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.