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ISHLT, Holy Grail, Progress and Mark Twain, Again

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Editor-in-Chief, ISHLT Links Newsletter
Professor, Pulmonary and Critical Care Medicine
Medical Director, UTMB Texas Transplant Center
Director, Lung Transplantation
University of Texas Medical Branch
Galveston, Texas, USA

The goal of the ISHLT is to do what's best for patients. The Holy Grail for our society, which is best for patients, is 100% survival (not in the work place, not in research funding and not in individual accomplishments and certainly not for us); 100% survival refers to our patients. To get closer at achieving this Holy Grail we strive for no rejection, no infection, no complications and 100% patient performance as well as 100% patient satisfaction. But we're not quite there. Tremendous progress over the years has guided us along. Progress has been there, is here and will always be forthcoming.

Mark Twain's, A Connecticut Yankee in King Arthur's Court, is among the first novels about time travel. The notion of time travel has been one of the ultimate feats of science and has actually occurred in science fiction including: H.G Wells', The Time Machine; T.S. Eliot's, Burnt Norton; C.S. Lewis', The Hideous Strength; Isaac Asimov's, The End of Eternity, and the inimitable Charles Dickens', A Christmas Carol (probably the first reference to time travel) just to name a few. Among the many movies, we have The Planet of the Apes, Terminator, Back to the Future, Frequency, The Butterfly Effect, The Lake House, and Hot Tub Time Machine. The movie Contact stands out because there is Eleanor Arroway (played by Jodie Foster) stating "All things being equal, the simplest explanation that accounts for the largest amount of the evidence is usually the correct one" - Occam's razor. More importantly and thanks to Carl Sagan and his book Contact, Ellie's yearning for time travel began when she chose to read A Connecticut Yankee in King Arthur's Court. Also take note of this passage from Sagan's book and how he links with Mark Twain ...

After school, she had ridden her bicycle to a little park on the lake. From a saddle bag she produced The Radio Amateur's Handbook and A Connecticut Yankee in King Arthur's Court ... she chose the latter ... Twain's hero had been conked on the head and awakened in Arthurian England. Maybe it was all a dream or a delusion. But maybe it was real. Was it possible to travel backwards in time? Her chin on her knees, she scouted for a favorite passage. It was when Twain's hero is first collected by a man dressed in armor who he takes to be an escapee from a local booby hatch. As they reach the crest of the hill they see a city laid out before them:

"Bridgeport?" said I ... "Camelot." said he ...

She stared out into the blue lake, trying to imagine a city which could pass as both nineteenth-century Bridgeport and sixth-century Camelot.

Connecticut Yankee jars the social, political, spiritual, technological and financial conscience of humanity from late 19th century to today with a fantasy of travel back to Camelot with the unshakeable mordant wit of Twain. He pits the "Old World" against the "New World" and the North against the South in post Civil War America.

Trying to "sivilize" Huck Finn in a 19th century American slave-holding society is not nearly as ridiculous as attempting to "sivilize" the Arthurian culture of 6th century England as depicted in Connecticut Yankee. Twain fully takes us outside the box, in this case out of time and out of space from a culture of democracy, freedom, individualism and free enterprise in the name of progress and common sense to an aristocratic, religiously shackled and uncivilized culture of Medieval, England where birth dictates your status in the name of tradition and faith. Hank Morgan, a self-made foreman from Hartford's Colt Arms factory, wakes up initially on a beautiful landscape over 1300 years before his time with a knight in shining armor. Because of his allegiances to capitalism and technology he unintentionally destroys this agrarian and rustic landscape of Camelot in the name of progress. He simply wanted to clean up King Arthur's court by developing a soap factory, bring electric light to the Dark Ages, and unwittingly polluted the skies while cleansing the inhabitants and turned the Round Table into a stock exchange as money replaced both birth and heroic virtue as the source of status. Even the Siege Perilous became for sale. As he tried to impose 19th century America to 6th century ideals, in Twain's usual dead-pan manner, Hank remains unaware of how he had been "brainwashed" by the "inherited ideas" of his own culture as he tries to improve King Arthur's court. It is clear that he hates the shams of this day and wants to unveil the superstitions in hopes of defrocking their long-held beliefs in religious convictions, magic and magicians, like Merlin. Instead, he unknowingly becomes a wizard mightier than Merlin. He is referred to as "Sir Boss" with famous scenes about the eclipse to prevent his death, destruction of Merlin's tower, restoration of the Holy Fountain and the Yankee's fight with the knights.

Can progress be a problem? Progress is important but it can engender concepts based on biases, what's popular and what's preferred by the masses into new and embedded beliefs that resist change. These changes then resist change. Truth and reality become distorted. If progress and change are not controlled in quest of the real Holy Grail destruction occurs with collateral damage, unintended consequences and, in A Connecticut Yankee in King Arthur's Court, an apocalypse occurs.

What is the Holy Grail? To put simply, the Holy Grail is the truth, not whose truth but what truth? From fact or fiction, from beliefs to truths and from past to present in a humorous and polemic manner, what's best of the ISHLT and what's best for our patients is an unbiased truth. In reference to Roger Evan's Briefs from December on Lost in Translation, even facts have a half-life.

To better appreciate and have a deeper understanding of the genius of Mark Twain, I strongly advise you to read all his works I've referenced since April 2012. However, if time does not permit this, at least read or reread Huckleberry Finn and A Connecticut Yankee in tandem. Be sure to take note of his attack on Sir Walter Scott who Twain believes was the ultimate cause of the American Civil War. And take note of his attack on Imperialism, not just of Great Britain, but the evolving Imperialism of America. The lessons buried in these great works have helped me and I firmly believe will help all of us, the ISHLT and ultimately, our patients.

Disclosure Statement: The author has no conflicts of interest to disclose.