Do Boys Grow Up? Ever?

Identify the Adult in This Picture

Maybe some boys grow up. Perhaps in other times, boys grew up. But I'm not sure that nowadays boys really ever become men.
This may not be entirely a bad thing.

I suppose boys become "men" when they have kids, go to work instead of hanging out at the bar or in the airport lounge and they save money so they can buy a house and send their kids to college. But give any one of those grown up men a glove and a baseball diamond and a bunch of 8 year olds and he becomes, instantly, a kid again, trying to strike out the four foot opponent 60 feet away. You will say, that is an aberration, a momentary return to childhood. But, eventually, the kids leave home and those heads of household revert to form. I would argue the aberration is the guy who goes to work every day and acts like an adult. Something inside does not get any older than 18. That is the ceiling for male maturity. 
I've seen forty year old fathers come to blows at their kids'  little league games, soccer games, and certainly at their kids' wrestling matches. 

Unreal

Beaver Cleaver's father would never have done that, but I never knew a father like Beaver's, in real life. 

Sunday was the first baseball game of the season for my league. I actually got a base hit, which I'm sure surprised many on the field, and when I arrived, out of breath, at first base, the first baseman grinned at me and asked me how old I was, amazed a gimpy guy like me could swing a bat and hit a fast ball thrown by someone half my age, maybe less than half my age. 
"Eighteen," I started to say, and then caught myself. No, I am actually no longer 18, in the physical world of trips around the sun, definitely not 18.  Past that. Mentally, definitely no better than 18.  Call it arrested development. 
Put me in the same position I was in when I was 18 and I will be no smarter, show no more cool or reserve than I had before all my current experience. 

My son, one might argue,  has grown up. He slogged his way through pre medical curriculum in college, a model of deferred gratification. Then medical school, more deferred gratification, and now he  is a vascular surgeon. He is shown operating on his favorite patient to date. That would be Holly, an 800 pound gorilla at the Bronx Zoo. Ask him about his best experience ever and he will tell you all about the gorilla. He might hesitate a moment and consider one championship or another, meeting his wife in the gross anatomy lab,  but ultimately, it is the gorilla.  He has been to see her several times since. He is not a veterinarian. He, ordinarily operates on human beings. But the gorilla, that was the best experience in his whole life, so far. He will not say this in hearing range of his wife, but we all know it's true. He loves his wife, but Holly, well, that goes beyond love, to the sublime.  

Holly and Friends

Women, I know, are different. They actually do grow up. Some have babies, but all of them gain a certain composure and experience benefits them, and makes them more competent and confident.  They actually mature. They do not react to men or boys the way they did when they were 18. They are no longer nervous. They learn; they grow.
Boys just get older, no smarter.
That is the major insight for today from The Phantom. 

You're very welcome. 

Oliver Sacks and The Frontal Lobes

             

Dr. Oliver Sacks 

My third year in medical school I fell in love with Neurology. It had been a fickle year: I had fallen in love with obstetrics and gynecology, the first "clinical" rotation of the year, then internal medicine.  I was like the girl who can't say no; I just loved every rotation. 

But Neurology really hooked me.  

The chairman of the Department of Neurology, Fred Plum,  was as intimidating as he was famous, the author of several widely read textbooks, he believed in teaching by embarrassment and he did rounds every morning at precisely 10 AM, working his way down the forty bed ward, listening the precisely formulated presentations of each new patient, delivered by the terrified third year medical student who had evaluated the patient the day or night before. 

I had heard about these "horror shows" from my brother, who preceded me at the same medical school five years earlier and still broke into a cold sweat at the mention of Dr. Plum's name. 

But I had loved neuroanatomy, one of the few courses I really got into during the first two "preclinical" basic science years, and Neurology was basically neuroanatomy in action. If you knew where the tracts ran in the brain and from the brain down the spinal cord, it all made sense. There was order and precision there. 

Of course, there were parts of the brain which were still not understood, black boxes with functions still unclear. Even basic functions like memory were not as simple as the textbooks suggested. 

