sunupriya Master, trapezius, C-11 done. Thank you, please sit down. Can I have the next slide, please? C-11. First, just ask the patient to say something. Just say anything you feel like. Hi. Say a few words. Don't say just hi. The rain in Spain rules mainly in the plain. Hypoclosal testing. Listen to the articulation. Just articulation.  Now, you just see whether it is coming right or not. Next, just open your mouth, and watch the tongue in the floor of the mouth, as it is, inside too. Look for the position. Look for atrophy. Look for fasciculation. Look for anything, just in the floor of the mouth. Third step, I don't know why I'm laughing. There are two cluster of people who keep laughing. I will say it later on. OK, just look at the tongue in the floor of the mouth. Next, please protrude your tongue out. Good. Next, please move the tongue from side to side. And the last one. Too much. See, everything comes smoothly. Tongue in the floor of the mouth, tongue protruded, tongue moving from side to side. Everything moves slowly. And the last part of the test. Please push your tongue against the cheek. Keep it there. Please push your tongue against the cheek and push it there. Push.  I know what he's doing. So this is the last test. Done. Please dispose to your respective stations.


I'm just going to look out.   It's not often you can do that. And I can wave. And I can see everyone waving back. It's like we're living together. We're all in one digital, we're in like a quantum room together. And our little digital selves are smiling and waving at each other. It is beautiful. You know, you're all invited to come. And it's again that same feeling where it's no different than this. Nothing's any different.