Monthly Archives: September 2021

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Eenie Meenie Miney

I’ll be the first to admit that I have been left far behind in the vocabularic peculiarities that are now used to describe non-normative sexuality. Perhaps it’s Age, but more likely naïveté, that has led to this deficiency rather than lack of exposure.

I entered medical school in the mid-sixties when the youth were beginning to out themselves, and when some of the gloves were starting to come off -or maybe there was a growing awareness that a few of them had actually been wearing gloves. At the time -at least in my  school- Medicine seemed bicameral and only accepted two genders, male and female, with perhaps the door held slightly ajar for babies born with ambiguous genitalia or other genetic syndromes that made classification difficult.

For some of us, at least, it was a simpler time. Gender and sexual assignation were one and the same; preference as to which was really which was non-negotiable. But times and self-designation began to change; Medicine and the Law limped behind until the rift started to expose the consequences of their inaction.

I’d like to pretend that I saw these coming but, alas, I had no idea of the scope of the issue. In fact, in my mind, this straying from the norms was at best a marginal fashion. Anatomically, at least, we were what we had been assigned, and I assumed that perhaps the fullness of time and the machinations of society would iron any deviations into the acceptable crease. I had not reckoned with the discontent that enforced conformity might produce. When one has not experienced qualms, when one accepts the way the chromosomal dice have landed, it is not easy to grasp the uneasy restlessness of those few who will not play the game… or were not willing to join either team.

I say ‘few’ because I did not know; I did not understand. In time, of course, the discrepancies became too obvious to ignore in practice. At least in my gynaecological practice…

At first, there was confusion, I suppose -mine at first, perhaps- but theirs too. Not about their role, but mine. Initially, my lack of training forced me merely to listen, to empathize and then to help when and where I could. And, naïvely, I thought that was likely all that was required -and maybe all that they could reasonably expect. There was much psychological turmoil and disbelief that there was so little I could do, and yet I was relieved that I had heard them without disparaging their distress, or trivializing their problems.

But it soon became apparent that the eventual ramifications of their choices had the potential for far deeper consequences than either side had anticipated. And I’m not sure that I even appreciated the extent of the consequences of this disparity until after I retired. Only then, for example, did I come across an essay in the BBC Future series that touched upon some of the problematic issues. In an essay, Zaria Gorvett, a freelance science journalist for BBC, addressed the problem of why transgender people are ignored by modern medicine and what that might mean for their health: https://www.bbc.com/future/article/20200814-why-our-medical-systems-are-ignoring-transgender-people

‘[T]here are thought to be nearly a million transgender people living in the US… Rather than devising new ways to cope with changing social norms, transgender people are often shoehorned into inappropriate boxes instead.’

And the example she starts with is ‘a transgender man – he identifies as male but his biological sex is female. He has been living as a man for around 20 years… he is registered as a man on all his legal documents, from his passport to his medical records.’ All along, he had been taking small doses of the male hormone testosterone, but he suffered kidney failure and his condition deteriorated, therefore necessitating a kidney transplant. The criteria, for consideration of transplantation, however, differ between men and women and he lost valuable time in sorting out what criteria would apply to him.

As Gorvett points out, ‘When you factor in the large data gaps in everything from the average life expectancy of transgender people to the right dosages of medications for their bodies, along with the widespread lack of knowledge among doctors about how to address them – let alone treat them – and the high chance of them being refused treatment outright, it soon becomes clear that transgender medicine is in crisis.’

Indeed, in the UK, ‘“You can register as male or female, but you can still only choose between these two options – you can’t say if you are transgender or non-binary,” explains Kamilla Kamaruddin, a doctor who works for the National Health Service (NHS) and transgender woman. “So that’s quite difficult.” Or, if gender issues seem irrelevant to the visit, the patient may choose not to mention it, because of perceived stigma.

And, ‘The gender you’re registered as also dictates which screening tests you are invited to, meaning that thousands of transgender men could be missing out on potentially life-saving cervical (Pap) smears and breast exams, while transgender women could be missing out on abdominal aortic aneurism check-ups (or prostate cancer screenings, if they live in the US).’

Male and female physiology are different and many medications behave differently in each. ‘Females also have more sites for certain drugs to bind to, and are therefore more sensitive to them. They tend to clear them more slowly, so they are more susceptible to overdoses.’

