Know Thy Self

The thread from the common dread of the unknown weaves itself into the fabric of our lives, with all its knotty imperfections and colorful imagined details. This dread sinks ships and brings down great enterprises of humanity through inaction of thought. It paralyzes humanity with its circles upon circles of obtuse and opaque feelings until the mind whimpers for surrender. The magnitude of an invisible weight that descends on the subject employs the terror of impossibly circuitous reasoning that cannot allow itself a resolution. The dark becomes darker and the light fades faster and faster. Columns of understanding fall like dominoes to the force unlike any. Thus is the victimization of the mind.

Legions of artists have fallen to this lonely force. Some have forced themselves to self-mutilation while others have collapsed into a heap sniffing the vapor less odorless colorless stealth of poisonous gases. This ingenious mind that crafts via axioms, theories of life and understanding, is the same mind that is capable of such infinite love and unspeakable horror. The prisons that reside inside vastly outrank those on the outside, capturing the inner peace leading to a sustained discordant sound that grates the very nerve of contentment and life.

She was once a lady of fashion and means. The street used to stare at her, eyes worshipping the cloth colors that bound her heavily photographed figure. There was a parade of desire and sycophancy surrounding her day and night. Every move catalogued and reviewed for its elegance, poise and ultimately as all things commanding a stare, fiscal reward. The paparazzi made fortunes with their black cameras and long telescopic lenses, peering from nooks and crannies of the heavily shielded walls, half opened doors and supposed hidden vacations where a ‘lucky’ photographer would catch her in another stunning coiffure fit for the magazine cover. Life was good then, ideal for the sought and the seeker.

As all good things do come to an untimely end when least expected or desired this one too died a sudden death. The desire vanished and so did the seekers. Perhaps another elegance had arrived and taken over the mantle ‘worthy of worship’. The delight of one turned into a suffering for the other. This was the ying and the yang, transference without loss, no entropy a perfect example of the first law of thermodynamics.

“So what happened to her?”

“Oh she was hurt first and as all do she resorted to the crutch for stability; alcohol. She spent a lot of money on changing her looks to turn back the clock and un ring the bell but nothing worked. The more she tried the worse it got. Her face distorted with plastic surgery created hideous views for the cameras. Once loved for the looks now she was vilified through cruel jokes. It all turned hideous on her. The establishment seemed to rain down snide invectives. Life became a burden.” He said cracking his knuckles of his right hand, one torturous knuckle at a time.

“Is that when she tried to commit suicide?”

“Yes but it was more a cry for help.”

“So they saved her pumping her stomach and all.”

“Yes.” He said leaning over, his stethoscope dangling around his neck precariously. “But she could not understand that her time had come and gone. The fifteen minute of media created fame was over and now it was time for reinvention.”

“What could she do?”

“Reinvention is a subject worthy for all of us. Times change as the world turns and the past slowly and inexorably peels away from the present to reveal the future, just like the laminate off the diploma on the wall- slowly at first, then one day the diploma appears grey, dirty and unclothed.”

“But she lived didn’t she?”

“Oh yes that she did. She walked in and out of half way houses, specialty wards and hospitals trying to quell the need for attention. The monster that was created by her need and those on the outside could not be tamed for the longest time. Many bouts of self-inflicted injuries and finally after fifteen years of polishing the old paradigm, she came clean.”

“What happened?”

“Nothing spectacular. Just one day she cried her eyeballs out and then the next day she started the journey of self discovery.”

“Just like that?”

“Pretty much. Never looked back.”

“But financially she was ruined wasn’t she?”

“Yes that she was, but money did not seem to mean much anymore, just like the fame and being the eye of the media hurricane once, was a thing of the past. What mattered was one day at a time. She would spend days in the library reading everything that came in her view. She spent countless days researching arcane subjects of interest only to her. But slowly as surely as the night turns to day the gulf between the need and the want became obvious to her.” The pregnant pause of uncertainty loomed. He fell quiet not knowing where to go next, or what to say, or whether to prolong the conversation further.

“Amazing, isn’t it. How the fragile mind can replenish itself?”

“Truly! In fact it was a spring Saturday afternoon when I was in the library and she quietly walked to the corner of the table where I was sitting and sat her self down with an armful of books. She never looked up. But I knew then that that was the woman I was going to marry.” He thumped his fist gently on the table in front and a smile broke out on his face.

“What! You mean Mary is The Mary?”

“Yes, not many know, only a select few friends”. He said with a smirk on his face.

The way he said it with quiet self-assuredness showed the triumph of his life and the cornerstone of his being.

“Wow!”

Two souls, one lost to the outside world for a while and the other lost to the inner field of medicine both found each other on that happy spring day in a library. Happy in their togetherness, content in their discovery, now, as one in thought and mind capturing what life has to offer.

The consequences of detachment from a self that one does not know but fears for losing and that attachment for the self that one knows well will never be lost, is the essence of a human life’s wanderings. It is in the latter that contentment and happiness resides. This psychiatrist’s tale and that of his love, underscores the need for all to know the true inner self.

Mutiny against an Ancient Grudge

So colorful and exact in quality, so fluid in its flow, so functional in its capacity and yet so turbulent in its history, this blood, the humor of our humor, this life behind our living is the touchstone of being.

