The Michelangelo Code

Ian Suk and Rafael Tamargo see a pons and medulla / brainstem in God's throat in Michelangelo's Sistine Chapel fresco The Separation of Light from Darkness. I see it now too. [Hat tip to Dr. Douglas Field's article in Huffington Post for highlighting Suk's and Tamargo's Neurosurgery paper on the subject.]

In 1990 Dr. Frank Meshberger also observed in a paper published in JAMA that the stuff around God in Michelangelos' God Creating Adam looks like a brain in cross-section.

I guess all those hours secretly dissecting cadavers - an activity strictly forbidden by the Catholic Church at the time - really did have an impact on Michelangelo's art. I wonder if hours spent reveling in great art has an impact on our practice of medicine? I think it does, at least in subtle ways.

***

Addendum: This was my son's comment as he looked over my shoulder at the above fresco. "Is that supposed to be God?"

"That's how Michelangelo painted God on the ceiling of the Sistine Chapel," I replied.

He paused for a moment, thinking, then said, "I think God should be painted as a circle. No beginning, no end."

That's probably the best idea I've heard yet to express any concept I might have of God / a divine presence or energy in the universe. That, and the name given by God to Moses in the Hebrew Bible: I AM. No Patriarch-in-the-Sky for me.

Le Roi Est Mort, Vive Le Roi; or, is God dead? Or alive? And What Does That Mean, Anyway?

A week ago Craig Venter announced the creation of the first synthetic cell: an organism with a fully synthetic genome. That is, he and his team took more than 1000 preassembled units of DNA, constructed from them the full genetic code of the organism Mycoplasma mycoides, and transplanted this prefab genome into the emptied-out cell of the organism Mycoides capricolum. The latter's protein-building molecular machinery recognized the DNA and "booted up" the cell. In short, it came alive.

Some have gleefully touted this the beginning of the end of religion. One commenter at OnPointRadio wrote,

"Science has accomplished what was inevitable and finally robbed religion of the argument that life is more than mere chemical processes...that it is some mystical, magical thing for which only 'god' can account...Hopefully this puts religion one step closer to obsolescence...humanity will never be rid of this human scourge that is responsible for so much intolerance, division, war and strife, but little by little, science is removing religious dogma regarding the monopoly 'god' has on life...At long last, religion's final tenuous argument about the mystical nature of life dissolves..."

Art Caplan, who directs the Center for Bioethics at UPenn, said on the On Point radio episode about Venter's achievement,

"To make non-living parts come to life I think is a major achievement. Not only does it open the door toward, as you've been discussing, some of the design of the microbial world to serve our purposes but it also philosophically pushes the notion that some sort of vital force or special force is necessary to understand life itself. I think this achievement kind of refutes that and basically says it is possible to understand what makes life tick in a more reductionist, mechanistic way...

...When you start to be able to figure out your million base pairs and order them up the right way, and then transfer them into a dead husk of another microbe's cell, and have the thing fire up and do everything that a bacteria's supposed to do, you have in a sense brought to an end maybe 3000 years of debate among philosophers and biologists about what is life. You're basically saying it's something that's under the control of a set of coded instructions. If you have the right chemistry around it, you can make things come to life. That's a pretty amazing demonstration and a pretty important moment in the history of science. So in that sense, understanding life, understanding how it works, seeing that you can even create it and manipulate it - I don't want to push that into the background. That's major...[It] puts you on the road that says we will be able to pull apart the ingredients of life, artificially synthesize the whole thing someday, and that there's no mysterious force out there, no ineffability."

I agree with science writer John Horgan, however: the mystery of life's origins is not solved by this laudable experiment. I also don't think that simply being able to figure something out, down to its molecular mechanisms, or even recreate it, proves the non-existence of the divine or the mystical. Everyone has beliefs about what Reality is and little "proofs" to defend those beliefs, but most of the "proofs" I've heard from both rationalists and believers strike me as dissatisfying or incomplete. I have no well-formed concept of God, nor do I deny the possibility of us all being merely biological machines whose consciousness passes into oblivion when the machines stop working. But I have experienced the ineffable and the inexplicable. Thoughts and ideas themselves, attractions and aversions, enjoyment and creativity, to me would remain somewhat inexplicable, greater than the sum of their parts, even if one could parse out every molecular mechanism behind them.

