Wednesday, July 29, 2015

Do No Harm

Quick:  what do Michael Crichton, Saint Luke, Anton Chekhov, Copernicus, Ethan Canin, William Carlos Williams, Sir Arthur Conan Doyle, Carl Jung and Rabelais all have in common?  None of them are women?  Okay, throw in Tess Gerritsen, Alison Sinclair and Alice Weaver Flaherty.  They are doctors and writers.  What is it about the medical profession that along with the fragile art of healing comes the ability to tell a story?  Is it because the illness of the patient is steeped in narrative?  Is it that one cannot begin to heal what ails a patient until he or she understands that unique backstory?

To that list of physician-writers must be added British neurosurgeon Henry Marsh.  His recently published memoir, Do No Harm: Stories of Life, Death, and Brain Surgery (Thomas Dunne Books, 2015) is an insightful and poetic look inside the human mind.  It is, at the same time, technical but accessible, brilliant and beautiful.  We follow the surgeon’s microscope into the patient’s brain in the opening pages:  “I am looking directly into the centre of the brain,” he writes, “a secret and mysterious area where all the most vital functions that keep us conscious and alive are to be found.  Above me, like the great arches of a cathedral roof, are the deep veins of the brain—the Internal Cerebral Veins and beyond them the basal veins of Rosenthal and then in the midline the Great Vein of Galen, dark blue and glittering in the light of the microscope.  This is the anatomy that inspires awe in neurosurgeons.”  It inspires awe in readers as well.

The human brain, of course, has its own disturbing poetry.  Marsh tells us of the “angor animi—the anguish of the soul—the feeling that some people have, when they are having a heart attack, that they are about to die.”  The same feeling haunts those who face the surgeon’s scalpel as it slices through the brain.  Most of the pathologies that Marsh confronts are cancerous, and he names each chapter after a particular tumor type or affliction.  These are stories about life and the living hidden in the grey gelatinous structures of synapse and dopamine.  It is a brilliant ride, like venturing into space at light speed through the streaking light of the stars.

In many ways, Marsh critically examines his own arrogance.  He admits mistakes and blunders, patients he has ruined, left paralyzed, incapacitated, brain dead.  Still, here in the 21st century, surgery on the brain is an inexact science, which is the reason that Marsh operates on so many patients using only local anesthesia.  The brain itself does not feel pain.  Pain signals must resonate in the brain as they are felt in the body and therefore, all the nerve fibers spread throughout the body are connected back to the brain.  A physician may heal himself, but a brain cannot feel itself.  When the patient’s skull is opened while he or she is awake, Marsh and his surgical team can ask questions and elicit responses from him or her as different areas of the brain are touched and explored.  He will know immediately if something has gone wrong.  However, it is probably something most people would not want:  to be awake during brain surgery.

Throughout, Marsh does a lot of shouting at people.  He shouts in surgery to make himself heard over the controlled roar of the machinery.  He shouts at other people who annoy him, even once saying, as he is shouting, that he feels like a “pompous fool.”  He does not shout when he must deliver bad news, and this book is threaded through with these tragic scenes.  He does not shy away from describing the moments.  For instance:  “I left them in the little room, their knees squeezed together as the four of them sat on the small sofa and wondered, yet again, as I walked away down the dark hospital corridor, at the way we cling so tightly to life and how there would be so much less suffering if we did not.  Life without hope is hopelessly difficult but at the end hope can so easily make fools of us all.”

Perhaps what makes Marsh such a top surgeon in the United Kingdom is not just his skill in the surgical suite.  He has been touched by brain disease in his own family.  He must witness his son’s medical intervention and recovery.  The good doctor, himself, suffers a broken leg and nearly loses his eyesight.  So when he faces the loved ones of others, he must strike a delicate balance.  He has a duty to his patients from which he cannot shrink.  “Surgeons must always tell the truth but rarely, if ever, deprive patients of all hope.  It can be very difficult to find the balance between optimism and realism.”