It provides the first blush of a fair teenage girl on seeing her heartthrob. The color of cheeks suffused with the pink and redness of a rose or the color of the flame and warmth of the ill-gotten infection that rises to the face and disassembles the beauty by the invisible hands of the infecting agent. It is also the color of bodily response around a sustained wound. This color is the projection of this body humor called blood.

From Galen’s concepts of the origins of where blood is formed based on the “dark’ from the liver and the “bright red” from the heart to the circulating anatomical description by William Harvey, blood has been mentioned as a source for purity of the soul and as the scourge of plagues. In disease the oft-practiced venesection and bloodletting became a therapeutic endeavor for most illnesses. Many an intellect has fallen prey to the seductive powers of blood, proclaiming it to be the be-all, end-all of life and it is, for no substitute has yet to be discovered to take the burden of it’s claim. Blood therefore has endured this fame and its share of infamy over millennia.

Blood has always been as it now is, the transporter, messenger, supplier and mobilizer of cells and cellular products. It accounts for 7% body weight and the heart pumps 80 pounds of it every hour to keep the milieu in harmony. Attempts at transfusing from different species met with failure as equally also between humans, until the early 20^th century when an Austrian physician in 1901 figured out the cause of death after blood transfusion was due to a mismatch. He received a Nobel Prize in 1930 for his work in Blood Typing.

                                                        Sir Frank Dicksee 1884 painting

From two households close in proximity, modest in civility but silent in their anger towards each other, there blossomed an infatuation that proclaimed into undying love between the boy and the girl. The anger between the households stemmed from a silence, created by introversion and lack of neighborliness, which evolved into an unsaid but slow boiling dislike finally blossoming into hysteria of unexpressed anger. The children however drawn to each other by invisible tugs of unexpressed emotions found refuge in hidden pleasures of subterfuge and clandestine meetings. Love thrived under the canopy of darkness and shadows.

                                                      Casa di Giulietta in Verona, Italy

It was a winter’s night when she was awakened with a fast heartbeat. She was shivering with fever and soaked through her nightclothes that the alarm was sounded through the house. The following morning and the weeks beyond the family became familiar with the environs of the hospital and its doctors.

After repeated attempts at communications with his love, the sixteen-year-old finally found out the cause of the silence. In a fearful desperation late that night under the cover of darkness he approached her hospital bed. The family had just left and his love lay there quietly, eyes closed, breathing lightly, barely enough to register. The only external reference to life was the loose dark blonde hair billowing to the rhythm of her breath.

“Hi.” He said as he approached her. She looked up and the clarity of vision and her desire all rose into her face with a sudden blush, the same he had seen many months before when they had met.

“Hi.”

“What’s wrong?”

“I am sick and they can’t fix it.”

“That is not possible.” His voice rose in defiance. “My father tells me everything is possible all the time and I believe that.” He stuck his right fist into the palm of his left hand. Tears just lurking at the corners of his eyes. His dreams and desires were lying there in front of him. At sixteen there was a tomorrow and beyond but without her there was nothing.  “What did they say is wrong with you?”

“It is a bone marrow problem. They say they cannot find a match for mine. They have tested all my family and everyone is a partial match which is not good.”

“Can I be tested?”

“I think only family is allowed.” She answered doubtfully, her eyes seeking his and nothing else. A heart once fulfilled now crying of emptiness and hearing echoes of a lost future.

They fell silent for a while as their dreams and desires were held in the palms of their hands each clutching the other for safety and security. The nurses looked through the window periodically but did not interfere. They all knew the plight of the invisible embrace of the two. No words could describe their togetherness better than their proximity. After an hour when fatigue overwhelmed her into a deep sleep he rose from her side and went home.

“Okay genius, tell me again what this HLA stuff is all about.”

“MHC stands for Major Histocompatibility Complex region of the genome. It is located on Chromosome 6 and carries 3.673 million base pairs. This region determines who we are and so differentiates between “self” and “non-self”. His friends voice over the cell phone was tinny and detached. “What makes you so interested in biology suddenly? I thought math was your subject?” he asked.

“Curiosity?”

“Try me another piece of BS.”

“So how much of a match between two people is required?”

‘There are nine of these HLA genes within the MHC. The best matches need the HLA-A,B and DR subtypes. Always, the more the merrier.”

“But why so much difference within humans. It makes us so different.”

“Well, half the truth is that the first HLA-A,B,C carry between 800 to a 1000 differing alleles so having two people completely matching is next to impossible.”

“Its plain dumb. Nature is stupid as shit, isn’t it?”

“Not really. There is a special region in the MHC that deals with your sense of smell. It appears that women prefer the diverse smell of their future mates. That particular gene encodes the proteins for that aroma. It is nature’s way of saying “variety is the spice of life.”  There was a brief hesitation and then he concluded, “That is why you don’t want to marry your cousins. You get monsters for children!”

“If two people can’t be matched perfectly, how do transplants work then?”

“Immune suppressive drugs.”

“For the rest of one’s life?”

The chirpy broken response and the cloudy hiss of lost signal ended that conversation. He tried the number again but the network was overwhelmed with other teenager calls. He gave up and sighed.