The more important question, I think, is not whether Venter's achievement and synthetic genomics prove or disprove matters of faith (which are inherently un-provable anyway) but whether we have to worry about the Frankenstein phenomenon: lab experiments spinning monstrously out of control. Time and time again we get ahead of ourselves ethically and morally: we start doing and making things without having responsible conversations to prepare for the issues that inevitably arise with technological advancement. According to Venter his latest achievement breaks that mold, and bioethical discussions occurred before the experiment was carried out. I hope thoughtful reflection - so easily and arrogantly dismissed as unnecessary or unfashionable - becomes the norm rather than the exception in an era in which science is galloping ever-faster as politicians, lawyers, and religious leaders try to keep up.

A Spouse's Silent Sorrows

I have given anesthesia for a lot of breast surgery. I don't think I'll ever get used to the fog of pain and sorrow surrounding a double mastectomy.

All surgery is invasive in some way. Amputations, in particular, have a horror all their own; the idea that destroying someone - cutting off a body part, violating a coherent whole - should be necessary in order to save a life is almost too horrible to bear. When that kind of mutilation reaches the most private and intimate parts of people's bodies and lives, the very air around patients and their loved ones can be heavy with unspoken suffering.

As a woman I cannot imagine the grief of such a dramatic physical loss. I remember having bouts of depression when I was recovering from an elbow fracture years ago. Anxiety, too - I was afraid I would lose the ability to use my arm and hand effectively. Certainly that kind of functional loss would have been devastating. But there's something about mastectomy that makes the loss seem so utterly cruel, the devastation completely personal. Maybe I'm wrong, but I imagine the tears I would shed at having to face a mastectomy would be much more agonized and primal than those I shed worrying about my arm.

I wonder if anyone ever talks about the grief of husbands and partners. I think about that every time I see a patient supported by a spouse or partner who clearly loves her deeply and truly. I still remember the husband of a beautiful young woman who replied, after she said, "I love you" right before we wheeled her into the operating room for her mastectomy, "I am in love with you." More recently there was another kind, compassionate husband who kissed his wife and said affectionately, "Bye, Babe. Love you," then looked forlornly at us as we wheeled the bed away from him to take her to the O.R. He looked as if he didn't know what to do, as if he were about to cry.

In that one moment a thousand thoughts seemed to be emanating from his lost look: There goes the woman I love. I'm so sad for her. I have so many memories of her. The nights we held each other, the children she nursed, the decades of flirting with each other in the kitchen. How can I not feel her pain when it's my pain too? Is it wrong that I feel it's my loss too? I love her so much. How could this be happening? I miss her already. I miss what we had. I'm scared of what's coming. My heart hurts. I just wanna scream and cry. It's not fair.

I'm guessing, of course. But that's what his face seemed to say. Some men or women might feel people would criticize them for grieving the loss of their beloved partner's breasts. I think when there is real love between two people - sexual love, physical love, spiritual love, and committed love that inspires them to work on a lasting relationship every single day - then such grief is completely understandable and natural and inevitable and right. When you love someone body and soul, then Body and Soul are inextricably intertwined in the forging and deepening of the relationship. A loving partner would be saddened not because he or she thinks breasts are the end-all and be-all of female sexuality, or that a woman's worth is related to her body parts, but rather because such surgery strikes so visibly and painfully at the heart of a lot of shared stories, intimate moments, mutual devotion, and cherished physicality. Such raw, heavy grief hurts all the more because it is often unspeakable.

One time I was discussing a painful experience with someone, with my husband listening, and while I was describing the regret I felt I started crying a little. I looked up and saw my husband's face full of love and support for me, his eyes a little wet as he felt in part the pain I was feeling. So often the beauty of compassion between partners is overlooked or forgotten, but when it exists the connection between the two can be felt by everyone in the room. This is what I see when I meet supportive husbands, boyfriends, and lovers of women who must have mastectomies. I wish I could tell them their profound grief hasn't gone unnoticed, unwelcome; that the love to which it bears witness matters tremendously and has touched those of us who are taking care of the women they love.

Oboe Feast Day

The music director at my church says the sound of the oboe is supposed to represent the Holy Spirit - perhaps one reason he invited a wonderful oboist to play for Pentecost liturgy today.

My favorite piece for oboe, Ralph Vaughan Williams' Concerto for Oboe and Strings, contains several moments that sound Spirit-filled to me (the opening of the third movement, for example), so I'm posting it today, played by the incomparable Celia Nicklin.

As I listen I'm trying to reflect today on the symbols of the Spirit - wind and fire - and think of the things that "set me on fire" or "catch my breath":

• the people I love
• music
• dance
• the written word
• learning languages
• teaching
• learning
• working with others to create something special
• the desire to combat injustice

The concerto:

You can also listen right on Youtube through these links: first movement, 2nd movement, 3rd movement.