Perhaps because of the stigma and subsequent lifestyle, ‘The group has higher rates of heart disease, certain cancers, mental health problems, suicide, smoking, and substance abuse than the general population – as well as an HIV prevalence which is  up to 42 times the national average. Transgender people are not only more likely to get sick, but less likely to seek treatment when they do.’

Still, I think we’re beginning to understand the problems they face. This gender dysphoria is an ancient condition, though, and actually gender fluidity may go back farther still. Gorvett writes about more enlightened recent attempts at assisting both with surgery and with hormonal replacement. The problem, however, is in the continuing stigmatization of those who are not mainstream. Those who do not fit neatly into societally condoned roles.

Maybe my age is tempering my reaction, or clouding my judgment, but I do wonder why there continues to be such marked antipathy to those who do not look like us, behave like us, or (gasp) think like us. Are we so insecure in who we are that we are threatened? And is it redress for the difference that we seek, an expectation of contrition? Do we really demand repentance, or is it homogenization?

I, for one, have come to think that the world would be a poorer place if we -the cis creatures- and we alone, were all that was on offer…

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A shoe for your thoughts

I have often wondered about shoes. Not their styles, or colours, of course -I am indifferent to fashion- but rather about the protection they afford. The benefits they offer. Although I no doubt toddled around the floors barefoot when I was too young to know any better, and even if I nowadays relish the feel of grassy lawns or sandy beaches on the unshod skin of my tender feet, I am still on guard, lest I feel too much.

Feet are like that, though: pampered and protected from the world beneath them. On them sits the heavy responsibility of moving through the world; on them resides the ability to investigate what hides around the corner or what lives beyond the hill ahead. On them rests the weight of being.

I suppose I could have treated them differently from the start, eschewed (sorry) their comfort at least wherever society did not mandate their use, but I saw things differently then –felt things differently then. There are likely reasons why evolution gifted us with soles as sensitive as fingers; in our ape days -our chimp days- it was no doubt a valuable resource in our daily arboreal quest for food and mates, but times moves on. Gravel exists, broken glass and thorns adorn our paths, asphalt heats up like the barbecues we often use; it is the ground on which we move; it is not a tree world, anymore.

And yet, sometimes I wish it had been different. Sometimes I yearn to caress the ground beneath me like a face, but I realize I have left it too late. It would be painful now. But I can dream, and hunt for stories of those who have lived life differently -or at least, like me, have had adventuresome thoughts. Life lived in imaginative worlds is, after all, why we read.

I stumbled, quite by accident, upon an essay by a fellow traveller who had considered the zeitgeist of shoes with far more intellectual rigour than I could ever have hoped to achieve. Randy Laist is professor of English at Goodwin University in East Hartford, Connecticut, and his essay, entitled What do shoes do? immediately attracted my long-dormant curiosity on the subject: https://aeon.co/essays/why-shoes-act-as-a-symbolic-foundation-for-human-identity

He, too, was forced to confront the existential crisis of hope meeting reality: ‘My feet, blissfully shoeless, arrive at the curb to meet a jagged expanse of sun-baked asphalt, gravelly pebbles and the remnants of smashed beer bottles.’ It is a challenge we would all face in an unshod world -an unfair choice. But there is no doubt we have left something valuable behind. ‘As Shantideva, the 8th-century Buddhist monk observed, with the leather soles of just my shoes, it is as though I covered the whole earth in leather.’

And as Laist adds, ‘This leather planet, the world created by shoes, is different from the barefoot world: detached, abstracted, insulated. It is a world less concerned with the topography of the ground and less attentive to its objects and textures. It is ‘duller’ and less ‘sensitive’. At the same time, this artificialised condition releases me from the grip of my physical circumstances and lets me ‘transcend’ the physical world toward my own desires… The most fundamental thing about my shoes is not the way they look or what they do, but how they affect my mobility, my freedom and, therefore, my being. They act, even if at a subconscious level, as the literal foundation for my understanding of myself, specifically as that understanding informs my sense of where I can go – what kinds of projects are within my sphere of possible futures.’ The choice nowadays is, in essence, a Hobson’s choice.

‘The shoe, one of the oldest forms of human technology, is the prototype for all other technologies, a catch-all term for instruments and procedures that allow us to break ‘the surly bonds of earth’ and proceed into unnatural or unwelcoming environments.’ Laist then waxes even more poetic. ‘Vehicles such as cars, boats and rocket ships are like shoes writ large. Spacesuits, hazmat suits and vaccines are like whole-body shoes. The media of language and art can also be thought of as technologies in this sense; like shoes, they also separate us from direct experience to provide us with a new, ‘heightened’ reality.’

