Blow, Blow, Thou Winter Wind

There is a time, a dark time, when normal daylight thoughts are banished. A time when what remains are skeletal shadows, atavistic remnants of ancestral fears, unbidden fragments of anchorless dread which in the fullness of a sunlit day, are sheer cotton. -translucent at their best. It is when doors are left ajar and watchmen sleep. It is a time when filtering is impossible, and  vetting unreliable. It is the time of night when even the moon is asleep, or hiding…

And normally, so am I, but age and diet sometimes conspire to rearrange diurnal rhythms –shuffle the deck- and if I allow the shards of my imagination any attempts to organize unsupervised, the resultant patterns are not ones I would recognize in the light. Nor accept. It is an existential angst, a dark time of the soul.

A few weeks ago, I awoke sweating, and in the nocturnal silence of a moonless night, seemed trapped in an airless blanket of dread. I couldn’t see, and everything around me was still. Unmoving. Mute. If it had been preceded by a dream, I couldn’t remember it; all was numbed by the intensity of the terror, and I was helpless in the current swirling noiselessly around me. Suddenly, the sure and certain knowledge that I would be blinded from complications of impending cataract surgery gripped me like the jaws of an unseen, unexpected predator, and the ensuing silence convinced me of the extent of my coeval deafness. I was, and would be for all time, trapped in a silent darkness -solitary confinement on the authority of cast dice.

Of course the feeling passed, and my daylight remembrance of the event was suitably tailored in the sun, but the feeling lingered. What would it be like to be forever trapped in both silence and darkness, I wondered? What would be left of life? And for that matter, what would be the use of a gift I could no longer use? No longer experience… except as a living, solitary hell?

I suppose I’m being overly dramatic about a highly unlikely confluence of events, but even the possibility makes me shudder -makes me fearful about the fragile egg-shell in which I am encased, and the delicacy of the components it is charged with protecting. It is perhaps a wonder that we as a species –and more specifically, I as an individual- have survived at all, let alone this many years.

With this in the back of my mind, I am surprised I had not heard of Usher syndrome before, although perhaps my specialty of Obstetrics and Gynaecology quarantined me from an extremely rare condition that results in both blindness and deafness as well as a host of other non-gynaecologic impairments. But it was the subject of a BBC article that caught my eye and quickly brought back the horror of my panic attack: http://www.bbc.com/news/disability-38853237

It’s the story of a young girl, Molly, who ‘was born severely deaf and learned to lip read. But, at the age of 12, she was diagnosed with Usher syndrome, a degenerative disease which causes sight and hearing loss. Now aged 22 she has just 5% of sight left in one eye.’ The eye condition is called retinitis pigmentosa which progressively affects peripheral vision and results in night blindness as well.

And, as if deafness and blindness were not enough, she was also a teenager struggling like every other teen, to negotiate the serpentine interstices of social life. She did receive speech therapy, so communication was possible, but as she admits, ‘”I have to strategise everything I do. I am night-blind and so when I go out I would often ask to hang onto a friend. I will only go out with the close friends who do not make me feel a burden.”’

There are also mental health issues with Usher syndrome, not surprisingly, and Molly has a bipolar disease which can complicate her ability to cope with her disabilities at times. Also, ‘Her experiences are often dictated by the support she receives. While she says college restored her faith in humanity, she left university early due to a lack of assistance. “Lecturers didn’t have the time to understand my condition. Training and awareness sessions were set up for staff and nobody turned up. I just needed materials to be made accessible – large text, for lecturers to wear a radio aid that connected to my hearing aids – it’s as simple as that.”’

Some people are truly special, aren’t they? I suspect I would have sunk into an irremediable depression and yet ‘Molly has set up her own charity – The Molly Watt Trust – to support others with Usher and has spoken at prestigious institutions including Harvard University and the House of Commons [UK] outlining how capable people with Usher are.’

But perhaps the spirit soars, even in captivity –or maybe especially in captivity. I’m reminded of Victor Frankl’s book Man’s Search for Meaning and his thesis of ‘tragic optimism’: ‘How […] can life retain its potential meaning in spite of its tragic aspects? After all, “saying yes to life in spite of everything […] presupposes that life is potentially meaningful under any conditions, even those which are most miserable. And this in turn presupposes the human capacity to creatively turn life’s negative aspects into something positive or constructive. In other words, what matters is to make the best of any given situation. […]an optimism in the face of tragedy and in view of the human potential which at its best always allows for: turning suffering into a human achievement and accomplishment […] and deriving from life’s transitoriness an incentive to take responsible action.’

I suppose that it is difficult to judge a response like Molly’s from the outside, though; I suspect that true empathy –experiencing something through another’s mind- is nigh on impossible for most of us in her case. After all, it would require relinquishing all of that which we have come to accept as normal –sight for as many years as we have lived, and the sounds that have accompanied us through the years… An existence unimpeded -until now, perhaps- by significant impairment. The contrast between then and now would be overwhelming, I think.

