Category: General

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The Art and Science of Barriers

“Good Fences make good neighbors” is a memorable and salient line from Robert Frost’s poem, “Mending Walls.”  While the context of its meaning is a plea for the importance of privacy, it is a useful phrase for the COVID-19 pandemic as we all try social distancing as our physical defense and protective barrier from the Coronavirus. Six feet away from one another and swathed with a nose and face covering mask seems to be the barrier du jour. It has been that throughout life we must deal with barriers that represent either obstacles, as in the poetic verse of Robert Frost, or provide succor to our existence. In our current COVID-19 world, our imposed barrier, a protective mask, will be critical to manage our “new normal” prior to a transformative drug or vaccine. In essence, we need a science driven mask that is effective, comfortable and re-wearable.

Biologic barriers are present from conception. Surrounded by the amniotic membrane, we are protected from most pathogens. Upon its rupture and our ride down the birth canal we start the self versus society struggle.  Hepatitis B, polio, rotavirus, diphtheria, tetanus and pneumococcal vaccinations are our initial immune barrier. Child proofing mechanical barriers (plug locks, stair locks, edge protectors) are present during our formative years. Car seats and later seat belts protect us from motor vehicle morbidity. Science has driven these medical protections and public health measures have orchestrated their distribution to the public and their acceptances as standards of care.

Societal barriers have protected humans for eons from human aggression, accidents and microbes. The Caves of Lascaux  protected Paleolithic man, The Great Wall of China retarded invasion by the Mongols. The Roman emperor Hadrian built his namesake “wall” in Northern England to keep out the “barbarians.” Ramparts and moats around European castles in the Middle Ages slowed the devastation wrought by the Vikings. In our lifetime we put up with anti-terrorist barriers at TSA checkpoints at all U.S. airports. Physical barriers and screening techniques have been shown over time to decrease disease and death from outside threats to our well-being.

Our protection from COVID-19 now demands a barrier to our nasopharynx. We are now safely surrounded by our homes’ four walls and limited “world” contact through our UPS and Amazon delivery services. In order to integrate into society we need extra protection from the virus. A mask or “facial condom” could provide us with the protection and turn human interaction into an acceptable risk. We are now familiar with the N95, surgical, and home-made masks. We have YouTube videos of media celebrities constructing masks. Now,  “mask science” is the next logical step to assure that our efforts are working to prevent Covid-19 transmission. What we really need is some evidence based guidelines developed from a controlled study.

 The geometry is well known: N95 keeps out 95% of particles that are as small as 0.3 microns; droplets containing COVID-19 are 50 microns or less. Droplet spread is 6 feet, more if sneezing or aerosol transmission is involved from the contact. What we don’t know is what materials and layering are most effective against virus spread when used in a real world scenario.

Compliance and comfort are inextricably linked. When I donned a mask in the OR, my face felt like I was in the microclimate of Miami during the summer and my eyeglasses fogged up like winter in London. We have designers and aerosol engineers that can overcome “wearability” issues that could lead to improved compliance. We have industry and universities that have the capability of testing combinations of fabric under simulated and actual environmental conditions.  Distribution capabilities are available to send masks to every household in the United States utilizing the Postal Service.

Americans have internalized the use of seatbelts and TSA screenings in my lifetime. Introducing and complying with  a “new fence” is easier when the alternative may be a painful respiratory death. Wearing a fashionable, comfortable and effective face mask should become the “new normal.”  The design, efficacy and distribution is simply just one more barrier for science to overcome.

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Soup Saviors: Chicken and Matzo Ball Soup Stories

Chicken soup has long been an off-label medicinal treatment for the common cold and flu as long as most of us can remember. So, it seems in these troubled times of COVID-19, we are hearing of its use in both healthy and coronavirus inflicted patients. An elixir from antiquity, chicken soup and its Passover-inspired cousin, matzo ball soup, are the “magic potions” from yesteryear that have been a proven adjuvant to analgesics and cough suppressants. However an Amazon search for chicken soup brings up a dizzying array of “out of stock” and “delayed delivery” for dozens of pre-made poultry influenced self-prescribed potions.  Chicken noodle, chicken and stars, old-fashioned chicken noodle, low sodium, healthy request, chunky, cream of chicken and every conceivable form of soup on a grocery shelf is starkly absent. In fact, chicken soup is one of two most requested items on Amazon. When I took a moment to ponder why, my memory was flooded with memories of my grandmother, aunt and mother serving up large bowls of chicken soup for every childhood illness that befell me. And, to be quite frank, I almost instantly felt better after its consumption.

My maternal grandmother, Nan, unveiled her divine Matzo Ball Soup at the start of each Passover Seder. Even a “soup skeptic” like my father, devoured the contents of the bowl. I can still hear the clanking of his soup spoon on the bottom of the porcelain dish. My nuclear family had matzo ball soup anticipation throughout the year, and not unlike McDonald’s McRibs strategy, Nan would bring it out during random Erev Shabbat gatherings. While there were many proponents of Nan’s soup credentials there was not unanimous agreement. Aunt Rose’s Matzo Ball Soup was touted as the gold standard by my relatives north of the Bronx. The debate on the best soup went on for decades.

Chickens can incubate avian influenza but they can provide sustenance through their soup derivatives. The 12th century Jewish physician and rabbi, Maimonides declared the medicinal properties of chicken soup back in the 12th century. Modern science has weighed in on its medicinal values. Chicken soup can slow  the entry of white cells into the nasal cavity, explaining the improvement in airflow. Medical researchers at Mt. Sinai in Miami Beach ascertaned chicken soup challenge in humans showed an improvement in nasal mucus flow, a marker of viral clearance. Chicken soup can also improve cilia function, the hair-like projections on naso-respiratory cells that “clean up” the nasal and respiratory passages, The soup additives, onions and garlic can have antiviral effects.

As Jews celebrate Passover and recall the 10 plagues of antiquity while living through a 21st Century pandemic, let us remember the benefits and memories that our loved ones provided: the humble Matzo ball/chicken soup miracle.

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Now What? The Retired Doc Manifesto


My thoughts wandered back to my first year in college, afflicted with infectious mononucleosis during my first semester. After spending 3 days in a University infirmary, my dad flew me back to NYC for a second opinion with his company doctor. “So you’re majoring in political science. You know there’s not a real world job out there,” declared Dr. Sussman behind his mahogany desk on Park Avenue. “You should try for medicine,” he counseled. Fifty years later, mentally replete with the teachings of Hans Krebs, Bert Vogelstein, Sidney Winawer and a host of others, I walked out of the endoscopy center, bid adieu to colleagues, staff and my endoscopes and entered the world of the “retired doc.” Now what? Travel the world, sleep in and watch “Get Smart” reruns, volunteer in indigent clinics, hangout in hospital dining rooms and talk about the good old days? Turning to the internet, I found a plethora of sites advising me on finances, providing lists of post-doc duties but no voices of the retired physician community describing the journey of the medical retiree. In this blog, I hope to stimulate discussion of meaningful and whimsical topics of value to the retired physician community. Let’s go!