A Stigma...What?

 Home eye chart test: Safe Eyes America

      Stigma: a mark of disgrace associated with a particular circumstance, quality, or person, as in "the stigma of having gone to prison will always be with me" defined the Oxford dictionary.  But my "stigma" was more related to my eye exam; the world is round, but not really since our planet actually bulges slightly in the middle, which was now sort of like my eye.  It had somehow gotten out of roundness, if that makes sense.  The vision change was noticeable for me, as if I had woken up and my left eye (normally sharp for seeing distance) now matched my right eye (which was great for seeing close but not so good for far off).  The combo always worked, said my optometrist, because each eye was compensating for the other; I would likely never need reading glasses (and so far, still don't).  But now that I'm older, that may be changing.  I'll admit that I had been lazy in getting myself in for an eye exam, something people of all ages should do if only to be tested for glaucoma which can accelerate quickly if not caught early (and potentially cause blindness).  But lo and behold, despite the passing of nearly 4 years, my vision had remained about the same, except that the astigmatism in my left eye had shifted.  It's not like I was a pro-baseball player who got hit in the temple with a fastball (such facial "hits" caused serious injury through the early part of the last century, and the jagged history of the baseball helmet is quite the story, as summarized by Wikipedia).  But generally when my vision would become a bit blurrier than normal, I knew that my body was fighting some sort of infection; within a day or two my vision would return to normal.  But this time a few days passed, then a week, then nearly a month.  Something else was going on...

     The anatomy of the human body, as well as the seemingly endless numbers of designs in the natural world have always fascinated and confounded me; flowers are one thing but enter the microscopic world or the ocean world and entirely new universes opens up.  Who would picture a dolphin-like design gracefully and powerfully moving through water?  From my 30s onward, I have been drawn to the worlds of both medicine and the martial arts (although I have never actually studied or participated in either); and now as I look back at those interests I can start to see the similarities and the attraction in the way joints will lock from an elegant aikido move, and how the quick thinking mind of a surgeon on call can be equally logical and orderly in following the anatomical process.  And while I see that much of the flashy choreography of Hollywood action films are about as close to the real world of martial arts, as the hospital or police dramas are to actual life, such films give us the entertaining fantasy we want to see, even if the "actors" (some of whom may indeed be trained) are just following the professional advisors off-camera.  When Graham Norton asked Matt Damon about what training was needed for him to do all of the Jason Bourne films, the actor talked about practicing the elaborate choreography and how he had learned somewhere around 50 ways to disarm an assailant; but Damon said that when the instructor asked him what to do if attacked after all that training, Damon was surprised when the instructor quickly answered, "RUN."  That said, it took nothing away from hearing that Bruce Lee was so quick that the editors of his films admitted that they had to slow down many of the sequences lest the viewing audience think it was all fake and that Lee had never actually hit the person.*  

     The advice given to Damon mirrored that of Tammy Yard-McCracken, a Krav Maga expert instructor as well as a doctor of psychology.**  In her Understanding & Applying Self-Defense Strategies, she explained that as humans, we have been: ...able to develop the best-possible self-defense skill we know of: avoidance...those who focus only on physical training --whether with a weapon, in a martial art, or even in a self-defense class-- are preparing only for the physical fight, whose consequences can be physically, emotionally, or legally devastating, even if you do "win" the immediate conflict...your physical skills are the last line of defense.  The late Paul Kalanithi, a neurosurgeon at Stanford who discovered he had stage IV lung cancer just as he was beginning his career, wrote of how cutting just 2 millimeters deeper or to one side in the brain could mean the difference between stopping the tremors of Parkinson's or leaving a person without speech, and how that same close cut could remove a tumor or leave a patient paralyzed.  And yet, despite his 88-hour work weeks as an attending resident, he relived a call at 2 in the morning from the emergency room, waking him from a deep and needed sleep to tell him of a motorcycle accident victim with severe head trauma being brought to the ER; for the groggy Kalanithi it was automatic to dictate the meds and solutions to have ready as he rushed to dress and head to the hospital for surgery.  Just as with the expert martial artist, who Dr. Yard-McCraken reminds us can strike as many as 8 blows in a second, I am awe-struck by the reaction skills of such artists, while also realizing that both were levels I likely wouldn't have attained even when younger.  As I often tell people, my mind says that I am to young to feel old, while my body tells me that I am to old to feel young...

