Wednesday’s Child

Medical School: Physical Diagnosis

Humility

The teaching system is structured in such a way that it eases a medical student into the process of doing a patient’s history and physical examination. The student then, although not expected to be brilliant in deducing diagnoses, is at least expected to begin to think about at least one diagnosis that can be isolated to a single major organ system.

We were first required to start with blindfolded examinations of each other; then write down what we felt to be significant findings, only then to suffer the double humiliation of the proctor not only pointing out everything we had missed, but also pointing out all our own personal physical flaws.

The first humiliation, for example, was that we all made gross assumptions that skipped important details.

For example, most of the medical students did not even first state the gender of the person. This was followed by our omissions of simple facts such as the fellow student we had just examined might be wearing glasses, had a beard, or wore earrings.

All of this underscored a basic tenet in medicine that one should never overlook the obvious and also that one should never assume anything.

When I began my first presentation of an examination of a fellow student, I was stopped after the first sentence.

  • So, first of all, was the person a male or a female? Even blindfolded you can tell if a person has breasts, or buttocks, or a penis or not.
  • Well, yes but….
  • Then why didn’t you first say that the person you were examining was a female? There are many important medical issues that depend entirely upon gender you know.
  • Uh, yes but…I didn’t think I should…I mean she’s a fellow student. Wouldn’t she object to being groped?
  • But nothing and grope nothing. This is an objective clinical exercise, not a course in sexual harassment. So just because you might be embarrassed about this means you can sit there and tell me that someday you might miss a breast cancer? The medical examination of the breast is entirely clinical and is not the equivalent of fondling. At least it had better not be.

When I told my mother about this experience she shrugged it off as being nothing that should bother me too much. She trivialized it as she reminded me that her near-sighted brother Bobby had also learned his physical anatomy by the Braille method, albeit at night in the back seat of a car, yet never once seemed to have any problems with gender identification. She said:

  • Forget the tits. That’s how your Uncle Bobby discovered that women have three holes.

The second humiliation came with the fact that all of us then had our own physical imperfections glaringly pointed out to us; dermal scars, a murmur, a curved spine, acne, a sloped shoulder, a missing pulse, an old fracture, crooked teeth, glasses, or braces; you name it. The worst part about it was that we were all only about 21 years old. By the time the proctor was through with me I thought I was should just cash it in and apply for the job of being a cadaver for the class of 1974.

It was the beginning of a lifetime dedicated to thinking morbidly of even the slightest personal ailment, a thought that unfortunately played back into my mother’s perverse tendency to always look for the worst in people.

Noticing all the things wrong with someone or painting worst-case scenarios for diagnostic outcomes does not make for an optimistic outlook on life. By the same token, it does also constantly remind one that life is indeed very short. This thinking can either work beneficially by making one always try to live in the moment or it can backfire by incubating a ridiculous urge to live life to extremes.

In my case, it did not take more than a few clinical deathbeds prompts to instill a desire to do everything I wanted while I was still young.

I did, in fact, try more than few risky ventures or at least  stupidly , attempting some of them twice; like scuba diving the 130-foot-deep Maracaibo reef in Cozumel with no prior experience, scuba diving an ocean inlet on an outgoing tide, sailing and tipping over a Hobie Cat in a full October gale without a wet suit in 60-degree water, taking psychedelic drugs; smoking hashish, trying cocaine or more than once,  then when I became a House Office, attempting to screw every nurse in sight, without condoms. Damn the V.D. Full speed ahead and fire all the torpedoes.

The second phase of Physical Diagnosis comes in learning to logically format and to then scribe all the elements of a comprehensive approach to diagnosis; Age, Gender identification, Vocation (or not), Chief complaint, Past Significant Medical History, History of Present Illness, List of Medications, Social History, Family History, Surgical History, Allergies, Review of Systems, Physical Examination, Differential Diagnosis, Plan for Diagnostic Testing, and Therapy.

Then one must write a set of Orders to be carried out the actual implementation of the Diagnostic preposition and Care Plan.

At the end of this process I realized I had watched too many doctor shows on television because this was nothing at all like the relatively easy, carefree approach to medicine enjoyed by the likes of Dr. Kildare. It was also not even close to the equally irrelevant focus the actors had on each other, but not on their patients, in the complicated soap opera lives enjoyed by the likes of the cast on General Hospital.

These people spent all their time perusing sex when they weren’t screwing over all their other friends or relatives physically, emotionally or financially; but somehow never seemed to get down to the real business at hand: like taking vital signs and emptying bedpans.

  • Doctor. Your patient in Room 3 has a fever.
  • What was the exact temperature, nurse?
  • I don’t know doctor. But not as high as the hots I have for you.

Nothing at all like that, this new aspect of Medical School, being very difficult, was the first time I doubted my vocation. Unfortunately, it would only be the first of many self-doubting or soul-searching episodes as little did I know how bad things could ultimately be or how humiliating things were about to become.

First, when doing any clinical rotations, the student is expected to wear a shirt and tie, put on a short white jacket that designates the inferior rank of neophyte, as opposed to the long white coat that comes only when rising to the rank of an Attending Physician. One also then must carry around about twenty pounds of ancillary tools in a little black bag, or in the coat pockets of the white jacket, including a stethoscope, ophthalmoscope, reflex hammers, tuning forks, note pads, pens, calipers, EKG rulers and of course the Little Red Book.

I felt like a G.I. going off to battle or as uncomfortable as I was at any time I ever had to put on a tuxedo.

If I had ever thought a Cub Scout uniform was bad, having to dress like a cross between a Bus Boy and a Good Humor Man was nauseatingly stilted and made me feel as though I would be infinitely better off instead standing stiff legged still in front of a drill Sergeant. with a little round wooden dowel shoved up my rear end. Cinch tied like a wild bucking bronco under his first heavy saddle; and saddened by the reality of having to ditch my soft comfortable hippie togs for a suit that made me look like a fumigator, off I trudged to the hallowed halls of the hospital wards.

My first real test in clinical medicine was being rotated to a hospital to examine a patient with liver failure, after which I wrote up the findings per protocol and then presented the case to a proctor in front of a group of five other students.

I thought I had done a pretty good job. The proctor however, did not.

My paper was a monument to how much red ink can actually be held in a ballpoint cartridge and how close a graded paper can come to being a Jackson Pollock masterpiece. I had missed just about everything pertinent: spider angiomas, everted navel, ascitic fluid, liver size in centimeters, rhinophyma, etc.