I was very lucky to pull for my resident the most stellar of all Dr. Plum's housestaff: Kathy Foley. Dr. Plum did not approve of women in medicine because they would likely have children and they would place those children at least as high on their list of priorities as they put Neurology, and for Dr. Plum nothing should be higher on anyone's list than Neurology.  To be made chief resident on Dr. Plum's service Kathy had to be simply head and shoulders above all the other residents, which she was (figuratively speaking--she was only a wisp of a woman, physically.)

When my turn came to present a patient, Kathy had prepped me so thoroughly, I sailed through the presentation, although it was a complicated case with some unexplained findings. Plum, who usually interrupted the student after the first sentence listened quietly, his face clouding, looking as if he had just swallowed a sour pickle whole, and he allowed me to finish without a single interruption. He asked me the very questions Kathy had predicted he would ask, which, of course, I answered just as she directed.

Dr. Plum was very annoyed. He had not been able to skewer or flay the medical student. Every finding I reported was demonstrable at the bedside; the formulation of the case, the localization of the patient's brain tumor to his parietal lobe was on the mark. He turned to Kathy and said, "This is just a little too perfect. Has anyone prepped this student?"  Kathy met his glare with her pale,  icy blue eyes and said, "No,sir. Certainly not."  

"Well, Dr. Foley," I told her later. "You are going straight to Hell after that bald face lied."

Unsmiling, she said, "That's what you go to confession for. Besides, he is not a normal man."

So, I loved Neurology, and I always read Oliver Sacks, the British neurologist who writes occasional pieces for The New Yorker, and this week's (April 27) is a doozy.

I've had this odd connection with Dr. Sacks, which has built since I first read, The Man Who Mistook His Wife for A Hat.    I loved that book and  couldn't stop talking about it until my partner finally said, "You know, my father knows Oliver--they were at the VA together in the Bronx. He's an odd duck."  And he is.  He has prosopagnosia, the inability to recognize faces, and he has lived a celibate life, not friendless, but nun like, monk like, something I did (for only three years) but it's a mode of existence I have to remind myself to avoid, an affliction I see as a personal possibility. 

Sacks also has metastatic melanoma, one of my personal night howls ever since my internship stint at Memorial/Sloan Kettering, and worse yet, his began in his eye, another personal nightmare, and very atypically, it metastasized from there. And yet, he is still churning out pieces for the New Yorker .

What particularly struck me about the case he describes is that it involves the frontal lobes. The frontal lobes, when I was in medical school, were often described as "silent." It wasn't clear exactly what they did. Of course, "frontal lobotomy" was that old, misguided procedure they used on Jack Nicholson in "One Flew Over the Cuckoo's Nest" to render him pacified. Just cut the connections between frontal lobes and the rest of the brain and you get this tractable, joyless lump of humanity, hardly fit to be called a human being.

Spaulding Gray, the subject of Sack's article, suffered an injury to his frontal lobe in a car accident, and he became severely depressed, lost his creativity and descended into despondence. 

We knew, even back when I was a third year student, the frontal lobes had something to do with personality, with taste, with inhibition of behavior.  Patients who were loquacious, capricious were often described as "frontal lobey" but everyone knew this was all very vague.

When my own mother was found to have metastatic disease in her frontal lobes and these were resected, I asked my friend, who had been in on the surgery, what the frontal lobes did and how she would be affected. He didn't know. "They're kind of silent, you know."  I thought I had noted subtle changes in her tastes before the surgery. She had always had impeccable taste in clothes, but in the months leading up to the surgery, with her frontal lobes presumably already involved by mets, she sent me swimming trunks she had purchased for me which were so garish I thought it was a joke. 

Mr. Gray was treated with electroshock therapy (EST) at Payne Whitney, the psychiatric unit at The New York Hospital, where I had been asked to "clear" patients for EST when I was a medical resident. It's a pretty medieval approach to depression, but I had to admit, seeing the patients before and after EST, I was, despite my bias, astonished by the change in some of them, who went from inert lumps to relatively responsive and cheerful people, at least for a while. 

But that's where we are, or were in the years Mr. Gray got treated, sending electric current through the skull to the entire brain, treating parts like the frontal lobes, which are still mysterious, in a way for which we cannot explain a mechanism of action. 

