Sunday, October 2, 2011

Demons in our midst


There are two things, which cannot be attacked in front: ignorance and narrow-mindedness. They can only be shaken by the simple development of the contrary qualities. They will not bear discussion. Lord Acton

Warning: This post has charged particles in it that might disassemble your thoughts and reassemble them into new ideas. The comfortable cocoon of status quo is a prison for all fertile minds.

I got into a quandary the other day. It was tantamount to weighing differences between two philosophical outposts. You know, those irritating stigmata inured into some crystallized substance that prick and prod the conscience from time to time. Yes those very ones!

Anyway, off I went into that dark tunnel of thought with Justitia’s balance in hand, facts of logic and with a hope of some certainty. Ok, maybe a dialog. Or… and hopefully not, inviting disdain.

The word that arrested the moment was this ugly, insincere and very provocative word, Demonization.

Don’t you feel like quitting right now? Oh but you will miss out on all the rants and raves that are to follow. Be a good soldier, and soldier on here with me on this short interlude of purposeful enterprise.

Back in those classic days of yore the word demon was descriptive of the devil. If you did not belong to this or that kind of religion well, then you were in the roaring-fire class of hot trident-carrying demons. Thus proselytizers and their ilk were born to rid you of these horns on your head and the arrowhead tail stuck to your back. No, really! The ancients whispered that in my ear the other day.


As stories go here is one that surfaces quickly with a purpose. As the old Virginia Slim cigarette advertising campaign once said, “We have come a long way baby.”  Oh indeed we have! Thank goodness for the smarts of our most beautiful halves in the gender society, they realized that they were duped by an idea of equality for the wrong reasons. Their cognizance raised fears and with the deluge of reasoned thought, action flowed. And what followed was stemming the rising tide of health risks and lung cancer and determined as a result of the declining use of tobacco by women, and by the way is in tandem with the graphs and numbers found in they’re opposite sex. As plain as daylight it is comforting to know that people understand that there is, what we euphemistically call an “alpha-particle emission” from a glowing cigarette that is caused by the polonium-210 imbedded in the tobacco leaf and that is part of the cancer-genic potential of the cigarette, not to mention the ketamines etc. but we will leave that for another day. 

Ok maybe they really didn’t know that minor detail about Polonium-210, but they knew something was “rotten in the State of Denmark.” And they took action. Women are wise in general. They do understand concepts faster with their analytical minds! We’ll come back to the ending of this short blurb because we have a few more paragraphs to go before that answer, baby!

In the grunt and sweat of our daily lives, headlines abound on newsstands; newspaper, magazines and they have only one purpose, to get you to pay attention. So when you see a barrage of words against some entity there is some personal, philosophical or political motive behind it. Oh yes the news media wants your eyeballs. They embellish the advertisements to entice you to buy a product that the advertiser wants to sell. Nothing wrong with that, that is the “barter-market” way of life. You pay for the paper and the newspaper people are happy, you pay for the advertised product, when you buy it and the advertisers are happy with the paper for promoting their wares. Neat concept! But then going back to the headlines that got your attention in the first place, what do we do with them? Those large fonts designed to remain resident in the memory are what provoke and agitate you throughout the day. Those words originate from the nefarious creations of the pundits sitting in the Editor chair and churning out opinions! Words are troubling, when they keep you in a state of discombobulation, kind of like a toothache. Clever and discreetly manipulative, don’t you think?

Why, the other day, words splashed across the newswire proclaiming the ills of the “Big Pharma.” The words themselves appear derogatory, just enough to get your goat, slide under your skin like the “Alien,” and pop into your head creating a colossal headache, or maybe just tickle the alert of your common sense dander. Pharmaceutical Companies are in the game for enriching lives of sick people mostly and also themselves and their shareholders in the process. If their product does not have merit it is not used. To offset the cost of a drug production they have to charge the customer or his/her insurance company the amount they deem right based on their R & D. If they charge too much and the value of the product is limited the doctors refuse to use it. Case in point is a product called “Provenge” the concept so titillating and juicy of scientific fervor that a scientist would at first blush say, “Wow.” Only as the dust settles and the facts become known, the truth wins. Provenge costs $93,000 per treatment for a four-month extension of survival in a patient with metastatic prostate cancer. Unfortunately the cost/benefit ratio just doesn’t fit today’s fiscal reality. Ok so the company is facing an uncertain future at present. But to cast a wide net and demonize the entire industry is tantamount to crying “fire” in a room full of people to incite fear. Facts no matter how brazen or how ugly always rear their heads. Truth seeks and finds and supplants the innuendos and falsehoods. Cases like the advent of Adriamycin for Breast cancer, Gleevac for Chronic Myeloid Leukemia, Cisplatin for Lung cancer, Oxaliplatin and Avastin for Ovarian and Colo-rectal cancer are the successes that have transformed medicine against cancer. Newer techniques of selective antibodies against specific modes of action in cell signaling pathways and targeting specific gene/proteins are presently undergoing trials with hopes riding high. These successes abound in the annals of the “Big Pharma.” but they do not make good fodder for headlines. You would read them on the last column of page 36. (My disclaimer here is that I have no interests to support or vindicate the “Big Pharma.” Only as Joe Friday in Dragnet would say, “Just the facts maam!”). BUT there is a dark side to the Big and Small Pharma too. Really? you ask. Oh yes and here it is. They can and at various points in the cause for promoting a new drug against an old disease, or an old drug against a new "indication," they can and have spruced up, whittled down, amped or simply disregarded the underlying consensus of the real science from the data acquired. So let me say this with the peaceable conscience that allows comfortable sleep at night and a look at myself in the mirror at daybreak, that corruptive influences do abound in that field too. But you have to look at the real facts, to decipher the real meaning behind the headlines. Are all Pharmas the same, I hope not. One always sets out with the principles of doing good and overtime under some bean-counter, stock price and other pressures take over control. 


