Allegory, parable, rhetoric – Page 22

You Look Too Young to…

7/2017

I guess patients out there want their doctor to look like Marcus Welby. How did he get to be in his 60’s and not have to be a “too-young looking” doctor? He must have spent the first 40 years in a crack distributing motorcycle gang until he looked old enough and then went to Medical School.

So, let’s look a little closer at this process. You know, Medical Schools require a “pre-med curriculum” in higher education (College) that may take 2-4 years depending on the Medical School. I won’t even consider those hours.

Be aware that I am using very conservative data here. I will point out a few deviations that I have taken.

Medical School is a 4-year curriculum. 50 hours a week for 50 weeks a year for 4 years comes to 10,000 hours. This does not include any remedial studies, tutoring (for you or by you) or anything else.

After Medical School, there is residency. This includes 1 year of internship (an antiquated term that doesn’t apply much anymore) and 3 years of practicing your chosen specialty under the tutelage of experienced doctors. I am only referring to primary care specialties; internal medicine, pediatrics, family medicine and emergency medicine. Here one spends 90 hours a week 50 weeks a year for 4 years, or 18,000 hours.

It has become common for primary care specialties to spend another 2 years in a fellowship with emphasis on an area of focused interest within the chosen primary care specialty. We will lighten up a little with 50 hours a week for 48 weeks a year for 2 years, or 4,800 hours.

So before that pimple-faced teenager-looking person that calls him/herself your doctor gets to step foot in a private practice or open his/her own shop, they have spent 32,800 hours learning how and practicing their skills to take care of you.

If we give this adolescent, say, 3 years in practice (a doctor is never without someone looking over their shoulder, but…) taking care of “their own” patients, at 50 hours a week for 48 weeks a year we now have a doctor with 40,000 hours of experience.

I’ve not included many hours of studying CME (continuing medical education) at home and on vacation that is required for certification for this or that which starts during the residency and continues for the career of the doctor.

In addition, one can look at a more defined measure. In the primary care specialties, a doctor will see about 30 patients every 12 hours worked. So by the time a doctor has finished the residency and fellowship, they have seen about 100,000 patients and will see 6,000 patients per year more, for every year of private practice.

A primary care doctor, in some respects is like a mechanic. The patient/customer comes to you with a problem, you figure it out, fix it and go on to the next one. In some respects, the doctor isn’t like a mechanic. The mechanic will work on one customer’s problem at a time until it is fixed. He/she may add another one or two while waiting on parts to arrive, for instance. In the primary care specialties, the doctor is seeing a new patient about every 12 minutes with sometimes as many as 10 overlapping. Thirty patients a day will present, at a minimum of 20 different problems.

It is estimated that a violinist has to have spent 1000 hours to master the instrument. It is estimated that 3000-5000 hours are required to play with a national level Orchestra.

Consider this the next time you have to see a pimple-faced adolescent that is too young to be a doctor. Or the next time you want to consult Google.

Musings from your grumpy Uncle/Brother Dave.

Weary.

Trans What? Part 2

7/2017

These subjects are so prevalent in the media these days that I cannot, without a collapse of conscious, ignore them.

It seems that uterus transplants are a reality now. (1)

So this Doc in Stockholm, or thereabouts, has had five babies delivered to women that have had uterus (womb) transplants. Seems that my Alma mater has successfully transplanted a uterus, but that woman hasn’t chosen to become pregnant, yet.

So, and you’ll just have to believe me on this, Arnold was right. Men maybe can have babies. They just need a uterus transplant, some supplemental estrogen and progesterone and a lot of help from friends. And I promise, someone will try it.

But the complexities don’t end there. Consider the problems in Houston and elsewhere, with gender-neutral public restrooms. Now it’s not only gender determinant. What I mean is, the individual can choose which gender they identify with and which pronoun they prefer to have used to address them (choices in English are he, she and it for individuals). And, the pronoun can be indeterminate. (2)

Why am I confused by all this?

Because, when a patient comes to me that has, say abdominal pain, it is routine to get a pregnancy test if they could possibly be pregnant. My therapeutic options are affected if they are or are not pregnant. But, if I order a pregnancy test on a male, the computer rejects it and informs me that I’m stupid because males can’t get pregnant. And if I order a pregnancy test on a patient that seems too old, the computer rejects it. With appropriate hormonal manipulation, males may be able to have babies in their transplanted uteri at a much later age than females with a native uterus.

So what do I do? Base my suppositions and investigatory skills on the name, the pronoun of address or the physical exam? Any and all can be misleading.

From your confused and grumpy Uncle/Brother Dave.

Weary.