And yet, as Helena says in Shakespeare’s All’s Well That Ends Well, ‘”Oft expectation fails, and most oft there where most it promises; and oft it hits where hope is coldest, and despair most fits.”’

Thank you Molly!

 

 

Let Virtue be as Wax

We are all products of our era, and often unbeknownced to us, our language is to blame. Words become signposts that reassure us that we know where we are headed. Where we came from. And yet they can be as lost as us –especially in the domain of sexuality. Even the word ‘sex’ itself –a seemingly self-defining concept- can be misleading. It’s origin, commonly attributed to the Latin verb secare –to divide, or cut- presumably to explain the physical difference between men and women, does not necessarily entrain the psychological divisions. Or behaviour.

To paraphrase Socrates at his trial, the unexamined word is not worth using. That ‘sex’ and ‘sexuality’ were so inconsonant I had not suspected. Sex, quite obviously, is a physical assignation; sexuality on the other hand, is the more psychologically -the more erotically- imbued preference. Indeed, the concept of heterosexuality did not exist as such in the past. Nor did homosexuality as an article by Brandon Ambrosino in the BBC News pointed out: http://www.bbc.com/future/story/20170315-the-invention-of-heterosexuality?ocid=ww.social.link.email  ‘One hundred years ago, people had a very different idea of what it means to be heterosexual.’ In fact, ‘The 1901 Dorland’s Medical Dictionary defined heterosexuality as an “abnormal or perverted appetite toward the opposite sex.” More than two decades later, in 1923, Merriam Webster’s dictionary similarly defined it as “morbid sexual passion for one of the opposite sex.” It wasn’t until 1934 that heterosexuality was graced with the meaning we’re familiar with today: “manifestation of sexual passion for one of the opposite sex; normal sexuality.”’ It would seem that ‘all of our sexualities are “just there”; that we don’t need an explanation for homosexuality just as we don’t need one for heterosexuality.’

‘“Sex has no history,” writes queer theorist David Halperin at the University of Michigan, because it’s “grounded in the functioning of the body.” Sexuality, on the other hand, precisely because it’s a “cultural production,” does have a history. In other words, while sex is something that appears hardwired into most species, the naming and categorizing of those acts, and those who practice those acts, is a historical phenomenon.’ Or, to put it another way, ‘[…]there have always been sexual instincts throughout the animal world (sex). But at a specific point on in time, humans attached meaning to these instincts (sexuality). When humans talk about heterosexuality, we’re talking about the second thing.’

And as well, ‘[…] sexual desire was situated within a larger context of procreative utility, an idea that was in keeping with the dominant sexual theories of the West. In the Western world, long before sex acts were separated into the categories hetero/homo, there was a different ruling binary: procreative or non-procreative.’ So sexuality is the desire and although the act may be categorized as procreative (different-genital intercourse), or non-procreative (it doesn’t matter), with erotic desire -in the past at least- the intention was not further categorized. It was the act that was noticed. The act that was labelled. ‘Something […] happened with heterosexuals, who, at the end of the 19th Century, went from merely being there to being known. “Prior to 1868, there were no heterosexuals,” writes Blank [the author of Straight: The Surprisingly Short History of Heterosexuality]Neither were there homosexuals. It hadn’t yet occurred to humans that they might be “differentiated from one another by the kinds of love or sexual desire they experienced.” Sexual behaviours, of course, were identified and catalogued, and often times, forbidden. But the emphasis was always on the act, not the agent.’

And yet nowadays, we seem to require labels –as if the words were themselves expositors and not mere descriptors. ‘Debates about sexual orientation have tended to focus on a badly defined concept of “nature.” Because different sex intercourse generally results in the propagation of the species, we award it a special moral status. But “nature” doesn’t reveal to us our moral obligations – we are responsible for determining those, even when we aren’t aware we’re doing so.’

The difficulty of negotiating this landscape had occurred to me long before I read the article, however. A few years ago I walked over to a downtown bus stop, tired after having a rather long day at work. I’d left the office early, and I thought I was the only one there until I noticed two teenaged girls sitting on the little bench in the bus shelter in passionate embrace. I didn’t want to embarrass them, but I did feel the need of sitting down. Unfortunately they had both put their backpacks onto what little remained of the seat on either side, so I thought I’d wait until they’d finished, as it were. I kept glancing at them, but their fervour seemed unending and I eventually resigned myself to standing.

Suddenly a head disentangled itself from the osculatory machinations and stared at me accusingly.

“Got a problem, mister?” it asked, while a hand deftly extricated a piece of overly-chewed gum from its mouth.

I blushed, but did manage a conciliatory smile hoping to defuse the tension. “Sorry,” I said, when I could find the words, “I didn’t mean to disturb you, but I was hoping I could sit down…”

The other head opened its eyes at the sound of my voice and managed an embarrassed smile while convincing its hands to leave her friend and move the pack from the seat. “We didn’t mean… We didn’t know anybody was standing there…”

The first head dropped its eyes to the pavement in obeisance. “Yeah, I didn’t mean to be rude…” She picked her eyes up again and sent them softly to my face before she looked at her friend. “It’s just that, like, some people get… You know, like, upset when they see us kissing.”