And then another flash of photons enters my already narrowed pupils, “Big Oil!” Really? Come on folks. What pray do you fill your station wagons, SUVs or minivans with each morning to get to the other side?  For now there is no other alternative for mass transportation then the use of fossil oil. It is the truth, period! (Disclaimer: Oil companies, and I have no vested interests). Companies such as these serve the people to power their mode of transportation and or heating and air-conditioning etc., for a price of their product usage.  When the day arrives that I can economically, (cheaper and/or more efficient then gas) drive or fly from point A to point B, I will jump at the opportunity. Till then, lets cut this nonsense. Alternate proposed modes of energy don’t have much muscle-power. 

Windmills for instance, harness wind power but only so much, ask T. Boone Pickens who spent $2 billion venturing and lost. A better question is if this is so good, why not each household and every corporation put up a single or a few windmills in their yards and reap free energy from nature? Why not? Besides cost, the problem is none of us really want it in our back yards. As the proposed "Wind Farm" contemplated near the Eastern shore of Nantucket was crushed since it was a distant back yard for a politician.

Even though Cervantes’ Don Quixote would love to lean against those windmills, Sancho Panza would know better, now wouldn’t he? Solar power on the other hand harnesses sun energy but only so much, ask Solyndra a billion dollar enterprise funded by tax-payer money crashed into a rubbled heap of Chapter 7 in less the a year. (King Richard would have cried, “A solar panel, a solar panel, my kingdom for a solar panel”). Well if King Richard would have his way, he could pave his kingdom with solar panels and reap the rewards of free electricity. His subjects would be eternally in his debt. Wouldn't they? The problem is that they are grossly inefficient at present and the storage process is equally so too. When those processes are improved, the concept can be further developed as long as you and I love the idea of a solar paneled rooftops. Electric cars are another hot item now considered for transportation, a great concept but guess what, to move those turbines that generate the electricity to power that automobile comes from, you guessed it, coal (another fossil fuel). So lets get the facts before we start punching the keyboards and raising our political back hairs to a creepy state of hedgehoginess!

“And each particular hair to stand on end,
Like quills upon the fretful porpentine:” ~Shakespeare


And now of course we have the famed HAI. You know what that is, don’t you? “Hospital Acquired Infection.”  Now, let me get this straight, you think patients actually acquire infections inside the hospital? Right? Well here is the resident truth, infections don’t just blossom, they have an incubation period where they slowly or rapidly insinuate themselves through the body’s defenses. If the patients enter the hospital with a subclinical infection and then that manifests itself during the admission, is that a HAI or not? “Not” you say, because common sense would dictate such a reason, right? You would be wrong in the eyes of the bean counters. But the bean counters have never figured out that bacteria reside on surfaces of raw vegetables for example Klebsiella on salad surfaces etc. They also have not figured out (or read) medical literature that supports the communal pool of such bugs as MRSA and VRE that exist outside of the hospital environment. (eg. As innocent residents within normally functioning humans – saprophytic alliance between bug and the mucosal membrane) (Or they get buggy from the use of antibiotics used to cure another infection as in Clostridium difficile enterocolitis) It is the weakened immune system or a large enough inoculum that allows the bacteria to proliferate inside the human body. And yet the stigmata of such a vile occurrence becomes a manifest signal for the payer to deny payments to the hospitals. Is that fair? No, but the issue of fairness in this society, controlled by a federation of dunces,  has long been discarded. As some very self-absorbed individuals would say, “we have determined the cause and we have moved on.” Similarly, then, with hundreds of millions (Approximately 152,000,000 to be exact) of admissions and treatments rendered in the hospitals all across the United States the powers continue to focus on 85,000 “possible” deaths from mismanagements. That translates to 0.0005%. Not bad odds, Right? (I mean you have a better chance of being maimed or worse killed just driving to the hospital) But no they would have you believe that going to the hospital is like signing your own death certificate. It is agreed universally that transmission within the hospital inpatients must be kept to a minimum. Expecting a zero occurrence (or zero tolerance as some highly overrated minds might suggest) is expecting too much from the bacteria and viruses that invade humans for their own survival via “touching,” “sneezing” and other assortment of human reflex behaviors. Life forms have a golden predicate in their DNA: To survive! And they will do that under the weakest of all pretexts.

 Adding fuel to this proverbial hospital misdeed fire, listen to this, if you are elderly and have a reason for readmission within a 30-day period or for a similar diagnosis in 90 days then your care would be denied payments for services rendered. How this is portrayed in the drumbeat of the day is that the doctors don’t know what they are doing, or don’t care about the patients, or care only for payments for readmitting. Really? Ask the poor 80-year old person laden with multiple co-morbidities who is unable to breathe due to his COPD exacerbation or the tired heart that beats slower under duress and starts the cascade of a dammed water load leading to congestive heart failure. Whereas it might take forgetting to take a diuretic one time to an emotionally distraught day the next time to throw the poor heart out of frame. Ask that question at 2 AM on a Saturday morning and then maybe we can talk! Am I bashing concepts here? Yes, with certifiable reason, I hope. Oh, what a web we weave! (Disclaimer: I don’t defend hospitals, doctors, nurses, transporters, housekeeping etc. for any misdeeds).

