I have always been amazed by the different approaches people take to what appear to be very similar issues. Is this the expression of boundless human initiative? Or could this just be positive spin, a conspired plot by our leaders, teachers and gurus to help us feel empowered? I am inclined to think so and now wonder if we actually choose from a very finite set of responses, basking in a delusional sense of freedom. So, to be fair to everyone, should we perhaps bemoan the limited opportunities we have and share our pain? Let me tell you how I happened on this analysis of life.
In a slightly intoxicated state, at a large family gathering, in the warmth of a southern European late evening sunset, with dear friends from various generations (relaxed I guess), I chanced upon the realisation that people used toilet paper in different ways to achieve ‘anal cleansing’, a topic that appears to remain controversial. And to my continuing amazement, not many used it the way I do. If you are from a culture that uses this tool (we have to have a range of tools ready these days) then you might be as surprised as I was at the time.
At the beginning of this convivial discussion it appeared that humans had developed a wide range of techniques to achieve this same sparkling outcome. However, as the general enthusiasm for the discussion grew and more spoke of the intricacies of their own technique (including input from a few recent users returning to the group) we discovered that in this large group there were only three methods employed. These were as follows:
- Folders – usually along the perforations when available and using 2-4 sheets;
- Wrappers – wrapping the toilet paper around the flat hand; and
- Scrunchers – just randomly building a ‘bouquet’ of paper to do the job (crumple is an alternative label but does not quite capture the engineering).
I was delighted to have led this small scientific inquiry and to have managed to set up an all encompassing classification system on the spot. Further, it illustrated the magic of three. I have yet to find any alternatives in the literature despite considerable epidemiological data being available. What does all this mean?
By now you have probably realised that I am a folder. I seek some order in things and am a committed utilitarian. I firmly believe that folding is the most efficient and environmentally friendly technique and so it appeals to my moral character – or at least I can work on that. I have good friends who are wrappers and I even know a few scrunchers. We all get on regardless, on the whole. I am also prepared to proceed in life blindly respecting others privacy and can say quite honestly that I do not know what most of my friends and acquaintances do. I like to think it would not greatly alter my opinion of them. To be honest, I do sometimes wonder about the prime minister and leader of the opposition but am not overly troubled by these musings.
Which brings me to the metaphysical relevance. I suspect that much of the time we act or think in a way that feels like the embodiment of freedom. Consider the case in point. No one told me what to do with toilet paper and my solution worked fine. I did not realise there were alternatives, and when I found out, I did not realise that there might be a limited number. This was terribly enlightening. Are we all behaving similarly, within a very limited range, in most aspects of our lives? Are humans patterned in a profound manner, developing their uniqueness from the range of exposures rather than the range of responses? I suspect so. It hurts a little to think of it and I have contemplated briefly what this means for humanity in general. How can this enlightenment help? I can only rummage through my own experience and musings at the café yesterday morning.
Like all humans I don’t feel good at times. But I choose, on the whole, to blame the ache in my stomach or chest when I lie awake at night or other fleeting symptoms not associated with acute illness on what is going on in my life. This usually involves the ones I love or work with or recent past or upcoming events. I realise from my general practice that this is not what everyone does. Others look in directions such as deficiencies of vital substances, the food they eat, their genetic makeup, the exposures to toxic substances or the drugs and medicines they use or have been given.
I must declare, as a rural boy of the 1950s, that I have my own potential causes of symptoms which are recalled apparently without effort but which I choose to ignore. I will confess that I grew up in an asbestos house with a father who smoked until I was 10. I also sprayed the carcinogen DDT into the air I was breathing on a grand scale across the countryside, earning pocket money from farmers who were friends of my parents and perhaps had an inkling that there was some risk. (By the way, no one has apologised to me for the possible harm done). I have, to the suffering of my friends, been emotionally buoyed by and a proselytiser for the research into the extension of the lifespan of earthworms suggesting ongoing exposure to low level toxicity is a powerful enabler. Caffeine has since officially joined the likes of low level radiation, starvation and dehydration.
The advantage of looking at what is going on in your life rather than other sources of ‘illness’ is that there is likely to be an answer there. If there isn’t, I have usually found it fairly simple as a GP to find out what is wrong. However, when not accepting symptoms as generally harmless expressions of a person’s existence, it poses a massive diagnostic dilemma which is potentially never ending. The bedevilling of food as toxic agent is a current example, causing distress and pain from birth to old age.
By not blaming food for my symptoms, I and my relatively large and extended family all have the joy of eating everything presented to us without concern, just as my 92 year old father does between playing golf and avoiding doctors. I think, perhaps naively, that I still get the same symptoms as others – it hurts after I exercise, my head aches regularly, my stomach regurgitates and grumbles, my bowels complain randomly, my haemorrhoids are troublesome at times. I don’t look for biological answers unless I am really affected, which is fortunately extremely rarely.
In my work as a GP I see hoards of patients searching for answers to their subtle symptoms and dysphorias before they are ‘really affected’. It seems so complex but how many places do people actually look? Could we classify them usefully and gain understanding? I want to be clear that in my wildest dreams I am not suggesting that their individual responses would correlate with how they use toilet paper, but I do wonder if we are as diverse in our responses as we might think. This all came to a head yesterday when out for breakfast. The extensive and diverse menu was carefully classified as ‘gfo’, ‘gf’, ‘vo’, ‘v’, ‘df’ and ‘dfo’, carefully understated in lower-case. I guess that catered for most concerned customers – and if we take out the ‘o for option’ that leaves ‘gluten free’, ‘vegan’ and ‘dairy free’ – the magic number of 3. To be human is to be limited.
Medicine at the Deep End 