Weakness tortured the heavy eyelids and forced them shut to the outside world. She could hear the lingering echoes of words of endearment and then of encouragement. They were all mixed together, jumbled beyond recognition. From whom they came and where they seemed to disappear she could not decipher. The weight of the fatigued mind crushed all physical abilities. She wafted through the walls of the building like an ethereal being, saw nothing yet heard words she could not fathom. They seemed to call to her, but from where she could not make out. This disguise of fictional reality played in her mind’s eye until the first glimmer of understanding. She felt the hand she had come to hold and love. She felt it, firm and comforting, holding hers in its warm embrace. It was his and without opening her eyes she felt him near her and all was well.

Two week later the two families looked on through the window into the sterile laminar flow room where the two sixteen year-olds laid side by side in their beds with hands clutched across the divide. His bone marrow was a near perfect match and the transplant was an unqualified success. The cells from the two clandestine lovers were perfect among eight of the nine HLA loci. Karl Landsteiner, the Austrian Nobel Laureate, would be proud of this equanimity of cellular fortune. Both also had the rarest type blood O grouping, less than 1000 years old in evolution versus the others A and B, which were 25000 and 10000 years old. Rare creatures that life sometimes smiles upon to uphold the virtues of love over anger and misplaced venom are gifted with the simplest of reasons and strongest of desires.

Her marrow purged from its predecessor vile and villainous cells was now host to those that belonged to her young love. His marrow gifted with strength and love prevailed against all odds. A bond that could be broken in life from circumstance, a wronged stare or a flippant word was now laid permanent in deed. The shared blood now strengthened the unity of love. Love had triumphed over hardship, disease and consummated the desires of the future.

Two meager lights shown from disparate homes where ancient grudge once existed now dissolved into a bond of friendship, one that would seal civil fates of these two families in happy union for generations. From the conspired mutiny of ancient grudge to the inspired design of lasting friendship, the two households joined together in harmony.

At twenty-two they married each other and at twenty-four they were blessed with a child. Sometimes it takes the innocence of children to see through the profanity of misconceived ideas of adults. This is a tale of two young hearts beating with common blood. A single strand of simplified reason can untangle the most chaotic of knots built from least reasonable of ancient grudges.

The brevity of life like a string of melody is a poised potential for a beautiful symphony.

The Fall of a Sparrow

The history of humanity is awash with laughter and tears and speaks of the collective through the singular. Our dreams and aspirations, displayed in our daily life, are full and bright with the sweet touch of that elusive whim of hope. Yet sometimes in the midst of that dream of life a nightmare insinuates itself shattering the sharp reflections of a smooth glassy desire. The best-laid plans go awry. The marginalized fears collectively take center stage and a spiral of inconceivable torture of the soul is borne to its depths. Just as a singular event, like an untimely frost, imprisoning a beauteous rose in its frozen clutches, can force a withered decline, so can the growth and longevity of life be cut short by unimaginable suddenness of precocious sadness.

Sunday afternoons as they usually are, are full of reflections over the days gone by, the hope of what is to come and hurried attempts to get in the last bit of fun before the sun slips below the horizon. But on this day there is an approaching storm. The outflow is barely visible but the harsh wind is blowing within, and the walls, windows and doors of this house can barely keep the painful stinging out. The family of four sits around the dining room table at the afternoon lunch hour. A proud father rejoicing in his bounty helps his five-year-old with the meal as his wife looks on with a loving smile.

Meanwhile in his bloodstream the scene of chaotic impulse flows in rhythmic waves overwhelming the defenses. A battle rages within these vessels and not a single piercing bullet of pain or anguish has been fired. The population of these white blood cells is different in their demeanor and functionless in form as they continue to ripple through, their numbers geometrically increasing. The waves keep rising higher and higher heralding the oncoming Tsunami of disaster.

Fig 1: Acute Promyelocytic Leukemia Cells

It all started three or so months ago. There was this large onslaught of viral infection. It created an initial flu like syndrome, replete with cough, fever, muscle aches and pains and then as quickly as it erupted, it abated as colds and flu are wont to. Then four weeks ago the first impulse of the riot in the bone marrow occurred. The aches in the joint were minimal at first as the virus had deftly in its cruel but self sustaining mode inserted itself in the DNA of this human. It was an innocent piggyback ride for self-propagation. It was the virus’ means to grow and survive. A simple plant really. Just plug itself into the genomic material within the cell so that as the cell multiplies so would the virus also. And what better ride than the mother (stem) white cell that needs to multiply and divide to create many more white cells to keep the body safe from infection and harm. Surreptitiously in quiet stealth and design for means more innocent than devious the virus did it for its own survival. No wonder the viral population is in the trillions and far outweighs any other living or half-living species. The act of survival is paramount for a species to exist for millions of years.

Once inserted into the DNA as the mother white cell undergoes the division process, the DNA now with added material copies a variant of the original. The virus may not directly issue the edict but may jumble the DNA enough to make the “jumping genes” jump farther and a piece of one chromosome flips and translocates on another chromosome, as happens in Acute Promyelocytic Leukemia (APML) between Chromosome 15 and 17 stimulating the (Retinoic Acid Receptor) RAR alpha which deregulates growth behavior bringing chaos.