“Yeah, as if we were, like, tards, or something,” the second girl said as they both moved over on the bench to make room for me.

The word  tards seemed to offend the first girl. “She just means that, like, some people go strange when they see us being so… involved, I guess.” She looked at her friend and whispered something I couldn’t hear. “Like we’re pervs, or whatever,” she continued, after elbowing her gently.

“Yeah, the other day, one old guy walking by even, like, spat on the sidewalk when he saw us cuddling.”

“Yeah, as if he never cuddled with his partner…” the first girl giggled.

“He probably never had a partner, Joni!”

Joni shook her head. “Maybe not, but I don’t think he was, like, jealous or anything, do you?”

Her friend smiled. “He was just looking for a label, sweetheart. Some are easier to find, I guess.”

Indeed.

 

 

 

 

 

 

 

 

 

 

 

 

Sometimes the Twain Should Meet

That we are, each of us, different is a given; that societies and the cultures they produce are different, is also self-evident. But that any one individual picked at random should be representative of that difference is another matter. We humans tend to be bicameral when and if it suits us. For example: my Asian friend is clever and devious, so most Asians are probably clever and devious (inductive reasoning); but at other times: everybody knows the French are rude, so perhaps I should not hire that French person (deductive reasoning).

How much credence can we put in either type of reasoning when it comes to judging world views of different cultures? There was an interesting article in BBC News about this a while ago: http://www.bbc.com/future/story/20170118-how-east-and-west-think-in-profoundly-different-ways  And as you can imagine, the issue is complex: ‘From the broad differences between East and West, to subtle variation between U.S. states, it is becoming increasingly clear that history, geography and culture can change how we all think, in subtle and surprising ways – right down to our visual perception. Our thinking may even have been shaped by the kinds of crops our ancestors used to farm, and a single river may mark the boundaries between two different cognitive styles.’

‘[…] our “social orientation” appears to spill over into more fundamental aspects of reasoning. People in more collectivist societies tend to be more ‘holistic’ in the way they think about problems, focusing more on the relationships and the context of the situation at hand, while people in individualistic societies tend to focus on separate elements, and to consider situations as fixed and unchanging.’

For example: ‘An eye-tracking study by Richard Nisbett at the University of Michigan found that participants from East Asia tend to spend more time looking around the background of an image – working out the context – whereas people in America tended to spend more time concentrating on the main focus of the picture.’ So, ‘[…] this narrow or diverse focus directly determines what we remember of a scene at a later date.’ But because things like these seem to be so widely dispersed in a population, is it a genetic difference, or merely a learned, culturally favoured response? ‘Alex Mesoudi at the University of Exeter recently profiled the thinking styles of British Bangladeshi families in East London. He found that within one generation, the children of immigrants had started to adopt some elements of the more individualistic outlook, and less holistic cognitive styles. Media use, in particular, tended to be the biggest predictor of the shift. “It tended to be more important than schooling in explaining that shift.”’

The article goes on to suggest several theories as to why the so-called East-West differences arose in the first place -everything from epidemics, to types of crops grown by different populations, but the problem still remains: the differences lie on a spectrum –‘broad trends across vast numbers of people’. And yet even so, especially in small interpersonal discussions –dare I say ‘arguments’?- we are very likely to use whatever generalization makes our point.

But, for many of us, that tends to preclude any semblance of critical analysis. It’s far easier to succumb to the prevailing opinion without questioning the reasons for its presence, let alone its validity. And it’s not just the so-called East/West divide –the potential seems to arise whenever any culture examines another. Perhaps an example that stands out clearly in contemporary life, is that of the hijab –the headscarf. Sometimes the objections are couched in religiosecular terms of course, but they often boil down to simple perspective –Weltanschauung.

Aaisha, a Muslim friend of mine recently decided to wear the hijab, and although there were no prohibitive policies or objections from her bosses at work, she encountered resistance from a source she had not anticipated –her co-workers.

Some of it was just petty –“Why would you want to cover your hair?” one woman said to her, adding “It’s so beautiful” no doubt to take the sting out of her rudeness. But the woman had never complimented her hair before, so it rang hollow to Aaisha.

And then she told me about another, a man who had just joined the company a few months before and who seemed quite uncomfortable with hijab and glared at her whenever he passed her desk. Finally, she decided to talk to him about it.

“You keep staring at me, Jeffrey,” she said, smiling confidently as she walked up to his desk. “I get the impression you’re unhappy about something.”

He acted surprised at first, and then his scowl returned and he pointed at her head. “You didn’t used to wear that scarf, Aaisha,” he said, trying to keep his tone friendly.