In dealing with death and the end of consciousness every day, Marsh does not escape thoughts of his own end.  “Will I be so brave and dignified when my time comes?” he asks himself.  He walks out to his car in a lonely parking lot.  “The snow was still falling and I thought yet again of how I hate hospitals.”  He must remain detached and professional with his patients because if he does not, he risks being overwhelmed by the power of emotion and the tragedy of their plights.  His job is to bear witness, even if he is impotent to bring the patient back.  “I must hope that I live my life now in such a way that…I will be able to die without regret.”  He remembers his mother on her death bed saying, “It’s been a wonderful life.  We have said everything there is to say.”  We should all be so lucky.

Marsh believes that it is unlikely we have souls, or that we continue to exist after the brain is dead.  What we know as consciousness ends when the brain depletes its oxygen supply and is destroyed.  “Our sense of self, our feelings and our thoughts, our love for others, our hopes and ambitions, our hates and fears all die when our brains die.”  I do not want to believe this, nor do I want to agree with him, but the passage stopped me in my reading and I found myself staring off into the shadows of a hot summer night immersed in silence and lost in contemplation.  “There are one hundred billion nerve cells in our brains,” he goes on.  “Does each one have a fragment of consciousness within it?”  That is what makes this book so relatable and moving for the non-scientist:  Marsh asks the questions we want to ask.  In his musings and ruminations, he is not the superior surgeon with the highly trained surgical skill set.  He is just a human being questioning the mystery of existence.

This is a beautiful book, a life-affirming, human story of a man whose life intersects with so many others in the frailty of disease and the search for healing.  Henry Marsh is a philosopher at heart, the human embodiment of a deep and feeling intellect composed of those millions of nerve fibers.  In an age where doctors seem more worried about keeping drug companies happy and charging insurance companies for another round of tests rather than healing the patient, Marsh tries to live out the oath to do no harm.  But what we see in this book is that sometimes, despite the heroic efforts of the surgeon, the patient is harmed.  That is the cost of business in medicine, especially in neurosurgery.  Some patients cannot be made better.  In this book, we see the frustrations, the disappointments, the tragedies faced by this doctor, as well as the triumphs, the miracles, the resilience of the human body fighting to stay alive.  It is a rich and riveting story, one I could not stop reading and which left me thinking long after I finished the final chapter.

Friday, July 24, 2015

Philemon's Problem

Many years ago, I was assigned to read James Tunstead Burtchaell’s book, Philemon’s Problem:  The Daily Dilemma of the Christian, for my high school senior religion class.  Recently, I found my copy of the slim volume with my name and phone number on the front cover buried at the back of a shelf.  Sadly, that name and number were the only marks in the text.  I never read the book most likely, or if I did, I found little to take note of or highlight.  This does not surprise me; in those days, the way to make sure I did not read a particular book was to make it a class assignment.  I wanted to read what I wanted to read, not what some teacher demanded of me to read.  And like many of my assigned readings from that time in my life, I usually discovered their importance when I had to teach them to a new crop of students in my own classroom years later.  Since I am writing a paper about Paul’s letter to Philemon, one of the shortest letters from that section of the New Testament and one that most biblical scholars refer to as a postcard from Paul rather than a full blown letter, I decided it was time to complete my homework thirty-three years after it was assigned.

Out of curiosity, I looked up the author to see what had transpired in his life since he published the book.  In a copyrighted article from the National Catholic Reporter datelined December 6, 1991, Burtchaell, a member of the Congregation of Holy Cross (C.S.C.) and a tenured faculty member at the University of Notre Dame, was said to be facing disciplinary action after “he had engaged in sexual misconduct while counseling male students.”  A second article from from 2003 stated that “Burtchaell has lived for the past several years in a Holy Cross priests' residence in Phoenix.  Burtchaell does not have priestly faculties to celebrate Mass or otherwise perform priestly duties in the Diocese of Phoenix, according to a spokesman for that diocese.”  He has also had his priestly duties revoked in the Catholic Diocese of Fort Wayne-South Bend, Indiana as well.

This cast a shadow, most definitely, over his scholarship, but I decided to examine the book for its theological importance rather than considering the author who remains a priest today at 81 and who, in 2010, celebrated the fiftieth anniversary of his ordination.  It is tragic that he chose to engage in conduct so disgraceful that it ended his academic career, but he is definitely not the first such case to come to light in recent years.

