Private Parts

Possible prostate findings to feel for in the rectum.

Today we learned how to perform the genito-urinary exam. I was thankful that our afternoon began with a perspective-setting commentary from one of our faculty who pointed out that the day you learn to examine someone's penis, vagina, or rectum is one of those profound days in a life of medicine when you realize you are doing something very different than most other people in the world. How to feel a testicle without squeezing it too hard, how to perform a pap smear, how to insert your finger into the rectum to palpate the prostate; these tasks are about as visceral as it gets, and require both intimacy and calm detachment.

Indeed, in learning to handle the private parts of strangers, there seemed to be an interesting mix of emphases. On the one hand, confidence is paramount. One of my favorite quotes is that "it's hard to lead a cavalry charge if you think you look funny on a horse." Likewise, it's hard to examine a vagina or a penis and make the patient comfortable if you are sweating bullets and are visibly horrifically uncomfortable yourself. The patient must believe in you and they can only believe in you if by all appearances you seem to believe in yourself.

On the other hand, this is no time for cocksure behavior. The private parts are no realm for assumptions about your competence or calming presence. It is no time for assuming you know how the patient is feeling or for falsely believing enough perfect grace will extinguish their fear or discomfort. 

Thus, as much as confidence was emphasized, so too was humility. Always finding ways to keep the patient as covered as possible, always working the hands slowly from a place of comfort first before you arrive at a territory of primal sensitivity, always warming your speculum, always checking to see if the patient is doing alright; these imperatives remind you that as much as you try to detach and focus on palpating the private parts before you like it's your job (it is), you are dealing with human beings who feel, fear, love, cry, hope, think and worry as deeply as you do.

Einstein's Philosophy

Einstein wrote a beautiful 1000-word life philosophy that was published in 1931. His passion for a life centered around altruism, simplicity, awe, humility and science shine through. I like to re-visit it when I can. I thought of it tonight when I overheard some classmates worrying about declining salaries.

Here it is in full, with bolding of parts I like:

Einstein, Albert in Living Philosophies Simon and Schuster, New York 1931
Strange is our situation here upon earth. Each of us comes for a short visit, not knowing why, yet sometimes seeming to divine a purpose. 

From the standpoint of daily life, however, there is one thing we do know: that man is here for the sake of other men —above all for those upon whose smile and well-being our own happiness depends, and also for the countless unknown souls with whose fate we are connected by a bond of sympathy. Many times a day I realize how much my own outer and inner life is built upon the labors of my fellowmen, both living and dead, and how earnestly I must exert myself in order to give in return as much as I have received. My peace of mind is often troubled by the depressing sense that I have borrowed too heavily from the work of other men. 

I do not believe we can have any freedom at all in the philosophical sense, for we act not only under external compulsion but also by inner necessity. Schopenhauer’s saying— “A man can surely do what he wills to do, but he cannot determine what he wills”—impressed itself upon me in youth and has always consoled me when I have witnessed or suffered life’s hardships. This conviction is a perpetual breeder of tolerance, for it does not allow us to take ourselves or others too seriously; it makes rather for a sense of humor. 

To ponder interminably over the reason for one’s own existence or the meaning of life in general seems to me, from an objective point of view, to be sheer folly. And yet everyone holds certain ideals by which he guides his aspiration and his judgment. The ideals which have always shone before me and filled me with the joy of living are goodness, beauty, and truth. To make a goal of comfort or happiness has never appealed to me; a system of ethics built on this basis would be sufficient only for a herd of cattle. 

Without the sense of collaborating with like-minded beings in the pursuit of the ever unattainable in art and scientific research, my life would have been empty. Ever since childhood I have scorned the commonplace limits so often set upon human ambition. Possessions, outward success, publicity, luxury—to me these have always been contemptible. I believe that a simple and unassuming manner of life is best for everyone, best both for the body and the mind. 

My passionate interest in social justice and social responsibility has always stood in curious contrast to a marked lack of desire for direct association with men and women. I am a horse for single harness, not cut out for tandem or team work. I have never belonged wholeheartedly to country or state, to my circle of friends, or even to my own family. These ties have always been accompanied by a vague aloofness, and the wish to withdraw into myself increases with the years. 

