Friday, March 30, 2012

Gait and Posture

I often, in the midst of a busy Orthopedic practice, considered surreptitiously taking videos of my medical colleagues as part of a study of posture and gait. Observing the unique features of healthy men from the standpoint of the normal variants of gait and posture is of some interest to those of us concerned with musculo-skeletal anatomy and physiology! The long hospital corridors allowed me to clearly identify individuals I knew well, whose features were unclear from the distance, but whose gait and posture were identifiers. The good orthopedic surgeon was always aware of the need to observe the patient walking, sitting and standing as part of their assessment, apart from the necessity to do so where pathology existed. You can't always know abnormal, if you don't know the range of normal. For years I idly considered writing a chap book on the subject, or a chapter, based on my study but never got around to doing it, and now it's too late. Any way, it may have been too intrusive and earned me enmity! Still, I fondly remember examples! Drs. X and Y had short heel cords. A tight tendo achilles leads to a bouncy gait. The stride has a high amphlitude, so more energy is required to achieve the same distance. They would make a poor waiter or, in another era, a bad footman. A lax tendo achilles would lead to a low amplitude glider gait. They might say, no spring in his step! Good waiter material! Dr. Z had a military officer background. He stood erect and his head and eyes were directed upward to heaven as he marched down the hall! His gait and posture had an ethereal quality! Drs. A and B were topmost physicians and mild enemies. Nevertheless they required to speak of matters as they met in the hall. As they stood and talked of weighty matters they slowly rotated to the right in tandem, as it were, getting to the most vulnerable side of one another simultaneously! Pushmepullyou! The more florid variations of gait and posture are the most interesting but all of us have unique characteristics only modified from time to time by the state of mind. Mind- body activity will alter, but not fundamentally change. I have a neighbor who has a PhD in Industrial Ergonomics. My missed opportunity was to fail to do a collaborative paper with her at the right time. Oh well!

Tuesday, March 27, 2012


It may have been a Byronic Moment when I encountered shit-mix for the first time! Living with three adolescent teen and pre-teen children in Lotus City was a busy time for the pianist and me. Our down time for communication was the supper hour and after that I often went back to work or watched the hockey game. My daughter told me recently that the pediatrics learned to always show me, and get the report card signed, when the game was at a critical spot; so they were craftier than I thought! I had remained naively unaware of that subterfuge! "Hey Dad can you sign this?" I say "can", not "will", because I could sign my name without looking at what I was signing. I'm not proud of this! Also, another one of my pleasures was an abundant and varied liquor cupboard with a selection of offerings. That array provided a welcome choice for an after work libation! I did notice eventually that my supply was diminishing, but faster than my efforts could explain, and the leakage was evenly distributed. The pianist started looking to see how many finger widths were in my glass. I recognized the look but pled innocent! I began to wise up and, unannounced, marked with a felt pen the existing levels in the bottles. Over the next week or two, all the bottle's contents "evaporated" a half inch! I got a lock for my liquor cupboard door and kept the key. I mentioned to the local grocer, a friend, later in the month that I had solved my problem of the disappearing booze. He said, "The kids from the school are drinking what they call shit-mix! You mix half an inch or less from all the liquor bottles and come here for orange crush and put it in the bicycle bottle with the liquor mix! They have a big party at Gyro park! It must taste awful!" I can't say I was surprised. I can say that I was impressed with the creative drive they showed. It provided a good measure of invention and portended well for their future despite or because of the willingness to tolerate swill! It was a stunning Moment when I realized they were flesh! It was like a lock suddenly unsnapped in my head! Perhaps a good parent wouldn't have been amused!

Sunday, March 18, 2012

Caduceus, Warp and Weave

The Caduceus is a staff with a single entwined serpent that is an insignia representing the healing professions, particularly the medical profession, world wide. It has traditionally been regarded as of Greek origin dating from the Hippocratic Corpus, 460 to 337 BCE, or the healing and religious tradition of the Greek god Asklepios, beginning from the same era! We read however in the exilic text, Numbers, 21, 5 to 9, probably written from 586 to 538 BCE, that Moses, on instructions from beyond, created what was clearly the Caduceus, a staff with a bronze serpent, in order to prevent the frequent deaths from vipers in the wilderness. This of course is evidence of a creation, described in writing, more than 100 years before Hippocrates and the Asklepian priests, of an oral tradition from an even earlier era. Still, it is not of general knowledge that the Caduceus is a figure created from the warp and weave of what went for science and faith at the time of Moses. Whether Greek or Jew, whether mystic or pragmatic, the cloth one wears as a physician is created by the Weaver. Hippocrates the scientist, Asklepios the mystical god, and the exiled Hebrews codifying the oral tradition, spoken to, and repeated by, a bronze age people, shows us that modern medicine still has its roots in the warp and weave of timelessness. The haze of technology alone may seduce the unwary; the hubris of the antiscientist may founder, but the cloth of the Weaver will continue to stand.

