Dénouement

The saying goes, "ontogeny recapitulates phylogeny" and it is within the context of this complex biologic process that all is made clear and the sequence of life becomes a fully realized entity. Humans are, after all are a product of all the elements, chemicals and influences that have occurred in our lives. Our abilities, our weaknesses, our inspirations and the forces that plot our downfall and demise are wrapped up in a giant primordial stew of events and subplots that help mold and shape us and then follow our course through life to continue the process minute by minute until the very end.

Philosophy is not my strong suit but I can appreciate the applications of this phrase as I sit in front of my patients charts, trying to sort out my daily decisions for their health and safety. Medicine as a science and the daily practice of patient care commits a doctor to a life of endless decisions, the assumption of often agonizing risk and the constant need to plot solutions, redefine boundaries and negotiate skillful contracts and detailed instructions with patients. A doctor cannot practice medicine simply by decree or by force of will. There are too many elements to the patient's story and there are too many forces that are at work that impact on the successful outcome of a treatment strategy. If ontogeny really is the process that an organism passes through to achieve it's evolution then our human story and the final dénouement are also part of that process. It is the job of the physician to steward that journey to a successful outcome.

The theory of recapitulation, also called 'the biogenetic law' or 'embryological parallelism', and often expressed as ontogeny recapitulates phylogeny, was put forward by Étienne Serres in 1824–26 as what became known as the "Meckel-Serres Law" which attempted to provide a link between comparative embryology and a "pattern of unification" in the organic world. In 1866, the German zoologist Ernst Haeckel proposed that the embryonal development of an individual organism (its ontogeny) followed the same path as the evolutionary history of its species (its phylogeny).

Reference: Wickepedia

de·noue·ment (also dé·noue·ment)
a. The final resolution or clarification of a dramatic or narrative plot.
b. The events following the climax of a drama or novel in which such a resolution or clarification takes place.
2. The outcome of a sequence of events; the end result.

The Blond Goddess

I was just reading the obituary of the most famous female bullfighter in the world. Conchita Cintron lived from 1922-2009. She fought professionally and won legions of fans all over the world for her bravery and skill. Her legend was established when, in 1940, she was gored in Guadalajara, Mexico and collapsed. She was carried unconcious to the infirmary where she subsequently regained conciousness and returned to the bull ring, killed the bull and then collapsed again in the ring. Cintron was nicknamed, la Diosa Rubia (the Blond Goddess) and enjoyed a storied career before retiring at age 27 to Portugal to live with her husband.

Bullfighting is a sport that, in its pure form is truly dangerous and sometimes costs the bullfighters their lives. The sport pits the bulls against the human matadore (or matadora) in a death struggle on foot (as in the Spanish style) or horseback (as in the Portugese tradition). Cintron died of a heart attack last week.

Reference: The Week, March 6, 2009

Pilot Fish

Wherever you see people who seem to break away from the pack you will find the sneaky, opportunistic 'pilot fish'. If you are Barak Obama, Oprah Winfrey, Angelina Jolie or Warren Buffett then the swarms of pilot fish are endless. If you are the recently unemployed, George W. Bush then the pilot fish have moved on.

Ponzi investment schemes, shopping sales and traffic patterns all rely on our innate biological survival mechanisms help us to navigate in the midst of chaos. Pilot fish can quickly turn into a herd and are sometimes investors, sometimes homemakers and, in times of great economic or political hardship they are the unemployed and displaced who will migrate far and wide looking for work. People who watch the Home Shopping Network or live to strike it rich on eBay or the Antique Roadshow exhibit a herd mentality. When a person hits the lottery at a local convenience market, this triggers a rush by the other gamblers to gravitate to that shop in hopes of striking it rich. When my patients decide to stop their medication on their own because their postman told them of a 'better' medication their great aunt was on, these people are just following their instincts. The pilot fish is veering off to find a new herd.