 Fig 2: Chromosomal Translocation

The (RARa) receiving chromosome #17 site of attachment carrying the cell regulatory function works like a thermostat, too hot and the heater stops till it gets cold again and the heater kicks in. The attached material disarms this “thermostat” function and the regulatory function being lost creates anarchy of production without demand. The result is a mutiny by the dysfunctional many against the armed few.

As waves upon waves of these mutinous cells hit the shore, the defenses slowly crumble against the unending might of a self-replicating armada of wayward cells. They choke the supply of goods delivered by the blood vessels to the organs that digest, produce hormones collect fresh oxygen and remove waste products. The fight is waged and the duration of the fight is dependent on the age of the individual. The young ones override the signs and symptoms until they are overwhelmed; the elderly deteriorate slowly and progressively due to lack of reserves a bit faster.

The father reaches for salt to sprinkle on his soup and his hand never reaches the saltshaker. The shudder of the table and the dishes fly off crashing in a heap on the floor. The young children cry out in unison with alarm and surprise. The wife grabs her children and runs for the telephone. A decision that has to be made takes moments longer because of the suddenness and the implied gravity of the event, but it is made and the ambulance is on its way.

“How are you feeling today?”

“Better.” He replies looking at the figurine perched next to his bed given to him by his child to watch over him. The blue paint chipped off at the bottom. The figurine is just slightly less than beautiful but for the skin of the paint.

“Any shortness of breath?”

“No.” His face is pale with concern and his shock of black hair is disheveled. The stubble of beard has grown in the twenty-four hours since the event. “So what do I have?”

This question has faced many a person and will continue to haunt many more. The jeopardy in life is the wanting to know but staying in the comfort of not knowing. Something inconsequential is just that where knowing or not knowing is the same – immaterial. But where life hangs in the balance the question gets harder and harder to ask and receiving the answer even harder.

It is difficult whether the answer is what makes some people lift up and fight the fight while others slump down and crawl into a cave of insecurity. The impact of the unexpected hits different people differently. He seemed to take it in stride for the moment. But in the ensuing moments of nothing said the wave of future expectations came crashing down and the beachheads of expectation gradually caved. There in that “worst of times” was no glimmer of “the best of times.”  The “Lots to live for,” seemed a distant memory now with the little to fight with. He could not perceive his future. He could not see his children grow up and give him grandchildren. He could not even see his son’s first bike ride. The vagueness of the cloudy blur overwhelmed the clarity beyond. As the evening approached darkening the afternoon, his wife took the children home. Drowning inside the four walls of this bleached environment he was devoid of the air of family support briefly. He was alone, not hearing the words of optimism, nor the potential option of cure. All he saw through the tunnel of darkness was more darkness. The recent advance in therapy with ATRA combined with Chemotherapy and the potential cure was never brought to bear. Life could have gone on. It could have. But it didn't.

They would call this a case of Acute Promyelocytic Leukemia with an Acute Disseminated Intravascular Coagulation as the catastrophic bleeding event that caused his death but maybe it was the sudden shattering of a dream, the irreplaceable joy, the lucid harmony, his life till then that was suddenly lost to him and his family.

There is special providence in the fall of a sparrow. If it be now, tis not to come, if it be not to come, it will be now; if it be not now, yet it will come- the readiness is all.

Self-Serving Fictions

Scientific papers are polite or self serving fictions in their statements about doing science: they are at best logical reconstructions after the fact written under the conceit that fact and argument shape conclusions by their own inexorable demands of reason. Levels of interacting complexity contradictory motives thoughts that lie too deep for either fears or even self recognition all combine to shape the most complex style of human knowledge.

-Peter Medawar 1915-1987 Nobel Laureate in Physiology/Medicine for transplant graft rejection and acquired immune tolerance.

The passage of days is like the summer’s breeze, warm and comforting, full of promise, gifted with light and stealthy. It flows freely and with haste, quick without a return thought, gone before you know it. It becomes a prisoner to the unmoving mover; time. Looking back seems a grander path with memories rich and poor, big and small, grand and simple, all called in for compaction into a molded thought or remembrance. Memories thus become the ghosts of the departed past.

Looking forward the limit of time haunts with that knobby, gnarly and crooked skeletal finger poking its ugly joints from beneath the black cloak, flexing the message of the end of time. It is here amidst the magnetic pull of the past and the dour finality of the future where the mind resolves to cut its losses and come clean.

Now 89 years old and resting comfortably in his arm chair with one hand twirling his reading glasses and the other comforting the sore achy joint of his knee, he seems on the verge of saying something. The plaid green terry cloth robe covers his thin, stiff and slightly bent body. The limit of flexibility and the loss of elasticity conspire to evoke a sigh from him. He leans back against the armchair and another weak sigh escapes his lips.

“You know,” he finally says, “I was about your age when I headed the department. It was always chaos. It was fun arbitrating between two or more egos. That taught me a lot.”

“Its still the same.”

“Oh yes human nature never changes you know.” He leaned across to the table for the glass of water. His motion was slow and deliberate. No hurry, time was here to be used and suffused with events. Satisfied with the swig to wet his mouth he leaned back again. “I have to tell you a few things that I have never mentioned to others. I believe given the shoes you are stepping into you should know how to navigate from my experience.”

