Many Happy Birthdays

 

I wish to celebrate an important birthday today.  This piece has little to do with crime or writing, except for the odd fact of some things not being crimes, and the interesting differences between real life and storytelling.  What I mean by that, is that this true tale will take some turns very different than they would in, say, a movie about the events.

Frances Oldham was born 110 years ago today, July 24th, 1914, in Cobble Hill, British Columbia. In an era when few women attended college, she got Bachelor and Masters degrees in pharmacology.  In 1936 she applied for a job at the University of Chicago and was hired by a boss who assumed "Frances" was a man's name.  In that non-existent movie about her life this would no doubt provide many dramatic scenes about her battles with sexism, and some probably happened, but I found no record of them. 

The next year her boss worked with the Food and Drug Administration on a strange case, involving an antibiotic called sulfanilamide.  It worked fine as a pill but many people in the south preferred to take medicine in liquid form so a chemist found a liquid that would dissolve the drug.  Unfortunately, the liquid was poisonous and more than one hundred people died.

Elixir Sulfanilimide

The owner of the company said "I do not feel that there was any responsibility on our part."  The chemist apparently felt differently, since he killed himself.

Here is the strange bit: the FDA had no authority to force the drugs off of store shelves. At the time the  FDA could only deal with false labels, and the labels were completely accurate.  This resulted in a law passing in 1938 giving the agency control over the drugs themselves, not just the packaging - the beginning of all those pesky federal regulations some of us complain about.

Besides her experience in this field, Oldham also acquired at the University of Chicago  a Ph.D., an M.D., and a husband.  So she became Dr. Frances Kelsey.

In 1960 she got a job at the FDA reviewing drugs.  She was quickly assigned to check a trnquilizer/painkiller  the Richardson-Merrell company wanted to sell, called Kevadon.  It was already in use in almost two dozen countries, including Kelsey's beloved Canada.

But Kelsey said no.  She insisted on seeing the  clinical trials.  The FDA could only hold up a drug for sixty days but she kept getting two month extensions, while the pharmaceutical company ranted and complained.

In our imaginary movie this would be the part where she battles furiously with her boss.  In reality Kelsey said the FDA higher-ups supported her.  Good for the nation's health, but lousy for drama.

More than a year after Kelsey's holding operation started the news began pouring out of Europe: Kevadon, under its generic name Thalidomide, was the factor connecting the births of many malformed babies. A drug which had been specially promoted for pregnant women was causing horrible birth defects.  

Because of Dr. Kelsey's firmness and demand for scientific rigor, there were only seventeen such cases in the United States --  and those were because Richardson-Merrell had distributed "experimental" doses, which was allowed under the current law. 

Again, in our pretend drama, this might be the point to lament Kelsey's contribution being forgotten, or else attributed to some man. In real life that didn't happen.  Kennedy gave her the President's Award for Distinguished Federal Civil Service.  

But we get into more dramatic territory in 1966 when a new FDA commissioner, apparently resenting her fame and believing drug company complaints that Kelsey had refused the approval out of laziness, demoted her.  But when that commissioner left she returned to her role as Director of Scientific Investigations.   She retired at age ninety.  The FDA gives out an annual Drug Safety Excellence Award, named in her honor.

It seems fitting that on her birthday we remember Dr. Frances Oldham Kelsey, who was responsible in the early sixties for so many birthdays being happy.

Medicine and Mysteries: Justice Served

Medicine and mystery novels have much in common and this pandemic has highlighted one commonality in a very tragic way.

Many doctors I know are mystery readers. Many mystery writers the world knows are doctors, from Arthur Conan Doyle to Josephine Bell, Daniel Kalla and Tess Gerritsen.

Readers of mysteries are often greeted with a person facing a serious situation, or a tragedy, often from the first page or shortly thereafter. The rest of the book is all about unraveling the complexities of this story – the pain, the fears and, often with many clues – finally finding out whodunnit.

In medicine a person comes carrying a serious story and through listening to the story, unraveling the complexities of their story, their pains, their fears, we often add some tests and hopefully lift the burden of their story with a treatment once we’ve identified the disease or - in mystery terms - whodunnit.

The focus on the story, the complexities of people and the determination to find whodunnit: this is what mystery readers (and writers) and doctors share.

There’s something else they have in common: a sense of moral beliefs and justice being satisfied – as much as they can be – is part of this commonality.