But if you thought that physicians, the healers, the caregivers, the ones who think and plan against and manage a sick person’s disease are safe from this blossoming art of finger pointing? You would be wrong again. Sorry. There are now people who are trained as professional “patients” to carry out a sting on doctors they deem to be doing wrong things. Now I do agree that bad people in any walk of life or business, in any profession of any conduct or company must be dealt with strictly. But to make the whole profession quiver under the mighty fist of absolute power is tantamount to subjugation of entire nobility, which seeks only to better and further the cause of human health. Oh but what do I know? Those with the might and the understanding are all knowing and all purposeful. Indeed that is the lay of today’s landscape. And you might ask, does it not then hurt the patients? Of course it does, the bond and trust between doctor and patient that has been forged, dissipates and in the patient’s eyes his or her doctor is regarded with a narrow-eyed frown of blame and irreverence. Food for thought!

Speaking of food, here is a classic example of fear mongering. Today fish is bad for you because “x” amounts of polynomobolony was found in it, tomorrow however chicken meat has the quadravalent-hypo-banner-crisy in it and therefore not fit for consumption and later of course don’t forget the cows might be prion infested. Sometime in the wake of such generated fear lies the hidden truth of power plays between bigger and mightier players. The governing bodies have the mandate to determine the source of contamination with alacrity, intellectual prowess and rigid experimentation and recall the offending tainted food to protect the public. But to raise the specter of doom and gloom for all is improper and a disservice. The fish is no different today then it was yesterday and the chicken still tastes good, but the damage is done, to honor a completely different set of reasoning. And lo and behold the industry that produces the product is laid bare to financial destruction, ridicule and ruin. It is also true that sometime a bacterium or virus escapes the hatches in society and finds refuge in humans, animals or plants to survive and flourish. Assuming causation for the sake of finding fault has its rewards for those seeking it. Thorough and careful investigation, self-critique and preventative measures of such a “jump” are the rightful art and science to pursue and not follow a path to devastate with impunity. In a world populated with 7 billion humans, billions and billions of bacteria and trillions and trillions of viruses, escapes do occur and will occur. Bacteria mutate as do viruses and they do so at a much faster then the semi-plastic thinking of a rigid mind. It takes about 20 minutes for a E Coli bacterium to double in number. 


This growth rate is called the Malthusian Growth model and shows exponential increment based on a binary fission. Thus the rapidly evolving generations will “Evolve” via the DNA guidance for survival by finding mechanisms against them at a much faster rate. Human evolution in self-preservation is slower in spite of the wondrous “Jumping Genes” (Transposons) that we have manifesting within our molecular machinery. But each human generation takes roughly 15-20 years to complete. A much longer time to process and mitigate! Our purpose then must be to find these mutants without assigning some false intangible etiology to them.

Remarkably as concepts of evolution go, the industrial revolution created the new enterprise of productive humans that created cities and roads and homes with air conditioners, refrigerators etc. That lasted a century, ultimately to be replaced by a more modern electronic revolution that limited the foul and thick smoke of yesteryears. This did not happen because of demonizing but steadily by human enterprise and thought.  Just like Marconi’s invention changed the way information traveled from by hand to electrical signals, so to did communication via mails change from a postal service to the ease of free e-mail. This new format now threatens the Postal Service. So the powers that be would love to regulate the free-internet zone so they can reap the fiscal benefits from such a fiat. What Newtonian Physics did for the industrial revolution, the Quantum Physics is poised to do for the electronic revolution. Oh but I digress. Society is a large component of human intellect and its failing. It receives, processes and determines the rightful action over time without a hammer, a fist or a sickle.



A word about the “Green Revolution.” Everyone seems to be suddenly in love with the color green. Unfortunately the revolution seems to only benefit a select few “Green” people and companies while demonizing the rest of the industrial complex. I believe profligate abuse of litter is reprehensible but forcing shenanigans like “green bulbs,” “green cars” and “green homes” without reference to facts are as much bologna-rich nonsense, don’t you think? The planet from 35,000 feet seems so rich in its foliage and beauty. Interestingly you cannot see a single human down below, or cars for that matter. You do see large industries but without them we would still be rubbing sticks together to forge a fire, now wouldn’t we? Lets think for a moment and make that moment rich with reason. Preserving nature is a wonderful enterprise without question but a better carefully balanced understanding and explanation will enjoy support rather then brow-beating and demonizing people for barbequing in their backyards on a summer’s Sunday afternoon. Scientists and artists minds both validate truths. Is the green concept then a bad idea. Absolutely not. It is however embedded in dire and consequential fear-mongering that frightens me more. If "green" is the right thing hen let it stand on its own green legs and it will be a paradigm shifter. The pundits dictate and demonize, but they shy from reverence to facts. Hurling invectives at questioning minds is nothing more than a shrink wrapped, unchanging rigid philosophical construct of little import. I know that if all this goes counter to your imbedded focus that you have probably spit on the computer screen by now and denounced my rants as those of a mad man. But please, just in case there is a kernel of truth, wont you please just give it a thought?