Such isolation is sometimes bitter, but I do not regret being cut off from the understanding and sympathy of other men. I lose something by it, to be sure, but I am compensated for it in being rendered independent of the customs, opinions, and prejudices of others, and am not tempted to rest my peace of mind upon such shifting foundations. 

My political ideal is democracy. Everyone should be respected as an individual, but no one idolized. It is an irony of fate that I should have been showered with so much uncalled for and unmerited admiration and esteem. Perhaps this adulation springs from the unfulfilled wish of the multitude to comprehend the few ideas which I, with my weak powers, have advanced. 

Full well do I know that in order to attain any definite goal it is imperative that one person should do the thinking and commanding and carry most of the responsibility. But those who are led should not be driven, and they should be allowed to choose their leader. 

It seems to me that the distinctions separating the social classes are false; in the last analysis they rest on force. I am convinced that degeneracy follows every autocratic system of violence, for violence inevitably attracts moral inferiors. Time has proved that illustrious tyrants are succeeded by scoundrels. 

For this reason I have always been passionately opposed to such regimes as exist in Russia and Italy today. The thing which has discredited the European forms of democracy is not the basic theory of democracy itself, which some say is at fault, but the instability of our political leadership, as well as the impersonal character of party alignments. 

I believe that those in the United States have hit upon the right idea. A President is chosen for a reasonable length of time and enough power is given him to acquit himself properly of his responsibilities. In the German Government, on the other hand, I like the state’s more extensive care of the individual when he is ill or unemployed. What is truly valuable in our bustle of life is not the nation, I should say, but the creative and impressionable individuality, the personality —he who produces the noble and sublime while the common herd remains dull in thought and insensible in feeling.
This subject brings me to that vilest offspring of the herd mind—the odious militia. The man who enjoys marching in line and file to the strains of music falls below my contempt; he received his great brain by mistake—the spinal cord would have been amply sufficient. This heroism at command, this senseless violence, this accursed bombast of patriotism—how intensely I despise them! War is low and despicable, and I had rather be smitten to shreds than participate in such doings.Such a stain on humanity should be erased without delay. I think well enough of human nature to believe that it would have been wiped out long ago had not the common sense of nations been systematically corrupted through school and press for business and political reasons. 

The most beautiful thing we can experience is the mysterious. It is the source of all true art and science. He to whom this emotion is a stranger, who can no longer pause to wonder and stand rapt in awe, is as good as dead: his eyes are closed. This insight into the mystery of life, coupled though it be with fear, has also given rise to religion. To know that what is impenetrable to us really exists, manifesting itself as the highest wisdom and the most radiant beauty which our dull faculties can comprehend only in their most primitive forms— this knowledge, this feeling, is at the center of true religiousness. In this sense, and in this sense only, I belong in the ranks of devoutly religious men. 

I cannot imagine a God who rewards and punishes the objects of his creation, whose purposes are modeled after our own—a God, in short, who is but a reflection of human frailty. Neither can I believe that the individual survives the death of his body, although feeble souls harbor such thoughts through fear or ridiculous egotism. 

It is enough for me to contemplate the mystery of conscious life perpetuating itself through all eternity, to reflect upon the marvelous structure of the universe which we can dimly perceive, and to try humbly to comprehend even an infinitesimal part of the intelligence manifested in nature.

Dimming the Lights and Enjoying the Ordinary

Who's crazier: ancient humans drawing gods they could not see or us medical students diligently drawing molecules that we trust, in faith, exist just as we have been told?

So we are about to start our fifth of six intense weeks of physiology. Despite the pass/fail system at HMS, our class has worked itself up into a bit of a frenzy in its attempt to learn the absurd amount of new material we get each day. Thankfully, everyone was at least able to relax a little bit this weekend after our test on renal and gastrointestinal physiology.

For the biweekly exam, we are given a complicated case at 3:30pm the day before and have to try to understand everything going on with it before we sit down to be tested at 11:30am the next morning. It's crazy to think that even with everyone working together in various groups there is still often mass confusion on some of the more complex aspects of the case. Nonetheless, it is an exciting process to unravel the molecular underpinnings of a man's epic battle with diarrhea and to try to answer terribly specific questions about his electrolyte levels on a one hour exam. I suppose it is good practice for a future in medicine in which even collectively we do not always know the answers.