I wondered how Dr. Sacks got permission to tell Mr. Gray's story. Presumably, the family gave permission. Sacks has been accused of being "The doctor who mistook his patients for a literary career." I have been accused of the same thing. But that smacks of sour milk to me. Opening up the real world of disease and patients and doctors to the general public has been, overall, salutary, not simply show boating for doctors.  From real life shows like "New York Med" to the fictional "ER" a more realistic depiction of what doctors face and what patients endure has provided more benefit than risk to the general public, and to the public health.

I hope Dr. Sacks has a few more articles in him, and more time before his disease claims him. 

                                                                                                               

Dr. Oz,Quackademia and Academic Freedom

Once he was a real doctor

It had to happen, eventually: The faculty of Columbia College of Physicians and Surgeons (the medical school with the world's best name) finally got embarrassed enough by the vice chairman of the department of surgery, Mehmet Oz, to gather together and write a letter to the deans of the school asking Dr. Oz be removed from the faculty because he is, well, a quack.

This of course, was greeted by the powers that be with a statement about academic freedom, the right to free speech, the importance of open inquiry, in other words, we, as deans of the medical school cannot admit we've tolerated this quack for so long and if we pretend he's respectable, we're off the hook.

Of course, quite the opposite.

Dr. Oz has, among many other transgressions, suggested that green coffee bean extract is a good weight loss medication.  When called to testify before a Congressional committee, he waved a few bogus publications in what were not peer reviewed journals to support his claim, as if any publication is the same as any other in supporting a claim to scientific respectability.

 There is always the problem of whether or not a quack knows he's a quack or is simply promulgating what is profitable for himself because he's made himself believe the garbage he espouses or whether he knows it's bogus, but pushes the remedy anyway, in which case he's guilty of willful fraud.

The point is, when you are using the good name and reputation of Columbia College of Physician and Surgeons to profit, to make believable your claims, the university has the responsibility to be sure it's name is not being misused and sullied. 

Not wishing to appear narrow minded, the university may lose all perspective and claim it's a free country and in the name of "free inquiry" all viewpoints must be tolerated. Quackacedmia.

There is a danger of being too hide bound and orthodox: Boston University's department of Dermatology expelled Michael Hollick, the man who developed the assay for vitamin D for the heresy of saying people ought to expose their arms and face for to sun 15 mintues a day to prevent hypovitaminosis D.  Sun is bad, as far as dermatology dogma goes, and for the most part, this is likely true, when you are faced with the prospect of melanoma.  But you have to listen to the other side and realize that low vitamin D levels may be no blessing.

And of course, there was Galileo and Semmelweiss. Galileo, of course suggested the heresy that the Earth revolved around the sun, and nobody in the religious or academic hierarchy wanted to believe that. Semmelweiss,  the Hungarian physician who suggested doctors ought to wash their hands between examining patients to prevent spreading disease from one patient to the next and he was hounded out of the profession, the country and just about out of his mind for having the temerity to suggest his colleagues and fellow physicians might be the source of uterine infections in women who they examined with their bare hands after they had examined corpses in the morgue without washing.  Doctors did not understand about sterility and hygiene and microbiology in those days, but they did understand about blame. Both offended entrenched authority.

The difference between their offense against established authority and Oz's offense is Galileo and Semmelweiss had made observations on which their heresy was based and they followed those observations back to the lab. In Dr. Oz's case, he is not seeing what any undergraduate ought to see claims are being made which are unsubstantiated.

On NPR this morning, they interviewed a patient and her holistic doctor in Bethesda, Maryland, in the very shadow of the National Institutes of Health, that bastion of scientific rigor,  because the FDA is opening hearings about whether or not holistic medicine is quackery. The doctor sounded sincere when he says, "We believe that there is a memory left in the solution. You might call it a memory. You might call it energy... There's no question that it helps patients. I have too many files on too many patients that have shown improvements."  Of course, nobody has critically evaluated these files; they are like the "studies" Dr. Oz waved at the Congressmen. Hold something in your hand and you've got "proof."
As Shakespeare said, "In speech, there is logic." Just say it, especially if you sound sincere, and there is the "ring of truth."
None of this would be a problem if we had an educated populace, capable of critical thinking, armed with skills to dismember these frauds, contemptuous of those who lack intellectual rigor.
But for the most part, most people do not have the time or the resources to be able to critically evaluate medical claims. They place their faith in institutions and names, or,nowadays, in the TV or the youtube, where if you are on the screen, you are ipso facto believable. 
In Huckleberry Finn two hucksters, the King and the Duke, sold a noxious mixture of snake oil which poisoned local townspeope and they were tarred and feathered and ridden out of town on a rail.
Oh, for some of that ante bellum justice for Dr. Oz and the homeopathic physician from Bethesda.
Certainly no such justice will emanate from the deans at Columbia P&S, who have tacitly endorsed quackacademia in the cynical belief claiming academic freedom can shield them from the truth. 