     Then came a few questions of another field I don't, and likely would never, understand, much less be attracted to...that of hate, greed, and the drive for power.  The hazy or almost-blind ambition of many is likely to become a stigma far from the one they intended.  TIME wrote about the changes happening in the world's view of both Putin and Netanyahu.  And in his book American Hate (noted in my last post), the author wrote that Trump: ...As a casino owner, ordered black casino workers off his casino floors during his visits and called them "lazy."  [While President]  He called Mexican undocumented immigrants "rapists"; ridiculed Chinese and Japanese trade negotiators using broken English; defended two white men who assaulted a Latino man as "passionate" supporters; criticized a judge because he was Mexican; approved the beating of a Black Lives Matter protester; mocked a reporter with a disability; stereotyped Jews as cunning negotiators; declared that "Islam hates us"; and repeatedly called an elected official of Native heritage, "Pocahontas."   And yet, recent polls show that Trump, in his 2024 run for the presidency, appears to be gaining support among blacks, Hispanics, and other minorities despite his comments.  How is this happening?  Even Netanyahu, despite declining popularity back in Israel, remains at a near-even approval rating here in the U.S., wrote Statista.  But such are the pendulum swings of politicians and car sales folk, which I tend to place on much the same level; indeed, more interesting to me was the history of the forceps (what??)...

     Giving birth is both a miracle and complicated (a process described in an upcoming post).  But as common as much of this is, much can and often does go wrong.  The placenta tears, or the uterus may rupture; the baby may be too big or the pelvis too small; the baby may be stuck sideways, or come out feet first, or head first but turned the wrong way and get stuck.  There are only minutes for the baby to come out at this point, or it will asphyxiate.  Wrote Atul Gawande in his book on doing surgery: There is, for example the Loveset maneuver for a breech baby with its arms trapped above the head: you take the baby by the hips and turn it sideways, then reach in, take an upper arm, and sweep it down over the chest and out.  If a breech baby's arms are out but the head is trapped, you have the Mariceau-Smellie-Velt maneuver: you place your finger in the baby's mouth, which allows you to pull forcefully while still controlling the head.  The child with its head out but a shoulder stuck --a "shoulder dystocia"-- will asphyxiate within five to seven minutes unless it is freed and delivered.  Sometimes sharp downward pressure with a fist just above the mother's pubic bone can dislodge the shoulder; if not, there is the Woods corkscrew maneuver, in which you reach in, grab the baby's posterior shoulder, and push it backward to free the child.  There's also the Rubin maneuver (you grab the stuck, anterior shoulder and push it forward toward the baby's chest to release it) and the McRoverts maneuver (sharply flex the mother's legs up onto her abdomen and so lift her pubic bone off the baby's shoulder).  Finally, there is the maneuver that no one wanted to put his name to but that has saved many babies' lives through history: you fracture the clavicles --the collar bones-- and pull the baby out.  So what about the forceps, a tool which has saved countless babies and mothers and yet takes residents as many as 2-3 years of practice to get right (for one thing, among the 6 or so types and sizes of forceps: ...You have to slide the blades symmetrically along the sides, travelng exactly in the space between the ears and the eyes and over the cheekbones...then a doctor must apply forces of both traction and compression -- pulling with an average of forty to seventy pounds of acial force and five pounds of fetal skull compression...too much force and skin can tear, the skull can fracture, a fatal brain hemorrhage may result.  

     The invention of the forceps came from Peter Chamberlen (1575-1628), "the first of a long line of French Huguenots who delivered babies in London."  Wrote Gawande: The Chamberlens knew they were onto something, and they resolved to keep the device a family secret.  Whenever they were called in to help with a mother in obstructed labor, they ushered everyone else out of the room and covered the mother's lower half with a sheet or a blanket so that even she couldn't see what was going on.  They kept the secret of the forceps for three generations.  In 1670, Hugh Chamberlen, in the third generation, tried and failed to sell the design to the French government.  Late in his life, he divulged it to an Amsterdam-based obstetrician, Roger Roonhuysen, who kept the technique within his own family for sixty more years.  The secret did not get out until the mid-eighteenth century.  Once it did, it gained wide acceptance.  Such selfishness has existed throughout human history, perhaps more recently as the opioid and illegal fentanyl pushers demonstrate.  But hate and racism is no different in that it can spread well beyond the people immediately affected.  Again from American Hate: Healing and restoring affected communities is critical because there is a growing body of evidence showing the devastating consequences of racism and hate.  Hate makes communities physically and emotionally sick.  Racism literally debilitates and kills.  It can affect blood pressure and cortisol levels, and lead to a greater likelihood of obesity, decreased immune function, cancer, or death.  This is expecially true when the affected community has previously experienced abuse and discrimination, because members relive that trauma and pass it on from generation to generation.