To say the least, in extremely busy times, I've found it's definitely hard to find the hours, energy and resources to do much of anything too exciting. Mental health begins to bank ever more on staying connected with friends and extracting the  little bit of juice that you can out of life's everyday events. On that note, here's a fairly ordinary study that -- even if not too rigorous scientifically -- I found somewhat relevant to getting through these monotonous, intense, but perhaps as I will someday view them, wonderful times...

In short, the authors found that ordinary experiences may make us happier as we get older. Reflecting on life events, younger people put much more value on the extraordinary, whereas the elderly take greater satisfaction in everyday happenings.

"Younger people, who view their future as extensive, gain more happiness from extraordinary experiences; however, ordinary experiences become increasingly associated with happiness as people get older, such that they produce as much happiness as extraordinary experiences when individuals have limited time remaining. Self-definition drives these effects: although extraordinary experiences are self-defining throughout one’s life span, as people get older they increasingly define themselves by the ordinary experiences that comprise their daily lives."

-- JCR: Happiness from Ordinary and Extraordinary Experiences

I want to continue to try to enjoy the little things as much as possible, like getting my coffee and daily smile from Francene, the beautiful motherly cafe-worker who knows us all by name, personality, and preferred coffee size. No reason to wait until I am old to cherish everyday rituals like these. Onward we go.

Holy Land/ Fantasy World

Inside the Church of the Holy Sepulchre, the site of Jesus' burial and resurrection.

Jerusalem is a very different world than Tel Aviv, an intriguing and endlessly complex religious mosaic, a shared holy land, a center of both godly revelation and three millennia of human squabbles.

As a Christian growing up attending Sunday school, you get a mystical mental vision of the holy land. It was a place where miracles could happen and where God was engaged with the world, speaking via angels, prophets, bushes, you name it.

I wish someone would have showed us little kids a map of the world, pointed out Israel and Palestine, and then the exact little cities where it all went down, but that never happened. Maybe some churches do this, but I imagine certain churches might be afraid of getting a little too historical and having the ancient land lose some of its mystique. In the holy land, after all, the biblical world comes to life realer than ever while simultaneously coming down to size.

When you show up to the Sea of Galilee, you decide that your doubt of some guy literally walking on water here was probably well placed. The lake -- it's actually more like a lake than a sea -- looks like many others I have seen.

However, even if Jesus didn't actually perform supernatural feats, being here in the holy land reminds you that he was a real person and he visited real places and did real things and faced real enemies. The more I envision and remember him as a mortal human being that actually walked the Earth, the more awe and deep respect I have for him as a great martyr for love and tolerance.

In today's world, when it comes to religion, I think young people too often throw the baby out with the bathwater. Though there are elements of parochialism and mysticism in Christianity, as well as a long history of cruelty in the name of God, it shouldn't mean we handwave away the wisdom and deep challenge of the Bible's message.

The biblical times weren't that different or disconnected from our world anyway; they were full of moral dilemmas, inequality, suffering, and poverty. Jesus offered one of the brightest and most difficult paths to take, sacrifice of our own comforts for something far greater than ourselves, a humanity full of peace, justice and compassion. It was never a fantasy world.

I don't think the decline of religion in many parts of the world is neccessarily a bad thing, but I hope that our increasingly godless world can still find -- somewhere -- inspiration to struggle for shalom.

Where Jesus was crucified.

Where Jesus was born in Bethlehem, Palestine, now the Church of the Nativity. His birth spoke to humility, although somewhere along the line that theme seems to have been lost.

The Western Wall, one of the holiest sites for Jews. On the other side is the Temple Mount, currently the site of the beautiful Dome of the Rock (where Muhammed ascended to heaven). Problematically, the Temple Mount that is now in the Arabs' possession is supposed to be -- as God dictated long ago -- the center of the Jewish nation and site of their great Third Temple.

An odd combination of mourning in the background (no Third Temple yet) and celebration in the foreground (who doesn't like to celebrate?).

 Young Israeli soldiers coming to the Western Wall. This was shortly before they all joined together for a roaring, jubilant celebration. Gun-toting soldiers all dancing in a circle is a strange sight for a holy place. I had no idea what to think of all the various groups and different demeanors coming together here.