Now we come to the trebuchets being fired at the citizens with high fences. The class warfare is in full force. Why? The rich are demonized for their success in life. That is akin to saying that if a good student got an A in class then everyone else should also get an A, otherwise the results are deemed as skewed and that success should be granted to all. There must be no failures in society. Really? Where oh where is the incentive then to succeed and become that unreasonable person to change the world? Unfortunately the failings of a few bad people make for a great drama for the media circus to revile the many. And in today’s world we cannot and must not with words or action hurt the fragile senses of any lazy individual. Even with my limited resources, I was able to find some information that is readily available to anyone who can point and click.

2010 facts and figures on taxes paid:

Bottom 20% paid MINUS -3.9% or they received some IRS compensation
Next 20% paid MINUS -4.3% so they too got paid for being poor
Next 20% (average salary $44,000) paid 3.9% or $1 of every $25 they earned.
Next 20% (average salary $58,000-$102,000) paid 15.1% or $1 of every $7 earned.
Last 19.9% (average salary - $1 million) paid 16.4% or $1 of every $6 earned.
And the very ultra last 0.1% (average salary $1.9 million) paid 16.5% or $1 of $6 earned.

 Based on USA Today 70% of all taxes are paid by the top 10% wage earners. Okay simplified enough! So before we go hurling fireballs of venom and vitriol let us keep a cool head filled with the truth and not animus. The rich get rich because of hard work. They create industries out of thin air and employ millions. Should we really make them the evil monsters? Look around, your job depends on one of them. If you work for the Government then, the taxpaying rich or poor, hard working stiff also pays your salary. The Government does not create wealth, now does it? And if it does, it does so by printing money, which really destroys wealth through devaluation of currency and inflation anyway. Oops, sorry, I digressed again.

Getting back to the Virginia Slims cigarettes, they are being sold for cheap over the Internet because the understanding and knowledgeable public knows the addictive risks of cigarette smoking. The makers of these cigarettes might get so deprived of the consumer dollar that they will get starved out of existence and that would be good riddance. No demonizing needed here. Human understanding is a resourceful ingenuity.

In the game of demonization all it takes is a motive and a voice. The rest as they say becomes “history!”
  
Rightly to be great is not to stir without great argument,
But greatly to find quarrel in a straw when honor’s at the stake. ~Shakespeare


Wednesday, September 28, 2011

Time & Imprudence

“To-morrow, and to-morrow, and to-morrow,
 creeps in this petty pace from day to day,
 to the last syllable of recorded time;
 And all our yesterdays have lighted fools
 the way to dusty death. Out, out, brief candle!
 Life's but a walking shadow, a poor player,
 that struts and frets his hour upon the stage,
 And then is heard no more. It is a tale
 told by an idiot, full of sound and fury, 
Signifying nothing.” -Macbeth

I am fascinated with time, aren’t you?

Is our time out of joint?

Or is our reference out of frame?

One wonders about time. It is a commodity in short supply. In a blink of an eye the world changes. We don’t see it change, but change it does. The infant you hold in your arms today is walking to school tomorrow and driving the scary red convertible the next day. The tree across the field grows taller and then one day is gone replaced by some form of concrete, or maybe a sapling. The progress through time comes with regress in our thoughts. We miss the past and bemoan the transit. We huddle and muddle and juggle to extract the nectar from within the fruit that dries up as we reach. We laugh away tears and cry out in laughter. All the while, time ticks away the moments into memories. It has a directional flow to it. Such is the linearity of this fickle ghost, like the flight of an arrow, it is drawn, stretching the sinews of life’s bow, with intrepid force and penetrating might, it flies, never relenting and never doubtful until it reaches its mark. And with that it draws to the end.

Remember Mr. Henry Belville of London. Back in the days of 1836 he became the first “time-carrier.” He carried a large chronometer made by the greatest clockmaker in the day, for King George IV’s younger brother. Large as a ”warming-pan,’ he carried it on foot and by rail to divest the information of time to banks, Firms and other wealthy individuals who needed the information for status up-keeping. He changed his name to John Henry later to hide his French origins. After his passing his widow, Maria, carried the mantle of the Greenwich Time and then Ruth their daughter. Finally in 1939 the “time-carriage” ended with the advent of other means of quicker (electrical) transmission. Thus was born this distraction of haste in the echo chambers of the restless human soul, by this most nebulous and fleeting of commodities.
Maria Belville

If you wanted to delve into more ancient play in this mud-filled playground of esoteric remembrances, you would see the 13th Century water clocks designed by Ibn al-Razzaz al Jazari

 and a hundred years stretch later, in the 14th century the first clock-tower erected in the city of Milan, Italy to mark the passage of the hour. From then on humans have been planning their lives carefully, with an assortment of sundials and jeweled timepieces that reflect their station in life, into the quiet slumber of their grave.

I remember a taxi ride in Manhattan, NY once. There was a predictable delay on 40th street as we snaked our way around to get to a Broadway show. Oh yes and I did not want to miss the beginning, I was told, when the humongous chandelier comes crashing down. The second sweep on my watch seemed in a flight of hurry, ticking its way, forcing the minute hand closer and closer to the XII mark. My foot was pressing the invisible accelerator in the backseat urging the taxi to lurch and jump past the car “parking-lot” ahead. It was not to be. That extra reach for a scarf, the misplaced keys to my car, the hurried phone call to the restaurant for reservation and all other unnecessary things that torch the “now” into the past had overtaken and cluttered the mind-space. No, it was predestined and not to be.