I like that thought -that I have perhaps, only traded worlds: one movie theatre for another. My son, in the way of most very young children, saw that from the start, of course. And yet, I wonder if he was seeing a different movie from me, even if I still feature in it. It was a very much less complicated life when he was young, and I still remember one incident as if it was yesterday.

Michael used to watch me, study my every move, and then try to copy it. I’d noticed, for example, that when he prowled the back yard behind the house, he grasped his hands behind his back like me as if he was considering something important. And if I happened to be wearing a hat that day, he wanted his, too. Our children are us in more than genetics.

I used to sit on the porch overlooking the lawn when he was out there, but since it was an old wooden structure, and rough enough to have splinters, I usually wore shoes. This frustrated him, I could tell -he liked to run around on the grass without shoes or socks- and I remember he asked me about it one day.

“Daddy,” he asked, standing on the lawn next to the porch, “You said you liked to walk on the grass in your bare feet…”

I smiled and nodded. “I’m not on the grass right now, Michael.”

He kind of nodded his head as he thought about my answer for a moment. “But you could be…”

I smiled again. “I’m afraid I might get splinters when I stepped back on the porch, if I had bare feet though.”

He tilted his head at that, clearly puzzled. “What’s a spinter, daddy?”

I had to chuckle. “A splinter is a little piece that pokes out of the wood and sticks into your skin.”

“Does it hurt…?”

“Well,” -I didn’t want to frighten him about the porch- “sometimes, I guess, but you have to pull it out of your skin before it goes in even further.”

I could tell by his face that he was processing the information inside somewhere. “Is that why we always wear shoes on the sidewalk and stuff?”

How do you explain societal customs to a 4 year old? “The skin on your feet is pretty sensitive, don’t you think?” He nodded, trusting I wouldn’t try to fool him about that. “And you don’t know what else you might also have to walk over, do you?”

He thought about it some more. So far it seemed to make sense to him. “So you have to guard your skin, Daddy?” He wasn’t really asking, I don’t think -just working his way through the idea. Then he raised his head to look straight at me. “But my feet like the feel of the grass and it’s soft…”

He walked away from me with his hands behind his back. There was a lot of thinking to do, obviously.

That afternoon after we had lunch, I told him he could play out in the yard again, and I would be out on the porch in in a few minutes.

“Maybe we can play catch, Daddy?” he asked, hopefully.

I nodded and went to look for a big ball we could throw around. When I came out, I sat down on the edge of the porch and removed my shoes and socks to make him happy. But I didn’t see him at first –I suppose he was playing in the bushes at the end of the lawn. “Michael,” I shouted. “I thought you wanted to play catch…”

He suddenly emerged from behind a tree at one corner of the yard, wearing his thick red winter socks. “I’m ready to play catch now, Daddy,” he said, running over to the porch.

I have to say I must have stared at his socks, because his face broke into a broad smile when he noticed my surprise.

“Whadya think, Daddy? Good idea, eh?” Then he noticed I was barefoot. “You don’t have to take everything off to feel the grass, you know…” he said, staring at my feet. “I’ve got my soft shoes on…”

Michael never stops teaching me things.

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We came crying hither

I have to wonder about myself nowadays. I used to be a typical, societally conditioned male who seldom shed tears; I kept my grief tightly wrapped, and only unexpected pain, or major anguish was able to wet the cloth. Nowadays, though, I find myself weeping at the strangest things -and not all of them sad. Compassion or forgiveness from strangers often makes me well up. The other day on the TV news, the sight of the head of state hugging a woman, who only moments before had been screaming invectives at him from a crowd was enough to have me sobbing. The trusting eyes of an injured dog is too much for me to watch; even the minor key of a Rachmaninoff prelude is often enough to make me wipe my cheeks.

Apart from being oversaturated with years, I’m not sure what has changed in my life; maybe I’m just top-heavy with the time, I have been allotted. And yet, I don’t mean to speak of tears as undesirable, or somehow a weakness. In fact, if anything, they make me feel more in touch with… well, with things out there -things outside my body. Things that were not obviously linked to me -until, that is, I realized they were. To paraphrase, the work of the 17th century poet, John Donne, ‘Nothing is an island entire of itself; everything is a piece of the continent, a part of the main… the death of anything diminishes me, because I am involved in the world.’