Then to make matters worse, when I attempted a verbal defense in front of my fellow students, the proctor jumped down my throat like that drill Sergeant would have done anyway, as he proceeded to rip me a brand-new asshole.

If I ever did have that little plug up my butt, this was when it would have hit the ground with a hollow empty thud as my knees turned to jelly and sphincter tone suddenly failed.

He said:

  • Do you know who I am? Do you know who I am? You don’t even know who I am, do you? Well let me tell you, then. I am Dr. Frank Iber, and I am a full Professor of Medicine at Tufts University Medical School. So, when I speak or when I critique; you will remain silent and do nothing but listen and learn. Your examination of that patient was a disgraceful example of incompetence. As such, we shall now proceed to go back to show both you and your fellow students how superficially incompetent your evaluation really was. And when we are all done with that, you will take your paper back home, then you will re-write it, after which you will also memorize the section in DeGowan on all the signs of liver disease for a verbal quiz, which I will administer at my personal discretion.

And so, we did. And so, I did. And so, he did.Bad enough I got the proctor with the bad temper and the inflated ego, but he also happened to be a national expert in Gastrointestinal Diseases who also wrote the textbook section on “The Liver.” I guess then this rotation was both the bait and the trap, eh?

It was stupid of me to have been mollified into assuming everyone was like the jocular, philosophical proctor who taught us all to be HIPPAYs. In retrospect, I guess that professor, with his pleasant affect and his all- forgiving non-offensive mentoring personality must have been a Psychiatrist.

To make matters worse, I really did not know who Dr. Iber was until I looked him up in the school directory, and thus learned a painful lesson about the mysterious hierarchies of the world of Medicine. Some people are, in fact, more important than others and obviously not ashamed to let you know it. Doing background research ahead of time, if nothing else, could have at least ensured me a few ingratiating brownie points.

I was hurt, humiliated, embarrassed, demoralized, angry, and ready to quit school. However, M. propped up my badly bruised ego, having encouraged me by the reassurance that everyone goes through it, and that after the first time it can only get better.

It was just another game that had its own set of rules, with a peculiar set of standards that had to be learned; such as the correct timing for self effacing groveling or the tossing of dust on and over ones bowed, scraping head. Once you know the rules, it becomes infinitely easier to play the game.

I was not so sure, but then again, the alternative would have been meeting a real U.S. Army Drill Sergeant and having to trade in my Little Red Book for a Big Brown Duffle Bag along with a one-way ticket to Southeast Asia.

It did take a while, but I got over it and I did improve.

My roommate M. said it was just like learning to drive. Scary at first, and you might hopefully have only a few minor accidents, or get a few tickets, but after you get the hang of it and learn to play the game, it’s just as easy as learning anything else.

But to me the length and breadth of medical knowledge seemed as insurmountable as a successful climb to the peak of Mount Everest; even with the added benefit of having some extra oxygen canisters on board.

M. also helped with the proactive part of things by proceeding thereafter to point out the best clinical rotations to take in the third year of school as well as the pitfalls of each one, the peculiarities of the proctors, the nice ones, the mean-spirited ones along with all the important signs, symptoms, facts, or trick questions to anticipate as each one came along.

When you come to think of it, the scary thing is that in just over twenty-two months of clinical training, the Medical student goes from the floundering, blubbering naive state I found myself under the hawkish scrutiny of Dr. Iber, to becoming an Intern in a hospital where he or she has the responsibility of making decisions that can mean the difference between life or death.

Because Internships begin in the summer, there is an insider’s facetious mantra in all the academic medical training programs that is unknown and secreted from the general public:             “Just don’t ever get sick in July”

The failsafe here is that the rigid pecking order ensures constant supervision at every level. The Attending supervises the Fellows and the Residents; then the Fellows and the Residents supervise the Interns.

But Interns will always at times find themselves in situations in which the decision to be made must be expeditious and solely his own responsibility. That is when the “Yell for help” becomes the credo of not only the real neophyte; but also of everyone else in the teaching hierarchy.

Then the more he is exposed to disease, dilemmas and disasters, the better trained the physician becomes as he slowly rises to the top of the medical food chain and finally gets to wear that long white coat: Full Attending Physician or Professor of Medicine.

One thing I came to learn for sure was that there is no shame in admitting “I just don’t know” because in Medicine when pride supersedes humility the unintended consequences might be permanent harm or even death. No one in medicine knows everything. But everyone does know something.

And just as is it at the highest levels of any professional performance, there is always someone who is better at something than anyone else is.

Even Tiger Woods could lose and eventually every icon becomes old, tarnished or simply out of date. Just ask Jack Nicklaus what he thinks about that.

At least I got the drift that when finally getting to the top of this academic world, I could still reserve the right to be somewhat nice or pleasant about it; and also learned that compassionate constructive criticism was probably a better way to teach a subordinate than abject self-promoting narcissism.

 

 

 

Ask and it shall be given unto you

Seek and you shall find

There is assurance of salvation

And blessings when you knock

(The Bible. Hebrews 11:6)

 

 

     Jesus:  http://www.carmelwagga.org.au

 

 

 

 

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Medical School: Year Two

Clinical Exposure

Physical Diagnosis is a medical school course that overlaps the conclusion of basic sciences and is given at the end of the second year.

Students are required to buy the “Bible of Physical Signs” other wise aptly known as: Physical Diagnosis, a little red leather covered book by DeGowan and DeGowan, which they are then told to memorize and carry with them in their little black leather bags for the rest of their lives. Memorizing it is easier said than done. After all, it is a Bible and if the Bible itself is all you must memorize, then perhaps over a lifetime you might become successful at regurgitating it.

Just ask Billy Graham, or any other Bible toting evangelist. Pose a question. Receive a parable in return. No real thought required. Problem solved. Or problem only temporarily shelved:

  • Go in peace my son; I know that your life really sucks, but keep praying to God for eternal salvation. Things might seem to be bad right now, but ultimately, they can only get better.
  • But that’s the same thing my stockbroker told me when I lost all my money. Twice.
  • My son. Do not ever confuse the secular world of monetary greed with the promise of joyous everlasting life in the next world.

