Is it really my fault?

– “Doctor…I can’t believe my husband cheated on me—after so many years of happiness.”

Laura X. is a mild-mannered, attractive businesswoman who has been married for more than twenty years and has always bragged about her caring husband and good teenage children. In her latest visit to my office, she looked very distraught and whispered hesitatingly, avoiding my gaze. She confessed to me that she found out that her husband was having an affair with his secretary.

Infidelity in couples is almost as old as the world itself, perhaps only slightly less than the famous bite to the apple that triggered so much passion and eroticism in human sexual relations. Even though in our supposedly modern societies this issue has lost some of its more edginess, we still react with anger and frustration when we learn that our “significant other” was not faithful. The majority of couples still expect to engage in a monogamous relationship and avoid philandering.

Women are particularly vulnerable to the extreme disappointment and hurtfulness of infidelity as they usually are the most committed part of the couple. The ones that strive “to make it work.” They make countless big and little sacrifices to share their lives with another person. One of the more damaging collateral effects of this emotional frustration is the surge of second-guessing and guilt feelings in the aggrieved party to the conflict.

Laura X. asked herself if she was not really at fault for his transgression because she felt that she might be dedicating too much time to her household and had little spare time for her appearance. We always found her attractive and well groomed, without any sloppiness in her body and mind. We had to chat extensively with her to assuage her that it was not her fault at all. It was solely his. We must dispel these toxic feelings of guilt because they can affect the patient’s mental health.

One of the greatest disappointments we had in our childhood was the separation and divorce of our parents at a very early age in our maturing process. Eventually both my brother and I recovered. But we could never overcome a certain disdain for our father—who we loved and respected—due to the fact that he certainly had a clandestine relationship when he was still married to our mother. Oftentimes my dear mother Gladys wondered aloud if it wasn’t her fault that he had an affair; a few times even my grandmother Yolanda scolded her for not being more vigilant with her spouse.

Did I miss any of the signals? How could I be so distracted with my obligations to abandon him? Did I forget to use nice perfumes? Or sexy clothes? Did I abuse of the “headaches excuse”, eh? Perhaps it’s my fault too…Perhaps his fault is not as grave at it seems… The tremendous reservoir of feminine empathy can even sugar-coat the most egregious behavior. As Friedrich Nietzsche, a tough appraiser of the dark complexities of human behavior, once said: “the victim takes the whip out of the torturer’s hands and starts to strike himself.”

Self-flagellation.The ultimate indignity borne by the abused.

When they separated, our parents were barely in their thirties; both my brother and I chose to live with our mother. We stood firmly by her side and consoled her when she wallowed in her grief. We reminded her that it was our father’s fault. Not hers. Raising two children with limited financial means and with no family around entailed personal sacrifices that she squarely faced with stoicism and courage. Muchas gracias Mama!

What do you think? Please tell us.

Don’t leave me alone.


The visionary of Trinidad

I remembered that moment as if it had happened yesterday. It was a late Sunday evening in the first week of March 1966. The next day my brother and I were supposed to go back to school after the summer recess. But instead of the joy to return to a familiar place with  my buddies since kindergarten, I was starting in a strange school. I was sad. Very.

In 1965 my mother and her two children left our centrally located apartment to settle momentarily in our grandmother’s spacious home in Colon to take some needed refuge. My father had been arbitrarily  jailed by a judge for some unpaid personal loans; there was no bankruptcy legislation in Uruguay at the time, which exposed the debtors and their families to great financial strain and emotional suffering. Even though he was assigned to a detention center in the Police headquarters where he shared his short stay with educated and friendly inmates, it was still an imprisonment. Our dear mother Gladys had a nervous breakdown and Yolanda, her mother, offered to take care of us all.

Instead of slumping in an emotional void, we decided to take the challenge in earnest. Yolanda, all wrapped up in a woolen poncho, accompanied us early at dawn in those freezing mornings to wait for the bus 411 in a deserted stop. We boarded it for 45 minutes trip to the “Lycée Francais.” When the noon break came, we boarded the bus again to have lunch in Colon (as we could not afford the mess hall every day) and then go back to our school to be on time for the 2 PM bell. At 5 PM we left the school for our return trip home. We arrived at dusk to have a café-au-lait and do our homework load; around 8 PM we had dinner and went to bed promptly afterwards. No TV or radio.

