Great Exudations

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.

There is a lesser known variant (isn’t there always) of, if I may, BBSOAS that results in otic atrophy (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)

Adnexal gnomes (JS!)

Why do we take selfies? That is what I was pondering yesterday after posting this one. My theory is that it’s not vanity, per se. But rather it’s a desire to see ourselves in the real world as other people might see us. It’s somehow a different visage from the one in our bathroom mirror (even if it’s a rest area bathroom mirror on an interstate in Kansas). And secondly, the point is to SHARE the image — to *ping* it someone else to remind them you are still alive and kicking out there somewhere. And further it’s to get a REACTION, some acknowledgment from the universe that your existence and whereabouts matter to another human. As I look at my own selfies, they tend towards attempts at humor or irony, though I doubt I would ever use one that I find highly unappealing (so some vanity, yes, and that’s why you often take several… to optimize the self-deprecation).

In this instance we were traveling cross country on a move from Denver to Baltimore and pulling a trailer. I was dressed in road-trip casual and was drawn to the etched graffiti on the mirror. I mean, who does that? And what should I write?? Not sure I understand the body stance other than it must be one that stabilizes the phone. And for the record, never with a selfie-stick.

I’m not on Facebook anymore and have never joined the morass of Twitter and Instagram, which intentionally restricts my audience to the contacts on my phone. I’m part of several running group chats, one going now for over ten years, and I’m sure I would have sent this to several. It says, “Hey, guys, we’re on the road and, in case you haven’t noticed, I’ve still got all my hair!” But in the end, I got exactly what I wanted, a laugh-out-loud funny response from an old friend (TH) who texted the following:

“You’ve definitely got COVID now.”

“Also, the estate of Steve Irwin ‘Crocodile Hunter’ called. They want his clothes back.”

Now THAT’s a fully-realized selfie! It has three components: the photo, the sharing, and the response. Because in the end, it’s all about the connection. Life as a running improvisation. But for that you need substrate/material, and what’s better than baiting your pals to (mildly) insult you?! I’ve lived long enough to know that everyone, deep down, wants a warm-hearted roast every now and then. And for that, my friends, I thank you.

This scene brought to mind the American artist Charles Sheeler (1883-1965), whose works I’ve gradually come to enjoy. His scenes are clean and uncluttered, being of the Precisionist school of modern art that depicted an idealized form of industrialism. Known for painting so-called “immaculates,” this group of artists (also George Ault, Ralston Crawford, Charles Demuth and Georgia O’Keeffe) reduced skyscrapers and factories to their very essence. Pleasing lines and color palette, all simplified, in the way our own memories might. Sheeler was also a notable photographer and filmmaker, and he was pioneering in his use of captured still images as the basis for his art. His imagery (and that of his cohort), to me, is similar to Edward Hopper — but crucially stripped of the human frailty and melancholia that so characterizes the latter. In that way, they work in tandem. Obverse and reverse. Timeless, while also dated. The hopefulness of technical progress pitted against the limitations of man himself.