Unfortunately for physicians, we must memorize a few dozen Bibles, as the solutions to our problems can often be so obscure that even invoking the name of God does not always result in a comforting resolution.

  • After this terminally ill patient finally does rest in peace, we’ll say perpetual Novenas to the Gods of Malpractice that we never get sued.

There is a rigorous approach to the Physical Diagnosis course stressing the basic elements of abnormal physical findings that my instructor boiled down to what he thought would be a jocular contemporary mnemonic to assist us getting through it: HIPPAY; which stands for History, Inspection, Percussion, Palpation, And…. Yell for help!

He thought he was being funny. We thought he was being idiotically insulting. After all, we were the nuclear radiated mutant hippie class, were we not, so why keep rubbing it in?

Medicine is replete with mnemonics that are designed to prompt memory and remain useful cues if they are appropriately applied; but not like the singsong one traditionally used to teach children the alphabet. It took my mother quite some time to force my understanding that LMNOP (ele-mena-pee) does not stand for one single letter or a single-minded desire to evacuate the bladder.

This point illustrates that in learning anything, Rote is not necessarily equivalent to Right, unless logical thought processes use the Rote in the Right way.

For example, using MOST DAMP as the mnemonic cue used to treat the internal drowning of congestive heart failure has a rational application, if it is used with a certain clinical panache. If not overzealousness automatic use of all of these elements may sometimes do more harm than good. Sometimes you only need M&Ms to treat heart failure: a little Merck (Lasix) and a few drams of Morphine.

This was only one of the reasons God invented narcotics and why a leading research Cardiologist at the Columbia–Presbyterian Hospital orientation program gives his first-year Fellows a button to wear on their white coats that reads: Lasix kills. This teaching point being not to treat every patient with a cook-book recipe as opposed to an analytical thought process with subsequent careful medical titration.

P: for Phlebotomy did not even work out very well; when in the Middle Ages leaches were used to bleed patients half to death, having subsequently been abandoned as an ancillary therapy for heart failure.

  • Yes. Once we leach out all his malodorous phlegmons, your husband will hardly be able to speak, much less ever be able to stand up or possibly even walk again. But he will be better.
  • Thank you doctor. I’ve been trying to get him to shut up, sit still and stop chasing after my ass for the last thirty years. I’ll be sure to remember you in his Will.

Mnemonic learning is also helpful in medical training because the body of medical knowledge is so overwhelming. But this method eventually becomes abandoned as clinical experience adds a base of reality testing to rote learning.

Yelling for help is always sound advice for the same reason. One cannot possibly remember everything and so asking a colleague for a consultation or advice or personally consulting text and literature can often be vital. Unfortunately, some egocentric doctors seem to forget this tenet; or worse they sometimes forget that they forgot.

It was amazing as my career in medicine moved along, as to how many colleagues seem to have forgotten that the story a patient tells is about seventy-five percent of the diagnostic battle, the physical exam adds another fifteen percent; and with a good synthesis of both, a seasoned clinician can then direct a limited number of lab tests that should hopefully finish off the job.

That is unless the disease entity is so obscure as to baffle even the best minds, which is why we have places like the Mayo Clinic or other Meccas of academic excellence. When in real doubt: Punt.

It is also unfortunate that many physicians do not care to take the time to listen or do not know how to peel back the onion-skin of the patient’s story to get to the core of the problem. This is a skill that takes years of practice to develop and even more years of practice to ensure that it can be done in a short framework of time.

For the most part, physicians do not have the luxury of the infinite amount of time that Marcus Welby seemed to have when as week after week, not only did he have only one patient to attend, but also found himself purposefully inserting himself into that patient’s personal life and then becoming the family’s best friend.

Better than having a family dog, just go out and get your own personal M.D. and although in real life it simply does not go down like that, some of my patients still think nothing of having me entertain their queries while I am shopping for food or practicing putting.

  • Doctah, doctah. I know you’re relaxing on your day off, but do you think you can take just one tiny little minute to take one eensy little peek at my teensy little new skin rash?
  • Oy vey. As you know, I am not a Dermatologist. But if I were going to guess, it looks to me like it might be case of genital herpes. So, you can put your clothes back on now, then go ahead and pay for your groceries.

Shortcutting the non-essentials is also critical to saving time. For example, when seeing a patient and asking when the chest pain problem first started, one is not interested in retorts that catalogue every action the patient did from birth or tedious monotonous histories such as:

  • I woke up today at 5 a.m. I usually wake up at 4:50 a.m. I knew right then I was in for trouble. Then I had a bagel for breakfast. That’s not what I normally eat. Normally I eat granola and yogurt. Then my coffee pot broke and I need my coffee and my normal food so that I can have my normal bowel movement. If I don’t get my normal bowel movement I know my entire day will be off and I will just be logy and tired and miserable all afternoon or maybe even have to take a nap even though I really don’t want to. So, against my better judgment I gave in and had a Sanka. Then when I finally had my bowel movement, later than I usually like to have it, it wasn’t like the normal one. Usually it is short, fat, tubular, dark and brown, then breaks into pieces and sinks to the bottom of the bowl. This one was long, thin, light and yellowish; about 18 inches total, stayed all in one piece and floated. That was when I knew I was really going to be in for a bad day. So, then I had to get dressed when I normally don’t get dressed and….

Prattling on and on and having nothing to do with the fact that this person is being evaluated for the new onset of chest pain; it took me years of experience to learn how to re-direct a patient’s thought process and expedite getting quickly to the point without being undiplomatic or making the patient feel as though I was rushing them.

  • Why don’t you just think about what’s happening in your case as being bad constipation in your coronary arteries. Now tell me about your chest pain.

Unlike the legal system, in which time, like a running taxi meter is endless, where time also then equates to  money, and additionally where the truth can be hopelessly perverted, ignored or purposefully obfuscated, in Medicine time is of the essence, money is discounted and the truth is the vitally important element that can mean the difference between life or death. I came to believe that the universally appropriate gift for a Law School graduate should be a tie tack shaped as the Infinity Sign.

After all: Time is infinite. And legal time means infinite money.

 

(Reminds me a little bit of the 3-Cs (prior post: Cornflakes, Coffee, and Cunnilingus). Except that now everyone is getting fucked, but no one is getting laid)

As a countervailing issue, in the modern era of medicine there is often too much reliance on the shotgun approach to lab or procedural testing, while too little emphasis is placed on basic logical thinking. Accessibility and availability of advanced technology as well as excessive malpractice litigation has sent the cost of medical care through the roof.