P.S.: I am told by my reliable sources at Columbia, Oz really was a highly proficient surgeon once, and his research was quite well done, but now he has gone Hollywood and the question is why.  I would guess the same qualities which drove him toward excellence in his youth are now driving him toward another form of reward. He is, like Kurt Schork, the Reuters war journalist, an adrenalin junkie. Schork, of course, never allowed his compulsions to taint the high quality of his work; in fact they drove it.

The Spring We've Earned Comes to New Hampshire

It's Easter, the day of Resurrection.  However you feel about that story, there is something about this holiday, coming as it does (at least in the Northern Hemisphere) at the cusp of Spring, and rejuvenation, there is hope in the air. Looking out my window now, there is still snow on the back lawn, running into the woods, but more grass than snow, and although the trees are leafless, you can see the buds at the tips. 

We have earned this Spring and summer in Hampton, New Hampshire. 

Hemingway said about Paris the only problem in Spring was deciding where to be happiest--you would be happy anywhere in that city in Spring.

And while it's not living in the city of light, we do have a sort of life on the airwaves in the 21st century and that life is full of light and marvel. This is the golden age of television and creativity and mastery. 
"Game of Thrones" is coming back, that tale of evil and evil and a little good trying to peek through now and then, based on the books, which my sons have read cover to cover, all 5,000 pages and now I can actually join their discussions.  What is most amazing about GOT is the most essential, intriguing, illuminating character has achondroplasia, which has got to be a first in television history and breakthrough for disadvantaged people worldwide. 

"Broadchurch" has the distinction of beginning its second season with episodes which exceed in every way the very good first season. It was a little too much like "The Killing" and nameless other shows where children were murdered or threatened and the killer or killers pursued by police who had their own demons. But the second season injects Charlotte Rampling, and re examines cases we thought were closed, signed and sealed, during the first season, and it turns out, "maybe not." It's a very sly reversal of the first season, where every thing seemed a little too familiar, but now, turns out not to be. 

"Mad Men" returns for a last season to much hype, most of it deserved, as it examines the mores and adventures of a certain class of people, of the important driving force they were part of in the 1960's (the world of advertising) , and it helps baby boomers and those just behind the boomers to examine where we came from, where we got our hang ups about the place of women in the world, about the importance of the workplace in a sense of self worth. If you want to look at values, there can be no better place than advertising, because that is where stories are told which embody the values by which a culture lives. "Mad Men" has turned out to be an intelligent soap opera, and, for my money, it has held up better than "Downton Abbey" and it's not even the product of Great Britain. If Freudian theory emphasizes the child is the father of the man, then "Mad Men" reminds us, we all came from somewhere, and that past may be behind us, but it's still in us.

"Justified," is a show with a premise which held no interest for me: A Southern cop pursuing local crooks, drugs and prostitution. I only watched it because my sister-in-law recommended it and my sister-in-law is intimidatingly brilliant, so I figured there must be something there. It took me six episodes to see what she saw, but I eventually did. "Justified"  surprises on almost every level. It is not exactly a hill billy "Wire," but the writing is extraordinary. The rhythms of the speech, the Appalachian formality is almost Elizabethan and works to make the listening to the lines a delight. Raylan, the cop, Boyd the crook, and Art, Raylan's boss, are indelible characters, each with his own complexities and rewards. 

