I’ve Seen the Future Brother, It is Murder

Take the only tree that’s left

And stuff it up the hole

in your culture

Give me back the Berlin Wall

give me Stalin and St. Paul

I’ve seen the future, brother:

it is murder.   Leonard Cohen, Recent Songs- The Future

Environmentalism has failed. David Suzuki

DSC_6335Travel in India is akin to shock therapy. From the moment you step off the plane, the sheer crush of humanity, the chaos and the obvious environmental degradation grab you in a choke hold and force you to witness the collision between an exploding population and limited resources. India, without question, is a beautiful country with many charms, but with 1.2 billion people, a continental divide between rich and poor and many whose sole goal is survival, the lofty ideal of environmental preservation is low on the food chain.    DSC_6028

DSC_6282My trip to the Taj Mahal was one of a series of shocks.  Such a visit is nothing short of a full frontal assault on the 5 senses. The air alone can be seen, smelled, tasted, and almost touched. A 200 km/120 mi trip from Delhi to Agra was a marathon 6-hour bus ride through countryside barely visible though the smog of car exhaust, dust, wood burners, brick foundries, and industrial fumes. Everyone on the bus coughed constantly. Food breaks were impossible as parking was nonexistent in the endless flow of cars, trucks, buses, motorcycles, bicycles, rickshaws and humanity. Upon arrival the bus parked 500 meters away from the Taj Mahal. No one is allowed to drive to the site because the Taj Mahal is melting. Pollution has carved and pitted the ancient marble and her structure is dissolving under the influence. As a solution, all visitors are put in an electric car to make the last part of the journey. The irony of our ride in the pollution free car seemed to be lost on the organizers as we coughed and  squinted to see this magnificent structure through a shroud of smog . The return trip was more of the same; back to Delhi under a lurid red sky, a city of 22 million, itself a vision of the apocalypse.DSC_6276

It is easy to be smug living in Canada. Many may even question, Why do we need to care about other countries? Canadians enjoy a low population density, clean air and water, abundant resources and one of the highest standards of living anywhere on the planet. Some of us dutifully recycle our waste, turn off unneeded lights and try not to idle cars unnecessarily. Unfortunately, many of us consider this to be the end of our responsibility for addressing global environmental problems. While Canadians like to brag about their National Parks and wild open spaces, we seem increasingly willing to turn a blind eye to resource development, no matter how polluting it is, as long as jobs are being created. As long as the economy keeps chugging along, everyone sighs and shrugs their collective shoulders as another pristine area is poisoned, because, after all, it is usually occurring somewhere we don’t see. We are good consumers and jobs and economic growth always come first. The same can be said for India, but with a population thirty times larger than ours, the result of such decisions and their impact on the environment are proportionally magnified. What we need to realize is that Canada and India (and many other areas of the planet) are no more separate than conjoined twins sharing vital organs. When disease affects one it will be the demise of the other.

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Davis Suzuki recently stated that the environmental movement has failed and I, reluctantly, have to agree. I am not a doomsayer, I am simply a traveller and my journeys have shown me that environmentalism unravels under population pressure.People require basic necessities and as population density increases and resources are scarce the environment is relegated to a luxury, a footnote, with stewardship in the back seat. Ffty years after its birth, environmentalism has fizzled out. In the 70’s, I recall the formation of the first Canadian Federal Environment Ministry to advocate for land protection. IIn the 80’s, clear cut logging was considered a sin, Green Peace was a hero and the Athabasca tar sands would never be developed because of the environmental destruction it would bring. In the 90’s, life got so damn good, everyone forgot about it all. We got wealthier and bought Hummers and so much more. In the 21st century a recession scared everyone and the economy and GDP growth became the only topic worth mentioning. The scare over the end of oil changed to oil everywhere – we just have to get it –  from the ocean, the rock, the sand and who cares where, as long as we get it. The mantra changed from sustainability to growth and jobs. Governments became more conservative and less visionary (No party will be elected that does not make the economy its first priority), Canadian academic research that was not pro expansion was suppressed or unfunded, and environmentalists became misguided exhibitionists or terrorists, while corporations promoted throw-away consumerism, all with overnment’s blessing.

There is now a collective indifference to greenhouse gas emissions, water quality, air pollution, you name it – because we are the only species on the block and, after all, what can we do? We titter about monster storms and then read our email, log on to Facebook or have a latte. Some ignore the fact we are changing the planet, or worse, deny it altogether.DSC_6216

Along with most, I am asleep at the wheel and that is why, for me, India was such a smack in the face. It forced me to see what I choose to ignore, to wake up and see the world today, to understand what the collective choices of my generation have led to and to question what we have left for our children’s future. Nothing short of a global environmental revolution will change the direction we are headed and neither the visionaries nor the warriors are in sight. Without them Leonard Cohen will move from a poet to a prophet with his words, “I’ve seen the future brother, it is murder”.

Photos of India courtesy of Debbie McCallum

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Letting Go

 

photoYour children are not your children. They are the sons and daughters of Life’s longing for itself. They come through you but not from you, and though they are with you yet they belong not to you.                                       The Prophet, Kahlil Gibran

One must choose whether to live one’s life or tell it.  Jean Paul Sartre

At a time when hair grows on my chin and wrinkles seem to metastasize, my daughter is blossoming into the woman. It is one of the world’s most reliable phenomena, the new replacing the old, one generation reaching its nadir as the next one rises. The old guard gives way to the new ripe with their vigor, energy and dreams, ready to forge new beginnings and carve a place that will be uniquely their own. It could be a bittersweet experience, witnessing and breathing the contrast of age versus youth but I am finding, thanks to my daughter, it is nothing of the sort. Contrary to what I may have expected this is a magic time, one where a doorway has opened to reveal a world of new possibilities and great joy.