Physicians go into medicine to help people – to deliver just and fair care to patients. Oddly, one can look on medicine as a means (within limits of science) to rectify the wrongs of disease. It is an attempt to give back the patient the best life they can have for as long as they can have it.

Readers approach mystery novels with a sense of righting wrongs and a sense of of justice delivered.

Imagine a mystery book where everyone throws up their hands and claims that they will never find a murderer because they don’t care or can’t be bothered. Where not even a smidgen of justice is served and the smirking murderer goes free. Now, of  course this may make an interesting plot but, let’s face it, it’s not the normal fare served by a mystery novel. In fact, I would argue, that seeing evil get their comeuppance is part of the satisfaction of reading a good mystery. Yes, we must often tolerate suffering of the innocent but suffering of the many innocents while detectives shrug their shoulders is certainly not the norm and would leave readers disappointed.

Now, imagine being a doctor during the pandemic. At first, physicians were swamped with patents they could not help because COVID-19 was a new disease. Not only did we lack vaccines and treatments, but we were woefully short of the knowledge and supplies to use masks. Then, vaccines came in, and when one waned, we had more vaccines and the promise (now fulfilled) of better vaccines. We had good quality research to show that masks work to prevent infection and even ample supplies of good masks, not just to protect healthcare workers but also the public. We now have rapid antigen tests - although they aren’t perfect, they give an indication of who is infected, allowing them to isolate and prevent further infections.

All of this good stuff should make being a doctor better than it was at the beginning of the pandemic. So, why are many doctors burning out, quitting their jobs or suffering from various mental health problems, including depression?

Part of it stems from the behaviour of the public. Many are eschewing updating their vaccines – or refusing vaccines altogether – and refusing to wear masks. If they get infected and hospitalized – there are some treatments. However, putting a COVID19 patient in a hospital bed may mean that a cancer patient doesn’t get their surgery or a patent in pain doesn’t get a hip replacement. The doctors caring for cancer patients who can’t get a hospital bed, can’t offer them optimal treatment and watch the unnecessary deterioration of their patients. As we add more patients with COVID19 and LongCovid, and lose doctors, physicians at times cannot get their patients access to the help they need for specialist care. Some physicians have been subjected to abuse – verbal and physical – from increasingly frustrated patients. 

The Canadian Medical Association has identified moral injury as a serious and growing problem during the pandemic:

“In the context of health care, when physicians are unable to uphold the oath they took to deliver the best care and put the needs of their patients first, they can experience moral injury. Moral injury is not considered a mental illness; however, those who experience moral injuries often develop negative thoughts about themselves and others, and these symptoms can lead to the development of mental health conditions.”

Moral injury is not a new problem for physicians, but it has increased during this pandemic. A pre-pandemic paper described the dilemma accurately:

“Moral injury describes the challenge of simultaneously knowing what care patients need but being unable to provide it due to constraints that are beyond our control.”

To not be able to properly care for patients is like a lousy ending to a mystery novel – except it’s worse. Much worse. These are real people. With lives, loves and people who love them. To not be able to help a patient because medical science is not up to the task is always sad. However, to not be able to access the care we have and allowing patients to suffer is immoral and unjust.

Epigenetics and Elephants

Most of the time I interview people and allow the things they ponder to guide my writing. This is not that article. This is about my late night pondering. Excuse the indulgence, but it’s been a a tough year and I’m prone to sleepless nights and thoughts.

Unable to sleep, I was ruminating on epigenetics and elephants. They may seem odd things to stay up at night about, but these are seriously important.


What epigenetics does is shake things up. DNA decides who we are but life turns our genes on and off - impacting everything from the architecture of our brain to the diseases we have. 

If you want to keep up at night too, just read about how this happens and how we can reverse the DNA changes that happened to your grandmother.

What actually jolted me out of a slide into a lovely slumber was a child. In a shopping cart. 

I was young - probably around 8 - and shopping with my mother. A child less than 2 in a cart passed by and she was sobbing. Her mother, her face clenched in that angry way that makes people truly ugly, slapped the child and said, “Cry again and I’ll give you something to cry about.’ As if that poor child didn’t have enough to cry about. I said to my mother, “Do something!” She said, “Shh.” Afterwards, my strong, well-educated mother told me that much as she would like to, it’s impossible to change how people parent.

