Trimming the Fat: A Story of Judgment

Family, Healthcare, and Medicine

Family –> Health card –> Medicine.

Family, Heat? Car? Medicine?

Fail Eat. Care? Die?

Feat. Cared, i.e…

Fat. Care? Die.

Fare? Die?

Free.

If Cadavers Could Talk

Having just entered the enchanted world of medical school, I am in the delightful disposition of sifting through endless articles of the ethics of science and drawing brash conclusions from them. It was a fortunate coincidence (or perhaps divine providence) that I had recently completed a week course of religious discourses (with a focus on Islam) and am now able to apply that new perspective to an old debate. Though I have previously focused on what is considered hard science, I am going to peer down at this from a new lens. The hope is that I will set a foundation for what is sure to be a tumultuous course ahead.

To quote Julie Andres, “Lets start at the very beginning:” day 1 of medical school.

I don’t think anyone would doubt that every American medical student has been exposed to the Hippocratic Oath (the pledge of ethical allegiance by doctors). How many, however, have encountered “The Prayer of Maimonides,” a Hebrew prayer recited by physicians before seeing a patient. The relevance of this piece in this discussion is not so much its message, but rather, its historical context. A quick blib from our professor informed us that Maimonides was a Jewish philosopher who lived in Cairo from 1166 onwards. Though this date may be unfamiliar to the masses, a little investigative research indicated that it falls during the Fatimid Period, a period of religious freedom in Egypt.  This period is also referred to as the Golden Age for Ismaili Muslims. Growing up in the United States, there is rarely mention of the vast contributions in science, literature, medicine, architecture, etc that Muslims have invested the global bank of knowledge, and it was refreshing to see it recognized. It begins to indicate our acknowledgment of  the diverse society in which we engage in. Let us move beyond religion from a micro scale and discuss it from it as a search for truth.

The second peace of literature discussed came  from a reputable and award-winning immunologist Lewis Thomas, M.D. (1932-1993). Here is an excerpt from his 1962 article “The Meaning of Science in Medicine.”

Like it or not, if man continues, as he will, his ceaseless and, on balance, almost infallible inquiry about everything related to himself, he may eventually, a thousand years or more from now, see God as whole and clear as Augustine hoped to. It may not look like God, and perhaps other names will at first be given to Him, or a Number, or a Code. But everything will have derived from Him, and He will contain all the meaning of things.

Whether you are religious or believe in some greater truth, it is undeniable that this is the prevailing belief of  modern day. How to conform or dissipate that view is quite another story.

Perspectives are evanescent. The search for them is incessant. The ability to search is everything.

As we continue to engage in medicine from the field of sociology, my writing will have those biases, but it will not be too long before a mention of pulsating veins and firing neurons resurface.

Apples and Oranges

I want to take a moment to address an issue of particular interest in present times, gay marriage.  I have chosen to approach this topic from a path of rationality rather than untamed passion.  Let us define gay marriage in its simplest of form, the union between two members of the same sex- a man and a man or a woman and a woman.  However, it is this very point I wish to put into question.  

What defines gender?  Is it genetics?  Anatomy?  Perhaps personality?  It is the very notion of categorizing people into two distinct collections that adds to the trouble brooding ominously in the air.  For the majority of the population, these components are in harmony.  We, however, are not dealing with the majority.  If inconsistency comprised the majority, than by nature, our self-governance would be accounted by this.  We are always dealing with the minority, whether imaginary or tangible.  It is derived from our needs to find meaning and purpose to the foreign.

 So again, what defines gender?  Think you are up for the task of labeling, then take a gander at the following examples:

(Note: XY = genetically “male” & XX = genetically “female”)

1.    An XY is being circumcised but the surgeon slips and cauterizes his penis.

2.    A transsexual, a person who identifies w/ the other sex and has transitioned to the other sex by means of hormone treatment or sex reassignment surgery (An XY with a clitoris or an XX with a penis)

3.    Congenital adrenal hyperplasia (CAH) = XX chromosomes that possess a genetic defect in corticosteroid synthesis (cannot produce cortisol), which leads to high levels of androgens prenatally because the brain is under the assumption the body needs cortisol.  Since the enzyme to convert androgens to cortisol is defective, it produces increasingly higher doses of its precursor, androgens.  It is eventually converted to testosterone, rather than the targeted cortisol.  This leads to androgenized genitalia, such as an enlarged clitoris and fused labia.  CAH patients tend to play more with boys’ toys, are more active, engage in rough-and-tumble play, labeled as tomboys, and attracted to women.

I challenge you to question a rule about a minority that was created within the constraints of its majority.  Trying to compare apples and oranges… looks like we are all FRUITS in the end.