Trans What? The original Trans What? post.

Trans What?

7/2017

Jimmy Soul’s “If You Wanna Be Happy” is based on the song “Ugly Woman” by the Trinidadian calypsonian Roaring Lion recorded in 1934. (1) Ancient history, right? Uh, maybe not.

You can read the entire lyrics (2), but for illustration purposes, lets at least look at the chorus.

If you wanna be happy for the rest of your life,
Never make a pretty woman your wife.
So from my personal point of view,
Get an ugly girl to marry you.

When first I saw Alex (need I say that this is not his/her real name), he was laying on the bed holding his girlfriend’s hand. He had on khaki shorts and a T-shirt. He was a bit overweight, had hairy legs and on his face was a goatee, of sorts. But Alex was not what he seemed. He also had breasts and a vagina, ovaries, tubes and a uterus. He labeled himself a transgender.

According to Merriam-Webster, transgender means, “of, relating to, or being a person (as a transsexual or a transvestite) who identifies with or expresses a gender identity that differs from the one which corresponds to the person’s sex at birth.” Transsexual means that the person actually altered his/her anatomy to replicate (copy, not repeat) something other than what it is, was or was wanted to be. Transvestite means dress-up, no permanent physical change has occurred. How is a person’s sex at birth determined? Well, that’s a sticky wick, to say the least (no pun intended). But even definitions change with cultural pressures. There is no reality, really.

As of the time of this writing, a vagina/uterus transplant has only been considered and attempted in women who have congenital absence of a uterus, that we know of. In other words, the patient has the plumbing and control mechanisms (meaning the exceedingly complex endogenous neuro-hormonal system to support the transplanted organ) and just need the parts hooked up. It has not been successful across genders, meaning that the organ transplanted has not succeeded in functioning as intended by carrying a fetus to delivery. Except in the movie Junior with Arnold Schwarzenegger.

A penis/testicular transplant, well, is not. The penis is not really a transplant and the testicular “transplant” is just a couple of glass marbles rattling around in a sack of skin. What happens is that the surgeon uses extra tissue not needed anymore (the vagina and harvested fat tissue that will not be missed from other parts of the body) to create an appendage that hangs out, not hangs in. So, technically this is a mixed autologous and exogenous fabrication, not a transplant.

So, this whole business is about self-identity?

During my exam, the patient exhibited obvious embarrassment at having breasts and continually tried to pull his shirt down, or uh, her shirt down (whatever) to cover them when he or she thought I had finished my exam. Most women do the same, although for a different reason.

Not that I am a big Freud fan, but let’s give the dude his due. Freud proposed that:

1. Id (das Es) is the unorganized part of the personality structure that contains a human’s basic, instinctual drives, particularly our sexual and aggressive drives and acts according to the “pleasure principle”, or the psychic force that motivates the tendency to seek immediate gratification of any impulse.
2. Ego (das Ich) represents what may be called reason and common sense.
3. Super-ego (das Uber-Ich) strives to act in a socially appropriate manner. Whereas the id just wants instant self-gratification, Uber Ich controls our sense of right, wrong and guilt and helps us fit into society by getting us to act in socially acceptable ways.

Very similar to that portrayed by Michael Keaton(s) in Multiplicity.

Alex’s chart lists anxiety and depression as his chronic “medical” problems. But these are not “medical .” They are psychiatric problems. In fact, everything I have said here is founded and grounded in psychiatry. Everything but the surgery and that I’ve shown to be a farce. A transgender “female” cannot conceive or carry a child and a transgender “male” cannot beget a child regardless of how much psychotherapy they go through. At least, not without a lot of test tubes, laboratories and artificial growth media. We are told that these issues are not psychiatric problems but rather the true core of our essence, our being. But those millions (or million trillions) of cells in our body still have either 2 X or an X and a Y chromosome. (3) Except those that have a mix of both. Rather than having a psychiatric origin to this conflict, we now have a battle of XXs and XYs within a body. Who wins? Is it a matter of quantity, quality or control? Or is it a matter of who’s DNA predominates? (4,5,6)

With all this being said, can a white boy be black because he wants to? Like our first black President?

Your grumpy Uncle/Brother Dave, puzzling through the biology, physics, genetics, culture and politics of sex determination.

Weary.

Trans What? Part 2

Over Shoes

7/2017

Galoshes; dickersons, overshoes, 4 buckle artics, Russian valenki or Qubecian claques.

You may or may not remember your mother yelling at you to put on your galoshes before you leave the house in inclement weather (I pretty much presume nobody does and I understand). In my day, this was a common warning from parents, teachers and those given the responsibility of caring for children. Actually, the concern was not for the children.