In October my daughter and I undertook a journey. For a month my adult child and I visited India together. Our destination was Kangchenjunga, the world’s third highest peak. With a group of 14 other souls we spent weeks hiking into its remote base camp to see Kangchenjunga soar up another 2 miles before us. For 2 weeks in a country of 1.2 billion people our group was totally alone.

The journey was hard. We walked a hundred miles over absent trails at great altitude. We camped in the snow and freezing rain, wore the same clothes for 2 weeks, shared a small tent, fell in mud and freezing glacial streams, got sick, cold, fatigued and leech infested but more importantly my daughter and I laughed. We shared the majestic sunrise of the Himalayan peaks bathed in the purple, pink and gold of dawn. We high fived each other on mountain summits that had seemed impossible to reach only hours before. From within our group, strangers became friends. We met individuals whose practice it has been to face adversity and shoulder on. Many shared their stories of disease and tragedy and their resilience in the face of hardship left us in awe.

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What I had not fully anticipated was the importance of the journey within the journey, the one my daughter and I took into our relationship with each other. For me, this was the most important journey of all. Mother daughter interactions can be fraught with danger and a trip of long duration, isolation and stress provides an ideal lab for brewing up conflict. Disagreement over issues of mutual respect, independence and power often form the substrate for such conflict. Knowing this fact prior to the journey, I had to ask myself difficult questions that required honest answers. For a successful trip I knew I needed to practice behaviors that let my daughter be the independent, responsible adult that she is. I knew that she was entitled to make her own mistakes and achieve her own successes without my interference. We needed a balance of power (the adult-adult kind, not the mother- daughter kind) and I needed to be respectful of her right to make her own choices. In other words, my job was to keep my mouth shut.

And what did I learn from this exercise? More than I could possibly imagine!

I witnessed my daughter through the eyes of others and they saw a capable young woman of great integrity, strength and empathy. I observed her make mistakes, accept them and adapt her behavior so they did not recur. I watched her accept hardship for just that, something transient to suffer, endure and then move on. I saw her overcome daily physical adversity and get up without complaint and do it again. Most importantly, I saw her enormous interpersonal skills, how she could instantly read a person, make others feel valued and included or reach out to someone who needed support. My daughter has people skills I will never possess and through her friendships she built me a safe bridge to others, paving the way for friendships of my own. Above all, I saw the light go on in the eyes of our companions simply in anticipation of her company and I felt a fist of pride that in some small way I might have helped her become the person she was.

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Far away in a small corner of the planet I learned that the definition of a successful parent is not to raise good children but to raise good adults and then to stand back and let them go. I discovered that it is in the process of letting go that the whole world shines.DSCF0667

Resilience as a Metaphor

Forces that threaten to negate life must be challenged by courage, which is the power of life to affirm itself in spite of life’s ambiguities.
Martin Luther King Jr

If I am not for myself, who will be for me? If I am not for others, what am I? And if not now, when?
Rabbi Hillel

Imagine you are a freestyle skier executing an aerial maneuver. You are sixty feet in the air, having launched yourself on an impossibly steep trajectory. Somewhere between the glorious rise and certain fall of take off and landing a tiny seed of doubt germinates as you analyze your speed, balance and body position. In that microsecond of awareness you know, that on this day, disaster and landing walk hand in hand.  Your thoracic spine crushes on impact. Doctors use the word paraplegia and you know that means a wheelchair. Can you visualize it? Some may not relate to this scenario, it will not resonate as a potential scene in their life because, after all, they would never consider freestyle skiing in the first place!

Lets try a different scenario. Now imagine you are a successful, athletic businessman who embraces life at full speed. Others whisper with both awe and envy that you are lucky, you have it all, but at 45 your physician informs you that you have a rare cancer. Your only chance for survival involves removal of the liver you cannot do without. You must find a compatible living donor – a friend or relative who will give you a portion of their liver, undergo risky transplant surgery and, should you survive the complications, you will require potent anti rejection drugs every 12 hours just to stay alive.

Or this. On an otherwise ordinary day your only child is killed in a motor vehicle accident. You must weather the confusion, fear, guilt, anger and loss. The world grinds to a halt as you try to recall every detail of your last interaction with your child. It is your job to make sense from senselessness. You take one more breath and one more step to survive this day and try to comprehend the eternity that follows.

If any of the above stories were yours, how would you cope? How would you fare if life had dealt you such a hand?  The fact is, none of the above are stories, they are events from the lives of real people that I have come to know. All of these individuals actively contribute to the rich tapestry that is the community in which I live. Soon the freestyle skier will compete in the Sochi Para Olympics (with a silver medal from the Vancouver Olympics in his pocket). He is a motivational speaker whose brilliant career is the substance of a recent Ted Talk (and the above video, The Freedom Chair) . The businessman has just returned from 14 days of wilderness trekking in the Himalaya. He lives everyday in the present moment and takes life as it comes. The child was an organ donor for many others and she lives on as a part of them each and every day. A scholarship for other youth with similar goals and aspirations has been set up in her name so that they may venture where she once did. The parents continue to do the activities they shared with their child, and find comfort and continuity in this. They have established meaningful relationships with her friends and together they keep alive the memories that are the rich legacy of a short life shared.

What all of these extraordinary people have in common is resilience. Psychologists define resilience as the ability to bounce back from hardship and to carry on. It is a priceless commodity, for those individuals who possess it are rich beyond measure while those who do not remain poor in the face of material wealth. Tragedy, accident and disease form a community of souls and at some time or another we will all gain citizenship. How we fare in this new community will largely depend on our individual resilience.

