The Last Essay By Dr. Oliver Sacks

Dr. Sacks on porch

http://www.newyorker.com/magazine/2015/09/14/filter-fish

Filter Fish
At life’s end, rediscovering the joys of a childhood favorite

Gefilte fish is not an everyday dish; it is to be eaten mainly on the Jewish Sabbath in Orthodox households, when cooking is not allowed. When I was growing up, my mother would take off from her surgical duties early on Friday afternoon and devote her time, before the coming of Shabbat, to preparing gefilte fish and other Sabbath dishes.

Our gefilte fish was basically carp, to which pike, whitefish, and sometimes perch or mullet would be added. (The fishmonger delivered the fish alive, swimming in a pail of water.) The fish had to be skinned, boned, and fed into a grinder—we had a massive metal grinder attached to the kitchen table, and my mother would sometimes let me turn the handle. She would then mix the ground fish with raw eggs, matzo meal, and pepper and sugar. (Litvak gefilte fish, I was told, used more pepper, which is how she made it—my father was a Litvak, born in Lithuania.)

My mother would fashion the mixture into balls about two inches in diameter—two to three pounds of fish would allow a dozen or more substantial fish balls—and then poach these gently with a few slices of carrot. As the gefilte fish cooled, a jelly of an extraordinarily delicate sort coalesced, and, as a child, I had a passion for the fish balls and their rich jelly, along with the obligatory khreyn (Yiddish for horseradish).

I thought I would never taste anything like my mother’s gefilte fish again, but in my forties I found a housekeeper, Helen Jones, with a veritable genius for cooking. Helen improvised everything, nothing was by the book, and, learning my tastes, she decided to try her hand at gefilte fish.

When she arrived each Thursday morning, we would set out for the Bronx to do some shopping together, our first stop being a fish shop on Lydig Avenue run by two Sicilian brothers who were as like as twins. The fishmongers were happy to give us carp, whitefish, and pike, but I had no idea how Helen, African-American, a good, churchgoing Christian, would manage with making such a Jewish delicacy. But her powers of improvisation were formidable, and she made magnificent gefilte fish (she called it “filter fish”), which, I had to acknowledge, was as good as my mother’s. Helen refined her filter fish each time she made it, and my friends and neighbors got a taste for it, too. So did Helen’s church friends; I loved to think of her fellow-Baptists gorging on gefilte fish at their church socials.

For my fiftieth birthday, in 1983, she made a gigantic bowl of it—enough for the fifty birthday guests. Among them was Bob Silvers, the editor of The New York Review of Books, who was so enamored of Helen’s gefilte fish that he wondered if she could make it for his entire staff.

When Helen died, after seventeen years of working for me, I mourned her deeply—and I lost my taste for gefilte fish. Commercially made, bottled gefilte fish, sold in supermarkets, I found detestable compared to Helen’s ambrosia.

But now, in what are (barring a miracle) my last weeks of life—so queasy that I am averse to almost every food, with difficulty swallowing anything except liquids or jellylike solids—I have rediscovered the joys of gefilte fish. I cannot eat more than two or three ounces at a time, but an aliquot of gefilte fish every waking hour nourishes me with much needed protein. (Gefilte-fish jelly, like calf’s-foot jelly, was always valued as an invalid’s food.)

Deliveries now arrive daily from one shop or another: Murray’s on Broadway, Russ & Daughters, Sable’s, Zabar’s, Barney Greengrass, the 2nd Ave Deli—they all make their own gefilte fish, and I like it all (though none compares to my mother’s or Helen’s).

While I have conscious memories of gefilte fish from about the age of four, I suspect that I acquired my taste for it even earlier, for, with its abundant, nutritious jelly, it was often given to infants in Orthodox households as they moved from baby foods to solid food. Gefilte fish will usher me out of this life, as it ushered me into it, eighty-two years ago. ♦

R.I.P. Dr. Oliver Sacks

Oliver Sacks

Dr. Oliver Sacks, eminent neurologist and brilliant author who explored strange neurological aberrations in books such as “The Man Who Mistook His Wife for a Hat,” died on August 30th at his home in Manhattan at the age of 82.

