Thanksgiving

This week we give thanks for a bounteous harvest, friendship between pilgrims and natives, family members who are willing to pitch in to clean the dirty dishes, friends who don’t harrass you about eating too much, big-screen TVs, soft carpet on the living room floor, and Alka-Seltzer.  Many families (mine included, on occasion) pause before digging into the feast to openly express their feelings about what in particular they might be thankful for.

Years ago I spent a Thanksgiving in Austria away from my family.  An elderly gentleman, knowing that I was out from my element on an important American holiday, kindly invited me to dinner with his large family where we were served wienerschnitzel, kartoffelknoedel and sauerkraut (not exactly turkey and the fixin’s, but better than frozen pizza).  He had heard of our tradition of “giving thanks” on Thanksgiving and asked each of us to take turns vocalizing our gratitude.  After a series of testimonials praising the blessings of health, happiness, family and faith, the old man—a retired city engineer—concluded with what he found most worthy of appreciation: a functioning sewer system.  He spent the next 20 minutes detailing the history of modern waste management and describing in fetid detail the state of affairs prior to flush toilets.  “Dig in,” he pronounced when his sermon was complete, although the gravy-soaked dumplings had strangely lost their allure.

The way my host expressed his seasonal thanks seemed a bit like reading the Dr. Seuss book Did I Ever Tell You How Lucky You Are? which contains page after page of people (like poor Herbie Hart, who’s taken his thromdimbulator apart) whose lives are clearly worse than your own.

Just tell yourself, Duckie,
you’re really quite lucky!
Some people are much more . . .
oh, ever so much more . . .
oh, muchly much-much more
unlucky than you!

In that vein, and in the spirit of my sewer-loving acquaintance, I’d like to make a short list of some of the things I’m thankful for.

1. My bowels.  Sure, you spend most of you life ignoring the sewer system of the body, but when you get a little older you realize how useful a fully functioning colon can be.  One of my original mentors in medical residency commented that as you get older bowel function replaces sex as the focus of men’s attention.  I’m not quite there yet (old, I mean) but I sure appreciate being able to devour my holiday meal without the turkey coming back to haunt me the next day.  At some point in the life of each of us we will suffer the indignity of dysfunction of our gastrointestinal systems.  For now, count your blessings.
2. REM sleep.  I spent 6 years in specialty training getting very little sleep.  I’ve been in practice for 10 years now and still slide into bed every night grateful that I’m not desparately trying to squeeze in 20 winks in the call room.  I’m not the only one who doesn’t take sleep for granted.  If I had to estimate the prevalence of insomnia based on my cardiology patients I’d come to the conclusion that 99.2% of people develop trouble sleeping at some point or another.  There are so many maladies that interfere with blissful slumber—obstructive sleep apnea, restless leg syndrome, paroxysmal nocturnal dyspnea, benign prostatic hypertrophy, and anxiety, among others—that it’s a small miracle that any of us manage a good night’s rest.
3. Durable telomeres.  What are telomeres?  Discovered in the 1970s, these are short stretches of DNA that sit at the end of each chromosome and make sure that all genes are present and accounted for every time your cells divide.  Healthy telomeres seem to be the key to tissue growth without cells going nuts and morphing into cancerous tumors.  When you look at the complexity of DNA replication you realize it’s a wonder that cancer doesn’t pop up more than it does during the course of one’s lifetime.  I have a particular fondness for the integrity of my chromosomes—cancer runs in my family much like the Missouri ran through the Midwest this spring.
4. My pancreas.  The pancreas is the key to a happy Thanksgiving.  Not only does it produce insulin—the hormone that allows your body to make use of sugars coursing through your bloodstream—but it’s also the source of most of the enzymes that your body uses to manage the stuff you put in your mouth.  The proteases  trypsinogen and chymotrypsinogen allow your digestive tract to dissolve your feast of turkey into the amino acids that can be absorbed into the blood stream and used to build your muscles, especially the all-important flexor pollicis longus (indispensable for appropriate manipulation of the TV remote).  Without amylase (the enzyme that breaks down carbohydrates), your plate full of stuffing, mashed potatoes, and candied yams would end up a mash of mush stuck in your stomach.  That tasty layer of thick gravy could never make its way from your small intestine to your love handles without a steady stream of lipase from a healthy pancreas.
5. The autonomic nervous system.  Here’s one that never gets its due recognition.  No one ever thinks about all the bodily functions that happen without one’s direct attention paid to them—we all seem to think that our cognitive brain runs the show.  Your arm, for example, sits idly at your side until you give it the conscious command to move.  Not so with the basic functions of life.  You can go years without ever purposefully thinking to take a breath, or make your heart beat, or trigger your peripheral blood vessels to react to bodily position.  The NPR program Radiolab did a whole broadcast on proprioception—the brain’s ability to keep track of the location of your limbs without visual cues—and vignetted several individuals who lack this so-called “sixth sense.”  Talk about people being worse off than you.  If ever you think you’ve got it rough just spend an afternoon reading Oliver Sacks’ book "The Man Who Mistook His Wife For A Hat" and you’ll immediately feel a rush of gratitude for neural tissue you never knew you had.
6. The liver.  Medical scientists have managed to develop machines that replicate the function of kidneys (dialysis), the heart (the LVAD), the pancreas’ islet cells (the insulin pump), and the lungs (artificial ventilator).  We can circumvent one end of your GI tract by feeding you through your veins and bypass the other end with colostomies.  We can give you blood transfusions, insert prosthetic joints, and regulate your heartbeat with pacemakers.  The one organ (other than the brain) that we just can’t seem to replicate is the liver.  This miraculous lump of tissue serves as the gas tank for the body (storing and releasing glucose), the factory that produces proteins and enzymes, and the organ responsible for detoxifying your blood of all the bad things your mother taught you not to ingest.  If your liver goes bad the only way to get a new one is if someone volunteers their own.

There are many people who find it hard to identify things they are thankful for.  The economy is in a slump, a cold winter is on the way, and the stress of the holiday season is right around the corner.  There are plenty of people who suffer from health infirmities that limit comfort and activity, and others with social and family challenges that occupy their emotions and attention.  While I don’t mean to diminish the difficulties that many of us face, I would like to remind everyone to simply take a moment this Thanksgiving to remind ourselves of those things that are right in our world.

Even if it’s just the sewer system.