"Call the Midwife" is not for everybody, but as an essay on the meaning of meaningful work, on the role of women in the 1950's work force and as a reminder of how long it took England to recover from World War II, it is worth recording. It is based on memoirs of a real woman who lived through it all and it again provides a stark reminder of times when women did not have full control of their own fertility and its consequences. 

And then there is "Wolf Hall" which I have not yet seen.  Nor have I read the books, but  reliable sources say it will be worth seeing. And it has Damian Lewis, (from "Band of Brothers" and "Homeland.") I have never been able to sort out Thomas Cromwell from Thomas Moore, and this promises to settle that much. The manipulation of religion and its place in power politics,  as Henry VIII proclaims he can speak for God just as well as the Pope can, has got to be instructive.

And that is just TV.  For anyone with a Kindle, Life After Life  by Kate Atkinson, is not to be missed. A girl gets born, dies, reborn and manages to avoid the thing that got her dead in the prior life, and moves on, but at some points, she wonders whether it was such a good idea to have made it past that early death because the life she's got is proving pretty miserable, but she moves forward. 

With all this available, I have to wonder when I will have time to take the dog to the beach, work and practice my piano scales (in about that order of importance.)

Spring is not yet sprung, but with all this available, time management is going to become paramount. 

The question is, where can you be happiest--providing no disaster presents itself. 

A friend told me about her niece moving into her first apartment in Boston, having landed her first job out of college, and looking around at her new digs, she burst out, "I'm just so happy!"  Which sent a chill through the aunt, who is just old enough to know no happiness goes unnoticed and none lasts forever. It's just a question of how long. 

Which is, I suppose, where that phrase "Carpe Diem" came from.

For those of us who have had that joy, of leaving the nest, having our own place, being open to new people and adventures, that is a Siren's call. Likely that sort of joy happens only once. But Spring is here and there is joy enough. 

How Texas Saved Gail Collins

Ms. Collins

I was a little worried about Gail Collins, if you must know. Once Mitt Romney's dog--you remember: strapped to the roof of the car on the family vacation--faded from public view, her favorite touchstone to the ineffably  bizarre style of Republican America was lost. She simply seemed a little adrift, searching for the essence of the American experience. But then she went back to the one source of inspiration which has never failed her: Texas.

29 year old virgin surgeon

She still obviously watches the Texas state house with some avidity and she found what she was looking for: A state rep named Stuart Spitzer (you cannot make up a name like that) sponsored a bill funding abstinence-only sex education for students in Texas, a state which has a teen sex rate twice that of California's (where abstinence is explicitly not taught as the primary contraceptive method).  Rep. Spitzer said he had been a virgin when he got married at age 29. and he added, "What's good for me is good for a lot of people."  Except, of course, for those teens who get pregnant when abstinence doesn't hold up. 

As Collins has noted, Americans, even Republican Americans have got a lot more rational about gay sex, but some Americans--mostly they are  male Americans--seem to be getting more and more crazy about heterosexual sex. 

Elizabeth Cady Stanton

Once people actually reflect on the gay folks they have known, they tend to say, "Live and let live." Her own mother, a conservative Catholic from Ohio, came under the care of gay medical attendants in her later years and "wound up riding on  float in Cincinnati's gay pride parade."  Oh, how I love that image.

Maud has pointed out that Gail Collins bears an uncanny resemblance to Elizabeth Cady Stanton, who in the 19th century insisted her wedding vows be amended to strike the phrase she would "obey" her husband (as in "love, honor and obey") which she found untenable in a relationship which she viewed as a partnership of equals. She was a pioneer in the quest for women's rights to vote and to control their own destinies. Whether there are any shared genes here, I do not know, but there is a shared legacy of anger at the way women have been pressed under the male thumb, especially in state legislatures. 

In four states women requesting an abortion must be told that abortions are linked to an increased risk of breast cancer.

Breast cancer from abortions!

And here I thought that idea was the sole province of Jeanine Notter, (again, the name, just one letter from the truth) the New Hampshire rep (R-Merrimack) who testified at some hearing that abortions increase the risk for breast cancer, based on some bogus "study" of a naturopath or chiropractor or some sort of quack, which did not qualify for publication in The New England Journal of Medicine or any other actual peer reviewed journal. Notter's comments made the Huff Post:

"In an interview last month with the Merrimack Patch, Notter said she understood that abortion would cause spaces in breast duct tissue to allow for the growth of cancer cells. She said she believed birth control pills lead to the same issue. Notter last month also said that she believed that birth control pills taken by women cause prostate cancer in their male children."