Being a pilot fish is human nature. We humans survive better, live longer and happier lives if we take notice of what others are doing and follow their lead. In the case of taking medication, however, it is not always the person at the sales counter, the blogger from Arkansas or the lady in line at the bank who should lead the pack.

Bodysurfing Medical Research

Bodysurfing is a previously unresearched temporary cure for seasonal allergies. Some day in the spring when your allergies are killing you, try going to your local break and rip out a few waves. All the collected allergens in your hair and skin will be power washed off and your nose will be completely ripped out with the worlds most invigorating salt water rinse. Allergies gone!

Other cures found while engaged in the sport of body surfing include; a cure for boredom, a cure for aggravation, and a cure for lethargy. You do need to be a little careful of broken bones, teeth and sprained backs not to mention drowning (a bit) but these trifles are barely worth mentioning as you put your life, soul and body back into shape riding a wave to the beach.

There is a new bodysurfing magazine at http://bodysurfing.com.au/.
For those of us who love bodysurfing there is a great blog about the sport at http://bodysurfnow.blogspot.com/.

Photo: Greg Deets

"That's the fact, Jack!"

Colonel: "Soldier, do you mean to tell me that you finished your Basic Training on your own?"

Winger: "That's the fact, Jack!"

Stripes - 1981

Our movies and stories are stocked to the rafters with anti heroes. Anti heroes are people who, in spite of themselves seem to be able to pull off some sort of near miracle against all the odds. We love anti heros in our country. Our founding fathers were all anti heroes.

Steve Martin, Bill Murray, Adam Sandler, Buster Keaton, Laurel and Hardy, Charlie Chaplin and hundreds of other actors told us stories on the screen that allowed us to hope that someday, we too could save the girl, kung fu the bad guy and drive off in the Maserati with all the cash.

The next time you are looking for someone to emulate, you do not have to look farther than your own children, your spouse or co workers. The anti hero lives in all of us. We may not make it to the silver screen and probably no one will come up to us to shake our hands or slap our backs for a job well done. There are not many ticker tape parades for the every day anti hero anymore. My suggestion is to keep looking for ways to help an elderly person in your town, praise your kids a little more for their every day accomplishments and bring a surprise bouquet of roses home for your wife (who had a tough day too). You will get that warm, fuzzy 'anti hero' glow just like they do in the movies. In that moment, you will have become a better hero than of any of Hollywood's characters.

Labradoodle-palooza

Our neighbors have a very friendly but odd looking dog. Apparently, the labradoodle is a popular breed to own. The dog was very cute when it was a puppy but now that it is a tall dog it looks....strange. The hair appears coiffed and fluffed even though the dog has not been groomed. The dog seems to bounce all over the yard instead of just run. When deer amble through the yard, the labradoodle throws it's tongue out and springs up as if to say, "Hey guys, wait up!" The dog appears somewhat embarasses by itself sometimes and I often wonder if it is lonely watching all the other regular dogs walk by in the neighborhood. The labradoodle is very social and outgoing. This dog needs friends. Lots of friends.

My neighbors own an event planning business and would be perfect to host the first informal gathering for dogs and their owners. We have a Folk Festival in town along with the Newport Jazz Festival every summer. Why not a arrange little Woodstock for dogs? A Labradoodle-palooza would be great! Kids, soda, popcorn, dogs, music and...oh yeah...poop. Lots of poop.

Forget it.

Bud

Many of my patients come to the office and ask me to put them on antibiotics early in their illness before it becomes worse. These patients will always say the phrase, "I want to nip it in the butt."

Just to set the record straight, the phrase is, 'nip it in the bud.' This is a horticulture metaphore that indicates that we are trying to stop something that may develop into something else before it has time to blossom.

Nipping something or someone in the 'butt' is more of an animal husbandry metaphore or plastic surgery metaphore.

On second thoughts lets just skip all these metaphores to save time and just get right to the symptoms!