With the fear of the Medical Malpractice legal vultures always circling overhead; on wisps of doubt, as well as the fact that it does not cost a physician anything to order a test, we are now living in the era of medical errors of commission. Lawyers have taught us that if one can think of a test to do, one should simply do it. Meanwhile as always viewing issues from the perspective of Monday morning quarterbacking and self-righteous hindsight they constantly feed off the carrion of imperfect outcomes.

When asked to see some patients in consultation, where the requesting physician has omitted many elements of basic training, including a good history and physical examination as well as a dearth of logic or common sense having been applied to a morass of useless information, I rely on an axiomatic statement taught me by an attending physician who supervised us during those first years of training in physical diagnosis:

  • Ladies and Gentlemen, when all else fails, why don’t we just begin by examining the patient?

However, there is a certain degree of psychic trauma that accompanies the beginning clinical training as the second-year medical student leaves basic book learning behind.

This is a Right of Passage in which rote memorization does not help unless facts can be synthesized, in which introverted, socially isolated intellects actually have to meet, touch and talk to real people disadvantaged by illness and where quantitative analysis breaks down at the level of qualitative evaluation.

It is a time when multiple choice test questions become replaced by a differential diagnosis and when a patient may face the additional problem of dealing with multiple concurrent illnesses. Guessing wrong on this test runs a gamut of far different potentially negative results than only receiving a poor numerical grade.

  • Oops, sorry, it was a really a heart attack and not just a bad case of indigestion.

It is a time when deductive reasoning reigns supreme; but also, when a naïve student begins to develop a personal inventory of logic that only comes with continued experience and clinical exposure. The patient becomes a book that has a limitless number of pages, but a book that also does not have an index or chapter headings.

Every patient becomes a new black box. The student then must logically deduce what is potentially wrong with a person who cannot necessarily explain it well and who may also be covered with dirt, crust, scales, rashes, odors or sometimes even with insects. One also must be able to do it expeditiously; without regard to race, color, creed, personality, sexual identity or personal bias, and preconceptions; not even withstanding the deeper layers of the physical exam than can include a rectal or vaginal probe, or both.

It is a time when the art and science of medicine is a blank palette in a student’s hand and is also a time where the cornerstone of the Hippocratic oath is placed in the foundation of the medical student’s career. But as  with any potential building, some cornerstones and some foundations turn out to be more solid than others.

Being shyly xenophobic to begin with and since I had never even wanted to speak to strangers; much less then even having to touch them, I struggled to overcome the barriers I needed to expeditiously become superficially intimate with perfect strangers in a short period of time.

Medical training requires the ability to become intimate while at the same time maintaining a certain professional barrier that should preclude becoming friends. Because once a doctor truly befriends his patient, he tends to lose the ability to think objectively and thus the serious potential pitfall to provide a disservice.

One of the great failures of medical training programs and a disservice to humanity in general is to guide or to allow the student, Intern, or Resident to enter medical disciplines that do not suit any or all of his individual talents, his personality, or his individual skill sets; as well as failing to inform some of these individuals that they should seek career choices in another discipline altogether.

  • Son. Surgery is not your forte. But you are good with a knife, so you might want to consider a career as a butcher.

It is very hard to do this after a student has come so far and for so very long. But similarly, the mustard of medicine is often very difficult to cut and not every student really gets truly seasoned by the time he graduates.

Some physicians I know who did make it all the way through, unfortunately should have never even been allowed to lay a hand or a scalpel on a cadaver; much less to later lay either of these two tools upon the body or flesh of a live human being.

 

 

Swedish Aphorism

Vhere iss Yorgay?

Yorgay is in da bootcher shop practicin’ to be a doctor.

Vhere den iss Svengay?

Svengay is in da medical school practicin’ to be a bootcher.

Und vhere might den be Ingrid?

Ingrid is in da haystack practicin’ to be  a nurse

(Swedish Aphorism/courtesy of Michael)

 

 

The Battle of the Sexes: Part 2

Physically Speaking

One of the few things a man can truly hold over a woman’s head is the fact that in general, men because of their biology are physically stronger than women. Unfortunately for some abused women, their men like to occasionally give a live demonstration of this physical prowess in ways that result in bruises, broken bones or black and blues.

This fact of biology is why at the professional level in sports, women cannot compete in the same league with men and why there are clear-cut distinctive separations in their organizations: for example, the LPGA, the WNBA and the Women’s Professional Tennis Tour.

There are also some esthetically plain and simple “lack-of-interest” lines that will probably never be crossed, accounting for why we will not likely ever see a woman’s NFL or a female professional baseball league. Even the WNBA basketball is only marginally interesting and close to being a financial bust for its team owners.

People just have an innate penchant to preferring brute male gladiatorial strength.

The only thing that might really fly then would be a Woman’s Professional Mud Wrestling Organization (WPMWO). This is only because of the perversely innate titillation that men seem to relish when seeing half-naked dirt covered women with heaving breasts and visible camel toes duking it out in an ersatz good old-fashioned catfight.

The contrived tennis match between Billy Jean King and Bobby Riggs was a pathetic attempt to show sexual parity in sports; an event just about as interesting as watching water boil. All it revealed was that no matter the gender, given enough disparity in age anyone can beat anyone else at anything.

On that subject, Patrick McEnroe but it bluntly when he said that the number 150th ranked male tennis player could hands-down beat the number one ranked woman’s player, adding that no one would want to watch a match like that anyway, because it would only be boring. 6-love/6-love/6-love, if there even is such a thing as “Love” in tennis matches to begin with.

But promoters will try anything; so much so that the hype surrounding Michelle Wie, dubbing her the ‘Female Tiger Woods,’ and then trying to push her onto the men’s golf tour not only ended in a catastrophic non-event because she could never even make a cut; but one must also wonder how much damage this failed fiasco did to the poor 16-year-old teenager’s psyche. It took years for her to recover.

Even the so-called Champions Senior Golf Tour is barely yawn inspiring because it lacks the cache of youthful vigor; and only highlights a bunch of gray haired stars of yester-year hobbling around on shortened courses.

This is just about as exciting as it would be to watch retired baseball players come back to establish an old-timers league: 70 foot base paths, 200 yard fences and underhand pitching.