I was stunned when I read his post on Facebook in February which revealed that he had terminal liver cancer. The original source of the cancer was a melanoma in his eye which had been treated nine years ago.

Dr. Sacks was not only a highly respected neurologist and researcher, he was a prolific and incredibly gifted writer. More than a million copies of his books are in print in the United States, though the book he was most well known for was “Awakenings,” which was made into a movie starring Robin Williams. He was so popular that he received about 10,000 letters a year. Regarding the plethora of letters he received, he stated, “I invariably reply to people under 10, over 90 or in prison.”

I first met Dr. Sacks in 1986 during a book reading of “The Man Who Mistook His Wife For A Hat.” Though I had known for years that I wanted to become a physician, and that I had a specific passion for neurology, my meeting with Dr. Sacks re-ignited that passion. I devoured that book, and from that point on was a devoted fan, not only of his writing, but of him as a clinician and humanitarian. I have every book which Dr. Sacks wrote and thoroughly enjoyed reading them (I have yet to read “Hallucinations” and “On The Move” which were his most recent tomes). I was thrilled when Dr. Sacks had a book signing for “Oaxaca Journal” in 2002, and I made sure to attend that signing, speak with him, and have him sign my copy. I was a physician by then, and in the middle of residency training. Though I had ended up in family practice rather than neurology, my fascination for neurological cases was very much intact, and my admiration for Dr. Sacks only increased over the years.

In tribute to one of my medical idols, I am posting an essay which Dr. Sacks wrote in February of this year for the New York Times.

Original post can be found at:
http://www.nytimes.com/2015/02/19/opinion/oliver-sacks-on-learning-he-has-terminal-cancer.html

A MONTH ago, I felt that I was in good health, even robust health. At 81, I still swim a mile a day. But my luck has run out — a few weeks ago I learned that I have multiple metastases in the liver. Nine years ago it was discovered that I had a rare tumor of the eye, an ocular melanoma. The radiation and lasering to remove the tumor ultimately left me blind in that eye. But though ocular melanomas metastasize in perhaps 50 percent of cases, given the particulars of my own case, the likelihood was much smaller. I am among the unlucky ones.

I feel grateful that I have been granted nine years of good health and productivity since the original diagnosis, but now I am face to face with dying. The cancer occupies a third of my liver, and though its advance may be slowed, this particular sort of cancer cannot be halted.

It is up to me now to choose how to live out the months that remain to me. I have to live in the richest, deepest, most productive way I can. In this I am encouraged by the words of one of my favorite philosophers, David Hume, who, upon learning that he was mortally ill at age 65, wrote a short autobiography in a single day in April of 1776. He titled it “My Own Life.”

“I now reckon upon a speedy dissolution,” he wrote. “I have suffered very little pain from my disorder; and what is more strange, have, notwithstanding the great decline of my person, never suffered a moment’s abatement of my spirits. I possess the same ardour as ever in study, and the same gaiety in company.”

I have been lucky enough to live past 80, and the 15 years allotted to me beyond Hume’s three score and five have been equally rich in work and love. In that time, I have published five books and completed an autobiography (rather longer than Hume’s few pages) to be published this spring; I have several other books nearly finished.

Hume continued, “I am … a man of mild dispositions, of command of temper, of an open, social, and cheerful humour, capable of attachment, but little susceptible of enmity, and of great moderation in all my passions.”

Here I depart from Hume. While I have enjoyed loving relationships and friendships and have no real enmities, I cannot say (nor would anyone who knows me say) that I am a man of mild dispositions. On the contrary, I am a man of vehement disposition, with violent enthusiasms, and extreme immoderation in all my passions.

And yet, one line from Hume’s essay strikes me as especially true: “It is difficult,” he wrote, “to be more detached from life than I am at present.”

Over the last few days, I have been able to see my life as from a great altitude, as a sort of landscape, and with a deepening sense of the connection of all its parts. This does not mean I am finished with life.