The Holy Land is not a Fantasy World where a great claw controlled by an omniscient, all-seeing being plucks out creatures judged to be worthy of an eternity of heavenly bliss. It's a place where great teachers like Jesus and Muhammed and impossible arcade games taught us to humble ourselves.

Dome of the Rock.

 Noelle and I can easily come to the Temple Mount even though it means relatively little to us. For a Palestinian for whom it would mean the world, however, it would be nearly impossible to visit.

Inside our hostel, "The Citadel," in the old city of Jerusalem.

The view from the roof.

The Sea of Galilee. Okay, it does look pretty glassy... perhaps walkable under the right conditions.

Always Sunny in Santorini

We took ATVs all over the island.

Perissa, where we stayed.

Man achieves flight.

We went to this bakery every day. The family that worked there was so, so nice.

The Red Beach.

Thira.

The view of the caldera.

And the world famous sunset from Oia.

Santorini is known for stunning sunsets and being the most beautiful Greek island. It was a flourishing mercantile stop on the Aegean Sea well over three thousand years ago. The Greeks who posted up here were smart, although they unfortunately didn't predict the massive volcano eruptions that would rock their island and destroy the civilization they had built there. A giant hole remains, creating a gorgeous cliff-rimmed caldera, now adorned by thousands of perfect white houses, hotels and shops.

We stayed on the other side of the island away from the famous cliffs, at a cheaper (but still beautiful) black sand beach called Perissa. It was a week of bliss -- exploring the island on ATVs and finding secret beaches all to ourselves, sampling the local Santorini wines, laying out on the nude beach, soaking up cosmic rays, eating fresh fish and feta cheese, hiking to ancient ruins, watching sunsets, dancing the night away to live music.

It's hard to ask for much more.

While living the good life, a classic story came to mind. You may have heard it:

The American investment banker was at the pier of a small coastal Mexican village when a small boat with just one fisherman docked. Inside the small boat were several large fin tuna. The American complimented the Mexican on the quality of his fish and asked how long it took to catch them.

The Mexican replied, “only a little while.”

The American then asked why he didn’t stay out longer and catch more fish?

The Mexican said he had enough to support his family’s immediate needs.

The American then asked, “but what do you do with the rest of your time?”

The Mexican fisherman said, “I sleep late, fish a little, play with my children, take siesta with my wife, Maria, stroll into the village each evening where I sip wine and play guitar with my amigos, I have a full and busy life.”

The American scoffed, “I am a Harvard MBA and could help you. You should spend more time fishing and with the proceeds, buy a bigger boat, and with the proceeds from the bigger boat you could buy several boats. Eventually, you would have a fleet of fishing boats. Instead of selling your catch to a middleman you would sell directly to the processor, eventually opening your own cannery. You would control the product, processing and distribution. You would need to leave this small coastal fishing village and move to Mexico City, then LA and eventually NYC where you will run your expanding enterprise.”

The Mexican fisherman asked, “But, how long will this take?”

To which the American replied, “15-20 years.”

“But what then?”

The American laughed and said that’s the best part. “When the time is right you would announce an IPO and sell your company stock to the public and become very rich, you would make millions.”

“Millions?” asked the fisherman, “Then what?”

The American said, “Then you would retire. Move to a small coastal fishing village where you would sleep late, fish a little, play with your kids, take siesta with your wife, stroll to the village in the evening, sip wine and play your guitar with your amigos!”

-Author Unknown

A lot of people, including myself, love the tale. I'm sure it's in large part because we Americans are certainly so often guilty of getting caught up in the rat race. When one clearly compares the two, the simple life seems obviously preferable. I definitely don't mind the life here on Santorini, that's for sure.

The MBA lust for money is an easy target though. Too easy. The profit-hungry guy in the story is a total straw man. I think that's why the tale is so appealing to people: it confirms the value of a simple life, giving you the false sense that you shouldn't have to get caught up in so much striving and trying and caring about money. You should enjoy life.

The approach works, at least so long as man is an island. The fisherman story liberates your pursuit of an ideal life all without having to answer any actually difficult questions about justice and our human potential for affecting the lives of others.

Indeed, the story wouldn't be quite as satisfying if Jesus, Peter Singer, or Paul Farmer were the questioner instead. They are people who believe that as long as suffering is in the world, we should not rest easy on our good fortune. They would have a lot tougher questions to answer.

