Thought to Thought

Energy transfer.

Carbohydrates, digested and absorbed through the gastrointestinal tract, broken down to glucose, fuel for the human body.  Only glucose powers the human brain—food for thought, as it were.

Neurotransmitters diffuse across synaptic gaps, completing circuits—biochemical thoughts.

Thoughts: ideas, concepts, questions, solutions, formed in cerebral grey matter, transmitted through the pons to the spinal cord, anterior horn cell, nerve root, peripheral nerve, neuromotor junction, muscle—twitch, and twitch again.

Fingertips fly, propelled by kinetic energy, punching buttons on a keyboard, stringing symbols in rows of lines—symbolic thoughts, electromagnetic energy transmitted instantaneously at the speed of light.

In a galaxy far, far way—Arizona, perhaps; Pennsylvania, Massachusetts, Spain, or South Korea—photons fly across a flat screen, producing light symbols, the same symbols in rows of lines, the same symbolic thoughts.

Photons fly and strike the rods and cones of another human retina, triggering biochemical impulses transferred via the optic nerve to the occipital lobe of another human brain—reception of thoughts, ideas, concepts, emotions, problems, solutions—the stuff of life.

Energy transfer; lickety-split—thought to thought—via biochemical and electromagnetic channels.

Cosmic communication: the stuff of electrons.

Of Cosmic Significance

I spent the greater part of last week delving into quantum electrodynamics, the theory that now forms the basis of our understanding of how the universe operates at the atomic level.

Thanks to solid-state technological advances, through my personal computer I was able to access a number of video lectures on the web—several by Nobel laureates Richard Feynman and Hans Bethe—that enhanced my understanding of quantum mechanics.

Unfortunately, because I lack the mathematical background, I found that I was unable to comprehend both derivations and solutions to complex equations such as the Schrödinger wave functions and the calculations of probability amplitudes.  But then, perhaps even this knowledge might not have served to enlighten me further.  As Feynman pointed out in his 1979 Auckland lectures, “no one understands quantum mechanics.”

According to Feynman, it all comes down to this:  (1) electrons move through space in time, (2) photons move through space and time, (3) electrons and photons collide and separate, absorbing and releasing energy.

Thus far, theoretical physics has managed to integrate quantum mechanics and the atomic weak force. It has yet to meld the nuclear strong force into the equation, and gravitational force is turning out to be elusive as well.

Lately, M-theory, a derivative of string theory, has been proposed as a possible answer to the theory of everything, although we are far from integrating infinity into these equations.

When I made mention of these musings of mine in an e-mail to a good friend, he responded: “My own thoughts about life and the universe have become simpler as I have grown older.  Like the flapping of the butterfly’s wing, an act of love reverberates through the universe in a way that goes beyond the phenomenon of the act itself.”

Electrons, photons, butterfly wings—minute reverberations through a complex universe that extend well beyond our ken.

No act of kindness, no matter how small, is ever insignificant.

Whitman’s verses come to mind:

When I heard the learn’d astronomer,
When the proofs, the figures, were ranged in columns before me,
When I was shown the charts and diagrams, to add, divide, and measure them,
When I sitting heard the astronomer where he lectured with much applause in the lecture-room,
How soon, unaccountable, I became tired and sick,
Till rising and gliding out I wander’d off by myself,
In the mystical moist night-air, and from time to time,
Look’d up in perfect silence at the stars.

Through the Looking Glass

“Jackie, stop!” I say in my most authoritative voice.  “Stop it now—stop barking!”

I gather the struggling terrier into my arms and try to calm her down while my wife trucks bags of groceries into the kitchen from her car in the driveway.  Still holding the dog, I walk into the parlor, away from the kitchen commotion, where the dog catches sight of herself in the mirror on the wall above the antique settee.  Immediately she cues in, cocks her head, then raises her tiny black nose to sniff the dog in the mirror.  She begins to whine, insisting that I bring her closer.  She gets so excited that she jumps out of my arms and runs back into the kitchen, only to return momentarily and leap up on the sofa, where trembling, she stands on her hind legs and proceeds to paw at the base of the mirror, repeatedly jumping up to see if the other dog is still there.

