Brain

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After less than a week in second year medical school, I had survived the elimination contest exam, coming in 38th of the 650 examinees. Thus I earned my place in the amphitheater that held only 110 people, including the spare chairs wedged into the stairwell.

The cornerstone on the building — the original cornerstone — said clearly, “1568.” It was not a museum, but a living medical school building. I suppose some monks had practiced here in the building at the outset when medicines were mostly tinctures, maybe marijuana if they were lucky. 
In the ancient dissection room, were four slate tables for cadavers. They were not easy to obtain, for it was said very few wanted their bodies dissected after death. The slate tables had rivulets carefully carved into them. The floor around the tables had buckets to catch various bodily fluids.

During my dissection, the master who supervised pointed a finger at me and the three other students at our table. Tradition said that “Sylvius, of the “Sylvian Fissure” had dissected at that very table. Sylvius,” meaning “from the woods” in Latin is “DuBois.” a common name in French. This fissure, that separates the frontal and temporal lobes, is so named in all the language in which medical terminology is known to me. He is sometimes claimed by Germany and sometimes by Holland.

I have looked into it enough to know he had a couple of “teaching voyages” around Europe, and his dates of activity would have made his presence in my dissection room very possible, indeed. The first day I was in this amphitheater, my physiology professor, from an ancient French family which alleged lineage dating back to 18th century pre-revolutionary French nobility, sidled up to my table and rapped on it, as if to focus his attention on me — before starting his lecture. “Mademoiselle,” he said, “you should be ashamed of yourself. You have taken a seat in this class away from a deserving Frenchman, who could earn a salary and raise a family.” The amphitheater could not have been more silent since 1568. I heard my own voice tremble. “With all due respect, Monsieur, I am here according to the Napoleonic Code of 1802, which opened the Universities of France to people coming from all nations who are capable of speaking the French language, so that they return with French culture to their nations of origin. I am pleased to be so honored. Vive la France!”

Pretty much any time you say “Vive la France!” in am amphitheater of students it is fairly certain that the whole amphitheater will end up cheering and shouting “Vive la France,” which they did. My poor professor was silenced, and shook his head. Nobody else said anything derogatory about my origins to me for the remainder of my education.

Later that week was my first lecture in neuroanatomy. I had loved the brain and its mystery and majesty long before starting the study of medicine. In first year medicine we were focused primarily on learning the limbs, with the brain and the head, neck thorax, and abdomen saved for the second year. Strangely I cannot remember the professor’s name. He was ancient and had to be helped up to the master’s lectern, One of the students told me he had been teaching before World War II. He had an essential tremor — head and neck, and sometimes the whole of his body. His voice seemed feeble, even with the microphone of the lectern. He wore a vest and trousers beneath his white coat.

“Mesdames, Mesdemoiselles, Messieurs … To me, falls the responsibility of teaching you the brain. When I address you, I speak to your brain. Assiduously studied, for hundreds of years, we knew little about it before World War I. The brave “poilus,” the French soldiers who protected this great nation in WWI , gave their lives — and all too often, gave us their brains. From knowing what part of their brain was missing and what they were unable to do in their twilight of their young lives, we learned what part of the brain did what. From this, we have evolved into a people whose knowledge of the brain we share with the world.”

He stared at me, and I felt as if his eyes burned holes in my flesh. “This organ is so complex, I do not teach with the pathologists’ photographs or drawings, but with simple circles of colored chalk to show you their bunches and bundles in cross-section. Learn them well, for they were learned from people’s lives and memories.” The other students told me later, when I talked to them that they were suppressing giggles. Me, I was suppressing tears. I have heard many complaints about nearly everything about medical education. But I have never heard anybody tell me about a deeper contact with being part of the research and education tradition than I did at that moment.