We’ve had a wet year, locally. So, why do I not hear of galoshes? Well, there is a reason.

The weather has not changed, regardless of what you hear from Hillery, Al and the like. It is either wet or dry. It has been forever and will be forever. So in times past, people have looked for ways to deal with the weather, something about which they have no control.

Galoshes were a device to protect a valuable piece of clothing.

Back in the day, shoes were made of leather, they were expensive, semi-custom made and labor intensive. Leather is a very hardy material that resists abrasion and impact, protecting the feet from injury. But if repeatedly exposed to extremes of heat and wetness, will shrink, crack and fall apart. Those without galoshes would have all leather shoes that suffered the ravages of weather, thereby becoming useless. Shoes back then were expensive and expected to last for several years, even generations. They were protected and rather than being used relentlessly, were often protected leaving the children to go barefoot in weather unfathomable today. Things have changed.

So, somebody (an unknown Scandinavian inventor of the wooden shoe, Radley, Rickman or somebody) invented shoe covers that would delay this.

Goodyear and Candee found that rubber would prevent wet damage. And vulcanized rubber would better withstand the drying and cracking that natural rubber succumbed to. It was easier to manufacture in a variety of sizes and relatively inexpensive.

Now, kids/we wear %100 nylon (used generically here to refer to the multitude of modern plastic fabrics), and other water resistant/porous compounds that if they become wet will dry in minutes. Materials that supposedly are tougher, more weather resistant, cheaper, kinder and more stylish than leather.

So as parents and grandparents we send our children out into inclement weather knowing that their feet will become wet, but knowing that their precious feet will dry, eventually. Or, we don’t send them out at all.

Today, galoshes refers to a variety of shoe coverings, not that the exact term is always used. (1) The modern equivalent of galoshes are;

nylon and synthetic rubbers that cause all sorts of skin problems in factory workers exposed to wet environments of a variety of sources;

boots that cowboys think look so cool;

steel toed work boots that industrial workers have to wear to satisfy OSHA;

overshoes that protect slaughterhouse workers from the blood and guts of their work;

and the dainty nylon-ish paper covers I wear to protect my shoes (I guaranty are not $300 Nikes) from the blood and guts of … .

From your grumpy Uncle/Brother Dave, with similar thoughts on synthetic clothing for warmth and dryness.

(https://en.wikipedia.org/wiki/Galoshes)

Weary

Mother’s (Day)

5/2017

Mother’s Day was first celebrated in 1908 when Anna Jarvis held a memorial for her mother at St Andrew’s Methodist Church in Grafton, West Virginia. Her goal was to memorialize her mother who nursed soldiers of the American Civil War, both Union and Confederate. Mother’s Day is celebrated around the world at various times in March and May.

Jarvis intended the memorial to be a celebration honoring the mother of the family, as well as motherhood, maternal bonds, and the influence of mothers in society. But, Jarvis became angered by the commercialization of the holiday. Hallmark entered the equation in the 1920s and the popularity and commercialization escalated. At one point Jarvis was jailed for her protests of the abduction of her nascent holiday for commercial purposes.

Jarvis was an enigma. Jarvis fought against charities that used Mother’s Day for fundraising. She was dragged screaming out of a meeting of the American War Mothers by police and arrested for disturbing the peace in her attempts to stop the sale of carnations. She even wrote screeds against Eleanor Roosevelt for using Mother’s Day to raise money for charities that worked to combat high maternal and infant mortality rates, the very type of work Jarvis’s mother did during her lifetime.

In addition, Jarvis specifically noted that “Mothers’ ” (“Mothers’ Day,” versus “Mother’s Day”) “should be a singular possessive, for each family to honor its own mother, not a plural possessive commemorating all mothers in the world.” She felt Mother’s Day wasn’t to celebrate all mothers but was intended to celebrate the best mother you’ve ever known, your mother.

Not only did the common masses abduct the concept but the Roman Catholic Church thought the idea was splendid because it was strongly associated with revering the ultimate mother, the Virgin Mary.

In the US, Mother’s Day is the second Sunday in May, thanks to Woodrow Wilson.

In 1872, Julia Ward Howe, the composer of “The Battle Hymn of the Republic”, abducted the holiday for political purposes. She wanted the holiday to be for pacifist mothers, not just mothers. Her efforts failed despite the fact that Jarvis’ original Memorial was for her mother for charity work for War Veterans and Peace.

But commerce didn’t fail. Mother’s Day continues to be one of the most commercially successful holidays in the US. The prime promoters of Mother’s Day are the florist industry, gift cards, dinner outside the home and gifts. Mother’s Day is also prominent in the Sunday comic strips in the newspapers of the United States (for those that actually know what a newspaper is), expressing emotions ranging from sentimental to wry to caustic.