      Dr. Yard-McCracken pointed out how such factors can play out on a more personal level: Understanding how violence escalates and how you might be targeted is as important --if not more important-- than the physical stuff.   Criminals and inciters of violence (or perhaps even politicians) note such things as you being distracted (wearing ear buds or on a cell phone), being lumped in a group (tourists or business settings), being the weaker link (inebriated or appearing lost), being easy to separate from the pack (lure, follow, trick, intimidate, or wait), and the psychology (size, fear, vocal intimidation) and physical side of it all (weapon, size, numbers).  As she notes: Most people think of the physical part of self-defense in terms of "fighting."  Unfortunately, this word sends a mixed message because the idea of gaining physical control over another human is not a lesson about becoming a good fighter.  Fighters are trained to be effective combatants hemmed in by a powerful set of rules.  The rules --designed to control the degree of violence-- are critical in sport and are less obvious but equally powerful in chest-beating brawls.  If you defend yourself by following the social rules of a good human being, you are going to be at a remarkable disadvantage....It's a myth in our culture that who we are is deeply defined -- that our personalities are distinct.  But you can be whomever you need to be to get a mission accomplished.  And what you say inside your own head about yourself influences how your body moves, and how your move is being observed by all the other humans around you -- the good guys and the bad guys...How you think about yourself writes a story all over the outside of your body.

     Dr. Kalanithi reacted to his terminal diagnosis this way: ...The fear of illness wasn't life-altering; it was life-shattering.  It felt less like an epiphany, a piercing burst of light illuminating what really matters, and more like someone had firebombed the path forward.  Now I would have to work around it.  The actor Mark Ruffalo told GQ that after auditioning and being rejected for nearly 8 years and surviving on "apples and loaves of bread," he discovered that he had a brain tumor just days before his son was born, and then later heard that his brother had been shot and killed: ...It’s very easy to get cynical and hardened by tragedy and loss and trauma.  But if you can live through it and stay open, you get a tremendous depth of compassion for people.”  The article also noted that Ruffalo worked through part of that period by turning to sculpting: I feel like acting is sculpting in a way...When you look at the eye it’s actually no different than what your idea of an eye is.  What I'm learning is to see.

     The eye, of course, is full of information and is often credited with contributing up to 85% of our knowledge with its 2 million working parts, wrote the protective eyewear site, HexArmor.  "After your brain," wrote the site, "your eyes are the second most complex organ in your body."  Astigmatism, such as what I have, is correctable in many forms, both invasively (such as LASIK surgery) or non-invasively (such as wearing glasses).  And whatever method is chosen, your vision can generally be returned to clarity.  Such re-focusing brought to mind an essay from TIME:  So often, articles and essays such as this begin with a gathering of unnerving statistics.  Most of us don’t need those anymore: changes brought about by the climate crisis are becoming more tangible with the passing of each year.  We smell it in the smoke-tinged air.  We feel it in the seasons gone askew.  We exist in a place where all the problems of the universe are present.  And the problems we have today really can seem too great to surmount.  Too vast for any of us to do anything about.   But that’s just it. We think only of the inadequacy of what we alone can do.  This is partly because, over the past several generations, we’ve been taught to think of ourselves as individuals—pitted against one another to take what we can, while we can.  But if we believe staving off catastrophe is futile, that belief infuses our thinking, paralyzing our decisions.  Conversely, the opposite is true.  If our mindset shifts toward the realization that we --having invented all of the ways we go about modern life-- can change those systems, we would arguably make a sustainable future more likely.  In other words, if we think we can't, or think we can, we are right.