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She was an older woman, gray-haired and distinguished, one of those Canadian imports who had never forgotten her British roots. They were as close by as her slight English accent. I had known many people in Canada just like her, who would say “I’m just an old Brit” because that is what they felt like, in the “melting pot” America was alleged at one time to be, or in rich ethnic salad of Canada.

We knew her from her singing. We sang in a “showcase” of sorts in the San Diego region. My husband’s rich and jazzy baritone, my humorous songs or French songs long before my post-menopausal “croak” set in. Read more on Back To The Blitz…

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It was a particularly beloved patient who asked me if I had any advice about improving creativity. She believed, as many people do, that it is a side effect of treating (even a relatively minor form) of bipolar illness. A lot of research back in the days of lithium, one of the first really robust treatments for bipolar illness, strongly suggested it just wasn’t so. Read more on Will Bipolar Treatment Kill Creativity?…

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I remember my final day as a neurosurgeon. “Washing” a human brain with two humongous syringes of sterile physiologic saline, the same way my mother of blessed memory used to baste a chicken.

I thought maybe as a psychiatrist I had a chance, at least a fighting chance, of preventing a disaster like the one I was standing there trying to treat. Read more on The Decisions You Make…

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I often think of Emma Bovary.

In 1856, Gustave Flaubert’s first novel was helped along in sales by a trial for obscenity. And yet the school of thought Flaubert embodied was called “literary realism.” Read more on Literature and Psychology…

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Current science consensus: the state of the bacteria in your gut could seriously have something to do with whether or not you end up having Post-Traumatic Stress Disorder PTSD).  PTSD has been a horrible side effect of war for a really long time. Read more on The Colon (yucch) As A Factor In PTSD…

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I recently had a patient who walked in to see me wearing a vintage Dior suit. I complimented her, of course, as I think that an ideal way to dress. She presented as powerful, and in control of her life.

She looked me straight in the eye, as if she were delivering me a deep and secret truth. Read more on Useless Phase For Today: “Chemical Imbalance”…

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I had never heard of ECT (Electroconvulsive Therapy) until I was about 6 years old and my Bobie, my paternal grandmother of blessed memory, was folding laundry on the living room sofa.

“Your mother thinks you are stupid, ” she told me.  “Your mother actually still thinks that you don’t know that her mother, your other grandmother, is locked up in the crazy-house and that is why you never see her and never will.”

I don’t remember yelling or making any sound at all other than bounding up the stairs to my parents where my mother of blessed memory was folding another bunch of laundry on her own bed.

I told her my grandmother had told me this “stuff” and she hadn’t, and I was not stupid and needed to know exactly what was going on.

I barely got the words out of my mouth before my mother slumped on the bed and started crying like an endless fountain, like nothing I had ever seen and told me that it was true, and she just thought I was too young to understand, and she was going to tell later, when she thought I was ready.

I ran quickly into my room and pulled a book from the shelf on my desk and brought it back to her.  As I pointed out, I was reading “All about the Human Body” which told all about sex and the horrible things men and women had to do together to have a child.

They had signed something special that I was mature enough for this so I ought to be able to hear anything about someone who was sick, especially in my own family.

She brought a photo, 9 by 7 inches or so, of her mom in elegant 1930’s clothes.  She looked well-dressed and sophisticated enough, with curly short hair.

My Mother told me then and there that I couldn’t just hear about the sickness.  I had to hear about the woman.  Her name was Sylvia Gutensky Baver.  She has a gravestone in or near Springfield, Massachusetts.  She was a founder and lifelong fundraiser for the Jewish Home for the Aged of Springfield, Massachusetts.

She wanted more education than she had, always wanting to become a nurse or to work in a clinical laboratory or something like that, but my grandfather of blessed memory always said my grandmother was “just fine,” and since he, illustrious son of a blacksmith who owned a pawn shop, would give her everything she needed and she would be fine.

He had been very limiting with her.  She loved to write songs and stories.  He decided there was no question of her becoming published.

