We Live In An Age of Miracles

This past Saturday, my son's friend plunged into the surf at the Jersey shore and lost his wedding ring. His fingers responded to the cold water with cold shrinkage and the force of the waves did the rest.

But this man was born in the mid 1980's and he did not accept this loss as irretrievable. 

He went on Reddit, from his cell phone, and found a man who, in retirement, has made it his hobby to find things on beaches with his metal detector.

So the young man went on Google maps and sent the location of the beach where he lost the ring and the retiree went out on the beach, the next morning, Sunday, with his metal scanner machine and found the ring.

Presumably, the ring will get back to its owner by some lower tech means, like the U.S. Postal Service.

But here we are, and a ring, A RING, could be found amid all the grains of sand on that beach, while the owner was back in New York City, by a man on a New Jersey beach linked to the problem by a satellite, and using an electronic device.

What a marvelous age we live in. 

Sexuality, Gender, Desire, Behavior and the Incubus Physician

At age 22, having suffered through the nasty gauntlet game thrown down by the American university system and landed in the promised land of medical school, the Phantom found himself at an institution in New York City which just happened to be a the center of a Brave New World of scientific inquiry, the New York Hospital, Cornell University Medical Center located on the chic upper East Side of Manhattan, overlooking the East River estuary, housed in sparkling white buildings fashioned after a papal palace, and home to a biochemistry laboratory run by a dyspeptic old guy who could run blood through his beakers and test tubes and analyzers and dissect out the hormones which get made from cholesterol and sent down the assembly line of human adrenal glands, ovaries and testicles and made into sex hormones, hormones which support blood pressure and a hormone essential to life, cortisol.

In one of those fortuitous constellations of history, a group of remarkable women happened to reside in the pediatric endocrinology department of this same institution and these female physicians were forced to confront the problem of babies who were delivered with "ambiguous genitalia" that is, the happy mother looks down between her legs as the obstetrician grasps the newborn and she asks, "Boy or girl?" and the unfortunate, baffled obstetrician sputters, "A healthy baby!" 

The problem is the baby has equipment which is not clearly male or female.

These women carried the baby's blood down to the curmudgeon in his lab and asked him to analyze the baby's hormones. They did this because they knew that the shape and nature of a baby's external genitalia, that is whether it is a recognizable penis or clitoris, a scrotal sac with testes or labia all this is shaped and driven and formed by hormones and these kids clearly had deranged hormones.

These women, Dr. Breslow and Maria New and later, Julianne Imperato McGuinley, also knew that the hormone levels were in turn determined by chromosomes and by genes located in those chromosomes. 

So they knew that there was a role for genes, for the enzymes produced by these genes, by the hormones produced by these enzymes and that all this resulted in anatomy.

They also learned that the hormonal environment in some way conditioned the brains of infants and children.  They saw the most rare and exotic patients who had derangements in the hormone production assembly lines. 

And they presented these cases to the medical students assembled in a sweaty classroom theater, along with the diagrams of the biochemical pathways.

For most of the 90 students of this class, the lectures were a snoozer, but for the Phantom it was instant karma. Dr. Breslow described the case of a fourteen year old girl, who had never been much interested in playing with dolls, who preferred running around with boys who turned out to be something more than a tomboy.
She had shown no signs of going into puberty and had been brought to the pediatric endocrine clinic and it turned out she lacked an enzyme, a form of 17 hydroxylase, and because of that, she had not been able to make  enough testosterone in utero, when a sort of "first puberty"  and thus her external genitalia did not form along male lines. When the second puberty at age 11 to 13 was supposed to happen, she could not make much estrogen either. She had XY sex chromosomes and she had an underdeveloped phallus which was thought to be a clitoris but was actually a rudimentary penis.

She had been able to make enough varieties of male hormones in utero to condition her brain to a certain male proclivity, but not enough to masculinize her primordial penis or scrotum and her testes had not descended.

So there you had it: testosterone had not played its role in fashioning anatomy, but it had played a role in the brain, in behavior, thus the "tomboy" behavior.

The Phantom asked what the doctor intended on doing and she said the child would continue to be raised as a girl, given estrogens, have her testes surgically removed. This caused enough stirring among the Phantom's male colleagues, who seemed to arouse themselves from their stupor and one objected, "But he's a boy!" 

"Why do you say that?" asked Dr. Breslow.
"He's got testes, XY and a penis!"

It was then Dr. Breslow leaned over her podium and raised her little finger to the confrontational medical student, and she uttered the words the Phantom has never forgot: "If you have a penis the size of my distal digit, you are never going to function as a male. We can fashion a vagina, bring up her estrogen levels to normal and she can have a life. You want to sacrifice all that for a set of XY chromosomes?"

