Tender Bowels

Splanchnon, the Greek word for the intestinal organs, was frequently used by the ancients to indicate affections, tender mercies, and compassion.  While the Greeks regarded the bowels as the seat of the more violent passions, the Hebrews thought them to be the source of our tender affections.

In the book of Job, long regarded as the most ancient of the biblical texts, Job laments:  “My bowels boiled, and rested not; the days of affliction came upon me.”  The prophet Jeremiah cried in his distress:  “My bowels, my bowels!  I am pained at my very heart!”  And again, in the book of Lamentations:  “Behold, O Lord; for I am in distress.  My bowels are troubled; mine heart is turned within me.”

The apostle John admonishes us:  “But whosoever hath this world’s good, and seeth his brother have need, and shutteth up his bowels of compassion from him, how dwelleth the love of God in him?”

Thoreau echoes this sentiment in a line from Walden:  “If anything ail a man, so that he does not perform his functions, if he have a pain in his bowels even,—for that is the seat of sympathy….”

We still carry the vestiges of this idea in modern English idioms when we refer to “gut feelings,” “going with your gut,” “gutting it out,” or having “butterflies in the stomach.”  Somehow the gut and our feelings seem to be intricately bound together.

Medical research has borne this out.  We now know that the gut, rich with over 500 million nerve cells, is regulated by the same set of neurotransmitters found in the brain.  Amazingly, 90 percent of the neurotransmitter serotonin is synthesized by enterochromaffin cells in the gastrointestinal tract.  Serotonin — 5-hydroxytryptamine (5 HT) — stimulates a variety of chemoreceptors, triggering peristaltic motion in the gut and dilation of the stomach during the digestive process.

Serotonin also turns out to be a key factor in irritable bowel syndrome (IBS) as well as clinical depression.  Researchers now think of IBS as a recurrent symptom complex initially triggered by life-altering stressful events, altered bowel motility and heightened visceral hypersensitivity.  The result is increased sensitivity to stress coupled with an overblown visceral response, something akin to PTSD in the brain.

Gastroenterologists now routinely prescribe antidepressant medications to patients who suffer from chronic abdominal pain syndromes, such as functional abdominal pain.  At low doses, tricyclic antidepressants work in the gut much in the same way that they work in the brain.

As it turns out, the ancients knew what they were talking about: the passionate gut has a mind of its own.

Night Landing

Night Landing

Above her toes, from where she lay
Reclining at bed’s edge,
She glimpsed a light pass through the night
Above the window ledge.

The plane began its last approach,
A beacon locked it in—
The landing gear would next descend
And brace against the wind.

Blue lights would then come rushing up—
The runway in the night
Would suddenly materialize
Within the captain’s sight.

The plane would drop down at the last,
Wheels screech against the earth;
Air brakes up, flaps hold fast,
Into its final berth.

She wondered how the end would come—
She prayed she would take flight
As wheels against the tarmac run:
A knock, a lurch—then light.

Copyright 2011 © by Brian T. Maurer

A litany of symptoms solved

If you are an avid reader of medical narratives, you may have come across Dr. Lisa Sanders’ invitation to participate in solving the diagnostic dilemma of a 76-year-old woman suffering from chronic weakness, fatigue and mood swings posted in yesterday’s New York Times.

Over 500 readers, both lay and medically trained, weighed in on the differential diagnosis over the course of the day.  I submitted my two cents as comment #358.

The resolution of the case appears in today’s Times at this link.

You can read my final thoughts about the clinical case presentation here.

Hats off to Dr. Lisa Sanders and Times columnist Tara Parker-Pope for putting together this thought-provoking diagnostic exercise!

Town Meeting

I was exhausted from the six-hour drive home through the rain from Pennsylvania. I unloaded the car, stowed the gear, sorted through the mail and grabbed something to eat. The town meeting convened at 7:00 PM.

It was a short walk down to the local church. The parking lot was full. People filtered into the building, pausing at the small desk to sign the petition before ascending the stairs to the main parish hall.

Folding chairs had been set up in rows. Many folks ended up standing in the back and along the sides. Up at the front representatives from the postal service prepared their presentation. The community TV station camera panned the audience.

The meeting opened with remarks by the first selectman and the USPS district manager. The public relations spokeswoman presented a generic slide show, highlighting the financial plight of the postal service. Revenues had dropped by $30,000 at our local post office over the past two years. They were looking at profitability factors. No, they hadn’t made a decision to close the post office. That was the reason for the meeting. They wanted input from local residents. Everyone would be given a chance to speak.

A postal workers union representative voiced his dismay at the way the situation had been handled. Documents delineating proposed closings were circulated late; meeting times and places were unclear. In place of communication, Chaos reigned.

The union rep was clear. Be vigilant, take notes, draft documents, contact the powers that be. Keep the pressure on. Don’t allow them to get away with their underhanded approach.