There are many things that make us decide on our profession and making medicine my choice was about a series of decisions. All of them started at that moment. I was going to get an education that could help that child.


Choosing medicine would never have been something I did if I didn’t see a road to working with the damaged, the broken and, as I eventually did, stop the breaking and beating. I only went into medicine to work in mental illness.  

Let me tell you about mental illness and medicine and the place it has.  Many wonder why anyone would chose it. I have literally had people ask why I gave up medicine and chose to work with mental illness. Let me get this perfectly clear, I am a doctor who works with the mentally ill. As a doctor, I bring skills to the table because no brain tumour masquerading as depression gets past me. So, I am a doctor. Who works in one of the most important fields of medicine: with the mentally ill. I didn’t fall into it. I marched toward it, and went through medical training and 8 years of specialty training to have the privilege of working with patients that I wanted desperately to work for.

And that’s where epigenetic comes back in. Changing someone’s mental illness changes their genes. Leaving it does too. Those illnesses that all doctors battle, well I battle them too. In a different way, on a different battlefield, but it’s all medicine.

This all made me think of Dr. Fraser Mustard, who I had the honour of meeting numerous times. The last time I saw him was in his lovely home in Toronto, where his children lived in the apartment above him. After an illustrious career in medicine he had ended up pondering epigenetics and childhood trauma. He wrote about it brilliantly. He advocated for children. He was very old when i met him but this belief in helping children made him seem ageless. Children do that to you. In his apartment, so full of interesting things, was where I first thought of how he must stayed up at night worrying about children and that made it his life’s work at the end.



Sometimes, at the end of a career, you ponder the beginning. The thing that started it all. The work you have done and the value of it all.

Now I’m writing another book. It isn’t a departure from any of my other work. It is about the lost, the damaged and the suffering. I can’t change course because I simply don’t want to. It is what we see, truly see, that decides our course in life.

There is an African Zulu greeting: “I see you.” It is a haunting saying. When I was young, I visited many zoos around the world because my biologist father would meet other biologists and talk about the conservation efforts they were making at their zoos. I understand the conservation part. I do. But I really didn’t give a damn then, or even now. I hated zoos. Seeing the animals, really seeing them, in cages that were far too small or chained up - because that was the way zoos were then - I could see that the cages and chains around the elephant legs were truly like beatings. They diminished these animals, and their suffering was evident to anyone who bothered to look. In East Africa, where we spent many months on various trips, I saw wild animals on the plains. My first sight of elephants, not in chains but walking and taking such tender care of each other, made me fall in love. For the wildness of them. For the beauty of them. For the tenderness. I saw them.

Medicine or writing or elephants - it is all about seeing. All of it will keep you up at night if you let it. And these days I do.

And that child, being beaten in a shopping cart for all the world to see but not intervene. That too. That always. It shaped my life. I wish I could have told that tiny darling that. 











He Had Plans For Her: Part Two

by Mary Fernando

When Eve escaped, she took her children and went into hiding. She remained nervous and constantly vigilant. He had resources. He was cunning. He could show up at any time. She tried to shrug these fears off, but they haunted her. 

Four months later, Eve was in her kitchen. The children were in their rooms. The lights were low. It was night. As she emerged from the kitchen, she saw the end of his gun highlighted in the moonlight. It was pointed at her.

A ten inch cast iron skillet was in reach. She grabbed it and held it at by her side. As she walked up to him, with the gun pointed at her throat, she hit him in the head with all her strength and he went down. She looked at him and thought: I could hit him again and end this threat.

She suddenly saw her young son, looking at her from the hallway. Her eldest. He was his son too. She didn't kill him that night. She couldn’t. She called the police. 

This is not the end of this story. There is no happy ending with police stepping up and protecting Eve.

After being in jail for a little over a week, he bailed himself out and then went to a neighbouring county and filed charges of assault against Eve. Yes. That is the nature of abusers: they feel that they can manipulate the world into allowing them to abuse and kill. They have no shame. They are – in their own minds – the one who is the real victim, forced to hurt this woman because, above all else, she deserves it.

Even now, after many years have passed, Eve remains vigilant. Eve remains in danger: over half of all the murders of women in the United States are related to intimate partner violence.

