FRIENDS WITHOUT BENEFITS — Group Psychopathology

In this Sunday’s NYTimes Laurence Feinberg writes about the foolishness of youth when in the presence of friends.  It seems as if the company of others of similar vintage leads to self-destructive/irrational behavior.  Similar studies with rats actually revealed similar findings.  Solo behavior may encourage adolescents to consider the ramifications of their actions while having contemporaries around them leads to reckless choices.

I can recall my own teenage adventures driving with a college friend, blowing through tollbooths at breakneck speed.  How many of us, in hindsight, escaped injury or death by good fortune alone? 

Although Feinberg implies this applies immature individuals with immature brains (probably true ) I also fear that there is another element to this issue which transcends age or cerebral maturation–namely, group psychology.  

In essence this is tribal behavior. We human beings are capable of horrific activities, atrocities when in the presence of likeminded fellow tribesmen. Unimagined brutality seems tolerable if not admirable in a group setting.  Wartime murders of innocent civilians can occur in a moment of tribal rage. So it is not shocking to combine youthful foolishness with group insanity.

 History is replete with such shameful examples of this synergy.

JESUS’ BRIDE

Was Jesus married?  Does it matter to devout Christians?  The Gospel of Philip is discussed in the recent addition of Biblical Archeological Review (BAR) May/June 2014 Vol 40  No 3.  In this apocryphal text, discovered among the Nag Hammadi Codices in 1945, Professor Karen King of Harvard wrote The Gospel of Philip represents the incarnate Jesus actually having been married (to Mary Magdalene).”   The article references some Greek terms referring to sexual intercourse and marriage.

 Does this discussion offend believing Christians? Very likely it does but I believe it should not.  My extensive study of many religions since my undergraduate college days at Franklin & Marshall College have led me to one conclusion– ALL religions are “man made”.

 Now this does not denigrate the spiritual element of religions.  I believe they represent human insight into another realm of being which follows our physical existence on this plane.  What is created are the practices, rituals, details, religious writings etc. etc.  Was Jesus married or not?  Does it even matter? 

 If any religion offers its followers a prescription for living a loving, compassionate, caring life with service to others then we should all be grateful that it exists.

WHEN GOD WAS A GASTROENTEROLOGIST — Delivering the Ultimate Retribution

There are some fascinating lines of Biblical text from the Book of Samuel I.  In Samuel 4 it describes the capture of the Ark of the Covenant by the Philistines in their rout of Israelite fighters.  As one can well imagine such a catastrophe to the Israelite nation resulted in the shock and death of several leaders and Biblical figures.

 What could be the outcome of such a humiliation?  Well apparently Yahewh, the Israelite God took matters into His own hands (so to speak).  He smote them (love that term) with a beastly attack of hemorrhoids!!  The Philistines were so debilitated by this attack (like the plagues from Exodus) that they returned the ArK to the Israelites with a slew of statues of Golden Hemorrhoids as a recognition of Yahweh’s potency.

 Who knew?  My life’s two passions, gastroenterology and religious studies meet in the anal canal.  The uninitiated might laugh.  How could an attack of hemorrhoids bring the Philistines to their knees (wrong part)?

 Ah, ask a whole bunch of my patients.  They know the truth that the Bible reveals. 

DNR — Is A “Slow Code” Acceptable?

One of the more remarkable articles I have read for my course on Bioethics is one by Lantos and Meadow in The American Journal of Bioetehics, 11 (11): 8-12, 2011 on the ethics of the “Slow Code”.

As they quickly point out there is much in the medical literature and via established medical ethics texts to renounce any effort to resuscitate a patient which is less than 100%. Yet Lantos and Meadow offer their suggestion that there are times, perhaps many times, when it is the ethically preferred method for dealing with the end-of-life.

The article correctly discusses that cultural symbolism associated with CPR and the intense confict which grips families when they are requested to authorize a DNR.  For some families, even those well aware of the futility of performing one and the inevitability of their loved-ones death, the act of agreeing NOT to do something to prolong their life is a decision that they just cannot make.  In those situations the physicians involved may attempt to continue to push the family to agree, unilaterally and willingly confront the family by asserting the right to write a DNR order on their own, or accede to the family’s lack of decision by performing a full code despite their own strong beliefs in its futility.

The fourth possibility which the /authors advocate is the “slow code”.  It is a half-way or partial procedure which may be only symbolic in nature.  It may only last a minute, or less.  It is an act of futility with the emotional and psychological status of the family in mind. It is purposefully an ambiguous act for those patients who are dying but for whom any overt decision by loving family members is heart-rending.

 It becomes a ritual associated with dying, one hospital based and perhaps unsavory from a scientific perspective.  It is ultimately a powerful acknowledgement that physicians should be cognizant of the emotional trauma that the death of a loved-one has on their relatives.  The authors summarize the criticisms of this action.

 I, for one, believe it has a place in the hospital setting under appropriate conditions.  I believe that the options of DNR need to be offered to the authorized health-care proxy/family member when physicans believe it appropriate.  Discussion of palliative care and Hospice should not be avoided when deemed the correct choice.  But when family members cannot bring themselves to make those decisions, this alternative option should be considered.

