Tears of Joy

Any of you who saw the end of the Women’s British Open last Sunday witnessed one of the great pressure golf shots of all time. 31 year old Mo Martin hit a three wood 240 yard to within six feet of the pin on the par 5 last hole. She then sank the putt for an eagle 3. She had to wait while two contenders, playing after her, had opportunities to tie or beat her. In a stroke of directorial brilliance, the camera honed in on Martin’s face just as she learned that they had failed and her caddie relayed the news. “You won!” The pure joy on her face brought tears to my eyes and, as freely admitted, the broadcasters in the booth. Why?

I never heard of Mo Martin. Why would some neurotransmitters in my limbic system, the seat of emotions and memory deep in the brain, rev up because someone I don’t know over 4000 miles away was happy? And why would I cry?

There is a lot of information about the neurophysiology of tears. The roles of the Trigeminal nerve and the sympathetic and parasympathetic nervous systems* are well established. But I can find nothing expaining how an external event starts the cascade that ends in tears of joy or sympathy. There are evolutionary explanations involving tears as a sign to others of surrender or a signal of a need for help and support, but what is the initial stimulus?

My guess is that it has to do with consciousness, that intersection of brain and mind.  There is something in us that is non-linear and to my mind other worldly that we do not, and will never, understand. I think consciousness is the junction between this world and the other.  My friend and former partner Dr. Larry Dossey has written extensively about evidence for a universal consciousness, a modern day take on Jung’s collective consciousness. Just as Aspen trees share a common root system so too we may share a subliminal awareness of our interconnectedness. In a way when one suffers we all suffer. When one of us is joyful we all participate, even briefly, in that joy. And if the joy is intense enough, tears flow.

I reject the opinion that I am just a crybaby. Our tears have a much more noble origin!

* The Trigeminal is the fifth of twelve cranial nerves responsible for facial sensation and biting and chewing. The autonomic  nervous system, with sympathetic and parasympathetic components, acts below consciousnes to control bodily functions like heart rate and breathing.

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Not like me

I have been thinking a lot about prejudice recently. Or maybe it has just thrust itself in front of me. Islam, racism, and homosexuality are three areas that seem to preoccupy many Americans.

I grew up in a time and place where I had little contact with Negroes. I played on a baseball team in Borger, Texas in the 50’s that was integrated.  Very little was thought or said about it. There were none in the high school I attended in Dallas. College, medical school, and Vietnam increased my exposure to African Americans. One particular instance stands out as an example of the overt racism of the 60’s. Surgical Grand Rounds at Parkland Hospital attended by faculty, staff, students, and numerous surgeons from the community. The chief of surgery was giving a presentation on wound infections. The talk included information on animal bites, including human bites. The professor described the germs that could contaminate a wound caused by a human bite. During the question and answer session a “town surgeon” stood and, with a chuckle, said, “Dr. Shires, I’ve always heard that the bite of a Blue Gummed Georgia N***** was fatal.  Any truth to that?” There was silence in the auditorium.  Dr. Shires, speaking rapidly and in generalities, tried to diffuse the situation even as an African American surgeon at the back of the room stood and asked to be recognized. Finally, in resignation, Dr. Shires recognized him. “Dr. Shires, I am from Georgia. I have blue gums. As child I even bit somebody. Nobody died and I strongly resent the question.” The meeting ended with the chuckling surgeon trying to apologize. How well do you think that went? Things have changed. We were out to eat last week with a delightful woman who referred to our First Lady as Mrs. Buckwheat. Things have changed… haven’t they?

I am a Presbyterian and, like a lot of mainstream denominations, the Presbyterian Church USA has been struggling with the issue of homosexuality. This has been settled in my mind for some time. To me the cited scriptural references referred to in-hospitality, temple prostitution, and idolatry more than a proscription against homosexuality, a term that was not even coined until the 1800’s. Every gay person I have ever talked to describes their sexual orientation as a part of their core being for as long as they could remember. Nevertheless, honest people disagree. Recently the General Assembly of the Presbyterian Church voted (very closely) to allow individual churches and ministers to perform same sex marriages in states where this was permitted by law. Allow, not force. Individual conscience, which is very important to Presbyterians, still rules. I have always felt that the Church should be inclusive rather than exclusive. Nevertheless, individual churches and people will leave the Presbyterian Church and, again like other mainline churches, its membership will continue to dwindle.