I Want To Hold Your Hand

It is the sense I value least yet use the most.  It is in constant contact with my environment and provides me with my sense of reality.  I can be easily misled by smells, tastes, sights, and sounds, but the simplicity of a touch can glide me over a spectrum of emotions without losing their sense of meaning.  It is the most pleasurable of all the senses but also the most painful.  I must also mention that this pleasure is no way a sexual reference, but in the broader sense of an affectionate hug or temple massage.  It has the unusual ability of providing comfort, hope, and strength.  How is such an unusual property possible? ”Museums and art stores are also sources of pleasure and inspiration. Doubtless it will seem strange to many that the hand unaided by sight can feel action, sentiment, beauty in the cold marble; and yet it is true that I derive genuine pleasure from touching great works of art. As my finger tips trace like and curve, they discover the thought and emotion which the artist has portrayed.” – Helen Keller

Necessity’s Nagging Mother-In-Law

         The debate between nature and nurture has grown as ambiguous and mutated as my genes themselves.  The answer is obvious; genes provide us with the fabric and thread, while our environment provides us with the creativity to convert the cloth into clothing.  With questions of visual development, researchers have touched on the aspects of what, when, where, and how.

What: Development of a normal visual system

When: Embryo to Newborn Infant to Adult

Where: Eyes, Optic Nerve, and Brain (Visual Cortex)

How: Neurons, Receptors, etc

Now the why question is the true fascinating inquisition that tends to scurry behind his peers.  Why do our genes dictate certain proteins to be synthesized to put in place the vast complications of the visual system?  What is the driving force behind this mechanism?  Why did Ben Underwood’s genes select for echolocation over vision?  In what capacities has this limited our interaction with our environment?  Perhaps I need to set-up an interview through God’s publicist to have these questions answered.  In the meantime, however, I will hypothesize possible theories and explanations. 

         Obviously, our genes are accompanied by a set of instructions similar to the one associated with its predecessor.  When this basic structure is put into practice, it begins to unfold the limitations, which places the system into over-drive, attempting to repair and renovate gaps to produce the most efficient machine possible.  If you were born and raised in a dimly lighted environment, such as a cave or a movie theatre, you would have a far greater number of rods than cones in your retina.  Now if I were raised in total darkness, yet objects could be differentiated by heat (a concept utilized by snakes), then would I be able to see infrared radiation (IR)?  Since it would be unethical to test this on humans, it cannot be faithfully answered.  However, one could theorize that some sort of mechanism would develop to allow this transition to occur.  Necessity may be the mother of invention, but Purpose is her nagging mother-in-law.

Context, Context, Context!

                        

         All discussions of senses are meaningless unless one important concept is understood: perception is context dependent.  From mirages to Hermann grids, it is the environment in which the illusion is fixated that gives its remarkable effect.  This understanding reveals a far greater insight than expected.  It exposes the true potential of the human mind.  We are able to surpass the simple abilities of detection and discrimination and enter a world of identification through the complexities of Brodmann’s areas.  Regardless of the manner in which we perceive an object, we still have the phenomenal ability to recognize it in different times and space.  This concept is reflected in Epicurean epistemology, a philosophy about the universality of words and ideas.  For example, we are able to identify a new acquaintance as a human being even without being given any prior notification.  We possess a preconceived notion of the concept of a human being.  This also applies to your ability to categorize your Cocker Spaniel and your neighbor’s Husky as dogs.  It is a task we typically undertake subconsciously but are sometimes in quite a shock when we have done so wrongly.  (I.e. When you tried to feed your neighbor’s dog, and it turned out to be a wolf…woops!)

         Overall, we should be quite impressed with our ability to store tremendous amounts of spatial and temporal data and recall it on cue.  It is how you are still able to recognize your childhood friends at class reunions or your parents when you come back from a summer abroad.  We are in part able to perform these miraculous feats by analyzing our environment.  We assume that our Caucasian friend has not turned black in front of our eyes, but he has just walked under the shadow of a large building.  We are able to deduce this through our experiences of both light and the improbability of pulling a Michael Jackson in the blink of an eye.  Just as location is important to a realtor, experience is the biggest selling factor for perception. 

Spread Out too thin

When we have over-committed ourselves in extracurricular activities, schoolwork, and other hobbies, we claim that we are “spreading ourselves out too thin.”  This analogy is both accurate and relatable to the typical college student.  More importantly, it has clear associations with the complex understanding of the visual system and its correlating receptive fields.  The larger the receptive field, the less precision or narrow detection range is associated with it.  On the reverse side, smaller receptive fields are more discriminating and refined.  It is obvious that where the analogy overlaps is with the size of the receptive field, in which spreading too thin is the equivalent to a larger receptive field. 

The next question to ask is about the necessity of having one receptive field size  over another.  Why have we not been selected for an enormous amount of small receptive fields so we can detect finer and finer detail?  Why have these superman traits of remarkable vision not crept into our gene pool?  To make another analogy, without sounding too much like Dr. Seuss, the variety of receptors allow us to distinguish the forest from the trees.  The importance of detailed differentiations is both essential and beneficial, but without having the ability to analyze the environment from a greater perspective, they prove futile.  Without this mixture of dimensions, poor Seurat’s masterpiece would be nothing more than a palette of tiny dots. 