But nevertheless, there are still five great equalizers women can always fall back on in the event they are ever assaulted or beaten up by some physically stronger, abusive spouse or lover:

  1. A concussive swat with a good old-fashioned cast iron skillet.
  2. A pot of boiling water poured on the head or crotch.
  3. A head shot with a full swing 9 -iron.
  4. A Lorena Bobbitt circumcision.
  5. A blue-steel .44 magnum bullet between the eyeballs

Tennis anyone?

 

The Battle of the Sexes

The Battle of the Sexes 

The Battle of the Sexes is a theoretical concept applied to the constant strife occurring between the two human genders. But if it were a veritable battle, then by secondary implication it is unlikely there would ever be any successful mating and/or procreation. It is also true there would never be an ultimate gender winner or the world would not continue its proportionately 50/50 gender split after the ensuing onslaught of “gendercide.” A nation of Amazons only exists in romanticized fictional accounts.

This in notwithstanding the fact of how many times you might hear a spouse iterate the phrase:

  • Sometimes, I just feel like killing him/her.

Closer to the truth is because as a species we have evolved with two genders, and because we do hav sex, both for pleasure as well as for reproduction, the terminology “battle” really applies to the fact that women and men essentially must tolerate each other to achieve the means to both of those ends. This of course is no to demean or to degrade the concept of love.

All relationships at any level are either dominant-submissive, co-dominant, or co-submissive, such as that between a boss and an employee, between two business partners, or too exceptionally lazy co-workers. Some relationships are co-dominantly cooperative, whereas others encompass the infinite variations of extremes in the dominant-submissive domains; such as the physically beaten housewife or on the opposite side of the coin, the verbally abused, eternally henpecked husband.

What it really boils down to is that men and women are wired differently at the genetic level such that relationship conflicts a-priory originates in a biologically immutable substrate. Then when personality is layered on top of the genetics; a Pandora’s Box for potential conflict irreversibly opens the window that lets in an eternal contest of wills.

Relationships that work well are those able to achieve satisfactory compromise, whereas those that fail are constantly at war.

Some couples resolve conflict and achieve harmony by compromise, capitulation or just happen to be the rarely encountered phenomenon of “soul-mates.” Some conflicts are only resolved by physically splitting up the warring parties, some resolve by self imposed emotional separations or emotional isolation, and sometimes the final resolution does end with murder.

  • You mean you really meant it when you said you felt like killing me?

The best example of capitulation I can recall was when a man came into my office for a first visit. In the consultation room, his wife answered all his medical questions. When I put him in the exam room by himself and asked him some follow up queries; he told me to wait until he turned his hearing aid on.

I said

  • Do you mean to tell me you didn’t hear one word when I asked your medical history?

He replied:

  • It’s not you, doc. It’s her. Doc, I haven’t heard a word she said in over ten years. I learned a long time ago if I just nod my head up and down every time she opens her mouth that we get along fine. And if you blow my cover, I’ll just have to find another doctor.

To make matters worse, beside gender genetics and variable personalities, one also must take into consideration hormonal factors; with the only thing testosterone, estrogen and progesterone having in common is that they are all organic molecules. Women must deal with male testosterone surges, which despite a male’s massive repositories of maternal mitochondrial DNA, for some reason still cannot be suppressed; while men have to deal with the estrogen/progesterone flux that creates the unpredictable emotional imbalance of the notoriously dreaded monthly PMS; followed a potentially decade long menopause.

In fact, one of the most curious, self fulfilling and self defeating paradoxes about PMS is that even though every month a woman knows it is coming, for some strange reason about a week before it occurs, the hormonal combination in play at that time seems to specifically block the female brain from even remotely thinking about taking any sort of medication that might abort it.

On the flip side, the only way to eliminate testosterone rage rushes would be by castration; which is fine as long as one’s life ambition is to be a limp-dick cherub singing Soprano in the Vatican Choir or some pervert priest’s anal sex slave. Although, yet again, there are undoubtedly not just a few bored, lonely, sexually harassed or just plain pissed off housewives who wouldn’t really mind at all sending their husbands over to the genital guillotine.

My office manger’s husband, Fred, and I once decided we could take care of his wife’s PMS problem like the sedating method used on animals in The Wild Kingdom when laboratory studies or tagging is required. In so “Stalking the PMS Female” we would tag-team by waiting until late at night, then by stealth and cover of darkness creep up, slowly open the bedroom door, throw a piece of chocolate onto the center of the bed to bait the prey. Then when she came out from under the covers to get the chocolate we would shoot her with a Motrin dart fired from a safe distance with a mini-bazooka gun.

  • When I tap you on the helmet, Fred; that means she’s going for the chocolate, so “fire.”

His wife was not amused and had a much simpler answer. She said just bring chocolate home everyday for two weeks starting one week after her period is over, even if she adamantly says she doesn’t want it because she’s feeling bloated and fat.

  • No matter what. I’ll still eat it.

In truth, the only thing that men and women really have in common is that they are both Homo sapiens. The best long-term relationships between men and women, then, are those entirely predicated on friendship and compatibility with the ideal relationship being that occurring between those people who truly find that they are soul mates.

But this is by far the exception to a rule that probably occurs less than 5 percent of the time; if that much; leaving little wonder as to why the U.S. divorce rates consistently hover around fifty percent.

Falling in love is often exceptionally easy to do and even easier to justify as an expedience. Unfortunately, it often then becomes only a flimsy, transparent, poorly thought out excuse for heading into a lifetime of spousal sparring and jousting. Staying in love is the real test; a test that can be made significantly easier if the emotion is conjoined with a few ounces of proactive correct rational thought.

But therein lays the rub. Emotion has nothing to do with logic and ergo the tiresome but sagacious expostulation that “Love is blind.” Why stop there and not add in the “Deaf and Dumb,” too?

The problem is that too many people mistake love for the myriad factors having nothing at all to do with it as an emotion; which can be summarized in part by the following short list of caveats:

Do not mistake sex for love.

Do not mistake money for love.

Do not mistake superficial physical attraction for love.

Do not mistake pity for love.

Do not mistake nostalgia for love.

Worst of all do not fall into the trap of “The Salvation Army Complex;” in which love is mistaken for the ability to save someone from a self-destructive behavior; and then attempt to change them for the better. The latter is why the ex-spouse of an alcoholic will marry another one or the idiotic rationale that the drug addict will change simply because of the juxtaposed angelic aura of the non-addicted partner.