The most pervasive danger Eve faces, despite the safe life for herself and her children, is that reality can’t protect her. Whether asleep or awake, without warning, she is right back there, in his clutches, being abused and beaten, with fear flooding her and making her unable to breathe. At any moment, something can remind her of a terrifying moment and adrenaline floods her brain and sends her heart racing. At times she is numb. At times she is frightened. At times she simply withdraws and hides.

This was his plan for her: to never let her go, to never let her live her life without his presence forging her into a fearful compliance. 

Eve is now both free of him and yet haunted by him. This in-between place is what we call PTSD.

Eve has said, unequivocally, that you can’t talk about domestic violence without talking about PTSD. Eve is not alone in drowning in her past: of the 1 in 3 women and 1 in four men who have been victims of domestic violence, over half experience PTSD.

His plans for Eve was to forever keep her fearful of him. PTSD allows him to haunt her.

Treating PTSD is a critical part of fighting domestic violence. A specialist told me: PTSD treatment is long, hard and of variable effectiveness. We need investment in more research on methods of treatment and more investment in making treatment available for patients.

The best protection for women and men in situations of domestic violence is to give them a safe haven and to prosecute their abusers. The best vengeance against domestic abusers is something altogether different: it is for their ex-partners to finally and decisively put them in the rear view mirror and watch them get smaller and less important as they move forward with life.


He Had Plans for Her

“He laughed a lot, but not loudly. Other people naturally deferred to him. He was a skilled communicator,” she said, in that famous voice, like smooth whisky with a touch of honey. “We married very quickly. I was very young.”

After they were married, he began to reveal his plans for her. By humiliating and belittling her daily, he made her feel small, unimportant and made it easier for her to be controlled. It taught her that she was no match for him. If she disagreed with him, embarrassed him in any way, there would be consequences. There would be beatings. She learned to never disagree. Never to say anything he would disapprove of. She learned to avoid other people. To become isolated, because that too, made her easier to control.

She learned his rules. In the midst of fear and humiliation - she knew if she followed his rules, the beating would be less. And the beating would stop when she was pregnant. And he didn't beat the children.

She didn’t go to the hospital to give birth to her first three children, because he didn't want her to say anything when he couldn't control her.

When she was nine months pregnant with her fourth child, she said something that upset him. He threw her down the stairs, broke her coccyx and sent her into labour. He took her to the hospital.

To keep her in line, to make it clear how unimportant she was, he parked and made her walk, bleeding and in pain, the long distance to the hospital doors. 

When the x-rays showed her broken coccyx, she told the nurses and doctors that she had fallen down the stairs. No one, no nurse, no doctor, asked her if she had been beaten, if she felt safe. When she went into full labour, she refused all pain meds, fearful that she would say something she shouldn't if she was drugged.

After she delivered her baby, she began to realize that there were no rules that could keep her safe. Before, her pregnancies had protected her from severe physical violence. Now she knew that he was eventually going to kill her. And then who would take care of her children?

That provided the impetus to get help from a women’s shelter. Here she voraciously read their literature on abuse, found solace in those who cared for her and her children. 

But he still had plans for her. 


Before she could escape and build a life for herself, he kidnapped her children. To get them back, she had to go with him. She went with him.



For three days, he tied her down and he tortured her. Beat her. Humiliated her. Raped her. She still remembers that moment during those horrific days that she caught a glimpse of herself in the mirror. She was filled with loathing for the woman she saw in the mirror. She hated what she saw. What he had made her. 

“I now know I was just doing my best,” she said, whisky voice turning soft. “I was being extraordinarily brave to take the only path forward I could see for my children. For myself.”

That path was to get her children back, escape him and make a life for herself. 



You probably know her as Eve, or by her twitter handle @BrowofJustice. She is a nurse who is fierce about the care of her patients and the raising of her children. She is fierce in defending others. You can’t scare her, because she has been to hell and she walked out. On her own two feet. And she has other things that terrify her.


Eve is not alone, not only because she now has friends and colleagues. She shares the same story as the one out of every three women worldwide have been the victims of physical and/or sexual violence by an intimate partner or sexual violence by a non-partner at some point in their lives. Less than 40 per cent of the women who experienced violence sought help of any sort. Less than 10% sought help from the police.

Healthcare providers - doctors, nurses, nurse practitioners, PSWs - all need to be trained to see the signs of domestic abuse. We need to ask - do you feel safe? We are trained to recognize heart attacks and strokes. We need to be trained to help curb the epidemic of domestic abuse. 