Fortunately, one does not have to be extraordinary to be resilient. Without question it is the ordinary citizen, the one who does not let hardship define them, that I admire most. These individuals are not known beyond their circle of family or friends but they fully participate in life in spite of great odds. Some days in the office I will see in tandem individuals from both ends of the resilience spectrum. I recall a patient suffering from a soft tissue disorder unable to carry out many of the activities of daily life. Their  appointment was planned to discuss a long-term disability application, as the patient was unable to work. During the visit I was asked to take a telephone call. On the line was a dentist, seeking medical advice. After answering his questions he informed me he would soon be away for a holiday. He and a friend (who was confined to a wheelchair following a mountain bike accident) were off to kite ski. As I made my way back to the patient’s room, I was shaken by the conundrum before me. Why such a vast difference between how each individual deals with adversity? Why does one individual feel totally disabled by a medical condition while another individual feels a wheelchair is not an impediment to kite skiing?  More frightening was the question, Where in the spectrum would I stand if these hardships were mine? The answer of course, depends on the resilience of the individual, and you will never know the answer until it is your turn.

My next thought was, “What constitutes a resilient person”, and  “Am I resilient”?

Resilient individuals have the capacity to rise above, even flourish in the life that follows misfortune. If they were the clay of a future vessel, adversity molds them but resilience is the kiln that fires who they become. They come through the fire of hardship transformed, never defeated. They maintain a positive outlook, adapt to crises and moved on. Their misfortune does not come to define them but remains a paragraph in the story of their transformation. Such individuals serve as role models for how we would hope to see ourselves under similar circumstances.

Psychologists have found personality traits that correlate to high levels of resilience; a positive attitude, flexibility, an openness to change -what psychologist call an internal locus of control (the ability to affect the outcome of an event by personal action). Resilient people identify more with the survivor role than the victim role. They have strong problem solving skills and strong interpersonal networks. They are able to seek and accept help. Such individuals experience the setbacks of life as acutely as anyone else; feel stress just as intensely, but they move on to find solutions because, after all, setbacks are part of life and one can always move the goal posts and start again.

Fortunately resilience can be learned and the learning can come from such simple things as setting goals, addressing problems, nurturing and respecting your body, focusing on your strengths rather than your weaknesses, cultivating and feeding your friendships and realizing that, above all, each of us plays an active part in our destiny. The single action of stepping up to the plate, acknowledging that this life is yours to live, will vastly increase personal resilience. In the face of hardship when adversity comes calling, it will always be more successfully handled from the driver’s seat.

Understanding a concept such as resilience does not make it so and as a result the question remains – How will you do and how will I when misfortune comes to call? Lets hope we both have high resilience.

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History shows that for better or worse, Alabama was the birth place and slavery the mother, of modern gynecology.

If building the great pyramids had required the physical labor of women, gynecology would have been invented thousands of years ago. Instead, the birth of gynecology would have to wait centuries, for a prime time in history when women and men were equally subjected to punishing labor, to a time when one less bended back in the field meant cotton unpicked and money unearned, to a time when early and frequent slave pregnancy provided a master with more able bodies to be worked or sold, to a time when women unavailable for the field due to childbirth and its complications lowered productivity, to a time when the enterprising capitalist gentlemen of the antebellum south felt enough of a squeeze in the pocketbook to look into what could be done to combat those pesky women’s problems. History shows that for better or worse, Alabama was the birthplace and slavery the mother, of modern gynecology.

For the slave states it was good economics to minimize the complications of childbirth. After 1808, the US Congress forbade further importation of slaves to the US and as a result the only new blood for the system arose from the reproductive capacity of those already in bondage. Without access to new slaves from abroad, reproduction was the sole means of maintaining both the slave labor pool and the southern way of life. For their owners slave women were doubly valuable as laborers and as breeding stock. A doctor would often contract with a slaveholder to provide medical care for indentured women thus ensuring both slave fertility and the slaveholder’s profits. One such doctor was Marion Sims. Practicing in Alabama in the 1840’s, Sims was nothing if not innovative. Today, when a patient is positioned for a rectal examination they assume the Sims position, a left lateral position with the right knee drawn up and flexed. When a vaginal or cervical examination is performed on a female in 2013, the speculum used is not dissimilar from the Sims prototype devised from 2 bent spoons. When a patient has a wound sutured the principle of using a sterilized silver suture comes from Sims. All of these techniques have their origin in the experiments Sims performed on slave women suffering from the complications of labor.

The conundrum associated with medical advancements under such circumstances is that they were achieved disregarding the principles of beneficence and autonomy, that is, indentured women had no choice. For example, while refining the technique for a new procedure (incontinence repair) Sims operated on one particular woman on 30 occasions (He purchased a number of his slave patients from their slave holders for easier access.) over a 3-year period. Although ether was available, its use was not considered necessary for slaves although it was regularly used for the same procedures on white women of “a better class”. By today’s standards the ethics of Sims’ advancements in the field of gynecology leave much to be desired. Nevertheless, if you are interested, you will find a statue of Marion Sims near Central Park, NYC as well as in Alabama and South Carolina.

Until Marion Sims, women and their obstetrical/gynecologic problems were largely ignored. The Romans took interest for a time, creating an obstetrical treatise entitled (I’m not kidding) Soranus. Civilized societies used this same manual for all things female for the next 14 centuries. True, that it was updated in 1540 to become The Byrthe of Mankynde, but that was pretty much it until Sims came along. There are, however, a few important updates that have occurred over the centuries that are worth mentioning. These include the forceps delivery (pioneered by Peter Chamberlen (1560-1631) and then kept secret by his descendants for the next 125 years), and the discovery that hand washing between vaginal examinations proved to be an effective way to reduce infection complications (fetal and maternal death) in obstetrical patients.