Sadly, Jarvis died without child, without money and in the Marshall Square Sanitarium in West Chester, Pennsylvania. She had dementia.

So, in keeping with the theme of a holiday that the founder tried aggressively to expunge; that had social, political and commercial foundation competing with a foundation for dissolution; that honored every mother and only one’s own mother; that had a foundation that was used by the founder to attempt to abolish it. We look at more recent cultural honors of motherhood in song and movie.

Kill Bill 1 and 2: A 4 hour epic in which a hyper-violent, katana-wielding, homicidal pregnant bride finally reunites with her daughter in the squeal.

The Sound of Music: Well stepmother rather than the mother of 7 kids that flaunt their one-up-manship on the Nazi’s in WW-2 by singing cute little songs and performing kindergarten activities.

Terminator 2: Hey, how could we consider Mother’s day without considering Arnold. Let’s see how do I explain this. Linda Hamilton’s character, Sarah Connor, becomes pregnant with her son, after sleeping with a man sent from the future, but raises her son to be a warrior for his future role as the leader of the human resistance against a robot uprising with the help of a befriended robot sent from the future to protect her son the future leader.

Terms of Endearment: The antithesis of Terminator 2. Meaning that this movie won an Oscar for the most guy’s falling asleep within 10 minutes of the start of the movie. Seriously, Shirley MacLaine portrays a mother-bear, protecting her cub as no one else could have. My favorite is the opening scene where the father is trying to scare crows out of the trees at the social function (wedding party of some kind, I think) with his shotgun in their house in the residential section of town. What cajones! Then I fell asleep.

Bambi: One of Disney’s most traumatizing films, teaching a generation of impressionable young viewers that even mothers die. “Man was in the forest,” Bambi’s mother warns, casting us humans as the most dangerous villains of all.

Friday the 13th: Like mother like son. The original has the mother exacting revenge on campers for drowning her son. Jason and the “mask” came in the sequel(s).

Ordinary People: A dark side sister film to Terms of Endearment. Here we take America’s sweetheart-virgin-like actress, Mary Tyler Moore, that for 30 years we had come to know and love and cast her as an evil selfish mother that hates the son that survived and loves the son that died.

Mrs. Doubtfire: Not a mother but here Robin Williams could be the perfect Mother’s Day mother.

Mommy Dearest: Joan Crawford is outed by her daughter as a mean, abusive and nasty mother.

Cinderella: The evil stepmother from “Cinderella” has given a bad name to stepmothers everywhere with a special kind of evil, forcing her dead husband’s orphaned daughter to do all the housework and mercilessly mocking her efforts to go to Prince Charming’s ball.

Carrie: A tale of adolescent alienation and telekinesis by being tormented by far more than thrown sanitary napkins and buckets of pig blood; her fundamentalist mother denounces her daughter’s “dirty pillows” and will not suffer the witch to live.

Throw Momma From the Train: A tribute to what a good sport actress Anne Ramsey, Momma, is at the expense of her own vanity that she’s vile enough to make you actually root for her murder.

Species: Momma wanna-be is an alien seductress looking for a human to mate with. So, technically she is in the same boat with Robin Williams, being a potential but not yet recipient member of Mother’s Day.

From Jerry Jeff Walker;
And it’s up against the wall, redneck mother,
Mother who has raised her son so well.
He’s thirty four drinkin’ in a honky tonk,
Kickin’ hippies’ asses and raisin’ hell.

From David Allen Coe;
Well I was drunk the day my mom got out of prison,
and I went to pick her up in the rain,
but before I could get to the station in my pick-up truck,
she got runned over by a damned old train, …

From Willie Nelson;

Mamas, don’t let your babies grow up to be cowboys,
Don’t let ’em pick guitars or drive them old trucks,
Let ’em be doctors and lawyers and such

Mamas don’t let your babies grow up to be cowboys,
‘Cause they’ll never stay home and they’re always alone,
even with someone they love.

From Dolly Parton;
It is true we had no money,
but I was rich as I could be,
In my coat of many colors momma made for me.

From Merle Haggard
And I turned 21 in prison doing life without parole,
No-one could steer me right but Momma tried, Momma tried.

From Shirley Collins (a rather obscure folk singer of English music in the 1960-70s);
A British folk song about a woman who gives birth to one or two illegitimate children (usually sons) in the woods, kills them and buries them.

Happy Mother’s Day from your grumpy Uncle/Brother Dave.

Weary.