Eve is the voice of these women and her story is their story.

One of the reasons women don't speak, don't escape, is that they are frightened that their ex-partner will eventually find them and make them pay for breaking their silence. They are scared that they will never be free. Never feel safe. 

When I write the rest of Eve’s story next month, it will become clear why Eve, like many women, is justified to have these fears.

Death comes in...

by Mary Fernando

She is the first person I have spoken with who has actually killed. 


“Unlike a lot of people, I do kill,” says Dr. V. As a veterinarian, she does indeed kill as part of her job. “There is how I end a life and what it is like.”

She starts with the latter.

“As one of my duties it is a bit of a double edged sword - it is so sad. Euthanasia literally means good death in Latin- I have to concentrate on that. it is my job to stay professional and not show grief. It can build up over time.”

Veterinarians have a very high suicide rate. One of the contributing factors is the result of facing grief over killing animals they are attached to while not being allowed to express their grief. It is their job to stay calm and comforting when they need comfort themselves.

She then moves onto the how she kills. She is describes both how to kill and what you see when death arrives. Not just for the animals in her practice, but for all living beings. 

“I front load sedatives and anti-anxiety meds, so the animal is still with it enough to know their owners are there, but not as aware of the insertion of the IV catheter. We use pentobarbital at 300 times the dose used for anaesthesia. In 30 secs to a minute the syringe is fully injected and in 15 sec to 30 secs they pass.”

“I believe that is when the soul leaves the body. Breathing is slower and slower and then it stops - and I get a feeling - it is a deep stillness and you can almost see an emptiness.”

“I know what to expect and I warn my clients. The eyes will stay open. Even if you try to close them, they open up again. The  animals will urinate and defecate. When calcium is released from the cells, sometimes you will see muscles contraction and the most scary thing is when the diaphragm contracts it looks like breathing. But it isn’t.”

“If this was an overdose of sleeping pills, it would be just like this.” 

Listening to her, I think of the many dogs I have had over the years. How their pain and suffering was relieved by vets just like her. And how it must have worn each of them down. 

I also wonder if any of us can kill - and watch this stillness - the emptiness - followed by the open eyed release of bowels and bladder and the breath that is merely the release of calcium and not life. Can we watch this and not be gutted to our core?

As a doctor I have seen death marching in - sometimes slowly and sometimes on a rampage - and I have seen death arrive. I have heard people say that it was a mercy, for the best. I have said that myself. But here’s the thing, the arrival of death is always frightening. There is no way that you can wipe out a life lived without that. Even if it is for the best.

Bleeding, Sweating, Purging

Or, as some people call it, the good old days of holistic medicine.
Seriously, these were all the standard medical treatment from ca 200 AD until the first use of antibiotics in the 1940s.  Nostalgia isn't what it's cracked up to be.  The truth is, standard medical practice between those dates probably killed more people than all the wars in history.  And it certainly makes for some interesting possibilities as far as historical murder, because how would you tell a homicide from a treatment?

The reason bleeding, sweating, and purging caught on was because of Galen, the most famous Greek physician of the Roman empire.  A legend in his own time, his writings survived the wholesale wreckage of ancient books and learning of the Dark Ages:  they were the major source of medical information for Byzantium and the Arabic Abassid Dynasty, and got reintroduced to the West in the 11th century as part of the treasures that the Crusaders brought / sent back to Western Europe.  His influence was so great that, when 13th century anatomists found differences between, er, actual anatomy and Galen's theories, they explained that the human body had obviously changed since the ancient world...

Anyway, Galen practiced medicine by humors, which has nothing to do with jokes.  According to this theory (which probably started back in ancient Egypt), humans are divided into four types:

18th c. woodcut - Wikipedia

• Sanguine (enthusiastic, active, and social) - ruled by their blood, which Galen believed was manufactured in the liver.  Element, air; season, spring, infancy - warm and moist
• Choleric (short-tempered, fast, or irritable) - ruled by yellow bile, which came from the spleen.  Element, fire; season, summer, youth - warm and dry
• Melancholic (analytical, wise, and quiet) - ruled by black bile from the gallbladder.  Element, earth; season, autumn, adulthood - cold and dry
• Phlegmatic (relaxed and peaceful) - ruled by phlegm, made in the brain/lungs.  Element, water; season, winter, old age - cold and wet  

(There were also astrological aspects to all of this).  

