God the Creator is a plumber… or maybe a gardener

Prolog 1

I have recently had the privilege and deep enjoyment of volunteering various services at a nearby Carmelite Monastery of cloistered nuns.(1) The types of services I provide might be subsumed under the title of “Jack-of-all-trades” (Johannes factotum). They are variable and various.
There is much to reflect upon in the relationship that has formed between me and the community, as well as in the variety of tasks that have been assigned me. Most recently, I was asked to make repairs to the somewhat complicated and undocumented 100-year-old water line serving the large community house and gardens. Plumbing is therefore, the subject of this cancerblog.

 

Prolog 2

But first, I must apologize to subscribers to this blog.
I have demonstrated what may be a widespread trait to prefer pondering and carping about complaints, challenges, puzzles and frightening experiences. Once such issues have been neutralized either by being resolved or because one has become reconciled and accustomed to the “new normal”, people (or at least, “I”) find less motivation to reflect and write about the comparatively settled situation after the chaos of uncertainty and insecurity.
I fear I may have left off posting new essays just at the nadir of what appeared to be largely unexplained and puzzling reactions to my combined treatments for various physical ailments. I feel an obligation to redress the impression I may have, unintentionally, left upon my readers.
Not all the ailments about which I pondered, were directly related to my cancer. But each of the treatment remedies complicated my chemotherapy. So it was a messy set of circumstances that beset me at the time.
The good news is that most of the several complications have been resolved (save, perhaps one: an unexpected “breathlessness” following even very mild exertion.) Apart from being prematurely out of breath from time to time, I feel well, excepting days I experience what I would call intermittent, predictable, and completely manageable side effects from my chemo treatments. My oncologist has modified my chemotherapy protocol. She has reduced my dose by 20% (no doubt minimizing negative side effects).
Better news, still, my periodic CT scans and x-rays conifirm that the treatment is demonstrably effective. My cancer tumors are shrinking, and there is no visible evidence of the cancer metastasizing to other parts of my body.

After a recent welcome and pleasant visit, a dear friend described me to a mutual colleague, writing to him, “Chet may be on his way out, but, honestly, you’d never know it from our visit.”
From the very day of conception we are all, in a way, already “on our way out”. John Lennon described it in a thoughtful way when he penned the lyrics, “He not busy being born, is busy dying.”(2)  I would like to believe that the way my colleague and friend judged that my appearance means I reflected my intention to aspire to the converse of Lennon’s cautioning expression; i.e. to keep busy at “being born”.
To the bad news. After reducing the dose of my chemo, my oncologist prescribed that I report to the Infusion Clinic for a three- to four-hour IV Infusion every other week, indefinitely.
“Every other week” seemed daunting enough, but the word “indefinitely” struck Monica and me as ominous and ambiguous. “Indefinitely” could mean my oncologist expected my treatments to be efficacious for only a limited period of time. Perhaps, statistically, she thought I might be expected to succumb to the cancer sooner than later, and would shortly traverse the mysterious path to “the way out”.
Alternatively, my oncologist might have used the word to suggest that my treatment could succeed in keeping my cancer at bay for years to come, having reached a kind of equilibrium between my cancer’s imperative to expand and grow, in contrast to the chemotherapeutic mandate to surround and contain my cancer and restrain its expansion. In this matter I choose to believe in the second explanation of her words.

What I have learned from plumbing at the Monastery

Few people are unaware of the ditty “Righty-tighty, Lefty-loosy”. My Dad did not know it so he never taught it to me. Instead, he used the metaphor of a clock to teach me that tightening a jar lid, or connecting a pipe required that I turn it “clockwise”. To open a jar, or disconnect a pipe required that I apply “counterclockwise” twisting pressure. After repeated instructions of whatever type, and through personal experience, the proper turning motion becomes ingrained and is second-nature to most children around the world. We all take it for granted.
I’m pretty good at solving those puzzles requiring a person to visualize in 3D, a 2D diagram of complicated objects. The goal of such puzzles is to identify two of five or more drawings that correctly illustrate the shape of one object viewed from different perspectives. Three or more of the drawings describe different objects. Only two among them describe a single object from different views.
Though proficient at the puzzles, I occasionally need tactile help when confronting a faulty pipe break in a complicated water valve manifold.(3) I find myself looking at the assemblage, unconsciously twisting my hand in a clockwise or counterclockwise motion to help me visualize what part I require in order to join a replacement pipe segment to an existing unbroken fixture.