History shows that female circumcision was also advocated in 19th century Western liberal democracies in the form of clitoridectomies. Victorian physicians proposed removal of the clitoris as a cure for “female hysteria, nymphomania and the dangers of female masturbation”. In 1858, British physician Isaac Baker-Brown, championed removal of the clitoris stating: “intractable women become wives; rebellious teenage girls settle back into the bosom of their families and married women formerly averse to sexual duties become pregnant”. Medical textbooks discontinued such recommendations, but shockingly, not before 1937.

When women look back on the medical history surrounding their sexuality and “female problems”, they will discover it is a troubling history at best. Upon reflection, we all must quietly remember and give thanks to the exploited slave women who suffered for our benefit. Much progress has been made in the field of women’s reproductive health but it would not be unrealistic to admit that for most of history, women and their issues have been both ignored and misunderstood.

Mothers and Daughters

Bizarro

See wonderful cartoons at this site.( bizarro comics.com)

Freud analyzed her. Eminem rapped about her. Faye Dunaway portrayed her with a wire hanger in hand. Let’s face it: Mothers are the go-to figures in songs, stories and screenplays for good reason.

Oprah magazine

I have found the best way to give advice to your children is to find out what they want, and then advise them to do it. 


Harry Truman

Who are you? No doubt you’d like to think of yourself as unique, the end result of a shiny one-time blueprint used only to to bring YOU into the world. I used to feel that way, special and self-assured, until I reached the age when I would look at myself in the mirror and see my mother looking back.

I realize that my mother and I only share 50% of my DNA, but as a daughter I have come to understand that a mother has considerably more influence in a daughter’s life than just what goes into the hard drive. In fact, the soft ware that a mother gives her daughter is equally potent. In medicine I see mother/ daughter relationships and whether they are deeply loving or testy they are always intimate, intense,vulnerable, emotional and complicated. For many women it is the singular most determinant relationship of a lifetime. When conflict arises in these relationships it almost always fuelled by disagreements over power, authority and acceptance.

I think for every female our mother is the anvil upon which we forge ourselves to create our own identity, she is the whetstone for your blade, or if you prefer a movie approach, the mother figure is an avatar of colossal power. During my formative years I spent extraordinary effort honing my individuality against the grain of whom I perceived my mother to be ( I was wrong, as I discovered in later life when we were inseparable.) and it was my criticisms of her that provided the motivational grist. I wanted to be better, to be different, to be more.

The idiocy of rejecting everything a parent is and has to teach is, of course, called adolescence. Some are brave enough to call it individuation. Some never leave this turbulent purgatory and do not know that adolescence can extend far beyond the teen years and even into old age. The best part about being older is the development of an understanding, it is the quiet acceptance that your mother is/was just another flawed human being after all, and the struggle for every woman is recognizing that our mother is not always right, but neither is she always wrong. She may come bearing criticism but she also comes to you bearing gifts.

I think that the true definition of being a woman comes at the age when you stop blaming your mother for all that is wrong in your life. It is true that a mother’s influence is profound, but until that magic moment when you step up to the plate and say, “ This is my life and I am responsible for it”, you are not an adult. Without this acknowledgement you are never in charge.

When I look I the mirror I may see my mother but more importantly, I see myself. Although she is now gone, she is as integral a part of me as an arm or a leg, but I no longer see those parts we share as a cross to bear. I see them as gifts from my mother, recognized and valued and as well, I see more, qualities that she did not possess. Athleticism, determination, independence,  leadership- these are characteristics I possess different from her template, that I developed in adolescence to escape from her gravity, but I possess them only because she  was the whetstone for my blade.On further reflection I see things that belong to me alone; happiness, contentment, a stable family, a long standing marriage and good health. I realize that I have become more than the sum of the parts of me that are both my mother and myself and that in my small way, I have changed our collective history.

Anesthesia- From Life or Death to a Dining Experience?

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The Ether dome, first anesthesia

Massachusetts General Hospital, 1846. The first anesthesia.

It is over: she is dressed, steps gently and decently down from the table, looks for James; then turning to the surgeon and the students, she curtsies- and in a low, clear voice, begs their pardon if she has behaved ill. The students- all of us- wept like children; the surgeon happed her up.

 John Brown describing a 19th century mastectomy (taken from The Emperor of All Maladies by Siddhartha Mukherjee).

I have 9 toes.  I was born with 10 but along the way I lost one due to the complications of frostbite and finally, the surgeon’s knife. There are perks ( cheaper,quicker pedicures ) and drawbacks ( no flip-flops) to the revised me, but I have no regrets. In retrospect, sacrificing a digit was a small price to pay for freedom from for the daily pain of a seemingly incurable osteomyelitis (bone infection).

The surgery was uneventful. I walked into the hospital with 10 toes and left with 9. In between I had a pleasant conversation with the surgeon and the anesthesiologist and a really good sleep. I have had other operations in the past and I can say that I have never had a bad experience. Although general anesthesia should never be undertaken unnecessarily, and never should it be employed in Michael Jackson style as a drug for sleep, modern-day anesthesia for the healthy patient is relatively straightforward thanks to better anesthetic agents and the expertise of anesthesiologists.

As much as one may take elective surgery and general anesthesia for granted today, the process has not always been so uneventful. For most of history, surgeries were performed cold, that is, conscious, without the benefit of anesthesia. Early physicians employed various agents to induce sleep or dissociate the patient from the pain of the procedure and to this end combinations of opium, marijuana, belladonna, cocaine, alcohol, mandrake or jimsonweed were all tried with variable success and significant toxicity.  None of these agents worked especially well or for very long and as a result the decision to undergo surgery was a daunting one, made only by the courageous patient on the threshold of life and death. Under such primitive conditions one can only imagine with pity and horror the fates of young men centuries past who, when wounded on the battlefield, underwent amputation with the appallingly inadequate combination of a bottle of liquor, opium and a saw,

Under such circumstances it is not surprising that the reputation of a 19th century surgeon was built upon the speed of his surgery. In the 1840s Robert Liston ( a distant cousin of my husband) was considered a skilled surgeon because he could perform an amputation in 2 and ½ minutes. For additional speed he would hold his surgical knife between his teeth freeing up both hands for the procedure. As the germ theory of disease would not be recognized until 1865, fifty percent of surgical patients succumbed to postoperative infection and died.