Anyway, all your ills, moods, "humors", etc., were based on an imbalance of the blood, bile, phlegm. So the obvious thing to do was the cleanse you so that your body could rebalance.  (A lot like the eternal craze for juice fasts, fad diets, and high colonics...)  Thus, bleeding, sweating, and purging.

Folks, all I can say is that we are living in the best time to be ill in history.  Back during the plague years, one physician infamously said, bleeding patient after patient, "Plague, I will cure you by bleeding!"  All the patients died, but he soldiered on, knowing that eventually it would work.  And doctors continued on the same path until very modern times.  Louis XIV's oldest son, the Grand Dauphin, grandson (the Duke of Burgundy), and his wife, the Duchess, and their oldest son, the Duke of Brittany, all died within a year and a half because their doctor tried to cure smallpox and measles with bleeding.  The result was that two entire generations of the royal family were wiped out and the future Louis XV became the Dauphin at the ripe age of five.  (This was, in case, you don't know it, a disaster:  "Apres moi, le deluge".)

Throughout the 17th, 18th, and 19th century, heart attack patients were bled; young girls suffering from "green sickness" were either bled or advised to have sex; Marianne Dashwood of Sense and Sensibility was bled when she obviously had pneumonia.  And, aside from illness, it was largely believed that everyone should be bled regularly, to help balance their humors:  monks and nuns were bled about four times a year. The only real change over the centuries was that, instead of using leeches, doctors actually performed a phlebotmy using special lancets or knives.

Photo of Bloodletting in 1860 -
Wikipedia

By the 19th century, "One British medical text recommended bloodletting for acne, asthma, cancer, cholera, coma, convulsions, diabetes, epilepsy, gangrene, gout, herpes, indigestion, insanity, jaundice, leprosy, ophthalmia, plague, pneumonia, scurvy, smallpox, stroke, tetanus, tuberculosis, and for some one hundred other diseases. Bloodletting was even used to treat most forms of hemorrhaging such as nosebleed, excessive menstruation, or hemorrhoidal bleeding. Before surgery or at the onset of childbirth, blood was removed to prevent inflammation. Before amputation, it was customary to remove a quantity of blood equal to the amount believed to circulate in the limb that was to be removed." (Wikipedia, Bloodletting)  

There are fewer references to sweating than to bleeding.  The main one I can think of is in Little House in the Big Woods by Laura Ingalls Wilder, where a naughty little boy gets stung by a whole nest of wasps, and is slathered with mud, and bound up in sheets and left to sweat the poison out.  It apparently worked, because he survived.  When I was a child, if I had a fever, I had blankets piled up on top of me to make the fever break by sweating it out.  And, of course, sweat lodges, hammams, and saunas all operate on the theory of making you sweat, thereby cleansing you, both inside and out.

And purging is everywhere in the literature, from diaries to novels.  My mother, born in 1917, believed that in spring you need to eat purging foods and/or take a thorough laxative to cleanse the body.  In Jack Larkin's invaluable The Reshaping of Everyday Life 1790-1840, he describes a world of hard work, much fun, and horrifying medicine.  "Bleeding and blistering, purging and puking" were the standard remedies for EVERYTHING.  And they were the kind of thing that your average frontier citizen in America could do at home, for themselves, using plants, herbs and (sometimes) kerosene.  (No, I am not kidding.)  Thus when Zadoc Long's wife suffered what was probably a nasty gallbladder attack, he gave her a strong emetic made of thoroughwort to "puke her".  (88-92)

What about medicine?  Well, there wasn't much.  Quinine did work on malaria, but it was also given for almost any "ague", or recurring fever.  One of the most widely used drugs was calomel, mercurous chloride, which was used for such things as syphilis and yellow fever.  It didn't cure either of them, but it gave wonderful proof that it was strong medicine:  mercury [poisoning] made people salivate like a mad dog, then lose their teeth, and perhaps their hair.  A thorough purging indeed.  And let us not forget alcohol. Whenever you read in the literature about someone being given "cordials" that is some form of alcohol.  A lot of people died in a prescribed drunk.  Supposedly Oscar Wilde, being prescribed champagne on his deathbed, said, "I am dying as I have lived, above my means".