Handedness. Pipes, jar lids, soda-pop screw caps, screw-on wine bottle tops, solvent container caps, automobile gasoline caps, moisturizer cream tops, baby bottle tops, the wind-up spring of a Grandfather clock… even all the fittings for the tubing from the infusion bags containing my chemo solutions to my surgically-implanted access port… all share and conform to the ditty from which our knowledge was inculculated about which direction “opens” and its opposite: which direction “closes”. All over the world it is the same turnings that do the trick.(4)
Besides “handedness” things that twist on or twist off have three other attributes worth mentioning: thread-count or “pitch”, gender, and diameter.
Pitch reminds us that a screw (or pipe, or any of its relations as shown above) is—at its source—an application of a wedge. Wedges are thought to have been first employed by Egyptian engineers in antiquity. And the wedge is considered to be one of six ancient “simple machines” developed by human ingenuity.(5)
A wedge is a solid rectangle that has a triangular elevation on one side. It has the useful property of changing the direction of force by 90º. This means that if you place a wedge under an object and apply a horizontal force to the wedge, it will cause a vertical force equivalent to the changing height of the wedge along the dimension of the wedge’s hypotenuse.
On a length of pipe, twisting threads contain the action of a wedge. The grooves (or threads) at either end of a prepared pipe are, in fact, spiral applications of wedges. Wedges, whether arranged in spirals or straight, perform exactly the same useful function. Admirably, when two wedges are combined opposite one another–as they are on a pipe and the fitting into which the pipe is to be screwed, the effect is doubled. The force required to twist or twist off is efficiently halved.
The threads on the end of a pipe can, themselves, be insized very closely together (lots of grooves within a given dimension), or coarsly (fewer grooves in the same given dimension). The number of threads describes the pitch. Pitch modifies the amount of force needed to achieve a specific vertical displacement.
Gender. Naturally enough, gender is commonly described as “male” or “female”. Male gender components fit ”into” a receptor. Female gender components “fit around” a receptor.
Diameter. Diameter defines the size of a screwable object. Specifying the diameter can be frustrating. Pipe diameters are defined in two ways. One way reports the inside diameter of the space within the pipe walls. A second way is to report the outside diameter of the pipe. The first measurement is important to guarantee sufficient flow volume while the second may be critical for planning how to route pipes through tight spaces.

In the situation I faced in the Monastary gardens, I needed to replace a broken length of water pipe along the courses through the gardens. I obtained a new length of pipe matching the handedness, pitch, diameter, flow, and length of the original. I removed a broken stub of the original pipe from its fitting and screwed one end of my replacement pipe into it. After attaching the replacement pipe it might seem intuitive that I could reverse my gaze 180º along the replacement pipe and repeat the motion; intending to twist the other end, clockwise, into another existing fitting from which the remaining stub of the broken pipe would have to be removed.
Intuition would—in this case—fail me. The original pipe—had it been left unbroken—would have had right-handed threads all along as originally installed. In repairing the break, I couldn’t simply reverse the handedness during a repair (without a fitting called a “union”.)(6)
Furthermore, had I “tried” the reverse-handedness twisting motion would have meant that as I screwed the pipe at one end, it would simultaneously be unscrewed at the other end which would have gotten me nowhere.)
Looking back along the circuitous and very long extent of the water line in the Monastery gardens I could discern that the run was composed of dozens, if not hundreds, of fittings, turnings, and pipe lengths. Moreover, as originally installed, all the connections were made with right-turning threads all the way back to the water meter, and indeed, all the way from the meter back to the municipal water reservoir or other ultimate source of water.
This regressive consistency reminded me of an ageless Hindu myth (echoed in variant forms in China and the East, and repeated even in Native American Cheyenne Indian cosmology and creation myths).(7) The surprisingly widespread mythical explanation of the movement of the Earth asserts that the Earth is carried on the back of a (seemingly quite robust) tortoise. Four elephants, facing the cardinal points on the compass, stand astride the tortoise’s back. The elephants assume the initial burden of holding the Earth. The tortoise supporting the elephants holding the Earth on their backs, stands on another tortoise’s back, and that one stands on another tortoise’s back, which in its turn stands on yet another compliant tortoise’s back, and so on, etc. ad infinitum. As far as the myth asserts, it’s “turtles all the way down”.(8)

Three turtles of varying sizes stacked on top of each other with the largest at the bottom                                                                           Photo from Wikipedia

In plumbing, it’s right-handed threads all the way back (and all the way forward, too).