In 1846, an event occurred that would propel the field of surgery into the future. In the packed medical amphitheater of Massachusetts General, a Mr. Gilbert Allen was the ground zero patient for effective anesthesia. While a gallery of surgeons watched, ether rendered him unconscious and amnesic and a lump was swiftly removed from Mr. Allen’s jaw. This historic breakthrough in the field of anesthesia occurred just in time to be made available to the 50,000 men who underwent amputation on the battlefields of the American Civil War (Chloroform was discovered around the same time but tended to cause fatal cardiac rhythms).

Civil War OR

Surgeries were performed without sterile technique.

The advancements in anesthesia in the past 167 years are miraculous and the process of going under has gone from a harrowing ordeal to an experience that, for the healthy patient, more resembles a dinner of several courses (albeit a horizontal one). At the risk of being facetious, let me explain.  Start by thinking of the OR as the restaurant of choice. A reservation is made beforehand and you are taken to the appropriate table. The experience commences with a starter of oxygen, propafol (induces anesthesia) and rocuronium (paralyzing agent). Feeling a little dry?  The IV fluids will help. Then the general anesthesia, desflourane or a similar agent, would be your main course as it keeps you under for the duration of your stay. Having a little discomfort from the surgery? A little analgesic via your IV will help.  Any individual needs that arise during your stay will be immediately addressed by staff as you are the only customer. In this restaurant, dessert is included. It comes in the form of the reversal agents, to wake you up. The procedure is over and it’s off to the post op recovery room and time for the staff to prepare the next setting. The whole experience was not to your liking? Relax, you won’t remember a thing but when you are recovered, think of how anesthesia is just one more reason to feel  lucky to be living in this time and place.

Epiphany in a Graveyard

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We Boomers never think about death. We are too busy celebrating the fact that collectively, we are the luckiest, wealthiest and longest living generation ever born. We are the luckiest generation because we were born between 1948 and 1964, when vigorous postwar era economic expansion gave us a world with a strong labor force, high job security, generous pension plans, and guaranteed social security. We are wealthiest because we found reliable jobs directly after high school or, we paid for our post secondary education at a fraction of today’s cost. We bought our first home cheaply only to see that initial investment debt mushroom into a surplus as property values increased. The Boomers are living longer because of modern medicine and the many advancements in medical therapy that offset the afflictions of old age. As a result, we have more retirement funds than any previous generation and the health to enjoy them. Along the way, we have taken more than our fair share from the system and the planet and left less for the generations that follow. The Boomers are a generation that ignores death simply because we are too busy enjoying our luck, wealth and health. The sad reality is that we too, will die. From the first breath, we share the same inexorable pathway to life’s end. For the Boomers, time is up.

I am a Boomer, but I do think about death, perhaps more than the average individual. This is because I have seen death more often than most. In 3 decades as an MD, I have witnessed the ephemeral nature of life and the cumulative experiences have provoked sober thought and sometimes painful reflection. For me, caring for the dying has also prompted personal action. In my 30’s I composed a will, revised it when the children came, and will keep it up to date as the future unfolds. I am aware that the life expectancy of a woman in the Okanagan is 81 years, but I also know that between 50 and 70 many things go wrong, and some are terminal. (I am in that age group). My husband and I have had conversations about dying.  We have given each other the permission to move on should the other die, to remarry, or at least not to end life alone. I do not want the man that I love to face a solitary journey should I leave him early.

In spite of thinking I had dealt responsibly with the business of dying, I have recently discovered that there are parts of death that I had not considered. To my surprise, the epiphany occurred in a cemetery at a time when I have never felt more alive.

This summer in Paris I visited Pere Lachaise, a serene 140 acre cemetery in a city of 11 million. In 1804 when it opened, the cemetery was far from Paris, but as time went by, the city encroached upon Pere Lachaise, encasing it like a cocoon. Stone walls 30 feet high protect the silent inhabitants of this sublime place, buffering them from the cacophony of the surrounding city. Inside, ancient trees shade the cobbled roads that lead to the final resting sites of 1 million souls.

Pere Lachaise is the final resting place of many legends and heroes. I was there to visit, among others, Jimmy Morrison’s grave. Morrison is a touchstone for my youth long gone and I wanted a moment to recall a magic time before he tragically died in a Paris hotel. What I did not expect to find there were the young men who also came to pay their respects. I found them in the early hours, kneeling silently at Morrison’s headstone while they played Light My Fire on their iPhones. Forty years after his death, who could have imagined these young men? Born decades after Morrison’s passing, they needed to bear witness to a time in history that they did not share, but wished to remember. If Morrison was alone at the end of life, he was not in death.

I walked the uneven cobbled pathways past the winged sepulcher of Oscar Wilde and took a minute to thank him for making me laugh. With such a bitter end to his life I wondered what witty quip he would bestow upon the countless people who came to kiss his grave. (The lipstick of those kisses has eroded the stone and forced Paris to enclose his headstone in plastic).

Edith Piaf was alone, and I could imagine the strains of her beautiful music inside my head. I thought about our own Judy Rose whose voice brings Piaf back to life. Chopin was not far away and I marveled at his genius and industry. The rich legacy that is the body of his work was accomplished in the 40 odd summers Chopin spent on this planet.

