Monday, November 24, 2008

Faulty Design

Faulty Design

I am in New York with our daughter’s family for a combined vacation and treatment of a minor urologic problem. The procedure I am having is one for which Israeli physicians haven’t claimed priority and higher expertise yet. Whether it is weapons systems or high-tech medical gadgetry, we in Israel are used to keeping at the cutting edge of development, often by importing the parts from the USA at favorable terms, fitting the pieces together, then exporting the end product back to America and elsewhere. Trade agreements and dual citizenship machinations are such that the process turns out hefty profits and permits us to claim a front and center position in scientific and industrial development, way beyond our actual smarts. On this occasion, when I inquired about the new technology of microwave therapy for an enlarged prostate I was told that the one place in Israel that has some expertise in using this procedure uses equipment especially designed by and for Israelis. Recognizing my own questionable qualifications under those terms and wishing to avoid being experimented on by trainee prostate cooks, I sought to do the procedure here in NY.

The problem I have in common with many of my male cohorts is not as complex or mysterious as urologists make it sound. Basically it is a result of faulty design at source. It seems the designer was focused wholly on the new product and lapsed negligent when it came to the end result of utilizing this specific system over the useful life of the machine as a whole. Fresh off the production line and for many years to come, a man’s drainage system functions fairly well, better than that of the female counterpart for that matter. But as part of this intelligent design package, sex figures high on the list of improved functionality of the product. That is where testosterone comes into play, figuratively and literally speaking. And one of its unintended effects is that it pumps up the size of, among other things, the prostate gland, so much so that it ends up sealing the drainage system shut. Therefore the blockage has to be cleared away by scraping it with a sharp edged probe from inside, by buzzing it with a blue-light laser beam (don’t ask me why blue! Pink is definitely out of the question for this specific item) or by opening up your belly and peeling off the whole mess from around the discharge pipe. Then someone smart came up with the obvious solution of inserting a microwave-emitting rod up your penis and cooking your prostate to your plumber’s preference. Judging by the way I feel, mine goes for well done. And no, his name is not Joe! The advantage of this last procedure is that it doesn’t put an end to the co-functionality component, the sex thing.

The way it all came about for me was rather sudden: One day while sipping my after-dinner coffee at the home of friends in Nazareth, one of their children, a rambunctious four year old, suddenly stopped by my chair, poked me in the ribs and asked: “Uncle, how come your face is so pockmarked?” Before I could regain my equanimity and think of an answer he was gone chasing other children around the house. The question bothered me enough to excuse myself and go to the toilet where I could look in the mirror. And lo and behold, on close inspection the kid was right: blemishes of Senile Keratosis were all over the place, especially on my forehead. And the eyes informed of the same truth: For the first time I observed my Arcus Senilis, that darkened outer rim of the sclera that comes with old age, hence the ‘sinilis’ descriptive. It didn't look all that bad and I still recognized the image in the mirror as mine. But the terms, ones I had often flung casually as a doctor at other people, suddenly sounded awfully vulgar.

That night I didn’t sleep well, not only because of the shock of discovering that at age seventy I was getting actually old and starting to show it but also because of having to get up to urinate so many times. It might have developed gradually over time but I must have ignored it and tricked myself into accepting it as a variation on the normal. Till that night when it waxed pathological.

I recall the same kind of sudden awakening to my chronological age when I hit forty: That very same day I discovered a painful disfigurement on my foot, a bunion, and had to deal with hemorrhoids. And for the first time ever I felt short of breath running. I was born and brought up in rural Palestine where you run for your life from the day you stand up on two.

Faulty design is not the exclusive domain of the male of the species, mind you. The whole birthing thing, another side effect of sex, leaves much to be desired. The basic setup seems first and foremost to work to the benefit of the medical profession, witness if you will the terrible fate of so many women in the developing world who wind up with fistulas that leak out urine or worse, all the result of unattended deliveries. Why didn’t the creator, or Darwin or whoever is at the bottom of all of this, make little babies slip out early on and hide in a furry pocket on their mother’s abdomen?

If evolution has its way, at least Palestinian women are likely to develop a kangaroo-like reproductive system to avoid lengthy labor and delivery or even death at checkpoints. Evolution takes time but it seems the Israeli occupation will last long enough. And with the magic combination of American money and Israeli ingenuity we may start seeing experimentation with alternative evolutionary strategies such as Evolution on Demand and Fast-Track Evolution. Palestinians make the perfect species for such experiments: they look and act very much like humans, albeit a lower form of the genre; they have proven highly adaptable, witness how we have turned them all overnight into terrorists and suicide bombers and how we can set them at each other's throats at well; they have a fast reproductive cycle; and they are already conveniently in escape-proof cages.