One by one members of the audience rose to speak. Some voiced hardship in having to drive seven miles for mail, when before they could walk to the post office at the center of the village. Some wanted to know if the postal service was considering alternative locations in town. Others questioned the validity of the figures provided.

One erudite villager decried the modern postal service model. “You don’t seem to understand that the future of the USPS depends upon one thing—service. No one wants to drive miles to wait in line to be treated poorly by annoyed clerks who consider you a nuisance. At the village post office, one person serviced the needs of over 500 families, and she did it efficiently with a smile. That’s the sort of model you should be striving for—not the impersonal attitude of the DMV.”

Another fellow who had moved to the village from Brooklyn spoke. “In my old neighborhood, the postman knew everybody’s name. He knew the names of the kids on the block. He handed you your mail with a smile. That’s the sort of service I’ve come to know in this village.”

The spokeswoman responded to each comment in kind: “Thank you for voicing your opinion, thank you.”

Finally a man raised his hand to be recognized. “After you vacated the former location when the landlord told you the structure was unsound because of the snow on the roof, when were you advised that it was safe to return to the building?”

A hush fell over the crowd. The district manager stretched his neck from the tight collar of his shirt. “Two days,” he said.

The uproar was deafening.

“Two days! Two days? You mean you could’ve reoccupied the building in two days, and instead you made the decision to gut the office and move operations to another town? And you stand there telling us that you haven’t made a decision to close our local post office!”

More folks stood to speak. Several comments came on the heels of questions and observations from the audience before the postal representative could answer. I envisioned a meeting of the Sons of Liberty. Wasn’t New England the birthplace of the revolution?

In the end everyone had a chance to voice his opinion. As the meeting concluded, one woman summed up the general sentiment. “We might be a tiny town of two thousand people, but we’re diverse. We organized, we’re intelligent and we’re not going to let this rest. You haven’t heard the last from us.”

A thunderous round of applause erupted. Later, private discussions ensued, both inside the parish hall and outside in the parking lot.

An old-fashioned town meeting, New England style.

Who said all politics are local? I want to shake that person’s hand.

The eye of the thrush

The morning sun throws its light across the tops of the distant pines, turning their tufts a brilliant green against the grey backlit sky. Shafts of sharp light stretch across the expanse of back yard. The flower beds lie freshly edged, their black earth turned up to face the sky.

The same wind that stirs the branches of the distant pines stirs something in me as well. I pull on my boots, grab my old felt hat and binoculars and step outside. The morning air is fresh after yesterday’s soaking rain.

I head out toward the far hills, striding down the street past an idling car. Inside a man bows his head, thumbs flying across the key pad of his cell phone.

Just up the street the call of a phoebe resonates through the crisp morning air. He sits on an overhead wire that leads to the house where the young woman with lymphoma lives.  A light still burns in the vestibule.

Slowly, I track the muddy leaf-strewn path that leads up the hill and around the bend. Spotted violets dot the edge of the trail, shivering in the early morning air.

At the top of the hill near the concrete water tank I turn left and follow the rain-soaked path up the gradual incline of the old carriage road. I pause at the first bend to look out at the stand of decayed hemlocks, their stark broken branches bleached white in the sun.

Two additional switchbacks and I step onto the rock that juts out at the end of the overlook. I train the binoculars on the far ridges, blue across the river valley, filled with mists.

Further along, the rocks lie covered with moss, wet with dew. The cut where the power lines cross the mountain provides a view of the city to the southeast and the Barndoor Hills to the northwest.

Once more I enter the woods, steadying the binoculars to keep them from bouncing back and forth against my chest, lost in thought.

Suddenly up ahead, a brown flash darts across the path. Stock still I stand, feet planted firmly on the small outcropping of traprock. Ten yards before my eyes a small brown bird perches on the bare branch of a birch tree.

Motionless we stand, regarding one another. The bird boasts a limpid eye ringed in white, a speckled buff breast, a white throat and cinnamon rump. He chortles a brief burst, clearing his throat. Silently I wait. Again and again the bird chortles, several times over the ensuing minute, then drops to the ground among the leaves.

I ease a few steps forward, binoculars at the ready; but the bird flits down through the brush and into the forest.

Within the hour I descend the mountain to the sound of cars whizzing down the main road, commuters on their way to work.

Back home I kick off my muddy boots, settle my old felt hat on the rack, and retire my binoculars to their case, carefully wrapping the cinnamon brown leather strap around the center of the twin eye pieces ringed white with tear salt from four decades of use.

Author joins editorial board of Yale Journal for Humanities in Medicine

Author and practicing physician assistant Brian T. Maurer has been named to the editorial advisory board of the Yale Journal for Humanities in Medicine.

Maurer, a long-time contributor to YJHM through his monthly Notes from a Healer column, was welcomed to the position by Dr. Howard Spiro, M.D., founding editor of YJHM, on April 7, 2011.