![]() ![]() I always loved the song for its classical allusions and psychedelic power, but it took on even deeper dimensions of meaning for me later in life, after my tripping days were well behind me: I understand this song intuitively because I have lived it! It’s a feeling that everyone who travels can probably relate to at least a little. While he is traveling, he misses his homeland where he really belongs, but once he returns, he is restless for adventure and can't forget the girl that he met, who is preserved in memory as perfect, whether she really is or not - so what he misses may or may not even exist. He is destined to move on, but now he is doomed to be dissatisfied wherever he goes. And he probably can't stay at the "distant beaches" for the same reason - not only does he not quite belong there, but part of its magic for him is probably the temporary nature of his stay. Now that he has met her, he knows that he can never be satisfied without her - "you know you cannot leave her for you touched the distant sands." He knows he must return home to the "hard land of the winter", and he wants to take her with him, but he also knows this is impossible.and even if he did take her back there, it wouldn't be the same, and eventually the magic would probably be lost. It's about someone who travels to a foreign exotic place and falls in love with both the land and a girl (who represents the place in a way). So I think this song can be interpreted kind of that way. (For example, in the poem "Ulysses" by Tennyson.) Such needless procedures are a side effect of an unnecessary investigation and uncritical practice.One of the themes in stories about Ulysses is that even though he spent years struggling to return home, once he reaches it he is restless and can't be satisfied there, because he has "touched the distant sands" of foreign lands and has learned to live for adventure. The worried parents may even arrange for a second opinion, leading to more appointments and investigations on the child. If you request an unnecessary test in order to please the child's parents and to satisfy your wish to do something, what do you do if the results are slightly outside the normal range? Do you reassure the parents that it is probably a normal variation, or do you suggest repeating the test “to be on the safe side”? Do you admit the child for further investigation? At the very least you have set in train a very anxious time for the parents, further tests on the child, and at least one further outpatient appointment. The upper and lower 2.5% of the normal distribution of results are usually deemed to be abnormal, so 5% of the population are labelled “abnormal” even though they are probably healthy. ![]() Yet £400 brain scans had been requested, few of which would alter the clinical management and some of which would lead to further referrals and investigations because of results that would turn out to be normal variations. When a colleague (A W Coe) and I reviewed the records of children on the waiting list for magnetic resonance imaging of the brain we found that half had not had their head circumference measured, a basic indicator of brain growth. Otherwise we may condemn our patients to a similar odyssey. With greater choice comes greater responsibility and the need for greater discernment. ![]() It was first described 30 years ago, 1 and the number of tests available is now much greater. Ulysses syndrome is a side effect of unnecessary and inappropriate investigations or wrong interpretation of results. ![]() Patients with Ulysses syndrome find themselves caught in a web of further investigations, referrals, and sometimes treatment before finally being recognised as healthy, which they were in the first place. We might also request another test, and risk inducing “Ulysses syndrome.” Ulysses fought in the Trojan war but afterwards took 10 years, with many dangerous and often pointless adventures, before he got back to where he had started. However well meaning our action may be, it medicalises the child's condition: the parents may well feel that their child must have a serious problem because he or she is “under” a specialist. So, rather than discharge their child, we offer a follow-up appointment, hoping that by then the parents will be more accepting of the situation or that they will be seen by a different doctor. We have all felt parents' disappointment at the end of a consultation. What are the two hardest things to do in medicine? To say nothing (or “I don't know”) and to do nothing. ![]()
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