Saturday, March 17, 2012

Lotus Island Spring

March 17th, I was buzzed by the bumble bee today! The pianist and I counted 14 Harbour seals clustered together, four lazy swimmers, two little round hills, each moving slowly forward; ten stationary swimmers, vertical in the water, sharp little snouts looking skyward. Waiting for the herring spawners! The Indian Plum is in full flower and the Alder catkins are a cloud of red-brown. The Bufflehead ducks are weaving in and out of the seal crowd, taking their share of the grub. The raspberries and logans have started to leaf and the rhubarb is poking up through the leaf mold. The gooseberries and black currants are leafing out but the red currants are a little behind. The apples still have no green on the buds but the pears are earlier. The late storm surges over the last few days have thrown up an abundance of sea weed and have pulled out an abundance of loose vegetation from the shore shrubs that have mixed together and harbour all the tiny denizens of the shore that feed the gulls and crows. The ground is like a wet sponge with all the rain and the moss is especially thick this spring, giving a yellow-green luminosity to the canvas of Mother Nature, lying before us in the sunlight. I saw the little red squirrel today scampering about and he, (or she), allows me to approach four or five feet which is pretty good. They are quick, but I worry because the eagles are starting now on the hunt! There is green, green, green, everywhere on Lotus Island today and since St Patrick was of the green, it seems right. We haven't been diverted yet by the vibrant colors that will come in abundance in another month. Even the daffodils are in the anteroom. The greens are restful and as holy as St. Patrick! A different kind of vibrant, but no less. I think I'll toast the green with a Black Bush now!

Thursday, March 8, 2012


Trust the Medical profession to call an obituary record of physicians, Necrology! Death of tissue; necrotic tissue; "remains" described in completely organic terms. I guess it's reality, but you know, "remains" suggests that the necrotic tissue is just what's left. "The remainder!" What went? The Vital Force! Thousands of touchings; millions of seeings and hearings; hundreds of lovings; history for many; memories in abundance; connectedness to the Universal! The BC Medical Journal came the other day and I knew 10 of the group that died over the past few months fairly well out of the 20 or so odd physicians listed. That is not surprising given our ages, but some of us check the obituaries more frequently than others to stay in the loop, at a certain stage. There is no contest to see who is going to live the longest but recognizing eventually that, "When you are old you will stretch out your hands and someone else will dress you and lead you where you do not want to go", there may be the hope to defer. That was not just Peter's future, but is for most of us as well, at least the lucky ones that get to a ripe age. Those of us who practiced medicine for many years may fight against it, but in fact accept death at work all the time as a norm in ourselves and our patients. It always seems to come as a great surprise to most patients and family and yet the average "in hospital" death rate varies from 2.1% to 5% depending on the factors such as intensity levels, age corrected criteria, etc. Most people prepare for a new birth with all the paraphernalia for the newborn well in advance, not knowing exactly the time of arrival, but they all want to be ready. There can't be anything more important than the passage into a new life and the preparation to welcome the new Force Vitale! The passage out of the old life to "God knows where" has the same immensity. Why then do so many fail to get ready in the same way and operate by denial? I guess, like Peter, they probably do not want to be led where they do not want to go. I'm afraid necrology is just a little too organic for me. Pathology notwithstanding, there is more to it than just tissue.

Monday, March 5, 2012

The Good, the Bad, the Ugly and the Ridiculous

The country mice, the pianist and I, traveled to Olympic city for the weekend to celebrate my brother's 70th birthday. We were 23 family, three generations, and celebrated in his apartment high over English Bay with an unimpeded view of the sea, the sunset, the freighters gently anchored out and the distant and beautiful city lights. It was the Good. Equally high in our city hotel later, we looked down on the flat roofs of adjacent city blocks, covered with moss, green and black, pools of dirty water, spouts and pipes and chimneys and mildewed walls with a tawdry drabness seen from above that is never apparent from the lower levels or the street. It looked like Chim Chim Cheree without the music or dancing. It was the Ugly. From our hotel room in the morning I watched the Dumpster Digger work in what was obviously his laneway which was directly opposite my window. He was methodical as he checked his dumpsters up and down the lane every half hour through the morning for the treasures of the garbage. Recycling the throwaway culture to eke out a life without a hope of finding a beautiful thing. This was the Bad! Across the city from our vantage on the 19th floor, the high rise apartment penthouses, secured for the wind, had rooftop trees, evergreen and deciduous, some as high as 30 feet, resting in a potted forest on the roof! Strolling in their personal faux forest on the roof! This was the Ridiculous! The love and kindness the three generations of our family felt for one another, of course, transcends all these four images, or goes through them, carrying what is necessary, but in reality needing none of it. That is really the Good that trumped all. Still, we are called upon to look around as we go!