Later, my wife stacks cushions on the settee so the dog can hop on top of them to catch a glimpse of her reflection.  It appears that she still thinks there’s another dog in there somewhere, through the looking glass, and she’s frustrated that she can’t gain access to it.

A friend of mine, an expert on these matters (he has had at least two dogs in his household at one time or another over the course of the past three decades), tells me that he has witnessed dogs acting in a similar manner when they catch sight of another canine on TV.  They see the dog, they hear him bark; but baffled, they can’t seem to break through into his world.

In his book The Art Spirit, Robert Henri writes:

There are moments in our lives, there are moments in a day, when we seem to see beyond the usual.  Such are the moments of our greatest happiness.  Such are the moments of our greatest wisdom.  If one could but recall his vision by some sort of sign.  It was in this hope that the arts were invented.  Sign-posts on the way to what may be.  Sign-posts toward greater knowledge.

Like dogs discovering another dimension through a looking glass, we momentarily glimpse miracles.  Sometimes, struggle though we might, we are unable to make sense of them.  But if we are fortunate, sometimes the light breaks through—and in an epiphany we see truly, face to face.

Such are the sign-posts toward greater knowledge; such are the sign-posts of wisdom.

A Noteworthy Twitter

As I back into the parking space at the edge of the wood and step outside my car, the melodic trills of a veery sound clear and sharp, descending the scale like a xylophone in the early morning air. Punctuated by a pause, the song repeats in flawless fashion. The number of notes I can not count, but the pattern is unmistakable. I stop to listen and find myself transported back in time to another summer day years ago when my friend and I spent an afternoon exploring a stretch of the Connecticut River.

We put in near Gillette Castle and paddled our kayaks north against the current to Chapman Pond. As we entered the expanse of quiet water, we passed a sentinel cormorant perched on a rock, its wings held aloft like a semaphore signaling our arrival. High overhead along the far ridge a pair of red tail hawks sailed on the updrafts. We slipped across the pond, and a gaggle of mute swans descended over our heads, wingbeats whistling through the still afternoon air.

We circled the lake before stopping to eat our snack of fresh blueberries and granola bars. I glimpsed a number of goldfinches in the treetops before we returned to the river. The waves lapped against the kayaks in the current as we drifted downstream past the rocky cliffs where eagles nest in the late winter.

Here we entered the quiet waters of Whalebone Creek and followed the meandering stream back through canals bordered on both sides by tall marsh grass to a beaver dam. It was there, at the edge of a wood, that I heard the clear sharp notes of a veery in the late afternoon shadows.

In her recent piece The Trouble With Twitter, University of Oregon adjunct instructor of journalism Melissa Hart laments: “I worry that microblogging cheats my students out of their trump card: a mindful attention to the subject in front of them, so that they can capture its sights and sounds, its smells and tactile qualities, to share with readers. How can Twittering stories from laptops and phones possibly replace the attentive journalist who tucks a digital recorder artfully under a notepad, pencil behind one ear, and gives full attention to the subject at hand?”

Sound bites — those 140-character tweets — don’t begin to do any story justice, unless they happen to have their origin in the warbled notes of a mystical woodland singer.

The Big Tree (II)

Though to the outer ear these trees are now silent, their songs never cease. —John Muir

I ran into Loering down at the post office. His tall thin frame hovered over the long table by the window as he sorted through the stack of envelopes freshly extracted from his post office box.

“They’re taking down the big ash tree on Maple Street,” I told him.

The director of public works in town had ordered that the ancient tree be taken down. Many of its dead and decayed limbs had fallen without warning over the past year. The old tree had become a public liability.

“I saw them working on it this morning when I walked down for the mail,” Loering said. “That’s the last one to go.”

“Last one?”

“The last of the original trees on that street. Over the years I’ve watched them all come down, one by one—some diseased, some damaged in storms. I counted the rings on the last big one to come down before this one. I reckoned it dated back to 1806.”

Loering’s cloudy blue eyes danced in the late morning sunlight that streamed in through the front window.