On my way to an early morning appointment with my urologist I had to waste an hour. I went into a fast-food place and ordered a large coffee. Back in Galilee the same type of joint is the place where the well-off take their families for a treat. This one here, at the edge of NYU campus, is rather grungy and a little depressing despite the glaring music. As I sat watching the brisk human traffic I realized that there were a dozen more loafers like me who were seeking refuge from the cold. I counted five disheveled street people with their signal carts and/or backpacks and heavy coats. Three limped on canes. One looked around to borrow a pen unsuccessfully. My wife, Didi, finally donated to him one that was on the verge of drying up. He shook it to determine the level of ink and gave an understanding and forgiving smile. He sat down to his coffee, opened a torn bible and proceeded to underline every other verse with a repeated angry motion of his hand, nearly tearing the thin pages. He ambled to meet another street person, both with arms and necks heavily tattooed. Both fit the prototype of the army veteran who went off the deep end: middle-aged, bulky, white, broken and disturbed. They talked loudly, exchanged high-fives and slaps on the back, then parted before I had a chance to join them. I fought the urge to go over and let them know that I was their comrade, another misfit in this world, a Palestinian.

Another street person, black this time, walked out from the bathroom agitated and waving his walking stick in the air demanding to be given a mop to clean the floor. He insisted he had to do that because he himself was a janitor and had spilled soap on the floor. No one responded and he demanded to see the manager who waved his hand in a motion of dismissal. Eventually the cleaning lady, an Ethiopian-looking older woman, acceded and gave him a bucket and a mop. Later he emerged all smiles and explained loudly to his disgusted female colleague that he had jerked off at the wall and had to clean the mess.

The image in my mind of the American fast-food patron is that of an obese middle-aged person. Yet at this early hour the over one hundred customers that streamed in and out as I observed the scene from where I sat were mainly thin young people, mostly college students on their way to class: whites, blacks, Hispanics and Asian of all shades of color and slant of eye. The fat ones sleep late, it must be. One young Arab boy (perhaps he was Mexican, or he could have been Italian or Indian or Native American, or …) walked over with an endearing sway to the booth across from me with his breakfast roll, earrings, and ready smile every time our eyes met. A second beautiful smiling youth, a woman with West African broad features, ripe apricot skin, big expressive black eyes, and thick succulent lips completed the picture that epitomized to me the hidden potential of the whole human conundrum of New York: varied, cosmopolitan, youthful, full of promise, and potentially Palestine-friendly.

On the way back, having had my indwelling catheter removed after four days of feeling tethered from inside my gut to a heavy iron ball, I felt light footed, free and elated. The sun was shining warm and the Greenwich Village streets were full of smiling beautiful people. I kept thinking: ‘Wow! Have they all had their catheters removed?!”

Later in the day we went to the Chinese dumpling joint two blocks from my daughter’s house. Two years ago when we first found about it, it was a tiny hole in the wall with half a dozen cooks behind a counter that admitted one customer at a time. A line would form all the way out on the street for the dozen varieties of dumplings, sesame pancakes and soups, all prepared fresh as you waited. Despite its space limitations, Vanessa’s Dumpling House has been written up many a time in the New York Times as the place to quell one’s Chinese food longings at affordable prices. Now it is a big hole in the wall with the same half dozen cooks with knives and ladles still running every which way in the crowded space behind the same counter, a scene not unlike a public row in a third-world setting with machetes and sticks. But the customers now have a narrow wooden seat against the wall and a row of small tables to sit and wolf their chow down. Didi and I lucked out as another couple left their seats just as the cashier, who now pokes her finger at Chinese characters on a computer screen instead of writing on brown paper sheets, called our order number, one in the middle hundreds.

Half-way though savoring my soup some of the delicious liquid went down the wrong pipe engendering a cough-spasm that made some thirty heads turn and stare in alarm. Fortunately I quickly snapped out of my respiratory crisis. Now you tell me if it is the best design to have two passages, one for swallowing and the other for breathing, cross on their way down! Wouldn’t it be safer to have one’s nose under his mouth and have the two pipes completely separate? Esthetically, for people like me it should work well. For the two years that I was engaged to my half-Chinese wife, the only grudge her family held against me was on account of that prominent organ “sitting right in the middle of his face.”

1 comment:

Bob from Hawaii said...

I was pleased this morning to open to Dr. Kanaaneh's blog and find a new item! As I read through it in fascination, I breathed recurringly "What a delightful, informative, intelligent riff!" -- about serious topics and not, segueing smoothly from one another, related in every way via language even (in those areas) a non-medical person can understand and enjoy. I'm sure I've written this before, but I'll write it again: this commentary deserves wide scrutiny, perhaps exposure in the New York Review of Books along with other samples of Dr. K's great facility with the written word.