"What about all the hungry, poor kids in Mexico? They can't be too far away. You look pretty comfortable though. You have an abundance of resources. Don't you have any responsibility to try to help those beyond your immediate community? Perhaps wouldn't it be better if you stayed out a little longer fishing so that you could catch more food, so that you could ship some food to the poor?"

I can't imagine what they would ask me on Santorini, especially since, unlike the self-sufficient fisherman, I was solely consuming. More than a few times as I laid out on the beach, a quote at total odds with me laying out on the beach -- and at odds with the fisherman story -- came to my mind:

Comfort is the enemy of achievement.

I love it. It's good. Like the Mexican fisherman tale though, it's missing a recognition that there's more to the story. As much as I believe in the importance of continual self-improvement and constantly trying to improve the world little bits at a time, life would be miserable if we felt guilty every second we weren't doing something.

At the end of the day, I hope to have slices of the simple life in my life. I think it's important to cherish. At the same time, I hope I don't ever get too comfortable with my lot in life when others have never had a shot at such a good lot. 

Santorini is an island; I am not. I hope the slices of the good life I get can refresh me so that I may commit myself again and again to working hard and helping others.

That's the balance I think we all have to weigh for ourselves, a balance between enjoying the fruits of life and sowing seeds so that others may do the same. The more fruit we've been given though, I would imagine the more seeds we ought to plant. I think I got some plantin' to do.

Tainted Love

That men do not learn very much from the lessons of history is the most important of all the lessons history has to teach. 

— Aldous Huxley

We're in Athens now. As we explore the great monuments of Greece and the world, I wonder about how many of humanity's historical treasures would still have been built if their commissionings were put to a slaves-included-citizen-wide vote.

Aqueducts? Quite functional and helpful for everyone, green light.

Great Wall of China? Protective, practical for defending against Mongol invasions, probably cool.

Temples and churches? Most of them likely alright, although I hope the excessively gaudy or enormous ones would have gotten the boot.

Statues? 50-50, depending on the subject's street cred.

Obelisks? Maybe some of them.

Pyramids? Pretty doubtful.

Louis XIV's Palace? Good luck.

I guess in general: the more on the functional public works side, the better the chance, the more on the "immortal life through giant monument" or "I'm going to live filthily rich because it's fun and because I can" side, the slimmer the odds.

Organizing the construction of public works is a key task of any government, but its a tricky one that can easily be abused. As Jared Diamond describes it:

The difference between a kleptocrat and a wise statesman, between a robber baron and a public benefactor, is merely one of degree: a matter of just how large a percentage of the tribute extracted from producers is retained by the elite, and how much the commoners like the public uses to which the redistributed tribute is put. 

Throughout most of history, the common people have unfortunately had little say in how resources should be used. It's interesting how much we cherish things like the Pyramids then -- I would imagine the Egyptian people of the time would have preferred to spend all that energy in better ways.

Fast forwarding to a democracy in today's world, what if a society's rich leaders decided to build a bunch of giant monuments to boost their global image, despite most of their people still living in poverty -- would the common people allow it?

This has been more or less the question at play in Brazil the last couple years, as the government gears up for the World Cup and the Olympics, building giant stadiums and trying to give the country an extreme make-over in the process. As the protests recently exploding across the country attest to though, the people aren't too happy about it.

Brazil's leaders believe (or at least did at one point) that the World Cup is a blessing; it is incentivizing the country to make long-needed improvements. But the tough questions we heard from Brazilians are: why should it take some external commercial enterprise (FIFA) to awaken the government to address long unaddressed needs? Why does the government need an incentive to help its people? Moreover, is Brazil's attempted makeover for its upcoming global events really going to do anything meaningful in the long term? Or is the rush of quick improvements just a superficial, temporary bandaid? Will the economic activity of these huge events ever trickle down to those in the favelas (slums)? 

To the common citizens, the efforts are dubious. It's hard for Brazilians who need to use public transportation each and everyday to witness bus prices increasing while billions of dollars are being funneled to tycoons for building massive stadiums that are only needed for a one-time only event. The streets we walked in Sao Paulo and Rio de Janeiro are now full of protesters who have had enough of these kinds of choices, who would rather see much-needed education and healthcare valued first. 