There were a few things that worked:   As I mentioned in a previous blog ("Arsenic and Old Lace") there was opium in its various forms, especially laudanum (alcohol and opium combined - the pause that refreshes and the mother's friend).  Cocaine was used as a numbing agent, a stimulate, and even, apparently as a cure for dandruff.  There was an effective smallpox inoculation, using live disease material.  This was risky, because many patients got smallpox from the inoculation, and some died.  Even more effective was Dr. Jenner's vaccination using cowpox, which ran far less risk of infection and death.  While smallpox was never eradicated (not enough people were either able to get the vaccination or were willing to run the risks), at least it became rarer.

Basically, before 1945, the best thing to do for your health was to choose your parents wisely.  And not get in accidents, wars, or be pregnant.  If you could survive birth, infancy, early childhood (all of which wiped out about 50% of the population), and then could manage to not die in accidents (a simple scratch could give you blood poisoning or tetanus), childbirth, epidemics or war, you could become very, very old.  And be remarkably healthy the whole time.  Eleanor of Aquitaine had 10 children, a complex and busy life, and still managed to live active and healthy until she was 82.  The philosopher Fontenelle (1657-1757) was known for his intellect and his womanizing.  (He said to Madame Helvetius, when he met her in his late 90s, "Ah Madame, if only I were eighty again!")  A medieval letter from a visiting priest to an abbey offered birthday wishes to Brother Narcissus, on the occasion of his 116th birthday.

Good genes?  Undoubtedly.  And darned little bleeding, sweating, or purging.

Back Pain Attacks Writers and Readers

Do you love books? Reading them, writing them, anything to do with them?

And have you ever had back pain?

Chances are high that you said yes to both books and back pain. This is a site for mystery lovers, after all, and approximately 84 percent of adults get low back pain at some time in their lives.⁠1 ⁠2 So you and I are not alone.

(Wouldn’t that make a great birthday card? Happy 18th birthday! Party hard, because now you have an 8 out of 10 chance of hurting your back!)

So listen. I’m an emergency doctor who loves books. I decided to tackle this sucker by writing THE EMERGENCY DOCTOR’S GUIDE TO A PAIN-FREE BACK, which releases Thursday, April 21st.

Obligatory disclaimer: I am a doctor, but I’m not your doctor, so you have to go see your own health care  practitioner. All I can do is give you helpful advice on treatment and prevention.

I pored over research articles. I read other books and considered both traditional and integrative approaches, including acupuncture, yoga, and diet. What struck me is that some people want to give advice without anchoring it on research, so I’m proud to say that I included studies written right up until January 2016.

The other thing that struck me was that a lot of fact-based books were super dull, so mine is short, funny, and full of cartoons and pictures because hey, life is short.

Here are three tips for readers and writers:

1. You don’t have to be a book lover to get back pain. Even sitting all the time doesn’t automatically cause back pain⁠ 3, although it does predispose you to other problems (coronary artery disease, diabetes, breast and colon cancer ⁠4…I know! I’m full of good news today!). So try to get up and move throughout your day.

2. After you go see your doctor, you may well get diagnosed with non-specific low back pain. More than 85 percent of the time, we don’t find a particular cause.⁠5 I consider that good news, because you don’t want the herniated disc, fracture, infection, or cancer. You want to get better. Fast. And to do that…

Kathleen can do it. So can you!

3. “Don’t tell me I have to exercise,” groaned more than one writer-friend on Facebook.

Yes, I’ve got triple good news for you. You do have to exercise once you get over your initial agony, or to prevent it in the first place. Exercise and education reduce your risk of a back pain episode by 25 to 40 percent, as shown in a 2016 meta-analysis by Dr. Daniel Steffens and colleagues at the University of Sydney. They considered 21 randomized control trials of 30,850 people.6

There’s no hard evidence on which type or amount of exercise is best. “It seems to matter less exactly what type of exercise you do than that you do it in a regular way,” said Dr. Timothy S. Carey, a physician at the University of North Carolina at Chapel Hill, who co-authored a commentary on the mega-study by Steffens.

So choose exercise that you like, and do it. Cardio, core, strength training, flexibility, and working your upper and lower limbs were all included in that mega-study.