Her smile broadened and she pointed to his tie. “I don’t remember you wearing that tie before, either, Jeffrey.”

He blinked uncomprehendingly. “It’s just a tie. I wear different ties all the time…”

She didn’t skip a beat. “It’s just a hijab,” she said, obviously proud of the word and pointing to her head.. “And you may have noticed, I also wear different ones all the time…”

His eyes narrowed and his forehead wrinkled. “A tie is different, Aaisha…”

She waited for him to continue, but he seemed to think his answer was complete –and for him, it probably was. Finally, she decided to ask the obvious question. “Oh…?  And how is it different?”

He actually rolled his eyes at the stupidity of the question. “It’s what men are expected to wear to work.”

The smile never left her face and she pointed to another man at the next desk. “John never wears a tie…”

Jeffrey shrugged. “We’re different, that’s all… And anyway, I’m my own person.”

Aaisha stood there, for a moment, and then blinked. “And so am I, I guess…”

Jeffrey seemed surprised at her answer, then shook his head. “Nobody makes me wear the tie…”

At this point, Aaisha laughed. “And nobody makes me wear a hijab, Jeffrey.”

He didn’t seem to know how to react. “But… Well, how about your husband?”

She shook her head, still smiling. “I’m not married… And my father and brothers are still back in England -just in case you want to involve them,” she added with a laugh.

Jeffrey began to sense he was losing the argument. “It’s a family tradition -and also a society thing- Aaisha. My father always wore a tie to work –and his father before him…” But his voice was less confident.

Aisha sighed. “Should I tell you about my mother, and her sisters? They all wore the hijab back in London –and not because they were forced to, they’d be quick to tell you. They just felt more a part of the community wearing hijab, so it, too, was a society-thing as you called it…”

He blinked, but slowly. “Your society, Aaisha, not ours!”

The smile returned, and she nodded her head towards John again. “And what about John? Does he belong to another society, as well? We’re all immigrants, Jeff; we’re all other if you go back a generation or two. And thank god we don’t all have to dress the same,” she said, touching the sleeve of his fraying shirt with her hand and winking coyly at him.

And for the first time, he smiled at her.

Methought I heard a voice cry Sleep No More.

 

I have always had a healthy respect for fire. I suppose this is not unusual, although nowadays fire is not a regular component of our daily lives, so its presence awakens something that alternates between fascination and fear. Something atavistic. Fire –especially unexpected fire- can produce panic; smoke –also if unexpected, or inexplicable- can have the same effect. Both are worthy of our attention, both should command our respect, our search for the source.

That’s why smoke detectors are so valuable. The two commonest detection systems would seem to be either ionization and/or photoelectric –the former, ionization, grew from an attempt in the late 1930ies to detect poison gas, but the advance of the technology did not make it widely available –or affordable- until the 1970ies. The optical variety matured around the same time.

The purpose of both smoke and heat detectors, as we all know, is to alert us to the presence of the potential danger by activating some form of alarm –something that either by sheer volume or unpleasant pitch will demand action. It should arouse us if we are asleep, or get us out of our chairs if we are not. It should be audible over whatever other sounds are present in the environment, and sufficiently different from them to concern us. Usually, smoke alarms have a frequency of around 3000-3200 Hz and need to reach 85 decibels at 3 metres.

Anybody who has ever heard their smoke alarm sounding when the toast burns in the kitchen can attest to the discomfort this incites. It is piercing and –at least for the hearing population- impossible to ignore. Enough to wake the dead, as my mother used to say -but apparently not the child: http://www.bbc.com/news/health-38918056  As the BBC article reports, ‘Researchers at Dundee say there are several theories they were exploring as to why standard smoke alarms may not wake children.’ One, however, has led to an interesting innovation. ‘Rodney Mountain, from the University’s School of Medicine, said: “Children’s hearing ability, brain function, sleep patterns and stage of brain development is very different to adults. We are programmed to respond to human voices warning of danger, such as a mother’s voice shouting to warn a child. Children are not born pre-programmed for our modern world of danger warning sounds from digital beeps and sirens -they have to learn, recognise and interpret these sounds.”’

So, the researchers wondered whether the sound of a woman’s voice –a mother surrogate, essentially- might trigger a child’s arousal more effectively. ‘Research by Dundee University and Derbyshire Fire and Rescue found that of 34 children tested, 27 repeatedly slept through smoke detector alarms. They have developed an alarm with a lower pitch and a woman’s voice, which issues a warning: “Wake up, the house is on fire.”’ And, instead of the terrifyingly strident, ear-piercing pitch, ‘the prototype has a lower pitch of 520Hz, to which young children are more likely to respond.’

Of course, this approach is still in its experimental phase and ‘The researchers said it was important the study did not undermine the need for every home to be fitted with smoke alarms, as these will wake adults and had a proven record in saving lives.’

Several weeks after reading this article, I happened to be over for dinner at the house of an old friend. We were sitting in the living room enjoying a glass of wine before eating when the smoke alarm suddenly activated. Apparently some grease on the stove had started to smoke.