Closing his eyes and drifting into his memory with the eyeglasses still twirling steadily in a gentle defined arc, he said, “Nothing ever is what it seems. Even some things that are certain in all respects from scientific and all academic points of view to be truth are barely so.”

“How so?”

     Gastric (Stomach) Ulcer

“Take for example the peptic ulcer story. You know I was on the board of editors of a prestigious medical journal. There wasn’t an issue that went by not hosting an article crying the benefits for the acid reducing drugs like Tagamet and Zantac. Study after study showed that the peptic ulcer therapeutic drug of choice was one of these two contenders. The harder each pharmaceutical company tried to one up-man-ship the other with a new study every month. In reviewing these articles we lost sight of trying to understand the real cause of the ailment. Oh yes it was acid, reducing the acid load in the stomach ameliorated the symptoms. Bingo cause-therapy-benefit case closed. The two ‘pharmas’ however not wanting to cede dominance to the other fought the battle of wits with scientific articles, each showing some secondary benefit it could delineate from the study design. On looking back those articles were based on elegant acid level reductions and quality of life and symptomatic relief. Except for the first part the other two were extremely subjective and hence the answers were molded by the questions asked. Percentages and graphs of every kind and Log charts and pie charts and what have you filled the pages of the journals to quantify, verify and thus confirm as facts the premise in the abstract up front that most doctors really find time to read.” He fell silent for a bit. He raised his finger before his voice, “And where do you think the real answer came from?”

“Australia?”

“Absolutely. In 1982 it took two little known doctors, Robin Warren and Barry Marshall, with open minds, unencumbered by the prodigious and turgid literature of self satisfied authorship, became the stewards for the new generation of physicians in how to treat peptic ulcer. Facing rejection after rejection from the editors of medical journals, the ossified thinking of the establishment finally relented to the pressures of pure science.”

Helicobacter Pylori

“Didn’t they get the Nobel Prize?”

“Indeed. And Marshall drank a glass full of Helicobacter Pylori to create an ulcer in his own stomach to prove his point. Damned near killed him. Now that is a pure scientist.” His head bobbed slightly to the tune of his brain’s inner electrical dialogue. The aging process was in full metal jacket, slowly advancing on his realm.

He refused all help as he slowly got up from his chair and headed to the desk in the corner of the living room. The desk was covered with neat stacks of journals. He searched for one and retrieved it. He slapped it on the desk to remove all dust that might have taken shelter. No plumes arose from his action.  He made his way back to the chair and sat down once again. The entire movement was an echoed cacophony of groans.

“This one is what I am most disappointed in and probably was most proud of.” He proclaimed.

“What is it about?”

“I authored this thirty years ago. The fellow rotating through my service actually wrote this article and he was a convincing sort of character. He later became the head of department at a university. He gathered data from our hospital with about 30 or so patients used a crafty statistical methodology and came up with striking percentages that made our point of one treatment was far superior to the other in moderate grade Lymphomas. With graphs and all sorts of supporting materials he showed the data to be bullet proof. We sent out the article, with my name, it got the editor’s attention and with his ingenuity it got published. That article made him the celebrity in various medical meetings and added to my star shine which at that time was at its peak.” Again he fell silent as the tremors increased slightly probably from the agitated state of his mind.

“I remember, the multi-institutional study three years later disproved the premise and found both treatment regimens to be identical.”

“Yes.” His voice barely above a whisper, he put the journal down. “From ill-gotten pride to well deserved rebuke.”

“But no one ever questioned you. You wrote hundreds of other pioneering articles on various subjects.”

“I did. It taught me never to apply pseudo science and new-fangled gobbldy-gook charts to medicine or anything.” He reached for his glass of water to douse the flames of his internal struggle.

“You have accomplished much in your life. You should be proud of it.”

“Accomplished, yes. Proud, never! It reminds me of the  Piltdown debacle in England.”

“Piltdown?”

“Yes, in archeological circles it was the most egregious duplicitous find ever. A guy named Dawson along with two other collaborators managed to fill a ditch with the skull of a human and the jaw of an ape with teeth of an Orangutan. He then proclaimed to have found a new evolutionary step in the species. This was in 1913. It was not until 40 years later that the truth came out to the chagrin of many respectable archeologist who had used that imagined intermediate evolutionary construct to theorize their point of view.”

Charles Dawson is #3 from left in the back row

“I didn’t know that.”

“Yes, remember prevaricated data causes inventive constructs to keep the lie forged and moving forward. Truth on the other hand guides us on the straight and narrow.”

The evening ended with little further remorse. His mind seemed purged from the disease of self-flagellation. His one miscue made him a better person, a more cautious scientist and a better physician of physicians. The ever-burning flame of self-doubt now doused by the tale he had told comforted him. Inner peace smoothed the wrinkles and frowns grown wild from a single event.

In the end however reticent, the truth does triumph even if it is not with all its pomp and glory. If it cannot be now, yet it will always come

The Potholes and the Pavement

Surprisingly the very thing that made him quick to respond was what made him slow and deliberate. He would often shake his head three or four times as if tic riddled and prisoner to his brains fallibility. But you would be wrong in that assumption. He shook his head to clear the cobwebs from the intellectual cabinets in his brain. Always analyzing and then directing action to thought, he did not walk fast it was always slow and deliberate. Not tall in stature, or short in others’ presence, he willed his being to the environs. A gentleman by any standards of antiquity or the modern era, he was well spoken and spoke well when spoken with.