Interspersed among the famous people buried in Pere Lachaise, are many ordinary folk – the spouses, children and parents of ordinary Parisians. I watched family members quietly tend the graves of their loved ones, watering the flowers and sweeping the headstones. It was these small acts by ordinary citizens that led to my epiphany.

I have never been in favor of burial after death, but in Pere Lachaise I could see and feel the benefits of a cemetery. A gravesite is not a place for the dead, but for the living. It is a physical place to reconnect with a loved one, now gone. As I walked Pere Lachaise in the peace and quiet, I wished that I could visit my own mother in the same way I had visited so many others that day, others I did not know. I recalled being 21 and for the first time, being taken to my father’s grave. No one in my family had taken me before; so raw was their own sense of loss for this man, my father dead at 26, a man I can barely recall. I witnessed their grief, but for me, the visit brought a certain peace and closure. The physical presence of my father’s grave reconnected me with the 2 precious memories, long forgotten, that I have of this man in my first 2 years of life. Although I have not visited my father for many years, I did replace the weathered headstone last year, finding that the act provided me some small comfort.

That day in Paris I thought about my parents, and I thought about my husband and myself. I realized that, during all of our discussions, it had never occurred to me that I might outlive my husband. I had assumed that I would be the first to die.

And then the questions came. What if my husband died and I remained? How would I touch him? Where would we talk if he were cremated? If I needed his advice, how would I reach him if he were scattered on the wind? On a cobbled path in Pere Lachaise I realized with clarity and intensity, a personal desire previously unknown. Should I outlive my husband, I would want to bury him in such a place as this, a solid place, one that I could visit, one that would be a touchstone for the memories of a life shared, a place to anchor my experiences with him in a present and future I faced alone.

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The History of Vanity

Cleopatra

Cleopatra

I wasted time, and now doth time waste me.”
― William ShakespeareShakespeare’s Sonnets

“The air is saturated with the stink of perfumes at war. There are video screens on which flawless complexions turn, preen, sigh through their parted lips, are caressed. On other screens are close-ups of skin pores, before and after, details of regimes for everything, your hands, your neck, your thighs. Your elbows, especially your elbows: aging begins at the elbows and metastasizes. 

This is religion. Voodoo and spells. I want to believe in it, the creams, the rejuvenating lotions, the transparent unguents in vials that slick on like roll-top glue… But this doesn’t deter me, I’d use anything if it worked – slug juice, toad spit, eye of newt, anything at all to mummify myself, stop the drip drip of time, stay more or less the way I am.” (Cat’s Eye p113), Margaret Atwood

The history of vanity is as old as time, and for thousands of years cosmetics have been a big part of the vanity toolbox. Cosmetics provide a plethora of social signals designed to enhance beauty, indicate status and advertise sexuality. For centuries, they were the palate of the privileged class (and the oldest profession). For example, Cleopatra’s day would have commenced with slaves applying emollients composed of beeswax, olive oil, castor oil and fragrance to soften her skin. Kohl, a mixture of lead, copper, ash and burnt almonds, was applied to encircle her eyes to give the cat – like look so coveted in her time (and in the 60’s as well).

Flash forward to the 1600s when the pale face symbolized ultimate beauty. The highest class of European women responded by sun avoidance and to best their competitors, many resorted to bloodletting. The voluntary loss of a pint or two would achieve the desired pallor. The pale face became even paler in the 1700s when Ceruse, a white paint composed of lead and arsenic, became available at a time when smallpox scars were ubiquitous; the plaster- like substance could fill the depressed areas and hide imperfections. The downside to ceruse, however, was deadly.  Lead and arsenic caused eye swelling, rashes, tooth loss and even death. Another poison, belladonna, was placed in the eye to mimic the enlarged pupil of sexual arousal. The quest for beauty accelerated in the 1800s with the increased accessibility to the mirror and the invention of the photograph. To present a beautiful complexion for the camera, 17th century women ingested Fowler’s solution, a dilute concoction composed of arsenic to improve the skin.

The driving force behind the cosmetic boom of the 20th century was the movie industry. Cosmetic enhancement became mainstream and entrepreneurs like Max Factor, Elizabeth Arden, Helena Rubenstein and many more delivered what women of ancient times dreamed of, a whole constellation of products guaranteed to enhance the female face and body at an affordable price. Coco Chanel, for better or worse, convinced the modern woman that a tan was the new fashion accessory. At the start of the 20th century the average life expectancy of a woman was only 42 years. As advances were made in public health and medicine, people lived longer and the demand for cosmetic product to fight the visible signs of the aging process became big business.

In the 21st century the cosmetic industry became a multibillion-dollar industry and it keeps growing. Cosmetics, however, could only enhance ones features or hide imperfections, but as women lived longer, cosmetics fell short of the mark. Older women needed more. The movie industry and its aging leading ladies led the charge towards antiaging surgery and the niche of the cosmetic surgeon was born. The arms race towards youth and away from the grave escalated with the proliferation of plastic surgery procedures. Now a tighter face, flatter stomach, larger breasts, slimmer limbs and designer vaginas were only a nip and tuck away.

For those unwilling to go under the knife, Botox and tissue fillers opened up a new world of possibilities. Now for a price, anyone can have a wrinkle free face, plumper lips and look years younger.

Some may ask; When does the madness end?  My answer is that it doesn’t. As long as men and women are still breathing, there is a desire to be relevant in a culture that values beauty, status and sexual attractiveness.  Some may be shocked by the voluntary exsanguination by women in the 15th century to achieve pale skin, but today’s woman is willing to to do far more. Lest we think derisively about our ancestors, we should look at the behaviors we sanction today, before casting the first stone.