 I don't know if that bill became law in New Hampshire, but now I'm going to inquire.This had to be the best single revelation by a politician since Michele Bachmann informed the country that vaccines cause mental retardation, which she had on the best authority of a woman she had met in the parking lot outside the building where the candidates' debate was held. 

Really, if the Texas well runs dry for Gail Collins, she has another right up here in New Hampshire. 

And here I was marveling at the preoccupation of Islamic extremists with female sexuality. They may be getting some stiff competition in their concern for female sexual behavior from the male politicos in Texas. 

And don't forget  Congressman Louie Gohmert (R-Texas) who blamed President Obama for the imminent onslaught of rapes about to be visited upon the white women of Texas  by the dark skinned, Muslim, Hispanic teenagers who the President was inviting to breach the Rio Grande in droves.  Never did get the follow up on that story. I know Maud was concerned for her safety, but she lives in New Hampshire, so there was some protection in distance. 

I've never believed we ought to care much about the percentage of women in legislatures. Just let the best man or woman win, I always said. But now, I gotta say, I'm beginning to think we ought to limit the percentage of male legislators.  If you're going to have a quota, may as well start where you get the most effect. 

Watching Volleyball in Tehran: Better than Reading Lolita

Salacious Intent

Here's my favorite story de jour. A woman in Iran was jailed for attempting to watch a men's volleyball game and then complaining when she was denied the opportunity. (I think it was the complaining that really got her into trouble.) This is from the Huff Post, and not all the juicy details are available, but as I understand the report, foreign women are allowed to watch male volleyball players in international tournaments in Tehran, but Iranian women are forbidden to lay eyes on these males. 

One can only imagine the reasoning here. Let me count the ways:  Watching males play volleyball would be sexually stimulating for females and that would be contrary to the will of Allah. Foreign women would likely be not Muslims, so their souls are already lost and they can have all the sexual excitement they desire. 

Have I inferred improperly here? 

 Or maybe it's that Iranian ayatollahs believe if women watched men play volleyball they might get ideas about playing volleyball themselves, and who knows where that might lead?
Well, actually, we do know where that might lead. 

Women beach volleyball players are just so hot.

What A Great Sport

Water Nymph

                                                                    
















What is this thing the ayatollahs have about sex and women?  Is it just me, or do fundamentalists seem to spend 90% of their time trying to keep women from thinking about sex?  

Maybe it's because I'm just an infidel, but I don't think I spend 90% of my time thinking about sex. Eighty percent max.  But, the thing is, it would make me very happy to think women spent that much time fantasizing about sex. It would sort of level the playing field, if you know what I mean.  I'd settle for 40% of their time thinking about men. Or women, even. But sex.

Can Iranian Men Watch Her?

I understand this might cause problems for the men who believe that if women did get turned on by men, they might get turned on by the wrong sorts of men, non Muslims, for example. 

There is a telling scene in the Ring series where a gnome like creature (Alberich the Nibelung) is swimming among the gorgeous water nymphs, creatures who are tall and blond or red headed and very attractive, but they spurn him because he is short and dark and pretty ugly and that launches all sorts of passion and mayhem, and it involves race and sex and all sorts of explosive mixtures: See, the women are light colored and the man is dark. You can see why the Nazis loved Wagner. 

And maybe it's that sort of thing going on with the ayatollahs. They see themselves as the reviled and rejected gnomes.  The want to control the way women's juices flow.

Image of Self Loathing

I'm just guessing here.

I really need help. What do women think? Would Western civilization end tomorrow if women were allowed to give full vent to their sexual desires? 

I am pretty slow, I admit, but that sounds pretty good to me.

Gloria Steinem was asked why she had never married and she replied, famously, and droll, "I cannot breed in captivity."   Seems to me, and I'm just saying, women have been trying to function in captivity for a long time, and speaking strictly as a male, that is not in anyone's self interest.

Fantasy Object