Then there is the “Bonnie and Clyde Syndrome” in which love becomes linked to societal rebellion, accounting for why some women are especially prone to fall in love with bad boy criminals who ruin their lives or help them make their way to jail alongside them. Or also why some men believe that women of notorious sexual reputation, proclivities or persuasion will bring them the bliss they feel to be missing at home.

Nearly everyone is also aware of at least one situation in which: the rich old codger who in either denying his own mortality or in flaunting his wealth hunts down a trophy bride; that gold digging woman who marries the old coot while she alternates having illicit sexual liaisons with prayers for his expedited death. This is akin to the self-centered pedagogue who props up his insecure ego by wedding the Pygmalion student; the father who marries someone who reminds him of his daughter or vice versa; or the middle aged female Cougar who attempts to retrieve her evaporating youth in the arms of the pseudo-flattering sexual boy toy.

I can speak with a certain authority on this subject because I have violated just about every one of my own caveats. And even though I think I finally got it right when I married my second wife; when we do have a fight, which gets me really pissed off, I all but abandon rational thought by boiling the problem down to the emotionally simple irrational fact that no matter what:

Women just simply do not at all think the same way that normal people do.

My misogynist loan shark friend was less kind in his view of the Battle of the Sexes and put it in a simpler nutshell when he would opine that there is one rule in life that he could absolutely guarantee is a rule without a single exception:

If it has tits or tires you are inevitably going to have trouble with it.

That certainly may be true. But it still does not explain the other countervailing but paradoxically axiomatic truth that given enough time overall, women always seem to win the battle of emotional attrition and consistently wind up getting just whatever it is that they ever seem to want.

That is because they go by another rule without exception:

  • If you can’t nag them to death, drop back, assume the fetal position, start to cry and then if that doesn’t work either, no matter what else, just say ‘no’ to sex. 

 

 

 

Let us put men and women together

See which one is smarter

Some say men, but I say no

The women got the men like a puppet show

It ain’t me, but the people who say

The men are leading the women astray

But I say that the women today

Are smarter than the men in every way

That’s right, the women are smarter

That’s right, the women are smarter

That’s right, the women are smarter

The women are smarter than the men today

(Norman Span)

(Cartoon/ Unknown artist: may violate copyrights)

A facetious look at the genetic difference between Men and Women

The Shopping Gene 

Women (XX) have more DNA than men (XY), which is probably why women so often feel there is something considerably lacking in their male counterparts; especially so when it comes to boyfriends or husbands.

This is because there is more genetic material in the little extra leg on the X chromosome than in the Y chromosome.

Paradoxically, however, from a mother’s point of view, sons fall into a specially exempted category of male: the Favorite.

As a countervailing argument, men could claim that it is all this extra genetic material that makes women tend to drive them up the wall and equally why men will never be able to completely understand them.

Again however, many daughters are also exempted by the special rules that apply to being: Daddy’s Little Girl.

I used to tell my office manger that all the things causing men to complain about the female gender is located on that unbalanced extra leg of the second X chromosome, a place where we can always look to find such things as:

  • X: I need to go shopping.
  • Y: Again? But you just went yesterday.
  • X: My clothes still don’t match

 

  • X: Here’s your list of chores.
  • Y: More?

 

  • X: Why won’t you ever go shopping with me?
  • Y: I have too many chores

 

  • X: We need a bigger house.
  • Y: Why? You hate to clean this one.
  • X: Then we’ll have to get a maid.

 

  • X: Let’s re-paint the bathroom.
  • Y: Again?

 

  • X: Let’s re-paint the bathroom
  • Y: You mean today?

 

  • X: We need another vacation.
  • Y: What? We didn’t even unpack yet from the last one.

 

  •  X: My mother is coming over for dinner.
    • Y: Again? But she was just here yesterday.
    • X: You hate my mother and I hate you for hating her.
    • Y: Not really. It’s just like an additive drug. Small doses are always OK. Not over doses.

 

  •    X:  I need a new car.
    • Y: Why?
    • X: I just wrecked the new one.
    • Y: Again?
    • X: You didn’t even ask if I was hurt.
    • Y: Obviously not.
    • X: You could care less. You even love your dog more than you love me.
    • Y:  You bought the dog, then told me it would be not only be therapeutic for my depression, but it would always be “Ours to keep and love forever.” Capital O.

• X: I need some new shoes.
• Y: Fifty pairs aren’t enough?
• X: Yes. But none of them match my new clothes

• X: But you just played golf yesterday.
• Y: Uh oh. Hand over the chores list.

• X: Not tonight. I have a headache.
• Y: Again? You just had one yesterday.
• X: You already know they can last for weeks

• X: What do you mean, what do I mean?
• Y: Uh oh.

• X: Do we have any chocolate?
• Y: Uh oh.
• X: Why did you say that? Uh oh. It drives me crazy.
• Y: Because Choc-o-late is how I spell PMS

She told me this was a completely misogynist view of the world, that there was definitely something lacking all right, but only in my logic and not in the lost piece of Y DNA. Then, because we just had a patient cancellation, she suggested I should take her out to lunch.

She said the restaurant with the double chocolate mousse cake would do just fine.

Realizing my timing was not in synch with the female lunar cycle, which on certain specific days will automatically relegate humor to the back burner; in quickly absorbing the hint that it had been my misfortune to pick the wrong day of that particular month to test out my new theory, I mustered a cheesy little smile and said;

  • OK. And I’ll drive too.

 

 

Too much                                       Too little

 

Too late

 

© Queens University of Charlotte
http;//campus.queens.edu/faculty/jannr/Genetics/sexLinkage/.htm

 

 

The Genetics of our Founding Father

Our Founding Father 

Women participating in the U.S. female liberation movement always deplore the macho or masculine undercurrents attached to our western ways of thinking.

After all, it is a man’s world, is it not? However, there are two things that might make them feel better: Taking a hard look at Radical Muslim treatment of women instead; and boning up on several unique facts about human genetics.

First, even though it is the male sperm that determines gender, it is the female of the species that determines whether one has sex in the first place. If a woman is not interested, there is no way in hell you will ever be able to get into her pants; unless by brute force; which happens to be a felony.

