I threw the x-rays up on the view box. I thought to myself, “Moderate degenerative joint disease, nothing more." I walked into the ortho room and told the old man, “Nothing is broken, just a moderate sprain.” The patient, an old farmer who has spent much of his 76 years toiling on a farm not far from town, was relieved at the news. He had slipped stepping off of his tractor and turned his ankle. He said, “That’s good news. I still have several acres to plow." I replied, “The ortho tech will be here in a minute to put an air splint on your ankle.” As I was walking out the door the old man said, “Hey doc…. can ask you something kinda’ personal?” I thought to myself, “Okay, here comes the standard exit consult.” Out of respect for the old man I walked back into the room and sat on the stool. Then, he asked, “Doc, do you think I can get a prescription for some of that Viagra I have been seeing on TV?” I thought pensively for a moment and asked, “That's not a medicine we prescribe very often in the emergency room. Have you asked Dr. Williams (his family physician) about it?” He paused for a moment, looked down at his injured ankle and said, “Yeah I did, but he would not give me any.” I asked, “Why?” He slowly replied, “He said I can’t take it because of my chest pain.” I quickly asked, “Are you having chest pain?” He said, “Oh no, not now. I just have it when I work real hard or when I have relations.” I thought for moment and said, “I think Dr. Williams may be right. It sounds like you have what's called stable angina. It's dangerous to take these medicines when you have stable angina. Besides, we just don't prescribe these medications in the emergency department.” The old man looks down, takes a deep breath and says, “Thanks doc. I understand.” Later, he waves to me as the ortho tech pushes him out to the emergent apartment doors. Well, I started thinking.
Then, a thought came to me, “What would Darwin do?” For those of you who attended Christian schools, Charles Darwin was a 19th century scholar who described the science of evolution and the process of natural selection. Natural selection assures that only the strongest individuals breed to ensure continued strength and propagation of the species. That is, it assures that the offspring get the best possible genes in order to have the best possible chance of surviving a changing world and reality television. Thus, what would Darwin say about drugs like Viagra, Cialis, Levitra, fertility drugs, in-vitro fertilization, surrogate pregnancies, and similar practices that may seem to doom the species? Mother Nature went to great length to assure that Tony Randall, Hugh Hefner and Bob Dole no longer contribute to the gene pool by taking the lead out of their pencils. Now, along comes the pharmaceutical industry with television ads—the worst being yahoo Nashville studio musicians singing the nauseating, but catchy, “Viva Viagra.” In reality, they should be telling the truth. The real song should be the Rolling Stone’s “You Can’t Always Get What You Want.” But, in a somewhat altruistic way I really wonder if we are harming our species.
An infertile couple is certainly sad. We all have a natural need to propagate. But, if you have impotence because of diabetes, perhaps it is best not to have offspring who carry the gene and possibly threaten the species. Likewise, a woman with polycystic ovarian disease does her offspring a disservice by passing on a bad set of genes to her kids. Genetics is a crap shoot. If you get a bad set of genes, you obviously did not pick your parents well. Childless couples can be fulfilled through adoption. Many third world countries would love to have their orphans cared for in the United States (Romania, as of this writing, is having a 2 child for the price of 1 sale—no refunds, cash and carry). I have seen too many couples undergo $100,000 worth of fertility work only to have 13 miscarriages before they finally become pregnant with triplets. One dies, the other two are born at 23 weeks and spend 6 months in a NICU with a bill totaling a million dollars or more. What a life. Thus, I am proposing a new bracelet (magenta in color) emblazoned with “What Would Darwin Do?”
P.S. Right after I wrote this rant I ran into an article where geneticist Steve Jones has declared that human evolution is complete. He said, “Another factor [causing the end of evolution] is the weakening of natural selection.” This is distressing because, if evolution stops now, I will spend the remainder of my years listening to rap music, watching Paris Hilton and Brittney Spears show their cooch, and watch helplessly as Congress slowly takes every penny I have ever learned. So, all together: “What Would Darwin Do?"