"I did not sleep at all last night.  It hurts like the devil!  A snowstorm whipping through my soul, wailing like a hundred jackals.  Still no obvious symptoms that perforation is imminent, but an oppressive feeling of foreboding hangs over me... This is it... I have to think through the only possible way out:  to operate on myself... It’s almost impossible... but I can’t just fold my arms and give up."