Pills with Three Raw Pecans

“I’ll be back in a little while, Hon’. Will you be okay without me?” the frail old woman asked of her husband. She was standing at the front door and breathing heavily.

“I’ll be fine,” her husband replied from his wheelchair. His voice sounded as weak as his body looked – emaciated, scaly, and full of cancer. “I’m sorry I can’t come with you.”

The woman opened the front door. A gust of cold winter air scattered dried leaves into the foyer and chilled her lungs. The lone tree in their small yard looked tired and skeletal. She coughed against the wind, but pushed on. The walk down the stairs and across the driveway was exhausting. She wrested the car door open and plopped down into the bucket seat. Her breaths came fast, and she thought of calling the ambulance instead of driving herself to the doctor. But after a few minutes of rest she felt better. Her husband had wheeled himself to the front window and was watching her with concern. A nasal cannula graced his elfin face, and the woman thought how marvelous it would be to take a deep drag of his oxygen. But she felt good enough to proceed, and waved to her husband. He blew her a small kiss from his dried lips as she backed out of the driveway.
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It is 4 o’clock on a Wednesday afternoon in February, and I’m sitting in a chair with a laptop computer warming my thighs like an obedient lapdog. I’m swaddled in a cozy bathrobe. My feet are toasty warm inside slippers as I sip hot tea with honey. I’ve raised the blinds on the windows, and as I watch the wet snow swirling sideways in a chaotic display of white, I can’t help feeling giddy that work was cancelled today. I have an overall sense of unproductive euphoria as the gears and pistons of capitalism freeze over. Could blizzards be good for health?

On a normal day I would be 30-40 minutes late seeing patients by now. I would have a dull headache from concentrating all day on hundreds of problems, symptoms, and questions, and my blood pressure would be about 135/84, pulse 89.  But the white flakes of water drifting on the winds seem weightless, elemental, and self-sufficient. They certainly have no interest in me as I enjoy their infinite procession. I estimate my blood pressure is 108/72, pulse 61.
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On the way to the funeral you wonder how you’ll be received by the grieving. Although you are confident that your care for the deceased was sincere, professional, and adept, you still question if others will so assume. There is silence in the car. This is a trip you make alone.

You manage a bitter smile as you recall stories the patient shared in unguarded moments, behind the door of a small examining room. How he beamed with content at the thought of his grandchildren; how her eyes glowed as she remembered the view from the Eiffel Tower; how the tears and sobs and memories of a lost child wracked his otherwise impenetrable façade. Sometimes you knew his spirit as well as you knew his medical illnesses, and often he hoped you would tend more to the former.
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Today NPR ran a story about fierce competition and cooperation among mouse sperm cells trying to fertilize an ovum. Apparently spermatozoa from the same male will often clump together, wiggling their flagella in a collective swim that accelerates the group faster towards an egg. In the race to be the first sperm to fertilize an egg this team approach (with sperm of a feather flocking together) may confer an evolutionary advantage. Solo-swimmers move more leisurely. The research and cool video presented on NPR were of sperm from the promiscuous deer mouse.  Such murine sperm “behavior” may not be as evolutionarily needed in (usually) less promiscuous humans. Yet the idea of sperm cooperation, fitness, and competition in a microscopic steeplechase is fascinating.

Since this blog is oriented towards human health, I’ll keep my comments about mouse sperm to an ignorant minimum.  But the NPR article and several recent questions from patients got me thinking I should brush up on my male reproductive knowledge.  On a macroscopic level, optimizing sperm fitness is often a topic of men’s health magazines, macho boasting, cheesy websites peddling herbs, and urban legends of super sperm. But for those men with infertility, issues of healthy sperm can be no laughing matter. If a precise cause of infertility can be found then a specific treatment can be recommended, but there are also general measures which can positively affect sperm fitness (in no particular order):

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I’ve decided to take a course at Yale University called Astronomy 161 – Frontiers and Controversies in Astrophysics. Yale has agreed to allow me, a family doctor who enjoys astronomy without rigorous mathematics, to take this course for free. Although I will earn no official credit from Yale, I will be able to listen in with all the other Ivy League students in the class. Since I’m kind of busy, Yale has agreed to teach me in my bedroom when I get sleepy.

Yale and a bunch of other universities will do this for you, too.

I’ve known for some time that there are universities sharing online lectures, notes, and syllabi over the internet with the general public. Finally I got around to finding and starting a course. It is fascinating, and provides a nice break from all the continuing medical education in which I’m usually immersed. Although we’ll miss the “real college” weekends of partying and pulling all nighters, we would all be foolish not to sit in on a few of these courses when able.

Here is a list of some great sites that offer online courses. Some only share lecture notes, others stream entire semesters of esteemed professors lecturing. I’ll add more links to this page as I learn of them.
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His father and I were once young together, runners of long distances, across fields and suburban drives and teenage battlefields.

Tonight he’s carrying his baby boy, and walking with his wife and me back to their hotel, which looks far away down the concrete city sidewalk.

Revelers in hats and soaked heavy coats celebrate with laughter and drink. There’s only moments left in the old year.

Despite the wintry night we suddenly, naturally take off running, again, towards the glowing hotel. With us is an infant boy with a snotty nose. His eyes are wide, and he’s a spark of fire hurtling through the cold and damp night. He’s smiling, and we are promethean.

With wind in my lungs, spirit in my belly, and an electric storm in my muscles I’m practically flying. I’m giddy. Orion is constant in the firmament as the rest of the Earth streams by. I look ahead and see mother and father dashing on with their cherubic boy, their hope made flesh, laughing wildly as we all run like giants across the spinning globe.

There is no disease, no heartbreak, no sorrow, and no end. We are reckless and young evermore, and despite keeping their child awake on a dreadfully frigid New Year’s Eve, and running like scamps, wildly through the raining city lights – they are among the best parents in the world. I’m certain of it.

Like fabled marathoners, we are all runners in the night, carrying hope, light, and the battle-glorious news that life must go on for another year. It must be met bravely, and the act of living should make running hearts pound with joyful abandon at times.