The other important piece of news regarding the book is that Burtchaell updated and expanded his study in an edition published in 1998 by William B. Eerdmans Publishing Company, Grand Rapids, Michigan entitled Philemon’s Problem:  A Theology of Grace.  This time, I read the new edition in its 334-page entirety.  Burtchaell makes a number of key points that seem relevant today, especially in light of the racial tension in this country over police shootings of people of color and the need for human rights for all people since at its heart, the story of Philemon and his slave, Onesimus, is about how we treat people and how we address the issue of slavery’s corrupt assault on the sanctity of the human being.

First, some background:  Paul writes the letter from prison in Rome sometime around 63 CE.  Onesimus, whose name means “useful” or “beneficial,” has run away from his master, Philemon, after possibly committing a theft and has sought out Paul to assist him with his ministry while he is in prison.  Paul had converted the former slave to Christianity, and now he wishes to send Onesimus back to Philemon not to be a slave but as a Christian brother and equal to the former master.  Paul calls him “a brother, beloved especially to me.”  If indeed Onesimus is guilty of the theft, Paul asks that the debt be charged to Paul, himself, and that the slate be wiped clean for the former slave within the Christian community.  This is a bold and unusual request for the time.

Burtchaell’s book examines the case as presented in the letter and develops the lessons learned there into his theology of grace.  His theme “to which this book speaks is our ability—our calling—to be as outright in love of Lord and neighbor as Jesus has shown himself outright in becoming our Neighbor.  This means we must be able to sustain the language of endless obligation, an imaginative idiom in which we are only awkwardly fluent.”  What this means without the muddy language is that the change necessary to set Onesimus free is not a change in the slave, himself.  Burtchaell argues that the one who must change is Philemon, not Onesimus.  It is he who must see his slave as a Christian brother created in the image and likeness of God, the Imago Dei.  To change the mind of the oppressor, the slave owner, is far more challenging and necessary if the slave is ever to gain true freedom from his captivity.  It is a potent and logical argument.  One can issue words in a proclamation, but changing hearts and minds is much more difficult, especially when attitudes and behaviors have been entrenched in the culture for decades or even centuries.  Added to this challenge is the fact that Onesimus is charged with theft.  Truly, Philemon must not only reconsider how he views him, but he also must forgive him his transgression.

Burtchaell begins the book with a statement of Philemon’s problem.  He gives a brief biography of the parties involved and sketches out the cultural context.  He also details what Paul hoped to accomplish with his missive.  The basic premise is that if we are to follow Paul’s advice as Philemon must, it means changing the way we view the Other, the one who is not like us in appearance and is certainly not part of our class in society.  It is here that the book has much to offer.  Ours is a world of classes clashing violently at great human cost.  The violent actors dehumanize those they lash out against, and they refuse to see them as human beings, brothers and sisters not just from a religious standpoint but as human beings worthy of dignity and respect.

The main text of the book is divided into three sections:  A Distinctive Doctrine, A Distinctive Morality, and A Distinctive Worship.  Each section continues to develop this theme of a complete change in the slave owner, or person in power, that he or she may act in the name of God to see those perceived as less to be equals in the eyes of the Lord.  This message, although seemingly religious in nature, can be applied equally without bringing God into the situation.  If we believe in the sanctity of human life, Paul’s plea in the letter to treat people with respect and dignity, even when they wrong us or are not equal to us in class or economy, means changing the way we see all human beings.  We start from a base position of the person as a human being, valuable and sacred because of his or her humanity.  It is a powerful position and important in this age of often violent discrimination and human misery.

Like most theology books, I find Burtchaell’s writing style to be needlessly complicated and obtuse at times.  In examination of his sentences and syntax, I wonder if there is not a clearer, more concise way to make the case in support of his thesis.  The book is not for a general audience, and one of the surprises to me is that it was assigned in a high school religion class, even one occurring three decades ago.  Having taught senior students for many years, and now college students, I think Burtchaell’s writing would be difficult to understand and internalize for most of them.

However, the message is important and must be considered in light of the violence and oppression that occurs in our supposedly enlightened world.  One cannot legislate against oppression with words on a page stating the rights and freedoms of the oppressed.  One must change the minds of the oppressors to truly free the oppressed.  It is a logical thesis that must be accepted, even if the author has ended his career in disgrace.  In this case, the message is more important than the messenger.