“Now when that tree took root,” he mused, “Thomas Jefferson was president. Lewis and Clark were just returning from their voyage of discovery. The war of 1812 hadn’t been fought yet. Just think of all the history that tree witnessed over the years,” he grinned. “Why, if trees could talk, I wonder what they would tell us.”

Slowly, I nodded. The power of the imagination. Time and again I encounter the thoughts of a philosopher in the least likely of places. In this life there are no ordinary moments.

“From the diameter of the trunk, it must be at least 150 years old,” I told him.

“I guess we’ll find out soon enough,” he winked.

By the end of that day the town workers had taken down all of the branches on the big ash tree except one, leaving the massive trunk standing.

With no advanced notice, the men returned early one morning the following week to finish the job. They couldn’t have picked a more miserable day: cold, damp, overcast and rainy. Wearing fluorescent yellow slickers and yellow hardhats, the men worked steadily through the rain. By mid morning they had felled the trunk.

When the tree surgeon made the final cut through the base, a great volume of dark brown frothy liquid bubbled out. It was almost as though the old tree had hemorrhaged in its death throes.

That afternoon the sun came out. When I returned home from work in the evening, I went out to inspect what was left of the big tree.

I climbed up on the massive stump and with a straw broom brushed off the remaining debris.

The center of the stump had rotted, leaving a soft spongy black pulp devoid of any markings. I measured the base along several distinct diameters and recorded anywhere from 52 to 60 inches.

Genuflecting on one knee, I notched the first visible ring near the spongy pulp with my pen knife and started counting outward—118 rings. I measured the pulpy heart, and reckoned the tree to be about 135 – 140 years old—close to my initial estimate of 150 years. This tree dated back to 1869.

The ancient ash had certainly seen a lot of history: a century of wars; the invention of the airplane, radio and television; the atomic bomb; the civil rights movement; a man on the moon; the fall of the Berlin wall; the tragedy of 9/11; the election of the first black American president.

Loering’s words echoed inside my head: “If trees could talk, I wonder what they would tell us.” What would this one have said?

I rose to my feet and regarded the remnant of the old ash, straining to hear its ceaseless song.

Medicine and the Art of Motorcycle Maintenance

In his recent New York Times Sunday magazine article, The Case for Working With Your Hands, author-mechanic Matthew B. Crawford argues for the pursuit of work that is straightforwardly useful—like plumbing, electrical work, or car repair.  After earning a PhD and bolstering his résumé writing abstracts of scientific articles he admits he seldom understood, Crawford opened up a motorcycle repair shop.  Based on his recently released book, Shop Class as Soulcraft: Manual Competence and the Struggle for Agency in Modern Life, Crawford’s essay seeks to honor the manual trades as work worth pursuing.  Ironically, this piece could just as easily have been titled “Medicine and the Art of Motorcycle Maintenance.”

“[Useful] work is sometimes frustrating, but it is never irrational,” Crawford writes.  “And it frequently requires complex thinking.”  Do those words ring true for those of us involved in the practice of clinical medicine?

Medicine combines the disciplines of science and art.  Clinicians strive to formulate diagnoses by melding historical information gleaned from patient interviews with clues from the physical examination, laboratory tests and imaging studies.  There is an art to synthesizing these data, just as there is an art to delivering the diagnosis and treating the patient.

“Without the opportunity to learn through the hands,” Crawford maintains, “the world remains abstract and distant, and the passions for learning will not be engaged.”

Clinicians learn physical diagnosis by laying hands on patients.  They learn human anatomy by cadaver dissection.  Procedures are practiced under the adage: “See one, do one, teach one.”  In developing these skills, early successes spur the student on toward greater self-confidence.  Most practicing clinicians have experienced the satisfaction that comes from suturing a simple laceration, applying a plaster splint or draining an incised abscess.

As for the art of medicine, “The attractiveness of any hypothesis is determined in part by physical circumstances that have no logical connection to the diagnostic problem at hand.”  In spite of those myriad clinical algorithmic flow sheets designed to walk the clinician down the path toward formulating a proper diagnosis, Crawford surmises that “proper response to the situation cannot be anticipated by a set of rules or algorithms.”