What was inspiring was the ability to drown out everything and anyone around him when he addressed the little white golf ball. Suddenly the pockmarked white ball weighing no more than 1.62 ounces and standing 1.68 inches became the universe of his thought. He would still himself from the remains of the day and isolate his eyes and ears that nothing would bother him. You could hum a tune or laugh or cry out or any maniacal acts of distractions and he would remain unaffected. The results were nearly always great. A beautiful arcing slow draw from the right to the left dead center of the fairway was the inevitable result from the tee box and a similar predictable result from the fairway to the greens.

On this one particular afternoon when the day had shred itself of its morning chores and rung out the bell for playtime, he was ready for a battle with his wits. “For that is what this game is all about.” He said.

“How so?”

“Thoughts enter and leave without rhyme or reason it is when you willfully engage with them that action is affected. It is only when you start thinking too much about something that the muscles get all confused, some contracted while others totally flaccid and the unity of motion required for a smooth stroke is gone.” He held up his hand for a second looking for a communication reprieve. There were deliberations between his arm, hand, torso, legs and feet and a few moments later a beautiful trajectory of a parabolic curve that would make a geometrist blush with envy.

“Now as I was saying, remember that Yankee baseball player in the 90s. What was his name?” He snapped his finger and thumb in quick fire method urging his brain to yield the secrets of embedded time. “K something or the other, ah Knoblock. Remember what happened to him. He got so disjointed in his thought and action because his mind paralyzed his muscles.”

“I never looked at it that way.”

“Sure you didn’t. There were plenty of psychologists yammering at the possible causes on TV and radio then. I am sure he heard everyone of them.” He shook his head in revulsion. “The mind is a powerful organ.”

“Sure is.”

“You know what happened to me fifteen years ago?”

“No, not really. We have only known each other for the past 5 years remember.”

‘Yeah.” He said, contemplating whether he should pursue the subject further.

“What happened?”

“Okay,” he said reeling in his doubts, “I was told that because of my ailments, I would have maybe another five years of life. I used to be overweight, eating on the run, sleeping on the wink always grasping for time. Your friend, my doctor told me to quit the roller-coaster life or I would not be able to live my grandchildren grow up. That scared the hell out of me!” He said it louder then both of us expected. He looked around to see if anyone was behind us. There being no one he continued, “I changed my way of life.”

“Diet and exercise?”

“No not really.”

“Just slowed down a bit.”

“But you are in such good shape.”

“You mean for my age?”

“No, I mean in general.”

“Well seventy years old is seventy years old,” he held up his index finger,” but I am alive, fifteen years now and ten years past their prediction. The weight fell off after the stress wore off. The blood pressure self regulated and the blood sugar and cholesterol levels all seemed to come to normal levels.”

“Any magic pills?”

“Yes.”

“Care to share?”

“This pill is called – contentment.”

“Are you telling me that you just stopped the stress and that was it?”

“Incredibly, Yes!”

“I play golf with people I want to. I spend time with my family. I do what I love to do and nature takes care of the rest.”

“Really, that’s it?”

“Well it is not easy and yet very easy. You cannot cheat your way to it. You have to do it step by step, minute by minute and then like the earthworm, you lay down the casts and overtime the ground becomes fertile once again, layer by layer.” It is hard, industrious because the gravitational pull from the other side is always tugging – demands, concerns and needs. You measure them and meet, temper and supply what you can without inserting the self in all of it.”

“I still don’t understand.”

“Allow yourself.” We had reached his golf ball and once again within seconds he had entered the realm of a universe best known to him, created by him and regulated by him.

He shot a 74 that day, 2 above par, but what a wonderful lesson in life and commitment that was. His was a small-scale revolution. Piece by piece he built himself an inner sanctum of peace and tranquility that no outsider could ever pierce.

Some strain to gain a precious moment in a day for sanity, others live on the outskirts of life looking in while some lucky ones make themselves a life to live, by pealing away layer upon layer of useless thought to achieve an inner core of happiness. The road to this prosperity of a life is riddled with potholes of surprises, suddenness and calamitous events, yet the paradigm of the mind should always remain mindful of the pavement that leads to the future. We live not for the fear of the potholes but for the travels on that pavement.

The Right Tail

Born in a motherless home where authoritarian controls over individual actions were exercised hourly, he was limited to his thoughts. Undeterred in his lonely invisible cage, amongst the escapades he imagined, one was to live in a different world. The penitent of  real life released into his fluid and vivid dreams. What the world did not disclose to him under the crossed eyes and stern rejections, he accomplished in his daily escapes into the cloistered world of peace and tranquility where life belonged to him and him alone.

His birth had been traumatic leaving him with a deformity of the spine, kyphosis they called it. He countered this with the flair of certitude in his dealings at school. The in-room quiet nights with the low wattage bulb lamp next to his bed so as not to disturb nor raise the ire of his father was his sanctuary. The pale and pasty complexion gave him the sickly look and made him the butt of his schoolmate jokes. This dual battle of repression strengthened his resolve to commit his life from an imagined into a true reality.