Plumbers, as well as Johannes factotums, are thoroughly aware of what I’ve explained above (perhaps too exhaustively for most readers). Still, it is curious—especially for those of us capitalists accustomed to an inexhaustible supply of options—that, even in antiquity, engineers had defined a solution for plumbing applications by arbitrarily choosing a single option to the exclusion of alternatives. The chosen option (right-handed connections and fittings) quickly spread and eventually was adopted, universally, for screws, bolts, threads, and all manner of fixtures based on the simple machine, the wedge.
Scientist and author David Deutsch describes this situation in his book The Beginning of Infinity: Explanations that Transform the World(9) by explaining two limitations to genetic inheritance. (1) nature adopts the simplest workable option that survives the test of “survival of the fittest.” (2) once a genetic function is found to be of use to an organism for sustaining life and propagating itself, that genetic function thereafter resists modification. In fact, most of the genetic modifications that are later introduced to a functioning characteristic are promptly rejected and the original simple solution continues to be isolated from further amendment.

God, the Creator (“Mother Nature” if you prefer) introduced similar limitations against superfluous options into all life on Earth. Evolution capitalizes on adopting particular traits that will contribute critically for survival and propagation. There is seldom a genetic choice offered to the survival of the fittest. (No organism is provided with cells that will produce two equally useful options for, let us say, optical chemical mechanics for sight. Nor are options provided as to where to position eyes on a body). Only a single workable instruction is passed down per organism, even though Nature provides a proliferation of choices among the world’s organisms. It would simply take too much energy to follow a multiple-choice decision tree, and the result might be chaotic incompatibility across a species.
Remarkably, in our lifetime, scientists have discovered a fundamental example of such restraint in the DNA in all organisms living on Earth. The DNA that encodes life on Earth has been verified to be universally and exclusively evolved with a right-handed DNA double helix. All life on Earth shares this same characteristic!(10)
It is theoretically possible that life could have adopted a left-handedness for DNA. But it didn’t.
It is far less likely that some form of latitude could have arisen, letting individual organisms choose to have their DNA encoded for either right or left. But that would have resulted in widespread incompatibility and was not selected for, either. So neither of the alternatives evolved, not left-handedness nor “optional handedness”. Once the right-handed double helix had evolved, nothing altered its development further. And all life on Earth has adopted a right-handed double helix for its DNA, just like plumbing has agreed on the standard of right-handedness.

From seemingly mundane bits of work in the Monastery (this time, in their Gardens), I’ve been blessed by thoughts that make me better appreciate so many of the things I take for granted. Some things, like the handedness of our DNA, we benefit from but have no power over. Other things, like the Sister’s choice to pursue a life more solitary and prayerful than the world typically provides—are under our control.
It is easier to reflect on my blessings than it is to grouse about my complaints when wrapped in the ambiance of such a grace-filled enclosure.

 

Sources

(1) Strictly speaking, the Monastery is better referred to as a “Carmel” since it is home to a Roman Catholic Order of Carmelite Discalced (sandaled or bare-footed) cloistered nuns.  The Carmelite Order finds its historical beginnings in hermetical communities that arose around Mount Carmel in the Crusader States in the Holy Land around the 12th century.
(2) https://genius.com/Bob-dylan-its-alright-ma-im-only-bleeding-lyrics
(3) manifold = a collection of closely-spaced mechanical valves, each controlling a defined series of, for example, sprinkler-heads or remote garden faucets.
(4) Although there are specialized examples where the rule-of-thumb does not apply, I, myself, have only confronted two non-conforming examples in my lifetime of Johannes factotum work. The screw holding my saw blade to its spindle on my circular saw is one. In that instance the rotating left-hand spin of the spindle might dangerously loosen any conforming right-handed screw holding the blade to the spindle. The force of the rotation would likely counteract the resistance of the screw. So a left-handled screw is used for this particular purpose to eliminate the conflict.
Another example is that of a turnbuckle. Turnbuckles are purposely constructed of both right-handed and left-handed turnings to enable modifying tension along a rod or flexible rigging.
(5) http://idahoptv.org/sciencetrek/topics/simple_machines/facts.cfm
(6) In audio electrical wiring, analogous to a pipe’s purpose, an adapter equivalent to a “union” is more descriptively called a “gender changer”. Changing gender is what a union accomplishes in the plumbing application I’m describing.)
(7) http://www.enricophil.it/tales/South_America/Scripts/tortoise.htm
(8) https://en.wikipedia.org/wiki/Turtles_all_the_way_down
(9) Deutsch, Peter, The Beginnings of Infinity: Explanations that Transform the World, Penguin, London, 2012. ISBN 978-08-140-27816-3
(10) https://phys.org/news/2014-09-dna-right-handed-helix.html

