The Gyne Phone

The iconoclasts were people who destroyed religious icons for various reasons. It’s a practice that began thousands of years ago. And somebody’s messing with the icons again -but this time, it’s the  iconoplasts

The icon has ancient roots and the word derives from the Greek word eikon meaning ‘likeness’ or ‘image’. Originally, it was usually a religious depiction of a god, or saint, but destruction of icons (iconoclasm –clasm deriving from the Greek word Klan, meaning to break) gradually morphed into destructive acts against the status quo. However, given the ubiquity of the computer, icons today usually refer to representative symbols on the screen of different options or programs.

Before written traditions gained a foothold, the dissemination of information or tribal history depended on oral transmission –i.e. on memory. But this presented some problems in terms of the sheer volume and accuracy of what needed to be passed along. Addressing this issue, Wikipedia (sorry!) notes: “Without the use of writing systems to transmit information through time, oral cultures employ various strategies that serve similar purposes to writing. For example, heavily rhythmic speech filled with mnemonic devices enhances memory and recall. A few useful mnemonic devices include alliteration, repetition, assonance, and proverbial sayings. These strategies help facilitate transmission of information from individual to individual without a written intermediate…”

Then, with the advent of written transmission of information, one can imagine a gradually increasing dependence on this and perhaps a decline in the need for the enhanced memory techniques so necessary before:  http://www.historyofinformation.com/narrative/oral-to-written-culture.php  At the time, I suspect this phase would have been fraught with objections from those traditionalists concerned about the atrophication of memory itself. Change is worrisome; it can have unintended consequences…

Well, the Phoenix has once again been aroused: http://www.bbc.com/news/education-34454264  It seems that since most of us carry instantly –and ubiquitously- available information around with us in the form of smart phones or tablets, there is little need to memorize phone numbers or even addresses. And even less incentive, since we might remember them incorrectly. Egad!

I’ve noticed the transition over the years in my practice. At first, the patients would come in with lists –questions written on usually irretrievable little pieces of paper stuffed into their purses. Of course if they couldn’t find the lists, some of them then made desultory attempts to remember what they had written, but often to no avail. I became quite skilled at offering clues as to what they might want to ask, but alas, that too atrophied as time and computing advanced. It’s a two-way street, I guess. Use it or lose it.

But my younger patients (of course) appear to have taken it to extremes –or at least, so it seems to me… Judin was the most recent example, I think. She was a twenty-something woman of Persian extraction and she had come to me because of abnormal pap smears. Otherwise healthy, she sat proud and unmoving like a marble goddess in the chair opposite my desk. Her eyes tiptoed to my face and sat there like curious birds. She was dressed casually in a pale blue sweat shirt and white jeans, and as she moved her head from time to time, her earrings tinkled like little bells hiding inside her long, dark gleaming hair. Her phone lay dormant on her lab, but I could see her right hand clutching it like another equally precious jewel.

I commented on how beautiful and unusual I found her name and she smiled serenely, tossing her hair nonchalantly back and over her shoulders. “It’s the name of a village in Iran where my cousin was from. She came to live with my parents but died before I was born.”

“A village near Tehran?” I have to admit I was approaching the limits of my knowledge about Iran –my knowledge of its geography, at any rate.

She shook her head and the tinkling started again. “No, it’s in a very dry and poor region of the Sistan and Baluchistan province in the south east corner of my country -by the Gulf of Oman and the Arabian Sea,” she added helpfully, but she could read the confusion on my face. “Tehran is quite far north near the Caspian Sea.” She stopped for a moment to smile. “Judin is in the middle of nowhere.” Her eyes twinkled this time instead of her earrings. “Honestly!”

Judin –the woman- was obviously well versed in geography and family history, and I would have loved to pursue it further, but I realized, as did Robert Frost, that ‘I have miles to go before I sleep’… I had to press on with the consultation.

Some of the questions were background issues –housekeeping data that I needed to acquire to ensure I would not miss any other information that might be relevant to her abnormal pap smears. “When did your last period start?” I asked, assuming this would be a good place to start.

She smiled, and called her eyes back to roost while she lifted her phone from her lap like a religious icon. She tapped at it for a moment. “Just a minute,” she said sweetly enough. “Gotta find the app…” I could see her scrolling through the screen, her face intense, her body rigid. “Oh, here it is,” she said and glanced at me. “What was the question?”

“When did it start?” I prompted, fascinated by the effort she was making in her search.

I lost her eyes for a moment as they disappeared behind her lashes and then her lashes behind her hair as it fell forward when she lowered her head. “Well…” I could tell she was into it now: her voice seemed strained and I could see she was really concentrating. “…I’m having it now, and they only last 3 or 4 days since I started on the birth control pill…” Suddenly her face surfaced before she could restart a smile. “I don’t actually know… I guess I forgot to enter it.” She blushed and her smile disappeared. “Sorry,” she said, and looked at her phone again. “I’m going to say ‘yesterday’…” She thought about it for a moment. “No, it must have been the day before, or I probably would have remembered it.” She assumed the goddess pose again. “Yes,” she said, but more firmly now –more assertively. “Yes, it was two days ago!” She looked at me with an almost smug expression on her face that seemed to say “Isn’t technology wonderful?”

I nodded and entered the date in my computer –my substitute for her smart phone, I suppose. “And were your periods regular when you were not on the pill?” She looked at me strangely. “You know, once a month…?” I added.

