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"THE BRAIN IS WIDER
THAN THE SKY,
FOR, PUT
THEM SIDE BY SIDE,
THE
ONE THE OTHER WILL INCLUDE
WITH
EASE, AND YOU BESIDE."
Emily Dickinson
CLOUDS PATTERNED THE NORTHERN CALIFORNIA
SKY THAT FEBRUARY MORNING AS WE LEFT THE MEDICAL CENTER PARKING
LOT, OUR CARGO OF HUMAN BRAINS AND SPINAL CORDS BOBBING INSIDE THEIR
FORMALDEHYDE-FILLED CONTAINERS. The occasion
was "brain day," an annual event organized by Stanford neurobiology
professor William T. Newsome. Each spring for the past six years,
Dr. Newsome has mobilized graduate students from Stanford's Neuroscience
Program to leave the familiar surroundings of the laboratory for
a day in the less predictable setting of a middle school science
classroom.
For the seventh-graders at nearby Jordan and Jane
Lathrop Stanford middle schools, the day is the climax of their
study of the nervous system -- their chance to hold a human brain
in their hands and trace the folds of its cortex with their fingers,
to impress their visitors with their knowledge of the brain, and
to ask questions of scientists who spend their
days exploring its workings. For their teachers, the day is an opportunity
to connect classroom science to what goes on inside the walls of
a university that, despite its proximity, may often seem a world
away.
In return, we graduate students get to share our
enthusiasm for science and teach the next generation the value of
research on nervous system function and disease.
For many of us, the experience also reminds us of the brain's mystery
and restores a sense of wonder easily faded by the fluorescent glow
of laboratory lights.
The significance of this sense of wonder should not
be underestimated. Sir Isaac Newton, reflecting on his life's work,
said simply:"I do not know what I may appear to the world, but to
myself I seem to have been only like a boy, playing on the seashore,
and diverting myself in now and then finding a smoother
pebble or a prettier shell than ordinary, while the great ocean
of truth lay all undiscovered before me."
Newton reminds us that we are all born with the capacity
for wonder, a capacity that guides much of our childhood interaction
with the world. Indeed, challenged to distinguish
human cognition from that of our fellow creatures, the breadth of
our ability to wonder might not be a bad place to start. Unfortunately,
as adults we exercise this ability less and
less, its atrophy seeming so inevitable that many regard its loss
as synonymous with maturity ... a regrettable mistake.
Before coming to Stanford to begin the graduate portion
of my MD/PhD training, I studied medicine at Johns Hopkins University
in Baltimore where my final clinical rotation was a sub-internship
on the inpatient neurology service. On nights when my team was on
call, I answered requests for neurology consults from distant parts
of the hospital.
Late on one such evening, I was called to the cardiac
intensive care unit to examine an elderly woman who had undergone
coronary bypass surgery earlier in the afternoon and now complained
of being unable to see. The woman was suffering from a textbook
case of Balint's syndrome, a rare disorder of visual processing
that follows bilateral damage to the cortex of the posterior parietal
lobes. The key to understanding the intriguing constellation of
signs and symptoms exhibited by Balint's patients is that they experience
a narrowing of their visual attention, such that it becomes focused
on single objects or details, leaving them unaware of the scene
to which the detail belongs. This woman could, in fact, "see." A
CT scan revealed her occipital cortex, the part of the brain responsible
for the initial processing of images that fall on the
retinae, to be intact. She could identify single objects -- a pen,
a square, or a watch -- placed anywhere in space, provided the rest
of her visual field was empty. However, her overall visual experience
had become meaningless, a jumble of disconnected objects and features
that left her effectively blind, unable to assemble the whole from
its parts.
BALINT'S SYNDROME
IS a fine metaphor for a danger faced by all who practice medicine:
a danger that permeates our daily lives, yet is so finely woven
into our thoughts that we hardly notice its presence. This danger
arises from an idea, passed down from the Enlightenment like a gene,
a gene with malignant potential. It is the idea of dualism -- that
the body is separate and distinct from the mind: an idea that at
once liberates us to study the body through reductionist eyes and
distances us from those very characteristics that define our humanity.
An idea that leaves little room for wonder.
In clinical medicine the reduction of person to body,
and body to machine, encourages us to treat patients as diseases,
to regard death as an awkward embarrassment, and to tolerate elements
in our training that actively exorcise the empathy essential in
a good physician. In research, this same reduction encourages us
to mistake fragmentation for explanation, stifles approaches that
require raising one's gaze above the level of molecules and cells,
and disparages the importance of putting back together the phenomena
we pull apart.
Like a patient with Balint's Syndrome, our myopic
fascination with fragments can leave us blind to the whole. Fortunately,
most twelve-year-olds have yet to read Descartes. For them the big
unified questions remain: where do memories live, how do I dream,
why do I like and dislike, how does my brain make me me. The perspective
we gain through our annual middle school visits immunizes us against
the myopia of our scientific worldview. Forced to look at the brain
through the eyes of a child, we rediscover our lost wonder and marvel
anew at the profound mystery of three pounds of flesh that really
does encompass the sky. Each of us returns to the routine of the
lab pondering our piece of the puzzle in a fresh light and imagining
how, where and when it might someday fit into the whole. SM
LEO SUGRUE IS A GRADUATE STUDENT IN STANFORD'S NEUROSCIENCES
PROGRAM.
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