Anyway, it seems to me that’s how I feel, and it manifests itself in tears of recognition with some long-lost connection I’ve stumbled across; I am an old man finally digesting his years, cataloguing them and putting them in some semblance of order, finding meaning in the never-ending chaos of Life. So, yes, it is a sweet sorrow, but how, or why, the feeling is connected with tears has remained as much a mystery to me as the relief -or is it satisfaction- I experience from the episode.

I happened upon an essay the other day by Thomas Dixon director of the Centre for the History of the Emotions at Queen Mary University in London whose title seemed to promise some answers:  https://aeon.co/essays/read-it-and-weep-what-it-means-when-we-cry

He starts by suggesting that ‘Since ancient times, philosophers and scientists have tried to explain weeping as part of a shared human language of emotional expression. But, in fact, a tear on its own means nothing. As they well up in our eyes, or dribble down our cheeks, the meanings of those salty droplets can only be tentatively inferred by others, and then only when they know much more about the particular mental, social, and narrative contexts that gave rise to them.

‘We cry in sadness, grief and mourning, but also from joy and laughter. Some are moved to tears of pity by human suffering; others have wept the enraged tears of the oppressed. A tear-streaked cheek might be produced by nothing more than a yawn or a chopped onion.’ 

But, he soon gets waylaid by other, less noble ways of viewing them: ‘Theories of tears have always struggled to do justice to their threefold nature, as secretions, symptoms and signs. Are tears to be treated like urination, like a rash, or like a work of art? Does their interpretation require the expertise of the physiologist, the physician, or the metaphysician?… Those who object to public weeping often refer to it as a kind of ‘emotional incontinence’.’ I find it hard to view tears that way; I have to hope it’s more of a cultural thing -and yet it explains nothing to me.

Nor am I particularly enamoured with the mid 20th century psychoanalytical approach, attributing tears to either ‘repression [or] regression. The first implies that tears are a kind of overflow or discharge of previously repressed emotion, while the second presents the phenomenon of adult weeping as some sort of return to infantile, even prenatal, experiences and emotions.’ A bit too contrived, I think.

Darwin had a similar penchant for the laboured explanation of tears: ‘Tears, for Darwin, were never more than a side-effect of some other, useful behaviour. He started from the observation that the reflex secretion of tears was initially caused by ‘the irritation of any foreign body in the eye’. He then hypothesised that in cases of loud infant screaming, during which the eyes were closed tightly, that same reflex could be brought into action by pressure on the lachrymal glands. Over many generations, Darwin speculated, the association of tears with infant screams of pain and hunger gradually became extended to painful mental states of all kinds, so that tears could be produced even in the absence of irritating foreign bodies, or of screams.’ Uhmm…

Nobody seems to have come even close to a consensus, and as in previous considerations of the inscrutable, I am reminded again of St. Augustine’s likely apocryphal observation about Time: What then is Time? If no one asks me, I know what it is. If I wish to explain it to him who asks, I do not know.

And, despite the autumn of my long list of years, I’m not sure I know what to make of tears, either. I suppose I’m not even certain what questions need to be asked, but then again, maybe I’m looking in the wrong place. Asking the wrong people.

I remember when my daughter was still very small, and largely innocent of the ways of her elders. One summer’s evening, while I was reading on the porch, I saw her sitting quietly on the grass behind the house, just staring at the trees that guard us from the traffic on the distant road. The wind was riffling roughly through the leaves, and a robin was complaining about another bird that had just flown onto a neighbouring tree. Catherine seemed to be listening intently, rocking her body this way and that, obviously enjoying the branches swaying in the wind as if they were conducting an orchestra.

She looked so at home out there, so totally enmeshed in the moment, it seemed removed from time; the yard was an enchanted faerie ring. I put my book aside, swept up in the awe of the scene and walked over to feel her magic.

At first, she didn’t hear me, but when she turned her head I saw her face was streaked with tears.

I put my arm around her and hugged her. “Cath,” I whispered, so as not to break the spell. “Are you all right, sweetie?” But her eyes were calm, and her expression was enraptured. Beatific, almost.

She looked at me for a moment before answering, and I could see a puzzled look slowly forming on her face -as if she could not quite understand the question. Then she smiled, as if she suddenly realized my confusion.

“I wasn’t crying, daddy,” she said, stroking my cheek with her little fingers. “I was just emptying my eyes…”

I should have known, I suppose…

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Rage, rage against the dying of the light