Language Matters

Happy Eliza Doolittle Day!

This NPR article says it all for me.

Blog Anniversary #3: Let the Games Begin!

It's my three-year Blog Anniversary!

This year, I thought I'd take my inspiration from the wedding tradition of wearing

something old,

something new,

something borrowed, and

something blue,

but recreate it to reflect this blog - so we'll have

something literary,

something culinary,

something medical, and

something musical.

(I skipped "faith-related" because we had a pretty high dose of that during the recent High Holy Days.)

SOMETHING LITERARY

This is from a Facebook meme I found amusing. If you feel like it, share your version. Also works with movie titles and song titles.

"You Are What You Read": fill in answers to the following using book titles only (name the author in parentheses).

Describe yourself: A Moveable Feast (Ernest Hemingway)

How do you feel: A Separate Peace (John Knowles)

Describe where you currently live: A Tale of Two Cities (Charles Dickens)

If you could go anywhere, where would you go: Dancing in Petersburg (Mathilde Kshchessinska); or, The Most Beautiful Villages of France (Dominique Reperant)

Your favorite form of transportation: A Room with a View (E.M. Forster)

Your best friend is: Iron and Silk (Mark Salzman)

You and your friends are: The Complete Peanuts (Charles Shultz)

What's the weather like: Clear Light of Day (Anita Desai)

You fear: The Sound and the Fury (William Faulkner)

What is the best advice you have to give: Don't Sweat the Small Stuff (Richard Carlson)

Thought for the day: French Women Don't Get Fat (Mireille Guiliano); and, Their Eyes Were Watching God (Zora Neale Hurston)

How I would like to die: The Sweet Life in Paris (David Lebovitz)

My soul's present condition: The Secret Scripture (Sebastian Barry)

SOMETHING CULINARY

Anesthesioboist's Almost-Flourless Chocolate Cake:

• Preheat oven to 375F.
• Line a 9-inch baking pan with buttered parchment paper.
• Melt together 6 oz semisweet chocolate, 4 oz bittersweet chocolate, and 1 c butter.
• Stir in 1 c sugar and let cool slightly.
• Beat in 5 eggs one at a time.
• Stir in 5 tsp flour.
• Optional: also stir in 1 1/4 tsp baking powder / 2 1/2 tsp vanilla / pinch of salt / liqueur of choice. I didn't use any of these the first time I made this and it turned out fine.
• Pour batter into prepared pan and bake 30-35 min or till set but with center still a little wiggly. Don't overbake!
• Turn over onto plate and dust with powdered sugar. Serve with chocolate sauce and/or cinnamon cream and/or fresh raspberries.

SOMETHING MEDICAL

Guess the diagnosis:

Boy with a Drawing

(though in fact the painting is more of an association rather than a portrait of someone with the diagnosis in question)

Lincoln

Mona Lisa (I don't buy it)

SOMETHING MUSICAL

First, I give you a little background oboe music by Stravinksy, written when he was 25 and, I guess, in a sweeter/more lyrical mood than his later work expresses.

I also give you this tongue-in-cheek quote from one of the best oboe-related articles I've read recently, entitled "The Supreme Court Could Use An Oboist." Written by ex-oboist Meghan Daum (though, as she points out, "once an oboist, always an oboist"), the article explains why Judge Diane P. Wood would have made a great nominee to the Supreme Court (hat tip to Elaine Fine for the link to the article in the L.A. TImes from which it came).

"...Speaking for myself and so many others in the oboe community, I don't think it's an overstatement to suggest that even if Wood had no judicial experience at all, even if she'd never even gone to law school - heck, even if she were a fifth-grader squawking out 'Ode to Joy' on a plastic Bundy - she'd still probably be more qualified for the Supreme Court bench than anyone else in the pool. Why? Because oboists may vary talent, discipline, ethnicity, gender and taste in unfashionable clothes, but we all have one thing in common: We're just about the most judgmental people on the face of the Earth. Ergo, one of us should sit on the highest court in the nation."

LOL.

Hope you've enjoyed this little "blog party" I put together for Blogiversary 3. Thanks for being here!

Blogiversary Weekend

My 3rd Blog Anniversary is this Sunday!

I haven't decided yet how I'm going to celebrate, but maybe I'll have an idea by then. :)

A Music Competition Unlike Any Other

One of my friends recently told me about the film Meetings with Remarkable Men, (supposedly) about the life of G.I. Gurdjieff (about whom I know absolutely nothing), and I was so blown away by the opening scene, in which men playing ancient wind instruments or doing some overtone singing (!) participate in a contest to make the giant rocks around a particular valley "ring." The contest itself is riveting, and the handing out of the award (seen in Part 2) is, in my opinion, worth the wait.