In spite (or perhaps because) of this humongous sacrifice, I got a perfect score in my fifth grade of Primary School to rank first in my class and winning a much-needed full scholarship for sixth grade. Alas, our joy was short-lived. One day my father came back home and told us that the school director stripped me of my scholarship to give it to a politician’s son. We were so astounded and hurt that its memory still sears our minds.

My father quickly prepared a forceful letter to Mr. Chambord, the cultural attaché of the French Embassy at the time. He summoned my father to his office; he told him that they would give me the scholarship back, on the condition that he had to withdraw his letter of protest. “Absolutely not. Our dignity forbids it,” he rebuked him. Then my father filled the application to attend sixth grade in the “Escuela Jose Pedro Varela”, a public school just a  short distance form the French school. When he told me I agreed in silence. My dislike of the French (not the French culture) and politicians started right there.

When my mother and brother were fast asleep, I jumped out of bed and went to the kitchen to chat with my father. He embraced me warmly and patted my head. “Don’t worry…You’re a tiger…You’ll do well, wherever you go,” he said with a forceful tone.    We stayed together in silence in the darkness, forging a stronger father-child bond.

Mario Laplume Salguero was born on August 14, 1933 in Trinidad, Province of Flores, Uruguay and passed away on July 22, 2012 in Montevideo, Uruguay; he married Gladys Garbarino in 1953 and had two sons by that marriage: my brother Gustavo and myself. In 1967 he divorced her and married Isabel Mardaras with whom they had a son: Marcel. When he was a teenager he entered as a mail room clerk in the Swift meat processing plant located in “El Cerro”, across Montevideo bay. He was molded for life by the daily contact with those Post-World War II Americans that had a strong work ethic and a commitment to quality standards in the workplace. He could not go to High School due to his work schedule, but he attended English, French and German language classes after work. He started to read an collect a magnificent array of books that the has given aa a legacy to his three sons. One of my earliest memories of childhood is to watch him in awe as he meticulously took a book out of the shelf to pass a hand held-feather-duster on its cover and then open it parsimoniously to peruse a few pages. If he noticed me, he would ask me to sit down by. He taught me all the basics about World Literature, including all the classics in French and English.

He was a lifelong Socialist and union organizer in the bankers’ union (he worked in a private bank after the Swift company closed and pulled out of Uruguay); if he hadn’t had that financial mishap, he would have joined the armed insurrection against the military government. When I became a political militant, he understood my choice and, aware of the physical risks, he backed my decision. When the military government closed the Medical School and the police started to round up the die-hard militants, he convinced me to travel to Argentina to continue my studies in La Plata, sparing me a certain demise. If it weren’t for him, I wouldn’t be here writing this article today.

He always wanted to study Medicine as he considered that it was one of the noblest professions of humankind; he supported me emotionally and financially during my medical studies and he was very proud when I graduated from Medical School in 1981. He got one of his cherished dreams. He instilled in us the virtue of honesty and the value of a given promise to become a good man. Even though I questioned several of his progressive convictions as I grew older, he never lost his calm demeanor in discussing politics and economy; he never relinquished his core beliefs. From today’s perspective, I now fully agree that a life without a generous mission is not worth living.

Imbued by the strong work ethic of the Americans he had met in the Swift plant, he always admired the United States of America and he studied its politics and history in earnest; he became an expert in the Civil War, enjoying all the books, magazines and material I regularly brought him home. He enjoyed meticulously reading every section of the Sunday edition of “The New York Times.” He did not have to set a foot in this country to know how the system worked and did not too. He continually admonished us: “the USA is a land of chiaro-oscuri…But the brightness prevails. It will last 500 more years.”