She hoisted the phone once more and scrolled through it looking for the app again. It seemed to be taking a long time, so I pretended to bang my mouse against my coffee cup accidentally. “Yes,” she said hesitantly and without looking up. “But, you know I wish all months had the same number of days. Eyeballing the calendar to see if it’s the same would be so much easier.” She glanced at me, and then submerged her face in the phone again. “It’s easier to count the days I bleed than the ones I don’t.” Another glance to see if I was following her. “Fewer squares to count,” she added to make sure I understood.

“Maybe you should suggest that to the app-people,” I said, wondering if I’d used the correct word.

“You mean the IT people? The software engineers?” She smiled at me like a mother might to correct her young child. “What a great idea!” she said, when the idea struck home.

But I’d been skipping about in taking her history, and I thought I’d make sure I’d obtained the entire historical data before moving on to more pertinent issues. The age of menarche -or first period- can sometimes be helpful gynaecological information. “Do you remember how old you were when you first began to menstruate?” I could see a puzzled expression taking control of her face. I thought maybe English might be her second language and ‘menstruate’ might not be a word she would hear around the house. “When did you start your periods?”

The puzzled look disappeared, and a different one –an almost irritable one- replaced it. “Two days ago…” She cocked her head as if I hadn’t heard her the first time. But she was willing to forgive it, I could tell.

“No…” I paused for a moment, in order to figure out how to phrase it more clearly for her. “I mean you probably started to have your periods when you were quite young… Do you remember what grade you were in, or where you were living when you had that very first one?”

She nodded her head and stared at something on the wall behind me as if she was thinking about it. “I was young alright, but…”

I waited, for a moment or two and was just about to tell her to forget about it so we could move on when she suddenly fixed me with another puzzled stare. I could feel the weight of her eyes sitting on my glasses like two passenger pigeons that had already delivered their message.

“I can’t answer that question, doctor,” she said and sat back in her chair. My eyebrows must have moved because I could see her sigh in disbelief at my ignorance. “I didn’t have a phone then…” she said and shrugged. It was so obvious!

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Recycling the Old

For everything there is a season, and a time for every matter under heaven

Really? It made sense when I was young, I suppose -when all of Time was ahead. When I needed to think there was some order to things. That past and future meant old and new. But as the years slip past, I find myself wondering about disparate things. Opposites. Like what, really, is the difference between new and old? Is it merely a temporal distinction? A nudge along a spectrum? Or a more fundamental change -a conceptual shift? I suspect it can be any of these, of course, but it still begs the question: does any change, any difference qualify? What if there is no change in form at all, but rather a change in function? In Purpose? Would that be new, or merely a rose with another name?

The concept of recycling has been with us from the dawn of time. When materials were scarce or unavailable things were used again, either in their original roles, or repurposed for something else their makers had not anticipated -a new situation, a new need. And so the old rises from its ashes like a Phoenix, but this time in a different play as another, unfamiliar actor.

The tradition of respecting the wisdom of elders and retelling their stories is also an honoured tradition. But as stories do, they alter over time and are often interpreted in new and unexpected ways. The knowledge is not lost, it’s just explained in different words. Understood in a new context. Reconstituted. Society has learned that there is often a benefit that accrues to re-examining the old and looking at it from an altered perspective. So has Science: http://www.bbc.com/news/health-33635575 Bisphosphonates have been around for a while as treatments for osteoporosis, a condition in which there is decreased bone mass. They help to prevent bone loss and so strengthen the bones themselves. It is most frequently used in the post menopausal woman when she no longer produces bone-protective hormones from her ovaries.

Bone is a common site for breast cancer cells to travel to (metastasize) however, and they can lie dormant there for years after the primary tumour has been removed from the breast. And yet, interestingly, those women who were already being treated with the bisphosphonates in the menopause and later developed breast cancer, showed a 28% reduction in cancers developing in their bones. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60908-4/fulltext And because the patents on bisphosphonates have expired in many jurisdictions, the cost of these bisphosphonates is minimal when compared to other ‘new’ treatments on the market.

But there’s more. A medication originally designed for diabetes –glitazone- has been found to decrease the likelihood of developing Parkinson’s disease. http://www.bbc.com/news/health-33608725 Of course this is just a comet in an otherwise cloud-filled night because glitazone is not without its own serious side effects –bladder and heart problems, to name just two- but it is a promise whispered emphatically, albeit quietly, to anyone working in the field. A starting point for future research…

So I suppose we should keep poking about in the ashes. Stirring embers to see if there is a Phoenix hiding somewhere in the cinders, fast asleep and dreaming of another job. We affix labels to things –categorize, then name them for all time. It’s a way of keeping track. Knowing what to expect. The problem, of course, is that things change. Evolve. Mutate. And as Jiddu Krishnamurti, a philosopher, once said of the disadvantage of naming god, it constrains the concept. Limits it. Doesn’t allow for growth and development. I think it is sort of like naming and classifying something when it is only a seed and we are still unaware of its potential. Maybe old is something like that. Where there is life there is always a seed and its age is beside the point. Meaningless.

I’m beginning to see age as a definitional issue, and not in the currently favoured framework of chronological versus biological –or even psychological- age so condescendingly mouthed by those too young to have experienced the ill-disguised discrimination it entails. There is useful wisdom that accretes with years and experience of course. But age is an oven that cooks whatever has been put inside –changes it into something else. Sometimes something entirely new.

I opened with a quote from Ecclesiastes, so let me close with one from the Talmud: ‘For the unlearned, old age is winter; for the learned, it is the season of the harvest.