“It’s only natural”

This is a work of fiction. Names, characters, businesses, places, events, locales, and incidents are either the products of the author’s imagination or used in a fictitious manner. Any resemblance to actual persons, living or dead, or actual events is purely coincidental. This is not intended as a substitute for the medical advice of physicians. The reader should regularly consult a physician in matters relating to his/her health and particularly with respect to any symptoms that may require diagnosis or medical attention.

A very handsome, fit and well-dressed young man came in to see me about a nagging, chronic gut problem. This is the sort of thing that medicine doesn’t really have an answer for and the referring family doctor knew this as did the said dashing young man. The reason for her referral was that he had had enough.

I took a very long history filled with exacerbations and remissions going back to when he was a teenager, alleviating and aggravating factors that the tormented young man never really managed to leverage.

All the same, he was ahead of the curve in his career. He travelled extensively, ran a half-marathon and even climbed Kilimanjaro.

We were nearly certain that his condition didn’t have an organic cause we could address, but given the one or two potential pointers for such a cause, the duration and extent of his distress, it was decided that the gentleman should have some specialist investigations. As a sort of an advance measure, we gently suggested that in all likelihood, the tests won’t find anything and if so, there won’t be much we could offer him besides a few tweaks of what has helped him in the past. At this point he covered his face with his hand, then made a tight fist whitening his knuckles, plunging visibly into anger and frustration – not so much at us, it seemed, but at the powerlessness of medicine and his ill fate.

There is no denying that this high-flying man suffered greatly with his imperfect bowel. I was left there wondering two things.

This man is so accomplished, able to climb mountains and run marathons, why does he so firmly believe that his condition is “debilitating”? I can only presume that he has a kind of equation in his head where his potential plus his condition equals his reality. I did wonder if his reality could have been far more impressive had it not been for these bouts of gastrointestinal torture. I have the suspicion that the thought occurred to him. Perhaps it occurred to him many times a day.

Furthermore, if he is determined to eradicate this unidentified fiend sabotaging his gut, why didn’t he do more of what worked and avoid the aggravating factors? It would seem a little maladaptive to refuse to negotiate with the affliction. Or did he write down all his shortfalls to the condition, thus allowing him to sustain a vision of unadulterated, perfect potential trapped by the wretched disease?

I then wondered if that is our perfectionist millennial nature that’s always chasing the latest maximising-optimising lifehack or is that the sort of irreducible self-selection that particular kind of young person to hospital regardless of their generation or culture.

The reason I wonder this is that only last week I was trying to convince a much older man to consider treatment for his chronic pain, but he insisted, “it’s only natural”. Then again, I don’t think it would ever occur to him to climb Kilimanjaro.


Prior to the Battle of Cannae, a Carthaginian officer named Gisgo commented on how much larger the Roman army was. Hannibal replied, “Another thing that has escaped your notice, Gisgo, is even more amazing—that although there are so many of them, there is not one among them called Gisgo”. Source

I misread it at first and thought – Glisgo, what a fabulous name for a cat.

“I don’t approve of your self-harm”

As part of my Image experiment, I am experimenting with wax strips (and wine, to take the edge off).

My other half walked in and I asked him if he would like to help.

His response:

“I don’t approve of your self-harm”.

Talk about acceptance.

It’s that simple

A 60 year old woman told me today that she lost 10 kg (22 pounds) in the space of one month, without starving herself, etc. Her bloods even look better. Of course, she has a lot to lose (say 30-40 kg), but I just think it’s so amazing when people do actually do it.

I asked her what was the main cause she could identify – giving her a few a few options, such as changing what she eats, exercise, a life event?

And she said, “not overeating”.

And simple truth miscalled simplicity, indeed.


Whenever I struggle to make a decision, I think of Seneca’s letters. In short, the message is, if you had a very short time to live, what would you do?

I have recently discovered another method.

Imagine you are an 85 year old you giving yourself advice. What would your 85 year old self tell your present self?

Written under the influence of geriatrics and Saint-Emilion.

A little bit of Irish politics

What is the purpose of having four political parties if for the last couple of constitutional referendums they all virtually agreed with each other on how people should vote?

I don’t necessarily disagree with them, but there seems to be a resounding group-thinking lack of pluralism.

P.S. Are you painting yourself green for Paddy’s Day?