 

 

 

 

Chapter Two

Dear Friends,

Chapter Two…

…….…prior to which our Narrator…
1. …received cautious news that his colon cancer was “in remission”. Hearing this…
2. …he was unaccountably reluctant to share the news or blog about it; when…
3. …shortly (3-4 months later) during a carefully aggressive monitoring using CT scans and followup PET scans, doctors discovered that two marble-sized colon cancer tumors had lodged and grown rapidly in the nourishing environment of his liver, far from easy access to surgical excision; in response to which…
4. …able surgeons, stubbornly immune to mere logistical difficulties, responded with rapid alacrity and admitted our Narrator—almost immediately after discovery of the tumors (and just before Christmas)—to the hospital, to undergo a long and complicated liver resection operation to remove the tumors; in response to which…
5. …Monica and I await our oncologist’s recommendations about next steps; and…
6. …we continue, prayerfully, to stumble into the unknown future.

Detail

I don’t have the necessary medical training to possess easy command of the proper terminology and vocabulary, but… following are a few of the most important things I believe we are, today, understanding about cancer:

Genesis

Microbiologists now understand that specific cancers (there are many different kinds, each with their individual characteristics) have insinuated themselves into the fundamental genetic construct of our DNA. It is quite possible that the initial insinuation into our human genome took place thousands of generations ago. If this is correct, then cancer (which Siddartha Mukerjee defined in his admirable and thorough recent “biography” of cancer as “The Emperor of all Maladies” has, perhaps, co-existed with us humans for millennia. This evokes a very different awareness of Pogo’s “We have met the enemy, and he is us.” The various cultural metaphors that claim that both good and bad resides in each human being are also thus vindicated in the physical biological realm and put in shocking high relief.

Action

Oncologists have long studied the behavior of cancer cells and their unbridled growth. Cancer cells exhibit a unique attribute in that, once stimulated into activity, they appear to lose a normal cell’s inborn mechanism eventually “to die” and cease activity. It is as if cancer cells have discovered a way to achieve a kind of immortality. Indeed, cell biologists, today, study cancer cells in their laboratories that have directly descended from cells originally taken from one woman, a patient who, herself, died, now, decades ago! Certain chemotherapies exploit this constant and rapid replication by targeting rapid cellular growth as loci at which to deliver toxic chemical substances designed to kill the cells. Refinements are continually sought to distinguish the rapid replication of dangerous cancer cells from the rapid generation of beneficially evolving cells like hair follicles or digestive wall membranes.

Apart from the incontrovertible biological evidence about the workings of cancer cells, there are cultural echoes, again, principally in mythology, cautioning against the lure of the “fountain of youth” or describing the unintended consequences of Midas’ touch.

  Pathways

A focus of increasing attention for epidemiologists are the biological/cellular pathways through which cancer cells appear to communicate with one another to “stimulate” (one might be inclined to use the word “infect”) other cells. In my case, for example, it came as no surprise to my medical professional care-givers that my colon cancer reappeared, next, in my liver. There exists ample convincing evidence that this is one of the preferred evolutionary pathways colon cancer, particularly, exploits. Just what mechanisms enliven the pathways or stimulate the transmission of cancerous activity at one spot in the body to another are not yet known. The identified preferred pathways exist, at least, as promising targets for future research and therapies.

Stimulants

Finally, biologists are beginning to identify what substances, chemicals, infinitesimal elements can stimulate dormant cancer cells to “life”. These stimulants are more properly known as carcinogens. While the list of known carcinogens is growing (cigarette smoke, second-hand smoke, asbestos particles, certain petrochemicals, soot, some foods, etc.) precisely how they evoke a response in cells that appear to lie in wait in all human beings, why in some and not in others, in what concentrations or under what circumstances, is all rich ground for the minting of future MD’s and PhD’s.

So, for the time being, I will be subject to, perhaps crude, certainly experiential, therapies and remedies that will be prescribed by young doctors and clinicians who wish to find the proper therapies as much as I wish for them to do so. I cannot compete with their sophisticated understanding of what I’ve crudely outlined above, even though I can, perhaps, grow in my appreciation of what scientists have come to understand and how dreadfully complicated is what is not yet known. Be that as it may, I am confident and happy to turn over the care of my medical condition to the experts who have generously eked out a career in this forbidding territory.

What I may be better able to learn from, for my own well-being, if not specifically my body’s, is to examine the cultural and spiritual echoes that seem to resonate and whisper with each scientific discovery.

We’ll see… in future cancerblogs.

Chet