This movie was musically fascinating. It had me thinking playfully that maybe I had a past life in Central Asia somewhere. That would account for my attraction to Russia, old reed instruments, and the music and cuisine of the region, wouldn't it? :)

Happy Birthday...

Original cast of the ballet Sleeping Beauty at the Mariinsky Theatre, St. Petersburg, 1890, with Carlotta Brianza as Aurora, Marie Petipa (daughter of choreographer Marius Petipa) as the Lilac Fairy, Enrico Cecchetti as Carabosse, and Pavel Gerdt as the Prince.

Happy Birthday Tchaikovsky! (And Brahms, and Robert Browning - I don't mean to short-change them, but I'm in a Russian ballet state-of-mind at the moment).

Every year on May 7 I think of Tchaikovsky and what a huge part of my life his ballet music has been. Every time I see a gentle snow falling outside my window I hear his snow scene from Nutcracker in my mind, and not even Mussorgsky's Night on Bald Mountain can conjure up dancing goblins for me as well as Tchaikovsky's Carabosse music from the Prologue of Sleeping Beauty. There are also those exquisitely beautiful adagios filled with pathos, or longing, or even in some cases an almost prayerful reverence - I'm thinking of any number of pas de deux from Swan Lake or Nutcracker or Sleeping Beauty - that have the power to break hearts open and spill intense emotions a lot of people throughout the centuries have seemed to want to work hard to suppress. Tchaikovsky bares them all - he wears his heart on his sleeve and consequently has at times been criticized for being maudlin or even "vulgar." Perhaps this is why I have a soft spot for him: his music gives us permission to feel great joy and sorrow and love and awe in a world where there can often be distrust or disdain for such non-rational experiences.

Tchaikovsky met with a mysterious and tragic end after a deeply troubled life. I wish he could have known what joy he would bring to generations of people through his work and foreseen that over 100 years after his death there would still be people like me who would think of him with gratitude on his birthday.

When I was growing up I did a LOT of ballet - at least two hours a day. I wanted to be a ballerina and even took special classes in New York with a prominent teacher there. I read about ballet history, watched ballet videos daily and learned all the major parts, took master classes from Margot Fonteyn and Melissa Hayden, and had the chance to meet Rudolf Nureyev, Cynthia Gregory, and Robert Joffrey.

I gave up that dream when my skinny pre-adolescent figure ballooned in high school and I realized I couldn't sustain a 1000-calorie-a-day life forever, but dance has always been a huge part of who I am. Now I can enjoy it stress-free, and I've been getting back in touch with its history, especially after visiting the Mariinsky Theatre in St. Petersburg. I didn't realize until this year that Mathilde Kschessinska had been Nicholas Romanov's mistress, or had tried to sabotage Olga Proebrajenska by releasing chickens onstage during one of her solos, or that Marius Petipa and Ekaterina Vazem had aired out their resentments so publicly, or that Anna Pavlova had reduced Tamara Karsavina to tears over a "wardrobe malfunction." Colorful stuff!

Ballet has evolved into something truly athletic - high legs, gravity-defying leaps, eye-widening spins by both men and women - but it wasn't always so. Dancers from the early 20th century may seem technically less capable to us now - a perception which, incidentally, isn't necessarily accurate - but they had an artistry and elegance that has become increasingly hard to find. Fonteyn, Kolpakova, and Alonso might look old-fashioned to viewers with today's sensibilities, but there was something special about dancers of their generation that I could watch over and over again. They and the later 20th-century greats - Plisetskaya, Gregory, Kain - bridged the gap between the late Romantic Period / turn of the century, dominated by Russian ballerinas like Pavlova and Karsavina, and the stars of the 1990's / early 21st century: Sylvie Guillem, Alessandra Ferri, Darcey Bussell, Polina Semionova, Alina Cojocaru, Vishneva and Lopatkina.

Technique can dazzle but without depth and soul it's a hollow Fabergé egg with no treasure inside. There comes a point when getting your foot up by your ear is no more than a cheap thrill - a trick that comes from being born with flexible hamstrings rather than from the kind of artistic maturity and musicality that makes a true Odette or Aurora or Giselle. I'll take Cynthia Gregory's Rose Adagio from Sleeping Beauty over ANY young Mariinsky dancer's today, much as I admire the latter.