The marathon of constant struggle was the tempest of his vigorous and fertile mind. He devoted his studies to mathematics and from there he undertook physics and biology and then through esoteric subjects he one day descended on software programming. Even though for the next decade the programming was a means to make payments on a modest home and food on the table. His time at home was devoted to the use of the programming skills for purposes entirely his own. Logic.

The numbers of patents he filed always exceeded his age. One day after his thirty-second birthday he decided to write a sentence a day that would describe the day ahead. By his fortieth birthday he had written 8 books on far reaching issues. From as diverse topics as evolutionary biology to the more mathematically inclined probability functions. The diversity of subjects was fodder to his imagination. He opined, the publishers published and experts attacked him for his heretical, iconoclastic condemnation of business as usual. Most of his writings were proven correct and because of the evoked controversy, his works became known worldwide. 

He was well on his way to amassing a fortune that he did not desire, but life had other plans. It was the afternoon of his fortieth birthday when he was taken ill to the hospital. He had fever, a cough and some shortness of breath. After the medical deliberations were over the verdict was not good.

“That was 22 years ago. Really. They had me dead and buried. I still remember the doctor, a serious looking guy with reading glasses would not take his eyes off the chart while he told me I had Mesothelioma.” He put down the glass of water and resumed, “I mean come on man! Talk to me. Tell me my odds. I am no dimwit dummy crawling under the blanket of fear. I can take it. But no, he just dragged out his monotone and after five minutes of monologue he exited the room. What kind of crap is that?” The memories from two decades ago came flooding in with the anger and frustration.

“Maybe he wasn’t comfortable with delivering bad news.”

“Like it was his neck in the gallows.” He said peering over his thick-rimmed blue tinted reading glasses. "He was more interested in how I got it. I told him it was from working in the shipyard as a teenager.  That was it, he was done with the interview."

“Terrible approach.”

“So I decided then and there that I was going to make my own decisions based on the evidence at hand. One of my fields of research as you know is Conditional Probability. So when the initial fog rolled out, I read some articles on Mesothelioma and the overall survival rates.” He pointed to a filing cabinet next to his cherry wood desk, indicating that was where the data was buried.

“And what was your discovery.”

“I am here, aren’t I?”

“True.”
"I found out it is extremely slow growing. If you smoke with it the chances of having cancer is higher and that treatment is mostly surgical removal of the lining of the lung initially. However given the slowness of the illness one's survival is prolonged."
"As yours turned out to be."

“I do see the problem with the medical people it is not that they are dumb or anything remote to that. They are dedicated and smart otherwise they could not possibly be where they are. But they are illiterate in the field of statistics. The statisticians make up the numbers, coddle the data, invoke some mysterious law and variance test and then deliver percentages to suit what the investigator wants to say. All that is scientifically packaged with graphs and tables and all the hoopla of a true scientific literary presentation. The editors also schooled similarly look to their experts for the mathematical models proposed in the paper and having found no problems publish it. That seals the deal.” He picks up the sheaf of papers sitting on the end side table under a glass half filled with water. “I’ll show you. Now look at this nice Bell shaped curve.” He holds out a Normal Distribution Curve image. "This Bell shaped diagram is based on the Gaussian Function." (Figure to the right).

“Yeah, what about it?”

“What do you see in it?”

“The mean, and a 2 standard deviation from that mean showing a 95 confidence interval stating that majority of the population with this disease will die within 5 months to a 19 month.”

“True. So what would you tell your patients?”

“Just that.”

“Exactly my point. Look at the tails on the right side of this curve. The tail which is mathematically called kurtosis is fairly long isn’t it? The perfect bell curve we all are shown is not the normal as everyone will have us believe. There are always distributions of events on the left and the right side giving out left and right tails or widening and flattening the graphic function based on the events    observed. Not all of life flies on the strict aerodynamic principles of an airplane wing, some fly the circuitous and topsy turvy flight path of a broom handle as in Harry Potter movies."

“Yeah, you're right, I guess.”

“So what about the people in this tail who can live out longer?” (Figure below).

“But only a minority is in that tail.”

“True, but tell that to the individual. If I had resigned myself to the verdict, I got 22 years ago, I could have unwittingly given up all hope, lost interest in life, become unproductive and essentially dug up the ground with my own mental shovel and deposited myself with the worms. You would not be here and we would not be having a conversation today.” He said with a note of exasperation on his brow arching the wrinkle on his forehead into a deeper furrow.” I chose to understand the logic of medicine and defined my own terms. Not that I was the lucky one to be in that right tail of the curve, but lucky enough to understand the meaning of the right tail and take my chances. Whether my mental energies or the immune surveillance or just being to damn dumb about the whole thing made me live this long with that hope, I don’t know. But here I am.” Exhausted with the expressive monologue, he fell quiet.

The choices we make, make us. The linearity of time follows a circuitous path with many forks in the road. Our peregrinations when recorded show us what we have become. All the learning, looking, grasping at ideas, reading the written and understanding that which is not continues to evolve us onto a fate that we choose. This is the finality of purpose of a human life. Life is a spirit striving to understand and then drawing from that understanding devolves itself to live that time with a purpose.