Secondly, all of us have only maternal DNA in our mitochondria, the small intracellular particles that house the engines that drive cellular metabolism. This means we can all trace ourselves back to the ‘original mother,’ Eve, so like it or not, we all have a huge genetic repository that should make it infinitely easier for men to identify with their feminine side. So, it’s O.K. guys. When those feminine urges sometimes overpower your thinking, you don’t have to keep fighting them off. And yes, it is even all right to occasionally cry.

Third; female eggs (X) control fertility, while male sperm (X or Y) controls gender. XY is a male and XX is a female. XXY can exist, but YY cannot.

The chromosomal pattern of YY is not genetically possible which is fortunate for all of us then, because this guy would undoubtedly be a real prick, or possibly just have two of them.

  • Mommy, why does Johnny’s head look like a banana?
  • How many times do I have to tell you he’s one of those psychotic in-bred peckerheads?

Last, but not least, George Washington, is felt to have had Klinefelter’s Syndrome, a genetic anomaly that gave him a chromosomal pattern of XXY.

This pattern results in a large, round, soft, effeminate looking male with smooth skin, little facial hair, large breasts, and a small penis attached to shrunken infertile testicles; all of which may account for why Washington never had children. The overall appearance of a Klinefelter victim roughly resembles that of the Pillsbury Doughboy.

This genetic mishap may also account for Washington’s well balanced, undistracted thinking and why his even-handed temperament prevailed as he provided inspiration during the darkest days of the American Revolution.

He did not have to worry too much about sexual urges with their proclivity to impulsive action, and unlike Santa Anna, was not likely to have been caught off guard in  Sam Houston’s ambush while being cavalierly distracted with his pants down, bedding a mixed-race slave girl.

Washington rather, probably spent the winter at Valley Forge curled up with a good book.

Perhaps then, and because there is a modern wave of philosophy dedicated to correctly, or to  incorrectly revise history or in general to debunk the mythology of history, it would not be entirely inappropriate to begin the modern history of the United States by proposing that George Washington was not only the Father of his country, but that he was also its Mother as well.

XXY

Poor George. The big gun works fine but the little one only shoots blanks

Portrait from Lee Family digital archive
www.leearchive.info/rel/index/html

 

The Strange Prophecy of Tiger Woods

A Strange Prophecy 

I took golf lessons over a period of years from a teaching professional, Bob Joyce, whose family has a great legacy in the game; including the fact that his brother played on tour.

In 1997, early in Tiger Woods career, after he had just won his first Master’s Tournament, I was being tutored on the driving range when I paused to ask Bob:

  • So, looks as though Tiger may turn out to be the greatest player ever. Might even surpass Nicklaus. What could possibly stand in his way?
  • Two things. First, because his swing is so torqued and ferocious, he might injure his back. In fact, that’s probably why he only plays about 26 events a year. Needs to give it a rest.
  • What else, then?

Bob stepped back, made a small circular tunnel with his left hand, then poked his right middle finger in and out of the ersatz vagina as he simultaneously said:

  • Pussy

He was partially wrong about the first orthopedic disability, which turned out to be his left knee; before the back soon followed.

He was also dead wrong by not using the plural of the vernacular female anatomical descriptor.

Tiger Woods and Racial Bias

Tiger Woods 

Tiger Woods is one of the best athletes in modern history. This is despite the fact of many  people finding it hard to believe that hitting a small white stationary ball with a long stick requires any talent whatsoever.

If you happen to be one of those individuals who do not believe golf  to be the most difficult game on earth, try it yourself. The game has simply too many subcomponents to be easily mastered.

In fact, professional golfers have been proven to have the best eye-hand coordination of any other elite athletes; a bet you will surely lose if you gamble over sports trivia and do not know this fact. Tennis players and major league batters come in as close seconds. One sure bet however would be to lay odds that a soccer player wins eye-foot coordination “hands down,” so to speak. Thus, don’t pick the Olympic ice skater as your final answer to that query.

Tiger Woods also happens to be one of the most racially complex individuals to have gained modern notoriety as his mixture is one fourth each: Chinese, Thai, and Afro-American then one eighth each: Dutch (yes, White), and American Indian.

Early in his golf career, because of naïve stupidity, Woods suffered abusive insults from spectators who could not accept the fact that a person of color was breaking down the barriers of the last bastion of the White Man’s recreational sporting domain. Bigots in the galleries would call him “nigger” and occasionally threaten his life.

What could possibly happen next after all, if non-Whites started playing golf? The next horrifying thing would be them clambering to join private clubs or possibly worse, applying to colleges like Harvard University. Quell domage! It would be the absolute end to White culture, as we know it.

These same people who were pre-biased, being not remotely curious enough to discover the truth, were unaware that Tiger himself, in never even claiming the Afro-American as being his own, not only referred to himself instead as being “Cablinasian,” but then went on to marry a white woman of Dutch South African ancestry. Ironic, is it not that she descended from the same jolly lot that brought us the fabulous concept of Apartheid?

In professional sports, the extreme of retrenched recidivistic bias was exemplified by the fact that baseball started out with segregated Negro leagues.

Even in the modern era, the NFL refused to allow the Super Bowl to take place in Arizona until that state formally recognized Martin Luther King Day as a holiday while the USGA had to firmly refuse to allow The Shinnecock Golf Club to host the club’s first Open in 1987 until it agreed to admit at least one black member. Arizona, being the last state in the union to do so, reluctantly capitulated and sanctioned the holiday, as did Shinnecock, which in admitting a wealthy black man living somewhere in the south, knew he would not be too likely to travel north and pollute the hallowed grounds with his actual physical presence.

Even bigotry, I guess can be bought off if the cost is too high or if the price is right. That is Super Bowl football and Men’s U.S. Golf Open = Megabucks.

The real irony about Shinnecock is that the club is named after a local Indian tribe that originally owned the land it is on, but which also succumbed to the same fate of piracy, genocide and germicide that laid waste the rest of Native Americans. In the case of the Shinnecocks, there was additional attrition because so many of the tribe’s men were lost at sea in the whaling days of the 1800s, that local black slaves took their places and married the widowed squaws; because no one else would have them.

When we were kids we sniggered as we referred to them Nindians. Then as a final insult, the golf club did allow the tribe to participate, but only as being grounds workers and greens keepers. As a descendent Shinnecock you could work under the club logo and banner of a cameo Chief in a headdress bonnet, but you could never be considered as a potential member.

