“I WASN’T PREPARED FOR HIS PERFORMANCE IN SUCCESSION. I CAN’T SEE HIM ANYWHERE IN IT, AND I DON’T KNOW WHERE IT CAME FROM. I DON’T KNOW IF I’VE EVER BEEN SO SURPRISED BY AN ACTOR.”
— Colin Firth on his friend and fellow actor matthew macfadyen (tom wambsgans)
I love this quote (snatched from Vanity Fair… behind a paywall but, alas, not far enough!), not only since he’s my favorite character on “Succession,” but because one of the greatest gifts we can give our friends and family is this element of, shall we say, “contained surprise.” Stipulate that the full-fledged version of join-the-circus-or-worse-yet-a-cult-or-even-Amway is almost never a welcome event. Yet there is room in the folds and interstices of our textured personalities to find another voice — the way Barry Gibb stumbled onto his during an eventful recording session. Maybe a little Vaseline behind the ear to serve up the occasional spit-ball. I’m going to go so far as to say that this is our obligation to one another. And surely to ourselves. We should be seeking these joyful moments of, might we then coin, “expectation arbitrage.” Leave them agog at the Thanksgiving table as you quote Tolstoy in the voice of Beavis and/or Butt-Head. Go ahead and order that phat Appletini. The joke’s on them. All the better if you actually like the taste! Go bowling once in a while. And if you’re already a league bowler then try karaoke axe-throwing. To paraphrase Logan Roy from the same series, “The only rule is there are no rules!” Our goal is not to induce seizures; but it is to seize the moment, every now and again (i.e. Carpe fuck ’em!!). Balance and timing are key, of course. Done too often, it becomes a schtick. Too ham-fisted, you aren’t invited back. But remember this: it’s only not funny if it isn’t funny to you….
Like an old school comedy duo. About as good as it gets these days, for my money.
History of Present Illness (HPI): 52 y/o male with h/o fibromyalgia and chronic fatigue presents to Podiatry Clinic stating that his left foot has not been functioning normally for about six months, getting worse over the last several weeks. He reports no pain or tenderness. No fever or chills. No major trauma. He does recall walking on the boardwalk in Ocean City, MD last summer while barefoot when he stepped on a piece of ABC Gum (he clarified that this means “already been chewed”). He thought that he had removed all the gum using a small stick and then went about his business. Several months later he began to experience mild cramping of the medial left foot in the metatarsal region and this has progressed, altering his gait and causing mental distress.
Past Medical History: Borderline hypertension, GERD, hepatic steatosis, shingles (2016)
Past Surgical History: Appendectomy (1995), hemorrhoidectomy (2003)
Medications: Omeprazole, CBD oil, Xanax
Allergies: Penicillin, Marriage/Commitment
Social History: Occasional smoker, 10-12 drinks per week (the doubling rule applies here), sporadic marijuana use, works in finance
Physical Exam: Nontender left foot without swelling, ulceration, warmth, redness, or drainage.
X-ray Findings: Bridging bony excrescence joining the mid-shaft of the left first and second metatarsals. No acute fracture or erosion. Normal bone density. Mild DJD of the first MTP joint.
Assessment: Penetrating gum injury to the plantar surface of the medial left foot with proximal migration and secondary ossification resulting in ankylosis of the first and second metatarsals.
Plan: Regional block with open osteotomy and de-gumming in two weeks. The patient was advised to always wear shoes when walking outdoors and to never-ever-ever remove stuck gum from the skin surface with a stick or other sharp object. The patient appears to understand and agrees with the proposed course of action.
Time: I attest to spending approximately 15 minutes with the patient.
Constantin Brancusi’s sculpture “The Blonde Negress” (1926) at SF-MoMA in Nov 2022.
The rule of three is a familiar notion to us all, whether or not we are conscious of it. Stories have a beginning, middle and an end, and trios in stories are very common, like The Three Musketeers or the The Three Little Pigs. Or games like rock, paper, scissors (I always found marry, shag, kill a bit too harsh for my liking). In comedy, this rule is often used to both establish a pattern and to pay it off.
“Fat, drunk and stupid is no way to go through life, son.” — Dean Wormer from “Animal House” (1978)
“I’d like to recharge my batteries… and shut down the engines… and get myself back to neutral.” — the Vince Vaughn character from “Wedding Crashers” (2005)
Musical chords are made up of three notes (root, third and fifth), and beyond that are considered chord extensions (e. g. Bb9#11) or modifications. In fragrance analysis, we hear-tell of base, heart and top notes, though mostly that’s lost on me (it either smells good or it doesn’t). New heights of pretension are reached with oenophiles as they wax on about traces of tobacco, lychee and leather and with the added bonus of descriptors for both nose and palate. The latter brings in temporal variations of attack, middle and finish — not unlike an arpeggiated musical chord. In any case, there seems to be a magical power to the number 3 that transcends genre and period. These range from from the Holy Trinity (Father, Son and Holy Spirit) and the gifts of the Three Magi (gold, frankincense and myrrh) to the three ghosts who visited Ebenezer Scrooge that fateful Christmas Eve to Peter, Paul and Mary and Earth, Wind and Fire to thoroughbred racing with its vaunted Triple Crown and classic win-place-show format.