On the contrary, I feel intensely alive, and I want and hope in the time that remains to deepen my friendships, to say farewell to those I love, to write more, to travel if I have the strength, to achieve new levels of understanding and insight.

This will involve audacity, clarity and plain speaking; trying to straighten my accounts with the world. But there will be time, too, for some fun (and even some silliness, as well).

I feel a sudden clear focus and perspective. There is no time for anything inessential. I must focus on myself, my work and my friends. I shall no longer look at “NewsHour” every night. I shall no longer pay any attention to politics or arguments about global warming.

This is not indifference but detachment — I still care deeply about the Middle East, about global warming, about growing inequality, but these are no longer my business; they belong to the future. I rejoice when I meet gifted young people — even the one who biopsied and diagnosed my metastases. I feel the future is in good hands.

I have been increasingly conscious, for the last 10 years or so, of deaths among my contemporaries. My generation is on the way out, and each death I have felt as an abruption, a tearing away of part of myself. There will be no one like us when we are gone, but then there is no one like anyone else, ever. When people die, they cannot be replaced. They leave holes that cannot be filled, for it is the fate — the genetic and neural fate — of every human being to be a unique individual, to find his own path, to live his own life, to die his own death.

I cannot pretend I am without fear. But my predominant feeling is one of gratitude. I have loved and been loved; I have been given much and I have given something in return; I have read and traveled and thought and written. I have had an intercourse with the world, the special intercourse of writers and readers.

Above all, I have been a sentient being, a thinking animal, on this beautiful planet, and that in itself has been an enormous privilege and adventure.

Correction: February 26, 2015
Because of an editing error, Oliver Sacks’s Op-Ed essay last Thursday misstated the proportion of cases in which the rare eye cancer he has — ocular melanoma — metastasizes. It is around 50 percent, not 2 percent, or “only in very rare cases.” When Dr. Sacks wrote, “I am among the unlucky 2 percent,” he was referring to the particulars of his case. (The likelihood of the cancer’s metastasizing is based on factors like the size and molecular features of the tumor, the patient’s age and the amount of time since the original diagnosis.)

Should You Be Afraid Of Water Bottles And Cans?

Originally published on mensphysique.com on Sunday, 15 July 2012
cans_plastic
http://www.rxmuscle.com/blogs/the-lab-supplement-school/6078-should-you-be-afraid-of-water-bottles-and-cans.html

Unless you have been living under a rock you have heard about the concern over human exposure to Bisphenol A, also referred to as BPA. BPA is an organic compound (chemical formula (CH3)2C(C6H4OH)2 ) which is a colorless solid used to confer hardness to polycarbonate plastic. It is also used in epoxy resins to create and antibacterial coating in the lining of metal cans which are used in the food industry. BPA can leech from containers into the foods they hold and become ingested by individuals when those food items are consumed.

What makes BPA a concern for people is the fact that it is a weak endocrine disruptor which mimics estrogen and has substantial negative side effects on health. A U.S. Government sponsored review of the scientific literature on BPA was conducted in 2006, resulting in the following statement:”BPA at concentrations found in the human body is associated with organizational changes in the prostate, breast, testis, mammary glands, body size, brain structure and chemistry, and behavior of laboratory animals.” I don’t know about you, but such a conclusion is terrifying to me and enough to keep me invested in using containers made of stainless steel, glass, and BPA-free plastic for the rest of my life.

The Centers for Disease Control (CDC) reported that approximately 93% of Americans have detectable levels of BPA in their bodies. Even at low doses, BPA causes diabetes, heart disease, reproductive issues, breast and prostate cancer, low sperm count, altered brain development and obesity. When one considers the long-term exposure to which most of us have been subjected, the implications become staggering and quite disconcerting.

Diseases Linked to BPA Exposure

HEART DISEASE – Data from the National Health and Nutrition Examination Surveys discovered that men with the highest levels of BPA exposure (measured through urinary samples) were 10% more likely to develop heart disease. It is believed that BPA suppresses a hormone which has a protective effect against heart attacks, oxidative stress, and damage to blood vessels.