“She would have loved you a lot,” said my mother, “because you got to do all the things nobody ever would let her do.”

My mother told me that she sad sometimes happy, with her music and poems and would dance around the house, but became sullen and withdrawn when my grandfather became home.

It had been some kind of one of those old-fashioned Jewish “arranged marriages,” and it sounded to me as if it were some kind of a recipe for a complete disaster.

My mother could only nod.  She cried another flood.  “Yeah, I guess he pretty much drove her crazy.”

She died a couple months later.  My mother took a quick train trip to Springfield for the funeral.  She didn’t tell me why until after she returned.  She didn’t want to hang around with the rest of her family, who were pretty crazy.

I don’t believe her husband could go.  He was confined, by his profound Alzheimer’s disease, to the Jewish Home for the Aged of Springfield Massachusetts, that bore both a plaque to honor her foundership and a plaque as her memorial.

The irony was not lost on me, even then.

My mother told me briefly, only after her mother’s funeral, that my “Bobie Sylvia” had thoughts about killing herself when she got really depressed and saw it really as the only way to get away from my grandfather.

My grandmother’s treatment in Northampton State Hospital of Massachusetts had precious little actual treatment.  Her “work,” my mother said, was a large gray mat, she would knit and rip out and reknit so she “always had something to do.”  She had “some kind of medicine to knock her out,” and there was, of course, the Electric Shock Therapy or “ECT.”

I read enough to know it had evolved.

I didn’t have any kind of major trauma when a senior preceptor offered to “teach” me how to do this.  I did tell my mother, for I felt a little pride the granddaughter of the shockee was going to become a “shocker.”  I was told it paid better than pharmacology, as there was really not much anyone else could think of that could pass as a “procedure” for surgeon-magnitude building in psychiatry.

I think my mother of blessed memory was more traumatized than I when I told her.  Shouldn’t have told her.

Me, I believed (and in a way still do) that this paradox of life simply confirmed that knowledge could produce power.

Here is a little about the history of the procedure.

In my grandmother’s day, the major risk of the procedure was long bone fractures.  Anesthesia is wildly improved since then.

The person lies still and with one or another position or strength of electrode a “grand mal,” seizure, the kind that can make a body shake largely all over, is induced.  Not physically, for the body remains artificially paralyzed, but it is discretely recorded by a little EEG (electroencephalograph) meant to measure the same.

It is still used — and still works amazingly well — for something nobody seems to understand as well as they think they do.  Here is a modern discussion of the procedure from the Mayo Clinic.

Although depression, bipolar illness, and even psychosis can be treated with this, it is usually necessary to show resistance to pharmacology before getting insurance to pay for this.  Even more of a deterrent is patient mythology and fear.  I have not done this for many, many years, mainly because most patients run like crazy when you mention it.  I would not consider it “controversial,” but there are a few side effects and some folks still think it controversial.

As for the illness, my grandmother Sylvia Gutensky Baver was probably bipolar, as were both my parents and my brother, may all of their memories be blessed.

At one time, I kneeled before the Torah on the sacred Jewish altar, thanking God for having spared me from the effects this illness wrought on their lives.

I have used whatever it is I have got to fight this monster.

I think this is a really big piece of how I became the Renegade Doctor.

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There is more happening and more being done about psychiatry and the brain now than ever in the history of the world.  I like the idea of “consumer-run” organizations and I love the idea of this one:

Like most things I find on the internet, it is hard to describe how I got here.  Probably it has something to do with “keywords” and “searches.” Read more on …

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My favorite way to put people to sleep is Aromatherapy.  To help a person sleep, the requisite molecules have to get to the brain.  They certainly to not have to drag around the circulation of the entire body. The sense of smell is perhaps the most sensitive of all senses.  You need to smell only a few molecules of something, compared to how much it takes to see and hear, they say. I have heard it said many times, although it does sound a bit like comparing apples and oranges. Read more on A Sweet Way To Go To Sleep…