We certainly felt and heard this disillusionment with the government's World Cup efforts firsthand from the youth in Brazil so it's not too surprising to see what's happening now. Nonetheless, who ever would have thought soccer-crazed Brazilians would be mad about having a World Cup?

Aftermath of some of the Brazilian protests in Rio. Our friend, Luana, took this photo after a night of riots. At least as of now, a lot of the people we spent time with in Brazil seem proud of their generation standing up for themselves.

Fascinatingly, in our post-Brazil travels through South Africa (the site of the most recent World Cup and similar stadium-building and beautification efforts) we found their youth were still upset about all the money that went in to their great global event in 2010, money that its regular people never ended up really seeing. Indeed, the beautiful, enormous stadium that was built next to the ocean in Cape Town is hardly used today, with the exception of the occasional Lady Gaga concert. More poignantly, numerous new South African housing developments for the poor that were in construction leading up to the World Cup are still unoccupied. Perhaps the incentive to finish them is gone now that the world's watchful eye is too.

While the series of new stadiums are nearly built in Brazil, many Brazilians are saying they no longer want to attend the World Cup. A brief thought experiment though: I think if their society were to collapse today and a couple thousands years were to pass, the stadiums would be viewed as testaments to how great their civilization was, even though no one is really all too happy about them right now. Meanwhile, all the poorly built slums would be deteriorated, forgotten. I think the World Cup stadiums are probably on the pretty positive end of the spectrum of public works, but they still can make for an illustrative example of how a society's physical monuments don't always tell the full story, and how they may not always be worthy of unconditional praise. 

Indeed, I've noticed that in general, if we only put a little time between whatever blood and social injustice went in to making a great monument, we can find it pretty pure, beautiful and inspiring. We disdain modern dictators but exalt the greatest works of dictatorships if their crimes were a long enough time ago and they built cool enough monuments. At the same time, however, seeing as almost every great society up until the 20th century is guilty of one grave social injustice or another, totally protesting historical works for this reason would rule out appreciating most of humanity's commissioned achievements.

As far as Greece goes, thankfully many of the great monuments we're checking out came from a time of decently good-meaning government. The Golden Age of Greece was ushered in partly by Pericles, a near populist leader who seemed to have actually cared about the people.

At the end of the day though, I wonder: can you extract aesthetic beauty from an ugly context? Can something pure spring from impurity? Can Germany celebrate Wagner's moving classical music even though he was an anti-semite whose work inspired Hitler?

The world's a crazy place; there's a lot of good to be found in reviled men like Che Guevera, and so too a lot of ugliness in some of humanity's greatest works, so many of which I love.

The Acropolis overlooking Athens.

 One of Greece's old Olympic stadiums.

We have a tendency to hike whatever hill we can find. Perhaps it's not a bad life strategy.

 This monument is on top of one of Athens' hills. It was built by a guy that wasn't really even Greek. He was really rich and powerful though. Word on the street is that no one really cared too much for him during his time and they thought it was weird he built a monument for himself there. 

We all yearn for some sort of immortality I think. Whether it be through ultimate communion with God, our works in this world, or building monuments, most humans seem to have a deep fear of one day being forgotten.

Noelle is here! She'll be with us for a month of the trip -- Greece, Israel and Jordan.

Theater of Dionysus, that crazy god of wine and ecstasy.

The Parthenon.

Still having a blast, so thankful for the opportunity to travel with these guys.

Shark Tails

Toasters and coconuts kill many more people each year than do sharks, but I have faced those fears already. As for sharks, my time finally came.

Dave, Tanner and I went shark-cage diving off the coast of Gansbaii, South Africa, at "shark alley." It's one of the Discovery Channel's favorite places to film given the inordinate numbers of great whites that tend to show up. Dropping anchor near Dyer Island (home to a colony of 55,000 delicious seals), the three of us were the first ones out of the boat and into the water. Throughout the day, 11 great whites made an appearance, some of which were massive even by great white standards.

In the cage, the fight-or-flight response definitely kicks in pretty good. As the epinephrine flows, you unfortunately can neither fight nor flee though since you're underwater in a cage. On the upside, no one ever knows if you pee your wet suit.

Dyer Island, a.k.a."Shark McDonalds," is home to a colony of 55,000 Cape Fur seals. They're the sharks' snack of choice and the reason so many great whites come to the bay.