“Well, the alarm did its job, didn’t it?” she said, laughing and filling up my glass again when she returned. “It’s amazing how annoying they are. You can’t ignore the alarm –you just can’t!”

I chuckled and told her about the BBC article I’d read about the alarm failing to rouse children.

The smile never left her face even when she had another a sip of her wine, but I could tell she was still thinking about what I’d said. “You know, that reminds me of something that happened when my son Jeremy was still around two years old…” She closed her eyes for a moment, savouring the memory. “We were over at my father’s cabin at the lake. Jeremy loved it there…” Her smile grew even larger and transformed her face. “It was so different from the city where we lived. Everything was new to him –the birds, the trees, the lake with Grampa’s little wooden rowing boat… He was usually so tired, it was no trouble getting him to go to bed at night. He slept in a little crib in my room, and rarely stirred even when I eventually came in to go to bed at night.

“Anyway one morning dad and I were sitting in the kitchen enjoying a cup of coffee while Jeremy was still asleep. He’d just installed a new smoke alarm because he used the fireplace a lot at night and I told him I was worried about the dangers of fire in a wooden cabin. I suppose he’d put it too close to the counter, or something, because when our toast began to burn, suddenly the alarm went off. The noise was so loud and high pitched it was painful and I had to cover my ears. I remember my heart started pounding and I actually felt faint.

“’The man at the store told me it’d wake me from a coma,’ dad said once he’d turned it off. ‘I’m surprised Jeremy isn’t crying.’

“Or out here,” I said. “Your crib is so low to the ground, I took the side off it so he could get out if he wanted.

“I went in to check on him right away; I’d left the bedroom door partially open when I’d gone into the kitchen, but he was still lying motionless in the crib like he does when he’s really asleep. I even remember standing at the door and watching him for a while –he was so adorable when he was sleeping…” She sighed and had another sip of her wine.

“I could see the gentle rising of his chest as he slept, so I knew he was okay. Dad started calling me from the kitchen to tell me my burnt toast was getting cold, and I can recall speaking Jeremy’s name in a normal tone of voice, telling him to wake up. Suddenly his eyes flickered then opened and a big warm smile filled his face…”

Martha turned her head to look at me, her eyes little sparrows flitting from cheek to nose and hovering over my face trying to decide where to land. “Do you think that’s what they were describing in the article?”

I smiled and added a tiny shrug. “A mother’s voice is so important, isn’t it?” I said, but realized as soon as the words emerged that it wasn’t a particularly profound observation.

She nodded her head and laughed. “Curious how my voice could wake him as a child but not as a teenager.”

“Who starves the ears she feeds and makes them hungry, the more she gives them speech…”

“Pardon me?” she said, giggling with the wine.

I enlarged the shrug. “Just a fragment of Shakespeare,” I said. “It means that noise isn’t as valuable as words… I’ve always wanted to use that quote.” I glanced at my own wine and smiled.

 

 

 

Let No One Put Asunder

At my age, I suppose I should have learned to expect the unexpected, to revel in the entrepreneurism of a new and alien generation, and to wonder at its ability to see opportunity in the predicaments of others. But then again, why not? Isn’t that what lawyers are all about? And doctors…? Where would we be without predicaments?

Alright, I accept that the approach may seem cheeky, or even downright calculating, but I have to say I sometimes admire the attempt –a Swedish hotel chain is ‘offering a refund to couples who get divorced within a year of staying at one of its places.’ http://www.bbc.com/news/blogs-news-from-elsewhere-39382059 The idea being, apparently, ‘to encourage spouses to spend time together and work on their relationship’. And so, ‘It’s offering a “relationship guarantee” on mini-breaks at its hotels, so if things subsequently don’t work out and the marriage ends within a year, then the chain says it will reimburse the cost of a two-night stay’.

Of course, they’re not fools; nobody wants to be taken to the cleaners -they’re out to make a profit and, perhaps naively, figure that those who decide to vacation together for a while might not be that close to the brink. And, naturally, ‘There is some fine print: couples must be already married, stay in the same room and reference the relationship guarantee when booking. If they subsequently divorce and want to claim a refund, they have to submit court documents as evidence’.

I don’t know… At first glance, it might seem that they’re either very naïve, or really convinced they have an effective therapy -I mean, the divorce to marriage ratio in Sweden (2010, at least) was 47%. On second glance, however, the marriage rate in Sweden according to Eurostat Demographic Statistics –OECD Family Database (2014)- was only around 6 per 1000. So who, exactly, is sufficiently wide-eyed not to notice they may be on to something? I’m reminded of most private insurance agencies who offer great deals as long as you are low risk and have no major ongoing disabilities.

