Friday, 11 April 2014 15:41

The Little Brain That Would Not Cooperate

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During my postdoctoral fellowships in neurology and neuropsychology at UT Southwestern Medical Center I was blessed to work and train with many talented people. It was an honor to be a part of the efforts of these men and women who worked tirelessly day and night, fulfilling a passion they have to care for their fellow man. Theirs is a passion to relieve, as best as possible, the physical and emotional burdens of another’s often unfathomable suffering.

For nearly all the patients with whom I worked, the suffering was related to ongoing neurological disorders, brain injuries, or other various conditions that had set these lives and the lives of those who loved them on a trajectory of seeking help and contending with the subsequent outcomes.

Wednesdays, however, at least for an hour, were different.  I would make my way to the pathology lab to participate in the didactic of brain cuttings. I left caring for the living to observe the gross impact of disease on human tissue. All of this performed under the wonderful tutelage of pathology residents and the watchful eye of their supervising attending pathologists.

For the most part, this was routinely clinical. “The present specimen is from a 58-year-old white male who presented to the Parkland ER last Thursday with a chief complaint of…” Such was a typical introduction a resident would make to provide the necessary background information. They would then proceed with the orderly gross dissection of the tissue. This always started with a complete coronal dissecting slice just anterior to the mammillary bodies on the brain.

One particular Wednesday was different. It was different in that, while it was just another routine series of clinical procedures in pathology, I walked away feeling anything but clinical.

As I walked into the room the brain specimens were lined up on the dissection table. This usually consisted of three to four brains. However, this time, one of the specimens was smaller than the rest, much smaller. It was the brain of a newborn. It immediately caught my eye. It was different. The hills and valleys of the brain, the gyri and sulci, were not as defined as those of the adult brains.

When the pathology resident got to the newborn brain she began her description of the clinical history. Some details regarding prematurity caught my attention. I remember hearing her but, for a moment or two, not completely listening. I was too taken by the differences in the newborn tissue in comparison to the adult tissue. All of the differences. This was the first infant brain I had ever seen.

Then my non-clinical mental digression began: What about this baby’s parents? Where are they? Who are they? How are they doing? Is their extended family comforting them in their time of loss?

Then another line of thought came over me. During other brain cuttings, I would occasionally look at the adult brain specimens and think of the line between the metaphysical and the physical. For example, what part of the tissue contained the memory of this person’s first kiss? What fold contained the memory of the joy and sense of accomplishment of a particular job well-done? The death of a parent or other loved one? The memory of their first pet? Watching a sunset? This little brain never had an opportunity to create neural imprints of such events.

My brief reverie was interrupted by the realization that the brain specimen of this little newborn was not “cooperating.” The initial coronal cut was attempted. For whatever reason the specimen was not stable and began to fall apart with each attempted subsequent cut by the pathology resident. A bit of nervous laughter punctuated the noble attempts of the resident. Eventually, all present realized this little brain was not going to lend itself to a detailed examination. The efforts were brought to a halt by a confirmation of the attending pathologist to simply move on to the next specimen.

As the proceedings concluded we all left the lab and went back to our regular clinical tasks. For the rest of the day, I occasionally thought about that little newborn brain.

While “clinical compartmentalization” – that ability to appropriately distance one’s self from the emotional aspects of the clinical task at hand is important, it is also important to simply remain a human being and realize certain experiences will impact you in various ways. As a clinician (and human being), I think it is healthy to be open to these experiences and process them as the gifts they are.

Within my faith, I believe life begins at conception. I actually believe this within all aspects of my intellect. Furthermore, within my faith, I believe that the divine knowledge of each of our lives began prior to God crafting the universe.¹ These metaphysical things are hard for me to fully grasp. I often wonder how much of this difficulty is due to my particular materialistic, reductionistic education and culture in which I live. Nevertheless, I do believe these things and am greatly comforted by them as a clinician – and as a human being.

Also, due to my faith, I believe we will also one day see as we are fully seen and, while now I know in part, I will know fully even as I am now fully known.² I take the promises of my Maker seriously. I know He does not make mistakes. One day, I look forward to meeting this little one God so amazingly crafted for such a brief time here on this earth. God bless you little one.

I learned many things that particular Wednesday down in the pathology lab. Especially from the little brain that would not cooperate. I look forward to telling this to this little child one day in the hereafter. Perhaps this little child already knows.

¹ For it was You who created my inward parts; You knit me together in my mother’s womb. I will praise You because I have been remarkably and wonderfully made. Your works are wonderful, and I know this very well. My bones were not hidden from You when I was made in secret, when I was formed in the depths of the earth. Your eyes saw me when I was formless; all my days were written in Your book and planned before a single one of them began.  (Psalm 139:13-16 HCSB)

² For now we see indistinctly, as in a mirror, but then face to face. Now I know in part, but then I will know fully, as I am fully known. (1 Corinthians 13:12 HCSB)

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Jeremy Lelek

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