Doctor, Feel My Head. I think my Wavelength is too high

     

It would be quite repetitive for me to engage in another discussion about mirages and optical illusions.  Yet, it is extremely important to understand the limitations of our visual field in the context of our active lives.  We are constantly inundated with a plethora of sinusoidal wave functions and geometric representations, and we must somehow compact this into a streaming video for immediate use and a painting for later storage.  The main limitation of the eye, however, is one that is commonly overlooked yet frequently yearned for.  It is the ability of the eye to see an extended region of wavelengths.  Humans can only detect wavelengths in the region of visible light, spanning from 400 nm (purple) to 700 nm (red).  There is a world of vision that far surpasses this small range, constituting gamma rays, X ray, UV rays, IR, microwaves, and radio waves. 

         Snakes, for example, have a phenomenal ability to capture its prey by detecting differences in body temperature using infrared vision, developed in the trigeminal sensory system.  Since we have no true comparison to what they perceive, we assume that it is similar to a color gradation in which higher temperatures are represented by colors such as red and yellow, while cooler areas are represented by blue and purple.  It is as if these creatures do not detect physical characteristics like humans, but rather, it is as if they detect the presence of life.  This is an obvious stretch of the philosophical domain, but it somehow passes the message.  We are limited in our perception of the world by our perception of our eye.  If we were to mutate into beings with a greater range of wavelength acuity, our entire worldview would need to be reevaluated.  Aspects that were once hidden to us by our own inadequacy would suddenly be evident and obvious.  Houdini’s amazing feats would turnout to be simple child’s play.  Our definition of beauty and health would drastically change.  With greater intuition, there is greater confusion.  

It Doesn’t Matter if You’re Black or White…Or Does it?

The inquiry that I am undertaking is not one that understands the mechanics of an optical illusion, but rather, is an investigation about the manner in which we perceive an optical illusion, and what is the root of the disparities?  The first part of this question can be easily resolved through experience and simple deduction.  If all people were to observe an illusion in a similar manner, then it would lose both the pleasure and agitation for its spectators.  An austere and yet popular optical illusion is of the two faces in white and the black vase.  Initially, people perceive the image of the vase first for several reasons.  The primary reason is because it is in the center of the page, and our eyes immediately focus on its symmetrical shape.  In addition, we have been conditioned to read black writing on a white background; therefore, our mind gives importance to the black object over its white counterpart.  However, if we were to show this image to a person who has never viewed a vase or something similar in shape, it is more likely that they would indicate that they saw two faces rather than the one vase.  It appears that experience is the underlying factor that influences our perception and interpretation of optical illusions.  It is both obvious and ingenious.  With the infinite amount of distractions present in our daily lives, it is critical for us to be able to focus on the familiar and relevant.  If extraneous objects constantly sidetracked us in our everyday world, we would be both unproductive and perilous.  The term ADD would take on a completely new meaning!

Wernicktionary

         

After discussing the devastating social consequences following a lesion in Wernicke’s area, I was motivated to delve deeper into the functions of this area.  Present research has classified Wernicke’s aphasia as “an impairment of language comprehension and in speech that has a natural-sounding rhythm and a relatively normal syntax, but otherwise has not recognizable meaning.”  Are researchers, therefore, claiming that there is no pattern or rhyme and reason to the speech produced by these patients?  I have trouble fully believing such a statement when we are still so limited in our understanding of the inner workings of the mind.  The example given in class was: “I called my mother on the television and did not understand the door.  It was too breakfast, but they came from far to near.  My mother is not too old for me to be young.”  Although grammatically correct, an English speaker might assume that it was directly copied and pasted from a cheap language translator.  Perhaps this is the best lens to look at this through.  I will now attempt to breakdown what message was being conveyed.

         Let us look at the first line: “I called my mother on the television and did not understand the door.”  The bolded words are out of place and contributing to the confusion of the sentence.  If we substituted telephone for television and message for door, this sentence would pass along in everyday conversation without any odd looks.  It would read, “I called my mother on the telephone and did not understand the message.”  By simply replacing the ambiguous words with meaningful ones, it is easy to see where the confusion lies.  The words television and telephone share the prefix tele-, are electronic devices, and are used for communication. 

         When I was a child, I used to mix up computer with cucumber and sneakers with Snickers (the chocolate bar).  However, no one accused me of having Wernicke’s aphasia.  Is it possible that I, like many children, had a temporary episode of it?  Is it possible that certain words are simply muddled in the minds of these patients, and they simply require the appropriate translator?  Perhaps all hope is not yet lost.  Maybe it is still possible for them to function in society once again, but with their own form of sign language.  I hope you feel inspired by my rant and begin to make a Wernicktionary of your own.  Well, I’m off to eat my sneaker’s bar and wash it down with some computer water!