Time to wax philosophical and even somewhat theological as I’ll turn 85 tomorrow. Only a neurologist with decades of hands on clinical experience can know how fortunate an 85 year old with good health and a (semi)intact brain really is. Add to that 60+ years in the company of a very intelligent and very beautiful woman, and I’m even more fortunate.
A lot of this has absolutely nothing to do with anything I did. My father lived to 100 in good health, and when asked what his secret was, always said “I chose my parents very carefully.”
You’ve got to play the hand you’re dealt, but a fair amount of my time was spent with people who spindled and mutilated their cards (alcohol, smoking, harder drugs, obesity etc.).
But many of my patients (and friends and relatives) didn’t do any of those things, yet suffered terribly and died far too soon. So I was face to face with theodicy, even as far back as in college reading Camus’ “The Plague” with the scene of a child suffering and dying as the protagonist and a priest looked on.
Certainly, clinical experience in those early years did nothing to resolve the problems of disease and suffering. Gradually, as we learned more and more molecular biology and physiology the question of illness and suffering disappeared, and was replaced by the much larger question of why we’re as healthy as we are for so long. See the copy of an older post at the end.
A two year detour into graduate work in Chemistry right after college in the early 60s gave me the background to understand and follow molecular biology as we both grew up.
So how do you spend your time when you’re 85? For me it’s continuing to read the scientific literature (Science, Nature, Cell, Neuron, PNAS) on molecular biology, neurology and a variety of other things as the over 1,000 posts on this blog will show. Fortunately I have the background and the brain left to understand it.
That’s not all of course, there’s playing chamber music with friends and family. Unfortunately our family breeds like sequoias, and although my wife and I have 4 grandchildren, their ages range from 5 to 9, and it’s unlikely that I’ll see them all at 16 when they think they’re the smartest people in the world as I did at that age when I told my grandmother (who crossed the Atlantic alone at age 13) that she was the dumbest woman in the world.
One son told me that there are only 5 (or 6 or 7) basic plots of the novel. How incredibly dull ! Reading the five journals always shows something new and totally unexpected. It’s like opening presents not knowing what you’ll find.
The technological progress is immense. We’ve gone from the decade it took to map out the first human genome, to the fact that we’ve now done it a million times and in single cells to boot.
So I’ll keep on doing what I’m doing and taking Satchel Paige’s (https://en.wikipedia.org/wiki/Satchel_Paige) advice “Don’t look back, something might be gaining on you.”
The Solace of Molecular Biology
Neurology is fascinating because it deals with illnesses affecting what makes us human. Unfortunately for nearly all of my medical career in neurology ’62 – ’00 neurologic therapy was lousy and death was no stranger. In a coverage group with 4 other neurologists taking weekend call (we covered our own practices during the week) about 1/4 of the patients seen on call weekend #1 had died by on call weekend #2 five weeks later.
Most of the deaths were in the elderly with strokes, tumors, cancer etc, but not all. I also ran a muscular dystrophy clinic and one of the hardest cases I saw was an infant with Werdnig Hoffman disease — similar to what Steven Hawking has, but much, much faster — she died at 1 year. Initially, I found the suffering of such patients and their families impossible to accept or understand, particularly when they affected the young, or even young adults in the graduate student age.
As noted earlier, I started med school in ’62, a time when the genetic code was first being cracked, and with the background then that many of you have presently understanding molecular biology as it was being unravelled wasn’t difficult. Usually when you know something you tend to regard it as simple or unimpressive. Not so the cell and life. The more you know, the more impressive it becomes.
Think of the 3.2 gigaBases of DNA in each cell. At 3 or so Angstroms aromatic ring thickness — this comes out to a meter or so stretched out — but it isn’t, rather compressed so it fits into a nucleus 5 – 10 millionths of a meter in diameter. Then since DNA is a helix with one complete turn every 10 bases, the genome in each cell contains 320,000,000 twists which must be unwound to copy it into RNA. The machinery which copies it into messenger RNA (RNA polymerase II) is huge — but the fun doesn’t stop there — in the eukaryotic cell to turn on a gene at the right time something called the mediator complex must bind to another site in the DNA and the RNA polymerase — the whole mess contains over 100 proteins and has a molecular mass of over 2 megaDaltons (with our friend carbon containing only 12 Daltons). This monster must somehow find and unwind just the right stretch of DNA in the extremely cramped confines of the nucleus. That’s just transcription of DNA into RNA. Translation of the messenger RNA (mRNA) into protein involves another monster — the ribosome. Most of our mRNA must be processed lopping out irrelevant pieces before it gets out to the cytoplasm — this calls for the spliceosome — a complex of over 100 proteins plus some RNAs — a completely different molecular machine with a mass in the megaDaltons. There’s tons more that we know now, equally complex.
So what.
Gradually I came to realize that what needs explaining is not the poor child dying of Werdnig Hoffman disease but that we exist at all and for fairly prolonged periods of time and in relatively good shape (like my father who was actively engaged in the law and a mortgage operation until 6 months before his death at age100). Such is the solace of molecular biology. It ain’t much, but it’s all I’ve got (the religious have a lot more).
Chemiotics II 