As I am jotting down these lines on my laptop, my son Gian Luca, a born buff of everything cinematic, is watching a 1986 cult film called “My brother’s wedding” by Charles Burnett. Have you ever heard of it? I doubt it. Me neither. How does he know it exist? He inherited a gift… I still remember that in a small closet right next to the toilet in Montevideo, there was a tall pile of a French film magazine called “Les cahiers du cinema”; I always picked one to start reading it. Next to it there was another pile of the “Boxing” magazine, which hooked me to that “politically incorrect” sport for life.

When I told my father that Noel Marie, his first grandchild, was not pursuing a legal career, as we initially hoped, in order to become a video producer, he paused for a long second and then said: “Mmm…That little one will do whatever she wants in life.”

He was absolutely right. He is the family’s unique visionary that showed us the way.

Gracias Papa!




Keeping the marital flame alive

– “Doctor…We’ve been married for so many years—we hardly ever make love anymore.”

Sheila X. is a nice, successful lawyer “d’une certaine age” that has had increasing doubts about her marriage during the past few months; every time she comes to my office, I can see the tired look in her face with an evident readiness to say a lot of things but with an unwillingness to do it. She has been complaining of multiple minor ailments of various systems in the past few months that, after a complete medical work-up with referral to specialists, turned out to be “somatization.”

One of the most persistent misconceptions in our society is that the progressive decline in marital passion of married couples is directly related to the loss of libido and/or interest in their partners. Even though there is certainly a dearth of sexual activity in these “bored couples”, we believe that it is usually a symptom of a larger problem that needs novel solutions that go beyond the bedroom. So, recurring to our humble, limited but intense experience with the marital bliss, we recommended her the following:

1 – Watch the communication modes

In the beginning of every relationship, we tend to be obsequious and mellifluous with our partner; unfortunately, the daily routine and the wear-off from labor and family obligations will ultimately sap our readiness to say nice things, progressively drifting into rudeness and worse, indifference. We shake our torpor and try to see our romantic partner in a new light. We must listen to their concerns. We must talk to them as adults, not talk down like children. We must speak softly in their left ears. Why the left? Because the sensory input from the left side of the body goes to the Right Hemisphere, the center of affection, where there is no Right or Wrong (read more in my upcoming book) Never underestimate the soothing effect of the right word of encouragement at the right time.

2 – Respect the differences

When a romance starts we value the differences in our “significant other” as a nice challenge of our sentimental status quo and offer us some needed excitement to “feel alive.” However, that attitude might change over they years as we become less tolerant of previously accepted features. We strongly believe that it is almost impossible to “change someone”, a fallacy that many young women believe when they supposedly marry “the man of their lives” and start tinkering a little. When you love someone, you are ready to change your ways. A little. Sometimes may be more. But don’t you start vacuuming the living room when the football game got finally interesting.Or pester me that you want a salami sandwich when “gorgeous” is about to pop “the question” to her. Ca va de soi!

3 – Encourage the individual initiatives

Perhaps one of the most difficult and yet easier recipes is the fact that, in order to keep a healthy couple relationship, both women and men must have separate activities, either in the labor or social spheres, including reserved times for personal hobbies, old friendships, new business ventures. Of course, there were always couples that “do everything together” but that smacks of other times when women were more compliant and followed the lead of their men and relegated their wishes. Moreover, after some time spent apart, the yearning to be with the loved one gets even stronger.

4 – Surprise your partner regularly

One of the funniest ways to break the routine that might asphyxiate any kind of long-term relationship is to do something completely unexpected to surprise your partner. Perhaps one day you decide to stop by a florist shop on you way back from work and buy her a bouquet of red roses; maybe you even dare, not to use one of those lame pre-printed cards, but to write a few simple lines telling her how much you love her and appreciate all she does for you. Say it. Loud and clear…Or perhaps you decide to wait your hubby with a new dish that you learned from a TV program even if you got all the ingredients from Blue Apron. What’s the matter? Is cooking beneath you? Just do it.