 

 

Planet Lance

A Nike commercial in 2001that is a prophecy for Lance’s future 2013

Two things scare me. The first is getting hurt. But that’s not nearly as scary as the second, which is losing.
Lance Armstrong

We are still in the orbit of planet Lance. He is a weighty fellow and, for better or worse, he still attracts us.  Recently the International Swimming Federation banned him from masters’ competition, US Postal is suing him for $40 million, and Hollywood has at least 3 movies about him in the works, with lurid titles such as The Cycle of Lies, Seven Deadly Sins and The Secret Race. The spectacle of his fall from grace is irresistible.

As many know, it all started when the US Antidoping Agency (USADA) website posted its 202 page report. The document was a damning indictment against Armstrong and his legacy. It methodically interviewed everyone in Lance’s circle, and eventually breached Lance’s wall of secrecy. And that, in itself, was not enough. The USADA did not simply dismantle Lance’s wall, they needed an exhausting inventory of each and every brick. Who at USADA did Lance piss off (as only he can), because there is vindictiveness in the report that goes beyond accountability? USADA’s report wasn’t about cleaning up sport, it was a vendetta.

I have to ask – Did hard-core cycling fans deny that performance-enhancing drugs fuelled Lance’s 7 Tour victories, or did they suspect cheating and watch the spectacle anyway?  Professional cycling is a drug culture and the Tour de France, since its inception, has been rife with drugs. Back in the beginning amphetamines and opioids were the drugs du jour.  Anabolics had their day, only to be supplemented by EPO in the 90’s. Now noninvasive tDCS, (trans cranial direct current simulation where you electrically zap the part of the brain that tells the body to slow down, and bypass the redline puke and die stage every racer experiences), is on the horizon. Who knows what the future holds? As long as there is fame and money to be had, as long as races are grueling events that millions watch, there will be cheats and there will be drugs. Almost every top contender in the Tour has been busted. Did anyone think that Lance would be spared?

Whether you love him or hate him there is only one Lance. He has never deviated from whom he is to gain public approval. There was an appetite for a superhero and Lance was glad to oblige. It was a win-win situation – he got to win, we got a hero. We ignored the personality traits he revealed because they were incongruous in the man we wanted to see. Now the winds of public opinion have shifted. Everyone is furious that our Lance Armstrong, (the mythical, super human, heroic version) never existed. USADA has forced us to look at all of Lance and see him as he is, and what we see, unfortunately, has made us unhappy.

Early on, I questioned, Who is Lance Armstrong?  I read his books to find some answers (My conclusion: What a jerk!). Since the start of his meteoric rise, I was at first, awed by his raw talent and his laser- like drive to succeed. These are qualities that I admire.  And, I confess, I stood for hours on the shoulders of Mt Ventoux during the 2009 Tour, just to see him pass. I envied his quick wit and quirky language, his ability to spar with the press, deal with the naysayers, and say something definitive after every Tour stage. He was smart, charismatic and Lance was good TV. I was bewitched, but as time went by, I was no longer fooled. Lance simply could not be that good for that long, because, well, no one is. This is a fact that every cyclist knows. As a doctor, I tend to look for a diagnosis, a pattern of behavior to explain what I see. I paid attention to what Lance revealed in his actions and behavior. In short, I tried to see the whole man and he was quick to reveal his coldness, fury towards those in his crosshairs, strict control of all of those in his service and above all, his monstrous ego. He does what he needs to do, to remain the top dog no matter the price. There has never been room for anyone else in the rarefied atmosphere of planet Lance.

Martha Stout in her book The Sociopath Next Door states that 1 in 25 ordinary Americans are sociopaths with an antisocial personality disorder and what qualifies these individuals is a lack of conscience. She defines a lack of conscience as a state where the individual experiences no feelings of guilt or remorse no matter what they do, no limiting sense of concern. This state leaves the sociopath free to participate in society without being hampered by the fussy concept of right and wrong. If morality is absent and conscience does not come into play, then whatever decision is right for you, is the right solution.  There is a tendency for the public to think sociopaths are criminals but the vast majority is nothing of the sort.  They are ordinary citizens. When they possess great talent, strength or intellect they are our heroes and idols.

In my career I have interacted with many patients who were sociopaths. When an MD is presented with a patient, the Diagnostic and Statistical Manual of Mental Disorders (or DSM: fifth revision) helps to classify the difficult personality. The DSM-5 lists 5 personality types and gives criteria for each. For example, the antisocial personality type requires the individual to display a trait from each of the ABCD categories below.

  • A Criteria is defined as either; Egocentrism, (self esteem derived from personal gain, power or pleasure) OR goal setting based on personal gratification, absence of internal standards associated with culturally normal ethical behavior

 

AND

  • B Criteria is either a lack of remorse OR exploitation as a primary means of relating to others, including by deceit or coercion, the use of dominance or intimidation to control others

 

AND

  • C Criteria is a personality showing antagonism either by;

 

  1. 1.     Manipulation (frequent use of subterfuge to influence or control others, use of seduction, charm or glibness or ingratiation to achieve ones ends) or
  2. 2.     Deceitfulness –dishonesty and fraudulence, misrepresentation of oneself,
  3. 3.     Callousness –lack of guilt or remorse about the negative effects of ones actions on others, aggression or
  4. 4.     Hostility –persistent or frequent angry feelings, anger or irritability in response to minor slights and insults; mean, nasty or vengeful behavior

 

AND

D Criteria includes irresponsibility, impulsivity or risk taking behaviors

 Robert Hare, at the University of British Columbia, concurs that the Antisocial personality may be valued for audacious leadership, and that these individuals are adaptive to a highly competitive environment because they gets results for the individual or/ and the corporations who employ them. Often these individuals will cause long term harm, both to their co workers and the organization as a whole, due to their manipulative, deceitful, abusive and fraudulent behavior. Hare describes this personality as intra- species predators who use charm, manipulation, and intimidation among other things, to satisfy their personal needs. Because they lack conscience and empathy, there is no guilt or remorse. Further, Martha Stout states that the best way to identify such a person is that they will always seek our sympathy and often unwittingly, we forgive.