     Changing how we see ourselves, or others, or even the world, is possible, at least physically.  When I first put on my new "corrected" lenses, the view ahead was disorienting.  It was sharp and focused, and crystal-clear, but disorienting as if something wasn't right.  It would take a few hours or days, I was told, since the brain has to adjust.  Such good advice and if only we could take that to heart, to realize that given time our brains can adjust to see other things differently and more clearly.  For Paul Kalanithi, life seemed so in focus then so drastically out of focus; how could he have been blessed with such a mind and such skills, and then have it all terminated right as he began; his book about facing the end was even nominated for a Pulitzer (I had read his book earlier but wanted to listed to the audio version).  I'm not sure I could have written so clearly and so honestly if placed in a similar situation.  And when I told a friend about me watching the Krav Maga series, he mentioned that his 70-year old friend decided to try a class and had his leg shattered during practice (bones become quite brittle as one ages).  So no, I couldn't picture myself trying to learn any martial art at this point.  Hawaiians have a saying: Know who you were so you can know who you are.  Looking back, it seems that I was enamored with certain subjects while younger and still am, and yet somehow I knew then that becoming "fluent" in them was a fantasy.  We all have aspirations that have gone unfulfilled (that dreaded "should've, could've, would've").  As the popular saying on the tee shirt said: I thought growing old would take longer.  Life is life, it seems, a spinning ball shooting out talent as randomly as a lottery drawing.  And it doesn't seem to matter if you are a brilliant neurosurgeon or a Palestinian refugee, a famous actor or someone newly homeless, Steve Prefontaine or Kevin Kiptum.  Life gives and life takes.  Perhaps there will come a time when even "leaders" who bomb and starve and spew hateful words will see that and find that their own astigmatism can be corrected.  Perhaps for all of us, we may come to realize that it's possible to see our world, our shared home, with new and welcomed clarity.  As Jimmy Cliff sang, we can see clearly now...

Addendum: I'll admit that I didn't know where to put these, even if they were somewhat related, so here they are, thrown in at the end.  First up for those who don't mind subtitles (or perhaps are fluent in French), do catch the legal mystery Anatomy of A Fall, a foreign film which not only won many awards for its screenplay (and the top award overall at Cannes) but also saw Sandra Hüller nominated for Best Actress at the Oscars (who knew?).  As she told Vanity Fair about playing a grieving widow who may or may not also be the killer: The older I get, the more I know that it’s just a question of perspective sometimes.  And secondly, if you want to give both your eyes and mind a workout, try the sliding word game from the NY Times, Strands.  The subjects are offbeat, the rules simple, and the words many.  But more impressive is their filling the puzzle --a daily word puzzle, no less-- using every single letter?  Methinks, AI is doing most of the work...quite creative.

*From an interview with Bob Wall, himself a 9th-degree karate expert and one of the few Caucasian  black belt "actors" at the time, commenting on his being kicked by Bruce Lee in the movie, Enter the Dragon, a scene where Lee cut himself and required stitches: ...now remember we had to do that eight times, well he didn't have fake glass, everytime I'm breaking real bottles; well when I break real bottles, guess what, I'm not allowed to look down to see where the chunks go!  And guess what, I gotta fall on them!  The camera doesn't show that but guess what, that's real glass I got to fall on...so Bruce says when you break the bottles, come at me as fast as you can and aim at my right pec, all right?  He doesn't say throw the bottle away.  And so 6 times we do it perfectly, the seventh time he missed.  If you hit yourself anywhere between the hand and elbow, your arms are going to fly.  Anything above, it isn't.  So what happened was timing...I'm supposed to be half dazed and I'm just sitting there, not defending myself, not blocking,  Bruce comes up and sidekicks wherever he could have wanted to; it could've been at my head, my throat, it could 've been anywhere he would have wanted; but you know what?  He hit the same spot every time...the bottom line is the film is 25 years old and Warner Bros. is 75 years old and they've made thousands of films, and they brought out their top 10 grossing films of all time, and ETD is on that list and its the lowest budget film!  Bear in mind the statistics of 1973: a little film called Godfather came out which cost about $17 million and grossed $88 million.  ETD cost $850,000 and grossed over $200 million.  Now if you're putting up $850,000 or $17 million, which return do you want?  As to hitting in the same spot, a friend of mine who is a 7th degree black belt told me that at higher levels you begin to learn the nerve and pressure points so that your "strikes" are specifically targeted; one hit on a specific nerve can disable your opponent's ability to strike back.  My friend's words made me even more aware that a master at such an art can indeed leave a group of fighters on the ground, not from the power of his/her hits, but likely from disabling their abilities to fight back...

**Becoming a socio- or psychotherapist, or even a mental health therapist is not an easy task, wrote STAT: ...in general, candidates must earn a master’s degree, pass a standardized law and ethics exam, work thousands of hours under supervision, and then pass a standardized clinical exam to obtain licensure.  Doctoral-level psychology licenses follow a similar progression.  The exams typically cost hundreds of dollars per sitting; the academic degrees, tens of thousands or more...