But it speaks to something larger, I think: the institute of marriage itself. Marriage is something which is incredibly difficult to define. In its simplest form, it is an officially sanctioned union between two people that affords legitimacy to any offspring and entails certain rights and responsibilities -and these vary from one society to another. In Western cultures it has been the religious –or secular (usually governmental)- authorities that are required to sanction and guarantee those issues. But in other societies, families, traditions, and deeply held beliefs often prescribe the boundaries, duties, and also the rights of each person in the relationship. Hence the cross-cultural misunderstandings and misgivings. We tend to ascribe the most legitimacy to that of the society in which we were raised.

Guilt, is not imposed, by and large, it is acquired -usually at a very early age- by deviating from the expectations of those we love and trust: our family, and immediate friends, bonds that link intimately with cultural and, often, religious beliefs. Sexual mores and intimacy are no exception -in fact, they are often the incentives offered by matrimony.

But marriage is becoming more popular recently, even in Sweden, with the ongoing influx of migrants from other cultures who were raised with different familial and religious obligations to which they feel they must adhere -obligations which may not be as easily dissolved, or as readily ignored as in the host country. After all, ‘Marriage is a matter of more worth than to be dealt in by attorneyship’ according to Shakespeare.

So is the hotel chain actually reading those trends, too? And are there other conditions –loopholes- that are not immediately apparent in their advertisements? Fine print? Exceptions? I don’t know, but I certainly wish them well. It’s a gamble on their part, to be sure… But I think I’d put my money in real estate, frankly.

Perhaps I’m just being far too cynical, though. Far too… divorced –there, I said it- but I’m willing to bet that they haven’t read the famous definition of how realistic are the expectations of marriage by none other than George Bernard Shaw in his preface to ‘Getting Married,’ 1908: ‘[W]hen two people are under the influence of the most violent, most insane, most delusive, and most transient of passions, they are required to swear that they will remain in that excited, abnormal, and exhausting condition until death do them part’.

Pick your side on divorce and marriage, but they do seem to follow each other around and around like a tail the dog. I have to say, part of me is tempted to quote Samuel Johnston’s sarcasm (out of context) on the hotel chain’s promise -that it’s ‘The triumph of hope over experience’. And yet, when I stop to think of it, why not credit them with the courage of their conviction? Why not Alexander Pope’s ‘Hope springs eternal in the human breast’…?  After all, that’s what they’re trying to accomplish in those couples who stay with them… And that’s what we all hope for, isn’t it?

 

 

Cycling in a Dish

Where do they get this stuff? Menses in a dish –or, to be more academically abstruse, ‘A microfluidic culture model of the human reproductive tract and 28-day menstrual cycle’?

It has a pedantic ring to it, even though it doesn’t exactly roll off the tongue, but I have to ask a simple, quasi-lay interrogative: why? Critical Thinking 101 –at least as they used to teach it- would demand to know why it is important that we make this model. If the answer is vague, or even unnecessarily complicated,  then one begins to suspect academic foppery.

The model is unique –I’ll give them that –let me refer to a succinct description of the model from a BBC News article: http://www.bbc.com/news/health-39421396 ‘The 3D model is made up of a series of cubes that each represent the different parts of the female reproductive system.

‘Each cube contains collections of living cells from the respective bits of this system – fallopian tubes, uterus, cervix and vagina (all human cells), and the ovaries (taken from mice).

‘The cubes are connected together with small tubes, which allow special fluid to flow through the entire system, much like blood.

‘This also means the “mini organs” can communicate with each other using hormones, mimicking what happens in a woman’s body during a “typical” 28-day human menstrual cycle.

‘Tests suggested that the tissues in the system responded to the cyclical ebb and flow of hormones, in a similar way to those of the female body.’

At first, I have to admit, I was skeptical of the need for the model –and yes, I was inclined to see it as foppery. But when I actually read the paper (http://www.nature.com/articles/ncomms14584) I was impressed. Why not just obtain the same cells from, say, hysterectomy specimens, grow them, and subject them to whatever hormones or chemicals you pick to study? It quickly became evident that there are two types of scientists: clinical, and laboratory –as a practicing doctor, I’m afraid I fall squarely into the clinical end, and never the twain shall meet… The reason became all too clear as I continued to read.

First of all, as they explain in the introduction, ‘Preclinical studies often begin with individual cells, separated from cellular and physical contacts that are important for biological function. These dispersed cells must be propagated through weekly reduction divisions and maintained on flat plastic; however, these cells are missing the cell physicochemical microenvironment, three-dimensional (3D) tissue-specific architecture, and blood flow perfusion found in natural tissues.’ In other words, they take a long time to grow and aren’t subject to the same environment they would have in the body (i.e. in vivo).

Secondly, what is used to perfuse them may not have the same effect as the blood circulation they would receive in vivo: ‘typical media composition is based on basal nutrients, bovine serum and a few specialized factors that are placed in a static setting with random mixing. As a consequence, cell–cell and tissue-level cytokine and endocrine signals are not integrated into signalling pathways.’