Thursday, July 9, 2015

Lord Fear

The annals of addiction and the narrative of the dysfunctional family are the lifeblood of the memoir.  Lord Fear (Pantheon, 2015) by Lucas Mann is no different, although the author brings to the table the influence of Catcher In The Rye and the journalist’s skill of running down the story.  As we accompany him on his journey to understand the life of his brother, Josh, who died of a drug overdose, we see Salinger’s overtones in the teenage life of boys, the kind of nastiness that is second-nature to young men of this age.  They tease and bully one another; they display their gross habits, the usual masturbation and nose-picking and crass talk of sexual encounters that are often more bravado than actual experience.  And we learn that Josh was not a nice person, a dysfunctional screw-up who terrorized the people he met.  He is not a sympathetic character.

Mann brings us into Josh’s interior life through his journals and notebooks which the brother inherited after death.  He sectionalizes the memoir beginning with quotes from the volumes of written material Josh left behind, including poetry and song lyrics.  There is no doubt that Josh had many talents and many gifts, all of them squandered in his drug-fueled and often psychotic episodes.  But Mann does not sugar-coat his own foibles:  “I’m a writer now,” he tells us, “self-identified.  Really, I intern and sometimes freelance for bad pay.  I make a point of walking around with a reporter’s notebook in my back pocket, and I like to hit Play at random moments on the digital recorders I fill up, just to get the rush of hearing my voice asking a question, another’s answering me.”  This he shares with Josh, who also had the habit of making recordings of ramblings and nonsense, putting his friends and family on the spot with repetitive questioning about sex and sexual behavior, to the point of nausea for this reader.  Mann’s desire is to get at the truth, mainly because truth is illusive, even in the realm of fact.  What does something truly mean?  There are the facts of Josh’s life, but the nausea I felt in reading the story is a credit to Mann getting at the emotional truth of his brother’s psychosis and the impact it has on nearly every character’s life as he describes him or her.  These are not nice people in this book; they are flawed, but Josh is far ahead of all of them, a kind of frenetic nuisance who belittles and badgers until he provokes angry or even violent reactions in others.  Early on, Mann comes to the conclusion that “when an addict ceases to be the person that you loved or maybe is still that person somewhere, but on the outside, the part you have to interact with, nothing remains.”  However, this teaches him as a writer to “look for explanations in characters,” and so he embarks on a journey to interview the people who encountered Josh to rectify the fluidity of memory with the accounts of others.  Did they all remember the scenes as Mann does?  In the congruent moments and where they differ, the truth becomes apparent.  It is emotional truth over literal truth, the truth of recollection over the unsparing digital voices on a recording.  This is how Mann builds the life-story of his brother.

He integrates literature into the story, quoting at length from books like Thomas De Quincey’s Confessions of an English Opium-Eater and Philip Roth, as well as from films that the author remembers watching.  The title comes from a poem Josh, himself, wrote:  “Behind an iron gate with a steel fence in an iron compound there lives Lord Fear.  In his eyes is his cold, white stare.  His gun and his shield by his side, a metal sheet protecting his heart—Lord Fear is frightened of what has never been.”

We get it.  As with all memoirs of addiction that end in tragedy, Josh’s death is a waste.  In fact, he moved through his life leaving a swath of destruction in his wake.  People who encountered him were not just forced to endure his obnoxious behavior, they were scarred by it, and those scars remained open wounds for long after he left the earth with a needle in his arm.  But Lucas Mann’s story of his brother is not unique, and I think there may be others who have done the job better in both fiction and nonfiction.  I could not help thinking of the recently departed and dearly missed David Carr’s memoir/journalism, The Night of the Gun:  A Reporter Investigates the Darkest Story of His Life.  His Own. (Simon & Schuster, 2009).  He, too, went back to confirm the facts of his life story, lived while strung out on a variety of drugs resulting in many surprises and insights that felt more real and profound than Mann’s work here.

Sad to say, addiction and early death are not profound, especially when they end a reign of terror.  The book is called Lord Fear for a reason, and it is not just because of some poem scribbled in a journal.  As many witnesses to his brother’s destruction recounted on the pages of this book, his psychotic behavior was so extreme and out of control that the story could only end one way.  And quite possibly, this might have been a relief to everyone who knew him.