5 – Watch your personal hygiene

This is one of the trickiest issues. Of course. we know that we must take a shower every morning and get ready for our interaction with our work or study mates. But how about at bedtime, eh? We should avoid late feasts with too much red meat difficult to digest, carbohydrates that swell your belly, beans and broccoli that encourage the colon bacteria to produce malodorous flatulence. For years I have had the habitude of “moving my bowels” (Yes, I can talk at ease about this subject because I am a physician, remember?) at least once in the morning before going to work and at night before I take a quick shower to get to bed squeaky-clean. Try it. You’ll smell the difference. And, exuding lavender from Provence, your partner might be enticed to “take a bite out of you.”

6 – Maintain family and friendly relationships

The interaction with other people brings a much-needed breeze of fresh air to the couple, besides cementing their attachment to their family members and their friends. Humans are supposed to live in association with other individuals, not only the lifetime companion they have chosen. We know that it is sometimes tough to bear the relatives or fellow workers of our “significant other” but we have to remember that he/she/sie might feel the same. By agreeing to accompany them along in stride, we are helping them to ease the burden. They will be grateful for our gesture. And we might get cookie points.

What do you think? Please tell us.

Don’t leave me alone.

Cannabis in Epilepsy – Part II

Recently there have been several large, well-controlled studies of the use of Cannabidiol in children and adolescents but it was used as an adjunctive therapy, not in a standalone way. What would happen if patients were only taking a cannabinoid as some activists for the legalization of Cannabis are vociferously demanding in many American state capitals?

Emily Stockings et al., researchers at the National and Alcohol Research Centre at the University of South Wales in Sydney, reviewed the data of several clinical trials of Cannabidiol, focusing on 36 studies that studied the use of the drug in drug-resistant Epilepsy. Two double blind studies on the use of CBD—one with 120 patients with the Drayet syndrome and the other with 171 patients with Lenox-Gastaut syndrome—showed that CBD was 75% more likely than the placebo to reduce the number of seizures by more than half. In the largest pool of almost a thousand patients that were observed, almost half of them got some significant reduction of their seizure frequency.

The researchers admitted that the quality of the data was mixed as there is no reliable evidence of which preparation of Cannabis—either Cannabis sativa or CBD-THC extracts or oral cannabis extracts—is more suitable. Three randomized clinical trials studied the possibility of seizure-free by just taking CBD compared to placebo; even though they found an encouraging six-fold increase in the number of patients that ended up seizure-free, their data is not completely reliable. Half of the patients treated with CBD reported that the quality of their daily activities had improved. The overall data suggested that almost half of the patients reported some significant improvement.

The greatest gains were observed in patients with Drayet syndrome or Severe Myoclonic Epilepsy of Childhood (SMEC), a tragic condition that begins in the first year of life and produces constant seizures; we can understand the relief experienced by those parents when they noticed a change. However, all the studies with Drayet syndrome were case series with a 100% response, which should be interpreted with extreme caution. The Sydney researchers also studied the number of participants that dropped off the study, which could be an indicator of their tolerance to the drug; they found no real difference between the participants receiving CBD and those with placebo.

There was a significant increase in the rate of adverse events in patients receiving CBD compared to placebo, including the dangerous status epilepticus and elevated aminotransferase levels. The most common adverse effects were drowsiness, diarrhea, fatigue and lack of appetite. This fact should make clinicians ponder whether the addition of CBD is warranted in the med schedule. The use of Cannabis should not be taken lightly or “to see what happens. What’s there to lose anyway?”

Many policy pundits and media charlatans are jumping in the bandwagon of the medical benefits of Cannabis in the American states that have long approved it like Colorado and those like Florida that are just beginning to regulate its use. We should fund serious studies in prestigious centers; moreover, the parents of children with grave, chronic neurological diseases should have priority access to them. There is a fine blue line between the medical benefits of Cannabis and its purely recreational use. But sick children should not be taken as hostages by the perpetrators of this media driven-frenzy.

What do you think? Please tell us.

Don’t leave me alone.


Please welcome the sage words of Harbans Khajuria, a great Indian thinker and writer, besides being a close spiritual friend of mine across the oceans. This beautiful poem is an homage to the redeeming power of an honest, affectionate and stimulating relationship.