So not only can delicate organs be assessed as if they were still in the body (like the rhythmic beating of the hair cells that line the Fallopian tubes –cilia), but the effects of different pharmaceuticals could be safely tested in the model before expensive clinical trials were undertaken. ‘Despite large investments in research funding, only ∼8% of drugs for which Investigational New Drug applications have been filed will be approved by the FDA.’

I have to say that I am intrigued, and not a little embarrassed that I was put off by the title of the article. Perhaps to expiate that guilt a little, I mentioned it to Ted, a –I hesitate to say ‘older’- colleague of mine that I met for lunch the other day.

We are both retired now so, apart from our similar past histories, talk heads more towards hobbies and bowels, than to scientific literature. I’m not even sure how it came up, except that his niece was trying –unsuccessfully, it seems- to conceive and his sister had phoned him for advice. She had mentioned several chemicals she’d discovered in an online search –both as potential therapies, as well as putative endocrine disruptors. She wanted to know what Ted thought.

“So what do you think?” he asked me as he carefully cut his hamburger in quarters so he could manage the entry problems. “You retired a couple of years after me…” he added, as if that meant that I was a couple of years smarter than him –or at least a bit more up to date.

“Ted, you know as well as I do that it’s dangerous to speculate on the effects of chemicals on human pregnancies. There are too many variables, too many potential effects that may not show up till birth, or even later…”

He nodded. “I remember DES for threatened first term miscarriages and the later damage to reproductive anatomy -not to mention the clear-cell cancers of the vagina that didn’t show up till years later…”

“Or thalidomide for morning sickness in pregnancies…” I added solemnly.

He nodded thoughtfully and after carefully picking out shreds of lettuce that were hiding under the bun, attempted to cram a freshly-cut piece of the hamburger into his waiting mouth, but it leaked somewhere south of his lips. “They can’t even design a portable hamburger,” he said, unsure whether to laugh or blush. He wiped his face, picked up the meat, and then searched for more hidden pieces of lettuce and placed them on his plate.

When he noticed me watching his lettuce hunt, he shrugged. “I’ve always hated lettuce,” he explained. “So does my niece for that matter. Probably hereditary,” he mumbled and then licked his fingers, contritely. “I mean, look,” he said with a crooked smile on his face, “I solved this problem using in vitro techniques.” And he held up his now-clean fingers and licked his lips in embarrassed satisfaction. “There’s gotta be a way to test these drugs without endangering a pregnancy. Mice and rats are not humans and you can’t safely extrapolate the results to us.”

“Amen,” I said, shaking my head sadly. We’d had similar discussions over the years, so I suspect he was merely venting his frustrations again.

We sat in silence for a moment while he tried to improve his in vitro technique, as he insisted on calling it.

“You know, Ted,” I said after it looked as if his practice runs at the lettuce were failing, “I did read about an in vitro way being developed for safely testing things in women. It was in the journal Nature and entitled something like ‘Microfluidic culture model of the human reproductive tract’. I’m not sure they could adapt it to pregnancies, but maybe it might be helpful in seeing what effects drugs or other chemicals could have on reproductive cells in the events leading up to a pregnancy…” I tried to remember more. “And it seems to me they were even able to replicate a 28 day menstrual cycle…”

His eyebrows shot up, and then one stayed elevated, as if scotch-taped to his forehead. “Micro fluidic what…? My god, is your retirement that bad?”

I think I blushed –he made it sound as if I’d been caught downloading porn. “Uhmm, it’s called ‘body on a chip’, or something –or at least this part is…”

He suddenly turned his attention to the chips still languishing on his plate and smiled. “Thanks for the excuse,” he said. Obviously his wife or maybe Chrissie, his sister, had warned him not to order them, let alone eat them.

“Yeah, I gather that the idea, eventually, is to be able to take cells from somebody who needs a particular treatment and test those cells in the model with various chemicals to see what happens.” It seemed quite exciting to me.

“Mmmh,’ he said, polishing off the last of his fries, while the puzzled lettuceal remnants stared at him from the plate. “I don’t think I can tell Chrissie about it, though.”

I looked up from my napkin and cocked my head. “Why not, Ted? Wouldn’t she find it interesting?”

He rested his head on his hands and peered at me as if he were looking over a pair of bifocals like a professor with a sleepy student. “She’d be on Craigslist trying to buy one as soon as she got off the phone… In fact she’d probably try for a matching set –a male one as well as a female one,” he added when I stared at him.

I must have still looked puzzled, because he smiled and picked up a piece of lettuce. “Chrissie’s a dietician and she thinks her daughter has a terrible diet… and she certainly remembers mine,” he explained, shaking his head. “She’d be trying to feed this to the model to prove her point.” He sighed. “I’d never hear the end of it…”

I suddenly realized I’d not thought about it that deeply. He’s right, maybe the ‘body on a chip’ thing needs a bit more work before they advertise it on Facebook…

Weight and See

 

Obesity and dietary issues have been seen as major contributors to diabetes and cardiovascular health for some time now. No longer regarded as outward manifestations of status or wealth in most societies, they are now often subjects of disparagement, and those carrying extra weight frequently stigmatized and derided. As if the very fact of being overweight was an act of moral depravity, or at the very least, a manifestation of weakness. Self-neglect.