I get several e-mails a week about Islam, none of them complementary. They describe the “death to the infidels” mentality that is common to all of Islam, with the instructions to “pass it on.” The Poisonwood Bible by Barbara Kingsolver has a term that may apply here. ”Bible dipping.” It refers to finding a passage in the Bible that support your viewpoint, your prejudice if you will. I have not read the Koran but I accept the fact that there are violent passages in it. There are violent passages in the Bible that could be “dipped” to show that Judaism and Christianity are violent. I want to believe that there is a difference between moderate Islam and radical fundamentalist Islam but I don’t know any Muslims well enough to know. So that is my prejudice. But assuming that is true, I do not know what we can or should do about radical fundamentalist Islam. I once thought that opportunity, education, and the chance for a comfortable life would counteract the insane ravings of the radical Muslim clerics. But many of the 9/11 terrorists were well educated. One was even a medical student.

Maybe Jesus and the Beatles are right. “All you need is love.” That may not be enough but in our daily lives dealing with one another it beats fear and hate.

 

A Fall Day in ’63

Wanted for Treason Oran_resize

November 21st was a beautiful clear day in the low seventies and a waxing crescent moon appeared as darkness descended over the fledgling UTSouthwestern campus and Parkland Hospital. Several sophomore medical students had gathered in the North-facing pathology room that evening to review microscope slides when our concentration was broken by the shrieking of tires on pavement. We raced to the window to see only receding tail lights and a shower of papers fluttering to the ground. We hurried down the stairs and discovered hundreds of leaflets on pink and green and orange paper all saying – WANTED FOR TREASON – accompanied by a frontal and side mug shot of our President. We gathered up as many as we could and called the police. “No we didn’t see who did it” and “Yes this is all of them.” But of course it wasn’t. One is on display at the 6th floor museum and I have had one of each color all these years.

 

Friday November 22nd was clear but cooler as the four of us decided to miss class and head to Love Field to welcome President and Mrs. Kennedy. Cervando Martinez, Wayne Matthews, Charlie Briseno, and I found places 4 or 5 deep in the crowd on the tarmac where Air Force One was to arrive. We watched excitedly as it touched down and taxied in front of us. And then suddenly the door opened and there they were! Jack and Jackie, smiling waving, charismatic even from a distance.  They descended the steps and immediately moved to embrace the crowd. I held my camera over my head and snapped away. We were enthralled to be this close and as they moved toward the limousine I raced to the road where I guessed they would exit and sure enough they passed about 10 yards from me and I got a picture, that while blurry leaves no doubt who the subjects are.

We then returned to our car and cut across town to the Merchandise Mart on Stemmon’s Expressway while the motorcade wound its way through downtown. We parked near Harry Hines and walked to Stemmon’s and stood next to a telephone pole in front of the Merchandise Mart that still stands. As the motorcade approached we waved in anticipation. The motorcade didn’t slow and sped past us allowing only a glimpse of the limousine. Over the years what we saw and what we think we saw have been inseparably mixed. I’ve always told people that we saw the President after he had been shot and Jackie hovering over him but I can’t be sure. All we knew was that something untoward had happened, possibly that someone had gotten sick. As we raced to our car we asked a motorcycle officer what had happened and he said he didn’t know but the motorcade was going to Parkland Hospital. So we drove to Parkland and headed to the emergency room but were barred from entering so we raced up stairs to try another entry point and that’s when we heard. We passed a nurse on the stairs who said so clinically, “Kennedy’s dead and they’re taking Connolly to surgery.”  We gave up our mission and gathered in front of the emergency room with all the other stunned students, faculty, police, and citizens. I don’t remember much about the day after that.