DIABETES AND OBESITY – BPA causes an increase in insulin release from the pancreas which causes a reduction in the body’s ability to utilize fat, thus increasing the risk for both diabetes and obesity.

THYROID FUNCTION – BPA has been shown to bind to thyroid hormone receptors, thus disrupting normal thyroid function.

NEUROLOGICAL DAMAGE – Numerous research studies on different animal models have determined that low-dose BPA maternal exposure causes long-term neurobehavioral development in developing fetuses, interfering with brain cell connections vital to memory, attention and mood. Furthermore, BPA potentiates, or boosts, central dopaminergic systems, creating increased sensitivity to drug-abuse induced reward effects.

INTESTINAL DAMAGE – BPA can damage intestinal lining, causing “leaky gut syndrome”. This interferes with the gut’s ability to block toxins and bacteria from entering the body.

INFERTILITY – Chronic exposure to low doses of BPA can impair the growth and function of the egg cells which are involved in ovulation due to the fact that it binds to receptors in the cells which are designed to bind with estrogen.

ERECTILE DYSFUNCTION – A 2009 study conducted on over 200 Chinese workers in BPA factories found that those men were four times more likely to have erectile dysfunction and seven times more likely to have problems with ejaculation.

CANCER – BPA is capable of inducing neoplastic transformation in human breast epithelial cells and has also been found to reduce sensitivity to chemotherapy treatment of specific tumors.

Where BPA Lurks

BPA is far more pervasive than you may ever imagine. Here is a list of items which have been found to contain BPA:

· Water bottles
· Food cans
· Soda cans
· Infant formula
· Wine and Beer (due to fermentation in BPA resin lined vats)
· Recycled paper (including toilet paper)
· CDs
· Baby bottles
· Dental fillings
· Plastic cups
· Hard plastic 5-gallon drinking water bottles
· Credit card receipts at gas stations
· Plastic food storage containers

The Centers for Disease Control have conducted numerous studies which have detected BPA in the urine of over 90% of adults and children tested. Another study which was conducted in 2009 revealed that drinking from plastic water bottles almost doubled urinary BPA levels. Yet another study examined subjects who consumed canned soup during one test period and fresh soup during another test period. After only five days the participants consuming the canned soup had an increase in urinary BPA levels of 1221% compared to those consuming fresh soup.

Guidelines to Minimizing BPA Exposure
Fortunately a large number of food storage containers can now be found which utilize stainless steel, glass and BPA-free plastics. In fact many shaker cups are now being constructed from BPA-free plastic. A handful of bodybuilders who still incorporate canned tuna into their meal plans have the option of purchasing their tuna in foil pouches instead of cans which are lined with BPA.

I realize that the following list is rather comprehensive, so it is up to you to decide how aggressively you would like to minimize BPA exposure.

· Do not drink out of plastic water bottles unless they are BPA-free.
· Replace plastic storage containers with those made of stainless steel, glass, ceramic or paper. If you must use plastic, look for resin identification codes (the number on the underside of containers) 4, 5, 1 or 2. Make sure to avoid containers marked with 7, as these almost invariably contain BPA.
· Avoid purchasing food and beverages which are packaged in cans.
· Wrap sandwiches in paper or cloth.
· Do not drink soda from a can.
· Avoid purchasing recycled toilet paper or paper products.
· Never heat food in plastic or place warm or hot food into plastic containers, bags, or cling wraps.
· Do not put plastic items in dishwasher.
· Avoid contact between acidic or fatty foods and plastic.
· Use metal eating utensils.
· Purchase reusable water bottles and shaker cups which are labeled BPA-free.
· Buy glass appliances whenever possible. (eg: blenders)
· Replace plastic coffee filters with ceramic or metal ones
· If you use a French press for coffee, make sure it is all metal and glass with no plastic parts.
· Wash hands after touching cash register receipts or money.