Post-Cold War Generation

Photos from the train to St. Petersburg: my son and a sweet, bright young Russian boy bonding over hand-held electronic games...

...and, of course, chess. I would never have dreamed such a moment possible when I was their age: Russia v. the U.S. engaged in a peaceful game. No language needed.

Ok, people: these single-digit-age kids can do it. Now can we all just get along?

(This, by the way, was probably one of my favorite moments of the entire trip.)

Door Number Three

Our community has been hit by a sudden, painful tragedy: a freak accident that claimed a child's life. On what should have been an ordinary day - kids playing outside after school, others walking home from after-school activities, parents preparing the evening meal - one family in our neighborhood suffered an unbearable loss. We're all shaken and deeply saddened.

At work I face stress and anxiety-provoking situations all the time, yet people tell me I meet them with calm and grace under pressure. My home life is a different story altogether. As a mom I have a tendency to harbor deep anxieties over my children's well-being that I keep in check only with a lot of mental self-persuasion.

Right before we left for this trip to Russia I confided in a friend, "I worry that something bad will happen to one of us, and it'll be all my fault for dragging the family to Russia in the first place. I'll blame myself forever knowing they could all have been safe and intact but for my wanting to go." Just two weeks earlier two metro stations in Moscow had been attacked by suicide bombers.

"First of all," she answered, "nothing bad is going to happen to any of you. And secondly, what are you going to do, spend the rest of your life locked up in your house? Go live your life!"

So off we went. We rode the metro in Moscow - the relatives with whom we were staying, in fact, live right at one of the ones that was bombed. We rode a high-speed train to St. Petersburg - one of these had suffered a so-called "mechanical failure" (read: terrorist bomb) last fall. We flew in airspace that had been shut down for a week because of a volcano's threatening spew.

My friend was right: we can't let our lives be ruled by dread. But that's something I have to keep reminding myself. It only takes a moment to ruin a life, a number of lives; the current tragedy in our community is an agonizing reminder of that. What parents wouldn't give everything they had to rewind to the moments before such a loss, and somehow change things so that they could have that precious, unique, irreplaceable child back?

Years ago, when my first child was just an infant, I made a "dread list" as a way of exorcizing some of my demons, and I must admit it did help. Writing down my worries didn't dispel them entirely but it helped me let go of dwelling on them and constantly revisiting them. I won't say the words "carbon monoxide" don't cross my mind every time I wave goodbye as one of my kids goes for a sleep-over, or "roller coaster disaster" when we're at the county fair, but I don't mention my dark thoughts to them or prevent them from enjoying these normal treats of American childhood.

Change, too, makes me anxious, especially change of my own making. I worry that the decisions I make will be harmful in some way to my kids - as if I had control over everything that might happen to them - and if I allow myself to, I can fret about such decisions almost pathologically. The thoughts go something like this: Door #1 means we stay as is, Door #2 means we choose something else because of me. If we go through Door #2 and something bad happens to one of us, I will forever blame myself for not choosing Door #1 instead. If I pick Door #1 and meet with adversity, I'll wish we had chosen Door #2. What if I pick the wrong door?

This, of course, is a senseless, useless mental game, one that I banish from my thoughts when I have to make life decisions that affect my family, because if I didn't, it would drive me absolutely bananas. But the very fact that I have to banish it at all means that the tendency to entertain it is there, lurking like an imp holding out a temptation. People who tend to be plagued with "what-ifs" understand me, I think. And they would understand that the "what-ifs" I have to work so hard to suppress are nothing compared to the "if-only's" I am trying so hard to avoid.

If only I hadn't been there, gone there, stood there, done that. If only she had waited a second longer. If only he had taken the other road instead of this one. If only we had been able to do things differently. If only.

It's only human to want to avoid loss. It's small consolation that our capacity for experiencing loss is a corollary to our ability to hold things dear. Because we are human, we can recognize beauty, value things or people, experience wonder and joy in our relationships; but also because we are human, irrevocable separation from those we love hurts like hell. It is hell.

But I tell myself: we can't live in fear of what lies behind Door #1 or #2 or #3, or along this road or that road. We can't control everything that gets flung across our paths or berate ourselves for not being able to avoid the unexpected, the cruel adversities and unspeakable sorrows. We can only do what we can do: create life stories that bear witness to the best in us. We can't do more.

But my heart aches anyway. For my son's schoolmate and his family and friends. For the families I've met over the years at work who have wept the tears this family is weeping. For the loss of children, the sorrows and suffering of children, of families. If only.