And here we are, impatient that the taxi driver is humming a tune when he should be pressing the pedal to the metal, or tapping your feet so that aunt Marge would stop talking about a past that no one knows or cares. Such is the impatience of life. We rush to places that matter least, away from the heart of where contentment lies. We run to jump the highest hurdles, we drive a little faster to get nowhere and wish for the sun to come up or the moon to rise while “tick” in its inexorable advance “tocks.” Is impatience a vice then? Maybe or maybe not, for it is the unreasonable person who shakes the world and it is that impatience with inefficiency, which drives the gears of industry and innovation. So maybe it is imprudence and not impatience that drives us to tailgate, honk behind the other car, throw fits of rage at strangers, throw tennis racquets on the ground and even bend golf clubs in sheer disgust, then.  We want things done yesterday. Considering, that is even possible, we expect perfection when flaws drive the subterranean flow of life’s very existence. Strange, don’t you think, this dichotomy within our existence?

Oh and that little event in the hospital that I can recall, where the brother of a patient continued to interrupt the explanation of the therapy planned for his sibling, constantly interrupting, advancing the conversation to the next step, while he looked anxiously at his watch. He was asking questions but not waiting for answers to fill the space. The patient later apologized for his brother, stating that he was a “Hedge-Fund-Manager” and “his time was in short supply.” Really? Oh well, lets give the poor soul a little break from the debacles that were to face him in later years, sad, but true. Which leads me back to the question, where are we headed?

What is this dichotomous behavior that we humans have such a predilection for; speed to nothing and from nowhere. Passing the day to get to another day for what? Whence will that day just swatted away come back in the form of a bonus of survival? Never! It is gone. Done with. Over! Kaput! The moment ticked and the present has tocked out of existence, a figment only in the memory that the brain later embellishes, belittles, pleads and concedes to the higher principles of self-delusion. Yet the perfectly crafted moment where nothing is gained, except the smell of the air, the view of a field or a flower, a building, a passerby with a strange hat or the man with a briefcase standing perfectly erect at the corner of the street as a bird deposits its waste upon his hat, or a potential thought, is gone, Vaporized!

We ask, is it time, time for what? Should we move on? Move, to where? Must we wait? Ah! Maybe we should. For in that wait lies the wit and code of living. It is that moment of pause, which becomes pregnant with idea and a passing reflection, which may lead to a greater achievement.

Our impatience robs us of our comprehension. We speed and in that blur we forget to learn. Our focus stills a certain future and yet the millions of beautiful and wondrous things, sensations and ideas that embellish the present on this earth and within us are lost in that “zoom.” Creativity, clearly lacks speed, possesses capacity for comprehension and forgets the face of the clock. It bubbles under the boil of subconscious, cannot be rushed, can only brew, for the required time and warrants the idleness of patience.

It was in a carpenter’s workshop where I first encountered this thin weather-lined face, with it’s sun hardened skin, atop a lanky six foot frame. He was a master carpenter in his sixties. His shirt neatly buttoned and his thick black hair smoothed back in a two-sided symmetry. He spoke softly and his movements were ever so measured and confined to the pace of his thought that I kept stepping on his heels as he showed me around. He was slow and methodical, as he hovered over the edges of a chair-leg. He measured and re-measured before he took the burr or the saw or a nail. Watching him was like watching grass grow and yet he was the busiest carpenter in town with a sales chart that would make the CEO of a large corporation blush. He managed to do more in the ten hours of a workday then most people do in a week. He was slow and methodical, yet inventive and prodigiously productive. Time was his employee. He was its master.

I must govern the clock, not be governed by it. – Golda Meir

The joys exist all around us, yet we resort to the runaway wilderness of thought to find it. We define fun and excitement in nebulous terms and reach towards the unreachable. And then having succumbed to the despair of not reaching, we quench that despair in the elixir of mind-numbing spirits. We drive ourselves to distraction and destruction in the rush of it all. All the while for that stillness of the moment where beauty resides, is passed for “something else.”

Speaking of beauty, there was this gardener, who spent an arduous amount of time, in my opinion, weeding the flower-bed. He had white tousled hair with an Einstein sort of flare, wore overalls that were muddied at the knees and carried a collection of gardening tools hanging from every loop on his dungarees. He had a sharp set of eyes, which kept darting from flower to flower and bush to bush in hopes of comforting them from any nature induced peril. He clipped any petals that had a minor infraction of droop. The garden was immaculate, the flowers were robust, beautiful in full bloom and nary a weed to be found. His life revolved around a different perspective, the want to nurture. He was careful, he was measured in his stride and oh what a beautiful enterprise of thought, time and action he created in that slowness of action on that tiny patch of land.

We run to a place and lose sight of the beauty that abounds next to us. We seek the future and find no guarantees there. We hop on a thought without understanding the next step and we speak a word without so much as a thought to its meaning. In that speed of non-thinking the translation of life is lost. It is the present and only the present where truth, beauty and life exist and where the true nectar and essence of life reside. Time, that space has carved for itself is; still, reflective, all encompassing and bundled with the past, present and the future. For in that “Now” moment lie the immortalized truths embellished or sanitized in our hazy, lifetime of memory. After all, it is that second, that minute or the hour, which we need to craft, think, feel and live in! That is our world!

I remember the day my infant son and then my daughter’s tiny hands curled around my little finger. All was well in this world. All present haste devolves to those magical of moments for me, when in anguished thought or deep reverie where action for action’s sake forsakes the real pennant of truth. They are grown up now and my wife and I have been enriched with their blessing, yet those beautiful memories remain in that sweet locket of immortalized time.