Smoking –especially in North America- suffered a similar fall from grace when it became evident that it was a cause of major health problems. But it is much easier to hide a smoking habit than an overweight or frankly obese body. And whereas public measures to stigmatize smoking and outline the health risks may have some effect on smoking behaviours or smoking persistence, they seem to be counterproductive in successfully encouraging exercise for weight loss according to a large study from Britain: http://bmjopen.bmj.com/content/7/3/e014592

This was a long term study starting in 2002 of 5480 participants of both sexes, all at or over 50 years of age, and carried out by Dr. Sarah Jackson from University College London. ‘In summary, these results provide evidence that weight discrimination may be associated with lower participation in regular physical activity and higher rates of sedentary behaviour. Through this mechanism, weight discrimination may be implicated in the perpetuation of weight gain, onset of obesity related comorbidities and even premature mortality.’

The BBC News also reported a perhaps more easily assimilable summary of the study: http://www.bbc.com/news/health-39191100. The point being, evidently, that shaming or drawing attention to the weight a person is carrying is less likely to get them to exercise than a welcoming and supportive attitude. And environment -‘Exercising when you are overweight can be daunting, and the fat-shaming attitudes of others do not help.’

I suppose this study is much like carrying coal to Newcastle, but nonetheless it is important to hold a mirror to societal attitudes and prejudices. It’s often not so much that we mean to denigrate people who hold different values, or who do not seem to espouse the image we find attractive but rather that we hold ourselves apart. Withholding approval can be as devastating as active discrimination and, at least in this case, seldom leads to positive changes.

Unfortunately the problem of excessive weight sometimes slips by in a gynaecology office as well –noticed, but unmentioned- because of fear of upsetting the patient. Occasionally, an opportunity will present itself, however. One has to be alert –and sensitive.

Janina was a new patient to me. I first saw her in the waiting room sitting in the corner seat which was partially obscured by a large, leafy Areca palm. Her head and face were further hidden behind a magazine whose pages never seemed to turn. A large lady by any estimation, she attempted to camouflage it as best she could with an extra-large, loose fitting brightly patterned sweat shirt and bulky jeans. The effect was really quite beautiful –and so was Janina when she finally lowered the magazine. Her large, brown eyes were captive birds that fluttered delicately behind the bars of exquisite eyelashes. Her face was soft and her smile, although timid and infrequently offered, was captivating. She wore her hair long and auburn waves flowed slowly and gently over her shoulders like water on a beach whenever she moved.

She made a show of being nice in the waiting room, but I could tell that she was uncomfortable as she followed behind me to my office. She closed the door quietly behind her but before she sat she moved the chair as far away from the desk as the room allowed.

I smiled at her in an attempt to put her at her ease, but she had already dropped her eyes onto her lap and refused to retrieve them.

“Dr. Blackstock says you are having some problems with your birth control pills,” I said, when it became evident that she was not going to volunteer any information.

She sat perfectly still, her hands clasped motionlessly where her eyes still lay. Finally, she took a long, slow breath, looked at me, then slowly nodded her head. It was a sad movement, and for a moment, I wondered if she was going to break into tears. But she remained silent.

“What kind of problem are you having, Janina?” I asked, after another sepulchral moment.

She sighed again, but her face changed. “Isn’t it obvious, doctor?”

I raised an eyebrow to indicate that it wasn’t.

“Ever since I started on the pill, I’ve continued to gain weight,” she started. “I was never this heavy before…” She paused briefly to let that sink in. “Never…” She let her eyes drift around the room for a moment, finally settling them on a terra cotta statuette of a seated woman with a begging bowl that I’d placed on a little oak stand in the corner. “I don’t want to end up like her,” she said, pointing at the woman. She sent her eyes back to perch briefly on my face. “But even she isn’t as fat as me…”

As the words sank slowly into silence, a tear began to run down her now quivering cheek. I rose from my desk and walked across the room to hand her some tissues. She seemed to appreciate the gesture and her face softened for a moment. In fact, she used the opportunity to examine me as I walked back to my desk.

“You have no idea how people look at a fat person like me…” she finally volunteered and then her eyes focused on a wooden figurine on my desk behind a plant; it was a woman holding a child and peering out as if she were hiding. “I feel like that woman,” she said, nodding at the plant with her eyes.

I must have let a worried expression escape onto my face, because Janina seemed to focus on it. “It’s a different world when you’re fat, doctor. That’s all people see…”

I sighed. I couldn’t help it; she seemed so sad. “I see beauty,” I said –it just escaped from my lips. I hadn’t planned it…

Suddenly she smiled, and her hair danced once again over her shoulders. She straightened herself on the chair, and then with a gentle shrug stood and moved it closer to the desk.