The Perfect Note

The golden hue from the west stoked the fire in the underbelly of the fair weather cumulus in the sky. The azure color deepened as the sun slipped slowly behind the rooftops. The beach was deserted. The crowds had all but left, save for a loner looking for treasure with his metal finder as he scanned the white sand. Footprints devolved into softened craters where the sand had partially refilled the hollowed spots forming tracks of behavior of the various visitors. Some small going in circles of happy independent and uninhibited thoughts, while others more determined created a purposeful linear line, some showed deviation from their linear trance to cluster nearer to the water presumably lone fishermen exploiting the ambience of the quiet and the rush of the ocean waves for a quick catch of the day.

His path was of a quiet, slow determination, the hollowed craters were deeper and each step measured. It was a remarkable frame of reference; his rhytmic steps to the persistent roll of the waves over the sandy beach, both in tandem with life’s rituals. With every third step the slow rolling wave would crest and then crash onto the beach, withdrawing in a series of bubbles, leaving behind artifacts from the days of yore. There was a rhythm to this human-nature dance, unplanned, unrehearsed and unnoticed by the players.

“This is life.” He says with a slow rise of his arms. With both palms facing the sky and the wisdom of his age lit by the departing sun, it felt like Moses at the Red Sea. But there was none of that of course, just a memorable unconscious act caught in memory.

“Yes it is.”

“You know,” he paused with his right hand caressing his weathered chin, “I don’t know a better time then this for a little music.”

“Sure.”

The house was an architectural triumph. The large windows overlooked the ocean. The entire room scaled the breathed of the house. It appeared to have been built around this magnificent viewing room. It was immaculate in its whiteness. The only pieces of furniture; a lamp next to a large soft-leathered armchair perched against the window overlooking the ocean. Next to that was a concert grand piano, a Steinway in all its pristine glory, in a place all to itself. The lid was opened to reveal the enormous acoustic chamber and the complex arrangements of the strings. The ceiling had sound enhancing ceiling tiles. It was a musical chamber.

As the first felt covered hammer hit the string and made it vibrate, the flood of sound erupted in the room. The ambience changed somehow. The trickle of light from the fading sun briefly intensified and then all was rhapsodic, moving, exploding governance of the mind. The rhythmical flow of his hands over the keyboard was magical, swaying like branches of a tree to the whims of the breeze, barely touching yet eliciting a pluck on the heartstring with every note. Beethoven’s Fur Elise the first classical lesson to any student of piano music was being unleashed as a symphonic masterpiece under his fingers. The room and everything within it became one with the sound and the piano enlarged to encase the space and time. He changed from A minor to C major to a G major key through the 4-minute musical interlude. The echoes still remained long after the last key had struck the string. He was pleased with the silence that followed, for he sat there for a while.

“Wonderful!”

“Thank you," he said in quiet modesty. Then he reached inside the lid of the piano and with a felt covered hammer he tapped away at the interior, plink-plink-plink as the string took the hurt. “A little off,” he said. Pressing one of the black keys in concert with the hammering. “Now that sounds better.” As if what had just been played had not.

“You know that is how I knew something was wrong with me. I could feel the change inside of me. The melody changed and I knew something was amiss.”

“Really?”

“Yup. The body is like a finely tuned instrument. Any instrument, if it is out of tune you’ll know it.” He shrugged his shoulders as if it was a well-known matter-of-fact commonly visited issue of life.

“I have never heard Fur Elise any better than today and yet you felt a note was off slightly.”

“In my shoes any inharmonic plays out louder. It stands out.”

“I guess you’re ears are trained to hear any imperfection. But how did you know something was wrong inside of you?”

“Harmony is not only in sound but in your body too. It gives signals from time to time. I remember sitting in a cinema theater when I was 10 years old and my heart changed its rhythm. It happened several times and then it stopped when I got older. Oh it would happen again once in a great while after drinking coffee and all. That is when I started to listen to my body. Not in some paranoid, self absorbed, hypochondriac sort of way. I just knew when things were not in sync.”

“Any special symptoms.”

“Not really. A little tired maybe and the emotional rise from the music was muted. The stars were crossed. The alignment was off a little. This might sound weird but I felt disembodied.” He said and the width of both his hands hit the first few chords of Beethoven’s 5^th. It was his way of saying enough about that with the flare of a concert pianist. Later the ride back to reality was filled with sounds and melodies reverberating in space. The story of his illness was an art form in self-diagnosis.

Two years ago, It was a sunny summers day. He had just come back from jogging. With sweat pouring and a hunger for air, he quenched his thirst with cold water but for some reason he could not get enough air. He felt unsteady on his feet a little. The hunger for air lingered ever so imperceptibly that another person would ignore and move on. His vision perfect for his contact lens eyes seemed just a hair off in acuity. That day he went for a physical. After all the tests had been run, he was granted a congratulatory “in perfect health” word banner. But something still was not quite right in his world. His conviction resisted the desire to agree. So he decided to challenge his physician, looking for a malady that would answer the infinitesimal discord in his body’s metronome. After further testing and much searching a small colon tumor the size of a walnut was found which was subsequently removed by minimally invasive surgery and voila all his symptoms abated. Harmony was restored.

The concert of life is played out in all the keys. The inharmonic key will stand out for the fixing if we learn to look for it. Listen to the melody.