This reproduction of the tableau called “Supper of Emmaus” by Caravaggio shows a total stranger arriving at a roadside tavern and chatting with Luke and Cleopas, two of Jesus Christ’s disciples. Cleopas extends his right arm to touch him and the left arm towards us–a visual challenge as the stretched arms go in and out of the frame of reference. Jesus Christ is appearing to buttress their wavering faith. After this encounter, he will vanish.

The messenger may leave but the message stays behind. The essence of true friendship.

We are lucky if we can claim a few good friends in life that make a real difference. Harbans is one of them for moi. Thank you for your unique friendship, caro Il Chiaro. Enjoy his writings.





When nothing significant works for us

Every door for coming out

We find closed fatefully

No course of action

Seems open for us naturally

A fellow comes to our succor

Opens with own helping hands

The closed doors ajar

And provides the possibility of openings for us

This alliance so supportive

To pull out of any state

That ‘time’ presents itself  

For each other so caring

When the need arises.

Once amity is established

Then the friendship is further cemented

By the basketful of trust

Which gives the friendship

The stamp of permanency

This friendship could be between those who meet us daily

Or, possibly

From beyond the borders, we have not traversed ever

Between. those whom we have not met any time personally

This thread of closeness is felt by us instinctively

Because the indelible stamp of the God is affixed on this friendship.


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L’abus au petit feu

– “Doctor…It’s not how much he pisses me off—but rather how often he does it.”

Sheila X. is a jovial, good mannered and efficient nursing aide that has been suffering from chronic migraines for years; almost all the therapies we tried have failed and now she is participating in a clinical trial for a new medication. But her main trigger is located home.

She has a nice husband who nonetheless does not cooperate with any of the housekeeping and child rearing, preferring to slump in the sofa with a beer and the TV remote control after work. Their two teenage children scold him for his archaic behavior, but he ignores them altogether. Occasionally she bursts out in anger fits, which does not change his bad attitude but only exacerbate her headaches. Lately she has given up and tolerates his bad behavior in silence. However. we have watched how the summation of all those episodes is sapping her joie de vivre.

A French chef recently explained in a TV program the advantages of a slow burning fire to tenderize supposedly hard to cook meats like game and fowl; when I watched his explanation, I couldn’t help thinking about how Sheila’s husband is undermining her strength at home and also at work.  Often, I had to write a certificate, so she could skip work and lay down in her bed with lights out. I always asked her if he ever became physically abusive and she vehemently denied any incident.

A flutter of the hand that never lands on a woman’s face but still frightens her into submission. Or perhaps of a not-so-subtle-threat in the middle of a perfectly routine conversation of the couple. Or even worse still, a stony silence after the wife asks for some rational explanation to his deed. Women have been subjected to vast amounts of verbal and physical abuse all along their lives. Oftentimes it does not reach the threshold of intensity that will provoke a radical response. But these low-intensity encounters can slowly erode the self- esteem of the woman and even constitute a terrible example for the daughter. If Daddy frequently does that to Mom, is it then acceptable?

Without claiming the mantle of “political correctness’ in our relationship with women in general and our family members, we believe that we are doing better than our parents and grandparents did in other times when society tolerated little abuses in stride. And our children should be even better than us. There is no excuse for the mistreatment of women and children. None is acceptable. My father Mario always taught us: “the man that raises a hand against a woman is a coward.”

Occasionally we witnessed how such a silently suffering woman suddenly erupts in a fit of rage that breaks the status quo in a supposedly “happy marriage” to the dismay of all. But hardly ever they take the extra step. Nora’s move. Leave slamming the door behind.

In some traditional societies like Japan, more and more young women are refusing to get married or have children. They even suffer from the “Narita syndrome.” Named after the Tokyo airport for international flights, it refers to their reaction towards their inexpressive men once they come back from a trip and realized there is another way. They dump them right at the arrival gate. Hopefully they will put them on probation.

What do you think? Please tell us.

Don’t leave me alone.