The Phantom was hooked.  The confluence of biochemistry, brain, sexual organs, the beauty of it all was electrifying 

He tried to be reasonable. Endocrinology was a field of low remuneration. It had nothing to offer but fascination.

But he had seen the dawning of a whole new understanding. 
The same department later identified 5 alpha reductase deficiency.
They established a clinic for what is now called "complete androgen insensitivity syndrome" which the Phantom attended every chance he got. 

There was a research ward for these patients, which the Phantom haunted. 

The Phantom was not much welcomed by the women of the pediatric endocrine department, and he tried other specialties, but some years after he left the New York Hospital, he felt the gravitational pull back to the world of hormones. 

It was the path less traveled, but some planets exert so much gravitational pull, they are inescapable. You simply go into orbit and enjoy the ride. 

Drinking the Kool Aide of American Elitism

I am the mother of two sons who are both Princetonians. My older son had the good judgment and great fortune to marry a classmate of his, but he could have married anyone. My younger son is a junior and the universe of women he can marry is limitless. Men regularly marry women who are younger, less intelligent, less educated. It's amazing how forgiving men can be about a woman's lack of erudition, if she is exceptionally pretty. Smart women can't (shouldn't) marry men who aren't at least their intellectual equal. As Princeton women, we have almost priced ourselves out of the market. Simply put, there is a very limited population of men who are as smart or smarter than we are. And I say again — you will never again be surrounded by this concentration of men who are worthy of you
--Susan Patton, Princeton, Class of 1977

Just back from Alaska, which got me thinking about the Ivy League, the New York Times wedding announcements (advertisements of self proclaimed virtuosity), the East Coast, Silicon Valley, Bill Gates, and Daniel Okrant's, "The Guarded Gate" about the early 20th century, when the elites from Supreme Court justices to Eleanor Roosevelt, agreed that WASPs were the superior race, and with the help of the Ku Klux Klan, managed to get a law passed to deny entry to lower orders of the human race, like Jews, Italians, Poles and Slavs and to favor immigration from the British Isles, excluding Ireland. 

In Alaska, folks never ask where you went to school, and, in fact, they give every appearance of judging people on what they can discern from talking with them. 

I went through some towns where there was only one gas pump (not one gas station--one gas pump). Juneau, the capital, has no road connecting it to the outside world; if you want to get to Juneau, you have to take a sea plane or a boat. 

Russians lived in Alaska when it was Russian

A sign outside a Hertz car rental showed that Hawaii is closer than Washington, DC for folks in Sitka. 

Bill Gates, who may be somewhere on the autistic spectrum, spent only a year at Harvard. I haven't read a biography or memoir to give me insight into the man, but I do know that Harvard points to Zuckerberg and Gates as evidence Harvard knows how to assess talent and potential.  But is it not just as likely Gates and Zuckerberg chose Harvard, knowing they could go anywhere, and having spent a year there, realized Harvard, its faculty, its students had nothing important to offer?

Tony Fauci, the head of the National Institute of Allergy, Immunology and Infectious Disease, scandalized the faculty of Cornell Medical Center, The New York Hospital, when, at his investiture, having completed his year as Chief Resident in the Department of Medicine, with the grey beards of the Ivy League faculty mucky mucks gathered around, he was handed a set of the keys to the kingdom, admitting privileges to the hospital and appointment to the clinical faculty, and he said, "Thanks, but no thanks."

A Richter Scale 7 earthquake could not have shaken the foundations that white marble, faux papal palace on East 68th Street more. 

How could he turn down that honor? 

Fauci has never denied the story that when pressed by his friends, he had explained, "Some day I'm going to be either very rich or very famous. But if I stay at Cornell, I will be neither."

I'm betting Gates and Zuckerberg said the same thing to themselves about Harvard.

The fact is, institutions of the dominant tribe try to sell the Kool Aide that they have a process, a drink,  to convey the power, the glory.   But this idea of the cream rising to the top (to mix a metaphor) is simply a lie used to perpetuate power among some and to deny it to those strivers from below.

For that, it is salutatory to escape the ivy covered walls and to look at those in power, in their fine gowns, and to see through the cover on the emperor to the  naked truth below. 

PS: 
Bonus points: Can you deconstruct Ms. Patton's problem here?
Hint: Begin with it's amazing how little intelligence matters in a woman (to men)  if she is pretty.
Extra credit reading: Eugenics 101, "Guarding the Gate"
Extra hint:

Susan Patton