Tuesday, September 20, 2011

The Arrow of Time


Machu Piccu

                      A  fine mist rolls, dipping into the foliage. The flowers lick at the moisture. The sun hides behind the clouds above, the year is 1911. In spite of this quiet, there is much urgency in his footsteps as he ushers through the unmarked trails known only to him through broken limbs, trampled grass and footsteps. The birds sing or whatever they do to create the echo through the forested hills. He is an 11-year-old boy. His skin brown and patchy from the sun, reflects the silvery haze that surrounds. His name is Pablito Alvarez. His bony hand pulls and tugs at his follower, a 36 year-old American historian, a lecturer and a future Senator of the United States, named Hiram Bingham. 

Hiram Bingham

The pace is fast but the energetic legs that carry the 11-year-old have no bounds. The trail is obscured with trees and large foliage of ancient times. The insects and flies hover over the little boy, as he makes his way, but don’t alight on him. He knows the end is near as his feet in an almost a dead run seem not to touch the earth. Meanwhile his follower is out of breath. And then suddenly they are in the open.


All sounds turn into distant echoes. A cold drizzle is falling and the overcast sky seems to dip down and touch the face of the majestic mountains in front of them. “There! There!” the boy cries and knows little else to say in English. His grinning face resting on his slender arm as it points to the broad sweep of ancient terraces. 


They climb some more and beyond the foliage appear the granite walls of the 15th. Century. The three walled-enclaves are now known as the Royal Tomb, the Main Temple, and the Temple of the Three Windows. The Incas still live in spite of the Spanish Conquistadors.

There in the midst stands the Intihuatana, also known in English as the “Hitching post of the sun.” Here the sun during the winter solstice is astride the “sun-dial” casting no shadow. The Incas had determined the Space-Time co-ordinates for their civilization that fostered in the Peruvian mountains for more than a century.

Intihuatana

Well, now if you were to spend some time listening to the physicists who have time on their hands and a space to sit on, they will start by unfolding the universe into an accordion and then with the magic of mathematics they will claim the many universe states and that each human action predisposes one into a parallel universe where the remainder of the life ensues, until the next action. Even if and I am going out on a limb here, even if a scintilla of credibility can be afforded to this argument with the 7 billion people inhabiting the planet today and each to his or her own cognizance determined a course of action of this not that or vice versa we would have an infinite numbers of universes all jiggling around us. Parallel dimensions not withstanding ask the physicist about time and lo and behold they come up with another wondrous canopy of color, although this has some scientific basis in Einstein’s Theory of Relativity; Time is a dimension, fourth to be exact and the three dimensions of space are folded into the fourth dimension of time. Ok, you ask, like a tuna wrap? No! No! It is more like a book, he replies. So tell me then, how?

Time is pasted just as space is, in three dimensions. In other words if you wanted to look at your status at say age 85 years, you would turn to page 31,025 page and voila there you are all weathered and ready for a space-flight with your bionic this or that. Similarly if you wanted to do a Michael J. Fox, “Back to the Future” trick in a Delorean, you would turn to any page before, then the one you are resting on today. So time is affixed and represented, one just has to turn the page. The Past exists with the Present and all are married to the Future. Funny you think, there is that time paradox somewhere in there, isn’t there, you mutter under your breath. Yet seriously there are minds that are filled with this kind of stuff. And then when you bring up the “Arrow of Time,” the physicist would say well it is in flight. It knows which bow it came from and knows where the target is. The past, present and the future all there in one simple book-form! Right there to behold. If only we could see! Lets move on to more mundane issues in life. Like for instance this aging thing. – A function of time.

The Arrow of Time

Aging is a natural decay of a time-limited vessel. Like the rusted iron, a torn shroud, an exposed mineral on a mountainside, or the aging elderly hobbling with a cane down the road. The sighting from any spectacular or sea level view-stand is the same. The cataclysm of degenerative discord arrives unappreciated at every living cell’s doorstep. Can we affix it to a space as the Incas did with their Intihuatana time clock? Can we? Can we stop the ravaging storms of this linearity”?


There are some technical problems that are like the physics of the aeronautical limits that cannot be transgressed; exceeding the angle of attack will always cause a stall. The first one is the Hayflick Limit. A living cell grown in a culture media will undergo division for “x” number of times and then die. The “x” remains the propriety information of the cell. There is within every cell a coded piece of information residing within the DNA. That information resides at the 5’ terminal end of the DNA and multiple tandem repeats that tell the cell at each division when it will exceed its limit of division and then no more. This information of tandem repeats is called a Telomere. So if the cell has 6 telomeres at the end of its DNA then after the sixth division it will lose its ability to craft out a mitotic spindle and go haywire with cellular dysynchrony or just plain commit suicide. A preprogrammed limit of survival!  The obituary is written in the code at birth. No fuss! No Muss!
Telomere

What about this telomerase enzyme that the germ cells have so they can divide ad infinitum? You ask. Yes and that is true. But the problem is that if some one is harboring a potential precancerous rouge cell, addition of the telomerase enzyme will allow replication of that cell and create cancer, the very thing we are trying to avoid by attempting to live longer. Now if we could starve the cancer cell, which surreptitiously acquires the telomerase and use, it for their nefarious means to grow, and excite the normal cells that have normal functional powers why then we could all live to the golden age of Abraham.
Telomerase

But what about the weathering that goes on through degeneration of the cells; the wrinkling, the patchy skin, the arcus senilis, the crooked noses, the hanging earlobes, the weathered dry skin, the thinning of the bones and the sluggishness of the heart and the mind? Pray, how do we stop that?