 Lance has the criteria for this diagnosis. He has never hidden from us. He was always in full view. We just did not want to see him. The characteristics of his personality that made the USADA want to vilify him, to make him pay, are also the ones that have made him iconic. Lance Armstrong is one of the most fascinating figures in modern sport. He is the guy who beat the odds with cancer only to comeback from near death to win the most difficult sporting event in the world, not once, but seven times. He never quits, gives in, or admits defeat. He put flesh on the American dream.  We like that. He dominated his sport utterly, completely, and ruthlessly because that is his personality. We pretend to like that, but now, not so much.

Some may ask: What happens for Lance now? He will do as he has always done. He will keep his yellow jerseys because, as he will justify, everyone else on the podium with him and beyond has been caught doping at some time or other. Victory sustains him, and he will perform and beat everyone for as long as he can, even if it is just in a pool training session. He will reinvent himself, write another book and do personal appearances. Now we will come for his notoriety, or our curiosity. Others will come because he is charismatic, smart, a good speaker and he came back from cancer to win seven Tours. Although he won’t ask for sympathy, time will be the balm that leads us to forget and perhaps, forgive.

 

Chocolate as Food for Thought

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The First Thinker…

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Thinking about chocolate

The Aztecs used it to enhance strength in their warriors; the Spanish viewed it as a cure-all, and hid it from the rest of Europe for a hundred years; the 17th century British physician Dr. William Hughes thought it useful in pregnancy “since it nourishes the embryo and prevents fainting fits”; Thomas Jefferson sang it’s praises and the Swedish taxonomist Carl Linnaeus named it Theobroma Cacao (food of the gods). Yes, I’m referring of course to, chocolate.

In its base form, cacao powder is rather bitter, but once sugar and a few other goodies are added, chocolate becomes less a medicinal elixir and more the delicious and rather addictive confectionary we know it as today.  What can we say about its purported medicinal properties? We know that cocoa products are rich in flavonoids – antioxidants – that may be beneficial to overall health. Does that translate into tangible benefits? A new paper in the New England Journal of Medicine suggests the answer may be yes!

In his paper Chocolate Consumption, Cognitive Function, and Nobel Laureates, Dr. Franz Messerli reports a rather curious correlation between a country’s chocolate consumption and its ability to produce Nobel laureates. The Swiss, as one would expect, lead the pack in both chocolate consumption (a whopping 12 KG per person per year) and, somewhat less predictably, in Nobel laureates (34 per 10 million population). The Danes aren’t far behind. Canada’s chocolate consumption on the other hand, is a mere 4 KG per person per year and we, lamentably; produce a correspondingly low number of Nobel laureates at only 6 per 10 million population.  Dr. Messerli’s paper, it should be noted, was delivered somewhat tongue-in-cheek, but there exists an undeniably strong correlation between the two variables.

So what is going on here? Does eating generous quantities of chocolate boost brainpower? There has been some suggestion that flavonoids (also found in green tea, red wine and some fruits and vegetables) improve blood flow and may therefore improve cognitive ability among other health benefits.  A 2009 article in the Journal of Nutrition, suggests a strong correlation between brain function, as measured by a battery of cognitive tests, and the intake of flavonoids in the diet. So how does that relate to Nobel laureates?  Perhaps smart people just like to eat chocolate, or maybe the Swiss produce Nobel laureates because of some other reason and their enthusiastic chocolate consumption is a coincidence – just something they like to do.

The bottom line is chocolate, particularly dark chocolate (without too much added sugar), along with other flavonoids, can be part of a healthy diet when consumed in moderation. Be wary of the calories though – one ounce of dark chocolate packs about 150 calories, which, for the average person, would require about 1 ½ miles or 30 minutes of walking to burn off. Also, beware of highly sweetened chocolate or candy bars as they are more likely to enhance your waistline than your brainpower. Even if eating chocolate doesn’t increase your odds of winning a Nobel Prize, it might just put a smile on your face and that is a prize unto itself.

Rum Balls: My favorite chocolate recipe…I usually make these as a double batch and give away on trays at Christmas, or I freeze them, separated in layers, in cookie tins. When I have company I remove enough to fill a plate and serve with fruit . They last all year in the freezer.

12 oz. semi sweet chocolate chips, melted in microwave at 50% power

½ cup almond paste, crumbled into small bits

1-cup sour cream

8 cups graham wafers, ground up in food processor

3 cups icing sugar

2/3-cup cocoa

1 1/2 cups white rum

1 ½ cups melted butter

2 cups pecans ground in food processor

1 tsp. salt

chocolate shot(round balls)  or vermicelli(rod shaped). I like these better as are softer.

Combine all the wet stuff in one bowl, e.g. melted chocolate, butter, sour cream, rum, almond paste. Stir into wet slurry.

Combine all the dry stuff in a bigger bowl. I use a big plastic ice cream bucket with a lid.

Mix the wet into the dry to form a gooey paste.

Refrigerate till firm or overnight, covered.

Use a tbsp. to get an amount of the mixture and roll it into a ball. I put Pam on my hands to stop it from sticking as it warms. If you get it on your hands, scrape it off and put back into the dough.

Roll the ball in the chocolate shot. You can use ground-toasted pecans if you prefer.

Assemble on trays in small decorative paper cupcake liners or put in cookie tins in layers with saran/wax paper in between and freeze.

(adapted from Diane Clement)