 Family members should not be brutalized or beaten into submission when they clearly are unable to make the decision to order the DNR.  The “slow code” may be the ethically and morally right choice under such circumstances and I applaud the efforts of Lantos and Meadow to discuss it. 

RANDY’S LAST GOLF TRIP

I just found out.  Randy  passed away.  I could have easily written that he died.  But I prefer the euphemism “passed away.”  The word die is too powerfully sad and I am not adverse to using it at times.  And besides, death is not always the worst event in one’s life.  Suffering is.  I have kept a blog posting about Randy unpublished for months now.  I just noticed it.  Now’s the time to complete it.

I did not know Randy very well–yet ironically I believe I did.  What I mean is that I met him two years ago on a golf trip.  He was a friend of a friend– a fellow physician from Connecticut.  We only interacted over a 4 day period in Hilton Head, South Carolina.  I liked him very much. Everyone did. He was extremely bright, witty, could sing a cappella and was a hell of a golfer.

 Randy was diagnosed with an inoperable brain tumor but showed up last fall for another golf trip, this time to Greenbrier in West Virginia.  He had changed.  His personality was different.  He was now introverted and quiet.  He could still sing but with less vigor.  His clever sense of humor was unexpressed.  All of this was a consequence of the cancer advancing on his brain tissue.  Everyone else on the trip understood the situation.  No one spoke of it until John, an old friend of Randy, a former golfer arrived.  We had never met but did speak briefly about Randy’s condition.  John showed up just to see Randy and the other golfers. 

I had the opportunity to spend a brief moment with Randy on our last day when we had to rush to make the flight back home.  By chance he was sitting next to me in the golf cart as we hurried to avoid an incoming storm.  Although on this trip he never initiated conversation, now he did.  ” I had a really great time.”  It was a brief but spontaneous remark.  I was stunned.  I’m not sure how I responded.  Perhaps I said, “yeah, me too.” 

Randy died this week. There, I wrote it.  I didn’t know his condition before his passing but suspect he was comatose, no longer conscious and certainly not who he was.  Perhaps he was suffering, hopefully not, but I’m sure everyone who knew and loved him were.   He is at peace and I pray his loved -ones will be soon.

 Our annual golf trip is coming up.  It will be named after Randy.  I know he will be there.

THE FIRST DAY OF SPRING

Although April  2 is not the vernal equinox, and therefore not the official first day of Spring, for those of us in the New York metro area, it feels like it.  I was in the City for another class in Bioethics at Cardozo Law School in Greenwich Village.  Getting off the subway on the upper west side of Manhattan I felt the lingering rays of the sun, rain free air, and a sense of optimism long hidden by the abysmal winter just completed.

 After  dinner at a French bistro I felt drawn to Central Park.  It is an oasis of nature in the heart of NYC.  Of course it is still early in the season but the part pulsed with life.  People were out.  Joggers, bikers, people with a myriad of different sized and shaped dogs.  Fathers hit baseballs to their sons, young men played soccer.

There was an unmistakable sense  we all silently shared that the the worst was behind us. For a moment we could put aside our worries, fears and concerns.  We had survived another winter.  And it wasn’t easy.

WAS MARX RIGHT? Human Nature Might Disagree

A recent NYTimes article (March 30)  debated the virtues of Marxism.  A powerful utopian philosophy Marxism/Communism has been rarely seen in practice.  Based on philosophical, political and economic theory Marx predicted the eventually destruction of capitalism by virtue of the uprising of the working class.  Socialism would be government organized and supported, eventually to morph into a stateless, classless, humane society based on the principle “from each according to his ability, to each according to his needs.”

Of course it is unfair to reduce its complexity to a few paragraphs but in truth Marxism has never truly worked as a political/economic system.  The main reason–it fails to take into account human nature.

 I have little doubt that we possess an empathic, compassionate side to our nature.  We feel the pain of others, try to reach out to the less fortunate, offer charity.  But when there is a perception among the average citizen that hard work is no longer recognized, that benefits accrue to those who know how to work the system, when remuneration can be obtained without hard work, resentment ensues.  In effect when rewards are not proportionate to labor, there is trouble.

On a personal note I witnessed this phenomenon within my own practice.  We all work at our own speed.  No one dictates who should work what hours, take how much vacation, accrue expenses.  No one is concerned about what the other partners do or don’t do because our income is essentially based on our individual productivity minus our expenses.  It is fair so no one complains.  There is NO resentment among the partners.

The utopian concept that everyone will benefit from the labor of others presumes that everyone will produce nearly equal work.  This is not reality.  It does not recognize the differences among us.  Some of us are ambitious, driven, obsessed with obtaining material possessions and the vehicle by which they are acquired–money.  Some of us are extremely creative, talented, skilled.  Those are attributes which can often produce enormous wealth.  Others among us lack skills, motivation, ambition or just don’t desire money and material goods.  All of this reflects the world we actually live in.  

Recognition of these differences results in fair distribution of the products of such efforts.  Failure to maintain a system which rewards effort is…..lack of effort, or resentment.  Communism is a utopian dream which can work in small groups of like-minded individuals.  It can offer its offshoot socialism to balance raw, unrestrained capitalism (which can be devastating and damaging to society).  But only a mixed picture can balance concern for those who cannot produce, with recognition of those who do.

With all its imperfections, the American economic system comes closest to balancing all these factors.  Communism never did and never will succeed.