Dolly

Interesting pieces of information are emerging that may have a predictable future. Remember Dolly, the sheep. Well when Dolly was cloned she grew at a faster rate and aged rapidly in short order to her mother’s cell limits. So if taking cells from an older person and cloning it leads to an aging clone, why not save/freeze some of your cells at birth. Oh I am not saying to have your head frozen and then one day in some distant future when space hover-boards are available and taxis fly in vertical directions in all dimensions that a perfect body can be cloned and affixed to the head and all those memories come roaring back centuries later and you find your 21st century mind exposed to the real Star Wars. No that is not what I mean. Simply that if stem cells saved at an early date in life can be used to repopulate the damaged portion of a weathered body and allow normal living, wouldn’t that be great. The problem that has yet to be solved is whether the young stem cells through cross-talk will acquire the wisdom and age of their new older neighborhoods.

In the meantime one can continue the current trends of plastic surgery; the nose job, the facial pull, stretch and smooth, the turkey flesh tug, the transplanted hair and all other such things available today for vanity’s sake. Aside from taking massage with snakes crawling all over your body or heated rocks on the back of your chakras or being kneaded by a 300 pound female on your fragile ribs in some far off place called Rancho Exotico maybe, just maybe, eating healthy foods in limited amounts, not smoking or drinking or too much sunning might help preserve the natural visible enclave of your soul.


So, the Incas knew a thing or two about time and space. Their terraces and the agri-farming of the 15th century that has been repackaged as today’s new endeavor was and is the state of the art. Their carefully arranged steady streams of natural rain water trickling down via tiny rivulets feeding the burial temples drip by precious drip, exemplified their fascination with fixing time at a certain place. 

The physics of immortality clashes with the limits of Hayflick and that we still try to do as we do and always will, is our curious destiny; to reach for the stars and touch the face of heaven.

References:

Hayflick L, Moorhead PS (1961). "The serial cultivation of human diploid cell strains". Exp Cell Res 25: 585–621

Hayflick L. (1965). "The limited in vitro lifetime of human diploid cell strains.". Exp. Cell Res. 37 (3): 614–636

Griffith J, Comeau L, Rosenfield S, Stansel R, Bianchi A, Moss H, de Lange T (1999). "Mammalian telomeres end in a large duplex loop". Cell 97 (4): 503–14

Eisenberg DTA (2011). "An evolutionary review of human telomere biology: The thrifty telomere hypothesis and notes on potential adaptive paternal effects". American Journal of Human Biology 23 (2): 149–167

Sunday, September 11, 2011

I Remember the fall~9/11





I remember the fall,
I remember the feel.

It was the wrench,
It was the reel,
It was the hurt
And then the appeal;

It lifted the spirit
And raised the brow
That pulled the soul
From the deluged bow.

The waves all crashing,
The cries all haunting,
The eyes all wet
The hearts all wanting.

The feet all running
The smell of dust
The eyes all dry
The color of rust.


The smoke all rising
And lives all falling
The end is near,
The end is not.

What evil this is
That lives in hearts
All black,
All dark,
Riddled and cursed.


We think,
We love,
In Grace and heal.

I remember the fall,
I remember the feel.




Tuesday, September 6, 2011

Barriers in Communication



The evening had slipped hurriedly into the night. The street lamps outside had brightened their glow, their brown amber halos splashed onto the ground. like liquid gold  From where we stood in the hallway of the fifth floor of the hospital, business as usual was in progress in the external world. On the street across from the hospital, cars were buzzing by in their hurry to deliver their occupants, where they had been intentioned. And were I in one of the cars below, I would have thought the same business as usual was going on inside this giant well-lit hospital building. But no, I would be wrong.

My colleagues and I were standing in that hallway after encountering what could only be described as a “train wreck.” The patient was a elderly man who had a ruptured diverticulum in his bowel and he had progressed rapidly into a “shock-like” state. The bacteria from his bowels were teeming into his abdomen (peritoneal cavity) and through ruptured capillaries, filing directly into the blood stream. His life was staggering over the precipice looking down into a dark abyss called “septic shock,” - the event horizon from where half of those afflicted never come back to breathe another breath. The hallway was quiet, save for our muted conversation and the infrequent hum of the compressed and conditioned air as it crawled its way through the ducts in an a-periodic frequency to shake the decorative window-blinds from their reverie.

Surgeon: “You should have seen his interior, purulent and messy. Every tiny capillary was oozing. I found the source tic, though! And in feeling through his bowel we found an incidental colon tumor. It was the size of a golf ball. The frozen path suggests a carcinoid. That is the least of this chap’s problems unfortunately.”

Infectious Disease: “Well, I think he is going to need Broad Spectrum stuff and we will throw in some fourth generation for good measure till the C and S are back.”

Hematologist: “The poor guy is in DIC. Got to figure on treating that. Hope we can stop it or you might have to go back in there to evacuate blood, which as you know can further propagate the DIC in a vicious cycle.”

Surgeon: I don’t want to even think of going back in. It’s a nightmare in there right now and Heaven knows what it will be later. Especially with that Disseminated Intravascular Coagulation of yours that is going on.”

Nephrologist: “I got him on Bicarbonate and added some Calcium. I’ll watch the acid-base data in three hours and make changes. His Creat is 4. Might need Kayexalate for his K and maybe a temp dialysis too.”