Since we’re all busy, I developed a three-pronged exercise program where you can even work on your strength and flexibility in bed, at work, and while watching TV. My program is meant to be accessible to everyone. Look at my friend Kathleen. She’s a senior citizen, and she’s hitting it hard. With my book!

Click cover to preorder e-book now for a special price of $5.99 (regular price $9.99).
Direct Amazon.com link here.

Bottom line: most of us will get back pain sooner or later. As someone who loves words, you’re already at at advantage to prevent it through education. Keep reading and start moving, and you'll save your energy for more fun stuff like cat detectives and hard-bitten thrillers.

1 Deyo RA, Tsui-Wu YJ. Descriptive epidemiology of low-back pain and its related medical care in the United States. Spine. 1987; 12:264.

2 Cassidy JD, Carroll LJ, Côté P. The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults. Spine. 1998; 23:1860.

3 Chen SM, Liu MF, Cook J et al. Sedentary lifestyle as a risk factor for low back pain: a systematic review. International Archives of Occupational and Environmental Health. 2009 Jul, 82(7): 797-806

4 Lee I, Shiroma EJ, Lobelo F et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. The Lancet. 380(9838): 219-229

5 Deyo RA, Weinstein JN. Low back pain. N Engl J Med 2001;344: 363-70

6 Steffens D, Maher CG, Pereira LS, et al. Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA Intern Med. 2016 Jan 11:1-10. doi: 10.1001/jamainternmed.2015.7431. 

Medical Genetics

One of my many strange jobs was at a Medical Genetics Lab in the 80's.  It was your typical lab:  clean but shabby, hard-edged, hard-used.  The whole place reeked of what I called a "wrong smell" - which was basically amniotic fluid and chemicals.  Light came through glazed windows.  The samples came in bagged or bottled and sealed.  The results went out in plain brown envelopes.  The lab did buccal smears (cheek swabs) for babies, blood tests for children and adults, amniocenteses for pregnant women.

The technicians would take the samples and distill them down to that one little drop that went under the electron microscope.  The next day I’d be handed a blurry 8 1/2 by 11 photograph, full of chromosomes no naked eye could ever, would ever see, transformed into inch-long fuzzy banded crosslets, tumbled and curled and overlaying one another like sleeping puppies.  My job was to sort them out.

I got to know those chromosomes really well.  Me and my trusty scissors untangled 9s from 4s, 18s from 21s, and set them in neat ordered pairs for the first time in their existence.  At first, like every Other, they all looked alike to me, but time and use and my own fancy gave them personalities.  The first five sets were large and strong and unmistakable -- any flaw in them and there would have been no being to be tested.  6 through 12 were like the dancing men of Sherlock Holmes:  jaunty, poised, often with one foot kicked up in dance or play.  16 through 20 were smaller but just as playful, children learning at their parents’ knees.  13 through 15 were Hopi women, with their looped hair risen above long blankets, or nuns in banded shawls; an elemental female image.  And then the mysterious, smaller shrouded shes, 21 and 22, solid, dark, impenetrable, unpitying, even when you winced with pain, even when you cried as you found a third come to join their pair, or one so damaged that nothing good could come...


When I found a trisomy or a monosomy or any other abnormality, I took it to the lab director.  She would inspect my work carefully, assuming - usually correctly - that I had made a mistake.  But when I hadn’t, the whole lab went into panic, running and re-running the test.  When the results were certain, the phone call was made to the patient’s doctor and the sealed plain brown envelope, stuffed with test results and interpretation, was hand-delivered to the doctor’s office.  What happened next was between the patient and her doctor, her family, her God.  We knew what the options were:  we made no recommendations, rarely learned the outcomes. 

The search for sex was a lot more fun.  I found the male in microcosm elusive, mainly because the Y chromosome looks nothing like a Y.  Half the time I thought it was a scrap of something else.  I started a lot of panics until I got it through my head that what looked to me like a tiny, flat-topped, spread-legged 21 was not a trisomic sister of doom, but a Y, a HE.  My only comfort, as I sat with my scissors and a worried look, was that over in the hospital, with the baby right there in front of them, they couldn’t tell either.  Parents panicking, doctors shrugging, nurses whispering, and all waiting for me (!) to find that other damn chromosome and tell them whether it was a girl or a boy.  

This happened a lot more often than you might think.  Mother Nature does not always get it right, or perhaps she just has a very perverse sense of humor...