In motorcycle repair “[s]ome diagnostic situations contain a lot of variables.  Any given symptom may have several possible causes, and further, these causes may interact with one another and therefore be difficult to isolate.  In deciding how to proceed, there often comes a point where you have to step back and get a larger gestalt….What you need now is the kind of judgment that arises only from experience; hunches rather than rules.”  Is this not what we do in clinical practice every day?

Here are several more of Crawford’s aphorisms that lend themselves well to the practice of medicine:

  • “Good diagnosis requires attentiveness to the machine, almost a conversation with it, rather than assertiveness…” (The art of taking a medical history.)
  • “As is the case with many independent mechanics, my business is based entirely on word of mouth.”  (“Know of any good doctors?”)
  • “The mechanic deals with a large element of chance.” (Also the clinician’s constant companion.)
  • When Crawford succeeds in recovering an accidentally dropped feeler gauge from the crankcase of a Kawasaki Ninja, he feels as if he has cheated death.  “I don’t remember ever feeling so alive as in the hours that followed.”  (Remember how we felt when a timely intervention worked to save a patient?)
  • “Often as not, however, such crises do not end in redemption….a keen awareness of catastrophe [is] an always-present possibility.”  (Think malpractice suits.)
  • “The core experience is one of individual responsibility, supported by face-to-face interaction between tradesman and customer.”  (A good definition of the provider-patient relationship.)
  • “A good job requires a field of action where you can put your best capacities to work and see an effect in the world.” (Public health.)

In his subsequent review of Crawford’s book, Francis Fukuyama writes:  “All these activities, if done well, require knowledge both about the world as it is and about yourself, and your own limitations. They can’t be learned simply by following rules, as a computer does; they require intuitive knowledge that comes from long experience and repeated encounters with difficulty and failure.”  There you have it: the art of motorcycle maintenance; the art of medical practice.

Matthew Crawford praises people who do useful work:  “We idealize them as the salt of the earth and emphasize the sacrifice for others their work may entail.”

Even Osler would say “Amen” to that.

The Good Earth

Once again the sod has been turned, last year’s stubble now plowed under.  Rows of rich black earth await the disc and harrow.  Soon the seed will be sown, as another cycle of planting, growth and harvest begins.

I caught the end of a half-heard announcement over the radio as I drove home from work past freshly plowed fields at the end of a long week:  Five farms, a series of broadcasts about life on a family farm, to be aired this May.  The first, a Massachusetts dairy farm; then a hog farm in North Carolina; a southwestern Hopi farm in Arizona; a grain and livestock farm in Iowa; and last, a California organic fruit and vegetable farm.  Nearly half the land in the country—a billion acres—is still tended by ranchers and farmers.

The announcement transported me back to boyhood days, when I would occasionally help out on two dairy farms owned and run by families of friends I grew up with.  As a youth I lent a hand milking cows, baling hay, gathering eggs, plowing fields.  The thick-walled limestone farmhouses kept you cool in the heat of summer.  I close my eyes and still recall the spring scent of freshly manured fields and sweet hay drying under hot summer sun.

All this set me to thinking about the land and our connection to it, and that reminded me of a John Steinbeck novel I read in late adolescence entitled To a God Unknown.  When I got home I searched my book shelf; and sure enough there it was, wedged between The Grapes of Wrath and The Wayward Bus.  Of all Steinbeck’s works, this one speaks most poignantly about man’s ties to the earth:

“The spring came richly, and the hills lay deep in grass—emerald green, the rank thick grass…When April came, and warm grass-scented days, the flowers burdened the hills with color, the poppies gold and the lupins blue…And still the rain fell often, until the earth was spongy with moisture…All the flat lands about the houses grew black under the plows, and the orderly, domestic seed sprouted the barley and the wheat.”

Here in New England, recent rains have turned the countryside a luscious green.  Persephone has made her appearance, dancing through the woods and meadows.  In our back yard the hosta has leafed out, the bleeding hearts hang heavy in bloom, forget-me-nots cluster by the fish pond.

I step out onto the porch and survey our verdant quarter acre, a microcosm of those family farms from my youth; draw in a deep breath, and savor that ancient attachment to the good earth.