Surgeon: “No PD. His peritoneum is teeming!”

Hematologist: “Fix that acid-base stuff and the DIC might calm down. Those damn endotoxins in the abdomen are wreaking havoc. I checked the parameters; both PT and PTT are high and the platelets are dropping as the FDPs rise from all the clotting that is ongoing. So I’ve got him on Fresh frozen and ordered platelet infusions for now.” Then addressing the surgeon, “Did you run your hand over his liver. Feel any mets?”

Surgeon: “I did, the liver was slightly nodular, but when and if he stabilizes, we will have to scan him.”

Pulmonologist: “I am worried about his third-spacing. I will need the central line to monitor his pressures. Did you put one in?” And with only a pause in his breath he stated, “We also need a heart guy involved. His ticker appears time-limited.”

Surgeon: “Yup. Anticipated and done!”

Pulomonologist: “We’ve got to get an endocrinologist to monitor his diabetes. He is very fragile based on the history from his family. He has Type II.”

Surgeon: “Get someone of your choice. Ok guys! stay posted. I’ve got another one to follow in the OR. See you later. And thanks for your help!”

We all disbanded a few minutes later. But as we did so, I noticed a young 20s something guy lurking. I had noticed him fiddle with the vending machine before and now again noticed him staring at it. His eyes were fixed but his mind, one could see, was wandering. He raised his eyebrow and a sigh escaped from between his tight lips. He couldn’t fool me. There was a sense of desperation in it. A warm wisp of moisture, just barely enough to cover the glass panel of the vending machine escaped, as he tossed a look that seem to suggest a conundrum between choices E4, a peanut M&M packet or F6, a Snickers chocolate bar. Neither, however could or would satiate the desperation behind his saddened eyes.

“Can I help you?” I asked.
“No, no, just looking.”
“Oh! ok. Sorry.”
“Oh! Maybe you can.”
“Sure.”
“What were you doctors all talking about?”
“That is privileged.”
“No, I mean you speak in some language that is so difficult to comprehend.”
“We were discussing medical issues about a patient.”
“Yes, I know, but when I was in the room with my grandmother and the doctor came in to tell us about what was going on with her. He used these highfalutin words that none of us in the room understood.” He paused a moment and then finished with a deeper sigh, “He might have been speaking in Latin.”
“I am sorry to hear that.” I offered, but the words were hollow, even to me. “Maybe I can help?” I said, not knowing what I was getting into. He tried to explain his grandmother’s malady and I listened and tried to help as best, I could, but my hands were tied by the ethical and legal constraints of speaking with another physician’s patient’s family member. The best I could do was not good enough.

We parted company shortly thereafter, both parties dismayed, unsatisfied and filled with an emptiness that spoke volumes about the dilemma. This young man’s anguish was about a monologue instead of a dialog. Maybe, and I am quite certain of that, maybe the doctor had discussed it in a medical terminology unable to unburden it in layman’s version. He might have used “medical lingo” to describe the disease, its manifestation and the treatment that he or she was envisioning and fully expecting a complete understanding by the recipient. As patients sometime are wont to nod to hide their ignorance, the conversational gulf expands. The flow of those descriptive words however might not seemed to have bridged the gulf. The recipient’s slate remained blank and yet managed to get stained from a frustration and miscommunication. The power of the words for them might have been reduced to a barrage of indecipherable syllables and consonants. Even though words had been uttered with the greatest of  energetic emphasis, they failed to crossover, comfort and explain.

Physicians are constantly involved, coping with the burden of disease, thinking, speaking as specifically and accurately to one another about the management and they will sometimes continue that expressive dialogue with the patients and their family. Yet in the emotive, expressive, urgency of the disease and the nuances of proposed therapy the "expressive" reveals itself over the more controlled, conventional watered-down version of the explanation, meant for the patient. As physicians we tend to hold everyone to the same degree of understanding and that can be form the barrier in communication with patients and families. It is akin to a biologist speaking with an astrophysicist or an artist speaking to a Physicist about Quantum Mechanics (Something that he -the physicist, probably doesn’t understand either and then has to explain in metaphors), where the facts get bundled in the complexity of the detail. Sit down with the patients and their families, face to face and mete out the difficulties one by one.

Patience is a virtue for all things underneath this wide canopy of blue. A polite conversationalist never interrupts. So it behooves a physician to listen, direct a conversation to pertinent issues and never hide ignorance behind medical dictionaries. Somewhere in the vast literature of spilled ink is a statement that extols the virtues of honesty. That is good for both, patient and the healer. Recent graduates and others with some years under their belt should NOT emulate TV actors in House MD as models for communication. It is good drama but bad bedside manners.

To all things complex such as a consolidation of multiple diseases, a measure of simplicity and a dose of commonness is needed in discussing the ramifications of the malady with the patients and their family. Look them in the eye and behold the lack of understanding and then explain, until the glint and glimmer of “Aha!” is achieved. Understanding involves bringing the patients and their families into the circle of awareness. With that awareness comes the recognition of the complexity and the efforts that are being undertaken on the patient’s behalf to conquer the disease and save his or her life. Communicate with exquisite thoroughness and with mastery of each spoken word! The listeners are hanging on every nuance and word uttered by their physician. Make your words worthy of their attention. There is a difference between a robotic reciting of medical science and a human discussion, the same as there is a difference between a guideline-algorithm and excellence of care.