“Epitaph, Valentine, Paul Revere… I got the horse right here!!” — from the Frank Loesser song “Fugue for Tinhorns” in “Guys and Dolls” (1955)
“Guys and Dolls” (1955) showing us the power of 3! Stubby Kaye (center) as Nicely-Nicely Johnson absolutely kills it in the 11 o’clock number, and one of my all-time favorites, “Sit Down, You’re Rockin’ the Boat.”
But it probably harkens back to the orality of story-telling that gives rise to the old teaching adage that humans are generally able to recall three things about a subject or lecture, with a precipitous drop-off in retention beyond. This matches my own experience and perhaps yours, as well. So with that in mind, let’s try to learn three interesting things about Constantin Brancusi (from Wikipedia):
1. Constantin Brancusi (1876-1957) was a Romanian born sculptor, painter and photographer who made his career in France. He was a pioneer in modernism and has been called the patriarch of modern sculpture.
2. He worked for only two months under Auguste Rodin, whom he greatly admired. His explanation for leaving was simple: “Nothing can grow under big trees.”
3. He courted controversy with his work titled “Princess X” (1915-16) — an abstract sculpture that reportedly depicts Princess Marie Bonaparte (great grandniece of the Emperor Napoleon), a beautiful and vain woman who also happened to be a psychoanalyst and friend of Sigmund Freud (again, three things: id, ego, superego). She is known for conducting research into female sexuality and frigidity, prompted by her own lack of fulfillment in the boudoir. The sculpture has a smooth C-shape meant to mimic the curve of a woman’s torso who is gazing upon herself. Unfortunately, it also looks much like an erect penis and was thus removed as an object of scandal from the Salon des Indépendants . Brancusi was shocked about the misunderstanding and claimed to be making a comment of feminine desire and vanity… though the judges said he failed to account for the battery compartment at bottom-rear.
“What my art is aiming at is above all realism; pursue the inner hidden reality, the very essence of objects in their own intrinsic fundamental nature: this is my only preoccupation.” — Constantin Brancusi
I’ve been a neuroradiologist for longer than I’ve been most anything else, as I took up guitar later in life and haven’t played golf seriously or proficiently for many years. One thing that’s at once both alluring and frustrating about the job is that there’s still so much to be learned (a return to our theme of ROUTINE + NOVELTY). And even if today they froze all knowledge, I would never catch up. Not to mention all the new drugs seen advertised as I numb my mind with reality TV (if there’s one thing that “Summer/Winter House” has taught us it’s that Luke Can’t Close (LCC). Poor Luke…). Strange names, indeed: Skyrizi, Latuda, Tremfya, Ocrevus, Taltz, Cibinqo. Most peculiar, Mama. And the list goes on and on. I’m baffled as to how my clinical colleagues deal with it. Maybe someday there will be just one giant horse pill that cures them all (Omrizi? Alltuda? Pancrevus?). But then atop this burgeoning pharmacopoeia come brand new diseases that you’ve never heard of like Bosch-Boonstra-Schaaf Optic Atrophy Syndrome. Presumably know only to the seven authors listed above prior to this publication, my first notion was a somatic disorder of vision loss after viewing “The Garden of Earthly Delights” by Hieronymus Bosch. An emotional impact so strong, mind you, that it results in atrophy of the optic nerves to prevent repeat viewing.
“Don’t look, ETHEL!!”
There is a lesser known variant (isn’t there always) of, if I may, BBSOAS that results in oticatrophy (BBSOtAS). Even one listen from start to finish of Scott Walker’s 2012 album “Bish Bosch” can cause irreversible hearing loss. I know this only because several friends bought the record to their ultimate dismay.
All this to say that what caught my eye in skimming the above journal abstract was the unintentionally humorous use of the word “common.” Medical verbiage cannot help but veer into self-parody, and I found funny the notion that anything could be deemed common in such a rare disease. The authors list the following in this category: mesial temporal dysgyria, perisylvian dysgyria, posterior predominant white matter volume loss, callosal abnormalities (a bit vague for my money), lacrimal gland abnormalities, and optic nerve volume loss. Got it, team, and I’ll on the look-out! But to these anomalies I would like to suggest some “uncommon” findings that may, or may not, be associated with BBSOAS (and BBSOtAS):
Hypotelorism (or is it hypertelorism? I can never recall. Both??)
Fused thalami
Schizencephaly
Colobomas (what isn’t?)
Monoventricle
Bifid ribs
Gorilla lung
Chthonic kidneys
Pancreatic microcystic/maybe solid papillary and/or mucinous neoplasm of uncertain malignant potential but usually benign (PMMSPAOMNUMPBUB lesion)
Anal duplication (one case report of triplication… another friend of mine)
Great Exudations 