 

Geneticists are quite a bit more practical. They happen to know that the greater the genetic variability in a species, the less likelihood there is for unfavorable mutations and conversely the more likelihood for those favorable ones.

Also, the farther apart genetically, the less likelihood there is for unfavorable dominant or recessive characteristics to filter down in progeny. Ashkenazi Jews, whose entire ancestral DNA can be traced back to only four women, are, for example, particularly susceptible to about 15 genetic metabolic catastrophes or disease susceptibilities, such as Gaucher’s, Tay-Sachs, Ulcerative colitis, and the Niemann-Pick disorder.

Tiger Woods then, exemplifies the fact that human racial admixture is not necessarily the horrible mephitic, pestilential human catastrophe portrayed in the propagandist annals of viperous American White Supremacists.

In fact, I defy anyone to prove to some small degree that they are not remotely racially polluted and therefore genetically as pure as the driven snow. I am sure there is some degree of mutt or mulatto in all of us just as I also defy anyone to walk up to Tiger Woods today and tell him to his face that he is nothing more than just a common “nigger.” Just the opposite, in fact now anywhere he plays, instead of bigoted jeers, he always receives enormous accolades because skill trumps bigotry.

Yet there always seems to be at least one congenital idiot near the tee box , usually an obnoxious inebriated Caucasian, who feels compelled to shout just as the ball leaves the driver: “You’re the man.” This person is also consanguineously related to the same morons at every tee or green who can’t let any shot go by, whether it is a drive on a 600-yard par five or a forty-foot putt, without screaming: “Get in the hole.”

Although I am not necessarily advocating human interracial breeding, it is interesting to postulate how much better off or possibly even superior the human stock would be, how similar we all might look, and especially how much less hatred would result from a little more genetic mixing. It is interesting to postulate exactly what a racially balanced, genetically blended human being might look like. Not too shabby, would be my guess.

In fact, I find it ironic that having lived in an era when some of my classmates in grade school quietly derided blacks for the color of their skin or the size of their lips that now the year-round sun tan and silicone lip implants have become the current standard for Caucasian beauty.

Contrary in fact to what Hitler believed, the human superman then would be derived not from a limited interbred line of highly selected Aryans, who would eventually succumb to inbred genetic problems like those encountered by the Ashkenazi, but rather would derive from a perfect blend of all the available human DNA on planet earth.

 

Better yet: does it really matter?

 

Shinnecock Golf Club logo http://www.ecrewportal.com
© Scintific American: Cover December 2003

The Genetics of Bigotry

The Genetics of Bigotry 

Here is a good illustration of how bigotry operates at the genetic level.

When Spain conquered Mexico there were three races that came into play: Indigenous Indian, European Caucasian, and a few Negro slaves brought along by the Conquistadors. Later in time a few Chinese got snuck into the mix as well.

In general, and although to this day there remain intact gene pools in all three racial blood lines, there was enough interbreeding over the next twenty generations after the conquest to have created four large groups of people living in the country; distributed on a statistical basis as follows;

Caucasian:     9%

Mestizo:       60%

Indian:         30%

Other:             1%

Mestizos is the term applicable to any admixture of Caucasian with Indian; or throw in a little Negro here and there if you so desire, and you get a factor that really confounds the whole schemata.

Also generally speaking, it is the Caucasian Mexicans as descendants of Aragon and Castilian Spaniards, who own, control and rule the country. Thus, whereas the Mestizo largely makes up the working class, the 10 million or so Indians, who originally owned the land are largely consigned to being impoverished.

This makes the social hierarchy like the Communist model in which there is a very small ruling elite, a large slave labor pool, and then those who are expendable.

Therefore, it was an ignominious fate if your Caucasian ancestor, probably a rutting male, had sex with your Indian ancestor, accounting for why you now have to work for a living. However, this is not nearly as bad as if he had not so procreated because then you would be pure Indian and have nothing at all; not even a job.

In this social structure, you would even be better off if you happened to have a little black slave blood.

Based on the percentages it appears that either there must have a lot of rutting; or in the purely practical terms; if being a Spanish soldier so far away from Aragon, for such a long time, and even though your own mother back home would hardly approve, the rule of the day would undoubtedly have been “any port in a storm.”

Trust me on this one, even the most extremely bigoted white supremacist would probably take a black woman to bed, if after a nuclear holocaust, she happened to be the only female left on earth. Adam and Yvonne.

And although the general term that applied to this White, Indian and Black admixing hybridization came to be known as “mulato” or “little mule,” it is still the case that in the generic category of mulato there are yet perhaps as many as thirteen further subdivisions based on how much of what mix you happen to have as well as sometimes whether the mixing came from your father or your mother.

  • Peninsular (gachupin): Spanish-Spanish; both parents born in Spain
  • Criollo (Espanol): Spanish-Spanish; lower status; one parent born in Mexico
  • Limpio (clean origin): Both parents Spanish but cannot be proved
  • Mestizo: Spanish-Indian
  • Mulato: Spanish-Negro
  • Coyote: Mulato-Indian
  • Calpamulato: Indain-Mulato
  • Zambo grifo: Mulato-Negro
  • Galfarro: Negro-Mulato
  • Zambaigo: Indian-Chinese
  • Cambujo: Chinese-Indian
  • Lobo (wolf): Indian-Negro
  • Zambo (lascivious monkey): Negro-Indian; ergo little black Sambo

With dogs, it’s considerably easier.

If not a thoroughbred of any kind, you simply become a “mutt.”

Texans in the 1800s also had a simpler nomenclature. For example, a person who is one-eighth Indian or Negro would be known as an Octoroon, and would have such light skin color as well as such other Caucasian attributes as to possibly pass off in the highest castes of Mexican society.

But for the most part currently, the Mexican social system is a rigidly hierarchical one creating the many social and economic boundaries that cannot be crossed among the various castes.

This is not as bad as in India, however, where a truly rigid caste system exists and the where the quintessential height of genetic bigotry places its bottom dwellers in the relatively insulting group known as “Untouchables.”

  • But how do they mate, then, if they cannot touch or be touched?
  • That’s the point. We don’t want them to.

 

                      

Better                                                            Worse

In Mexico, being not the least bit ashamed of showing rank and reminding you of your exact place in the social hierarchy, they even paint it on the walls.