 

 

11.22.1963
President and Mrs Kennedy and Governor and Mrs. Connolly leaving Love Field

Hoof Beats, Horses, and Zebras

I went to a conference recently and heard Dr. Danielle Ofri speak. She is an internist in NYC, Bellevue to be precise. She has written a book, How Doctors Think, and her talk was on how doctor’s emotions affect the practice of our profession. Her talk energized my memory. I found myself plowing back through fifty years of encounters. As I mentioned in my last blog, physicians are given a unique privilege to look into the lives of others. So in these next few blogs I want to reminisce about some of the stories that affected me.

My first remembrance during Dr. Ofri’s talk occurred when I was a junior medical student. But first a little background and a few infectious disease facts. There are many aphorisms and slogans in medicine to help categorize the physiology and pathology that is the human body. One of these is, “If you hear hoof beats, think of horses, not zebras.” A poetic way to say, “Common diseases occur commonly and uncommon diseases occur uncommonly.”

Now for the infectious disease lesson. Upper respiratory disease is the most common infectious disease after dental caries. Most are viral and resolve in a few days. Some are bacterial – strep throat being the most common – the horse if you will. The streptococcus causes pus to form on the tonsils and a very painful sore throat. But, and this is important, the pus never forms on the soft or hard palate, the roof of the mouth. Never!

And now the story. I was a junior medical student on my pediatric rotation on the 6th floor of Parkland Hospital. (During that rotation Jack Ruby, the murderer of Lee Harvey Oswald, would die on that very floor. But I digress) It was a Sunday afternoon and my group was admitting children through the emergency room. The senior resident, who was supervising two interns and six medical students, assigned a young girl with a sore throat for me to see. She was in such pain that she had been admitted to the hospital.  The senior resident had already examined her and written a note on the chart. Diagnosis: Streptococcal Pharyngitis. Treatment: Penicillin. So applying what I had learned, I took a history from the mother and examined the seven year old. And what did I see? Pus. Or what we call an exudate. It was on the tonsils but also extended onto the palate, almost meeting in the midline. What does that? Specifically, what zebra does that? There is one thing that does that…diphtheria. And that exudate can grow to occlude the windpipe, a true life threatening emergency. I showed the senior resident what I’d seen. “Maybe,” he said, and assigned me another case. When we made rounds the next morning he told our professor that he’d diagnosed a case of diphtheria and instituted the appropriate isolation, observation, and therapy.

Such is the life of a medical student. But it was my first lesson of how making the correct diagnosis can save a life. I knew and that was enough.

 

Connections

David 250I “retired” a week ago. I can’t say it feels any different yet. I think most people that retire are working one day and then the next day are not. Sort of like an off/on switch. You are either shining or you are not. My trek has been more like a rheostat, gradually dimming over the last few years. I have broadened my interests and activities as I have cut back my hours in medicine. Finding interests and activities has not been a problem. So it doesn’t feel different…yet.

My wife and assistant insisted that I have a farewell party. So on my “last day” (I worked the next day) we invited all friends and patients to the office for cake and champagne. I must admit it was nice saying good bye. As I thought what I might say, I was reminded of an NPR Fresh Air program I heard about Mary Gautier, a Louisiana singer/songwriter who had a pretty rough road to success. Her songs are personal and raw and she used the word “connect” to describe the goal of her art. And that was the word that I used to say good bye. I have been allowed over the years to connect at the deepest level with so many incredible people. Folks like me that are not famous or rich (well some of them are rich) have consistently reminded me what a wonder each of us is. I have been privileged to see people stripped of pretense and false fronts, showing me their joys, their fears, and their incredible courage. I have also worked in prisons, on the Texas-Mexico border, and in Africa and I know we do not emphasize our connection, our commonality if you will, enough. Underneath our fear, our anxiety and anger we are all so similar. Theology and original sin aside I find a genuine goodness in almost all of us. I have been given a unique view to see that and I believe it to be true. We are connected and it is those connections that makes our life together so meaningful.