By Scott Haig M.D. Monday, Jan. 29, 2007
David’s head was literally stuffed with lung cancer. I was called in to take care of his hip and pelvic bones broken by the growing metastases. His seeming nonchalance about the pain and the surgery was clearly out of concern for his beautiful, young family–his wife Carol, a nurse, and his three kids, who were there every night. He couldn’t keep up the carefree charade over the next two weeks, though, as his speech slurred, then became incoherent. He stopped speaking, then moving.
I dreaded making rounds on a patient for whom there was no good news, no good plan. When his doctors rescanned his head, there was barely any brain left. The cerebral machine that talked and wondered, winked and sang, the machine that remembered jokes and birthdays and where the big fish hid on hot days, was nearly gone, replaced by lumps of haphazardly growing gray stuff. Gone with that machine seemed David as well. No expression, no response to anything we did to him. As far as I could tell, he was just not there.
It was particularly bad in the room that Friday when I made evening rounds. The family was there, sad, crying faces on all of them. I fussed with the hip a bit. His respirations had become agonal–the gulping kind of breathing movement that immediately precedes death. I knew Carol had seen this and that she knew what it meant. I said something inane and slid out the door fast, looking importantly at the papers in my hand, striving for the nice, empty corridor. But Carol came after me, needing to catch me away from the kids. Her eyes red-rimmed, she asked me where her husband was. I had noticed the cross around her neck. I said I wasn’t sure where he was, but I was pretty sure where he was going. She wanted to believe me, and I think she did.
Saturday morning the sun poured in as I checked the room. The bed was at chest height, made up and empty, with clean, fresh sheets over the vinyl mattress. As I turned to leave, I was blocked by a nurse, an older Irish lady with a doleful look on her face. She had taken care of David last night.
“He woke up, you know, doctor–just after you left–and said goodbye to them all. Like I’m talkin’ to you right here. Like a miracle. He talked to them and patted them and smiled for about five minutes. Then he went out again, and he passed in the hour.” My eyebrows went up.
Two weeks later I saw Carol in the lobby. It was busy and very public. But before her last “God bless you,” I couldn’t help asking, “Uh. Carol, did …?”
She knew my question. With a wide, knowing smile, she nodded and said, “Oh, yes, he sure did.” And I believed her.
But it wasn’t David’s brain that woke him up to say goodbye that Friday. His brain had already been destroyed. Tumor metastases don’t simply occupy space and press on things, leaving a whole brain. The metastases actually replace tissue. Where that gray stuff grows, the brain is just not there.
What woke my patient that Friday was simply his mind, forcing its way through a broken brain, a father’s final act to comfort his family. The mind is a uniquely personal domain of thought, dreams and countless other things, like the will, faith and hope. These fine things are as real as rocks and water but, like the mind, weightless and invisible, maybe even timeless. Material science shies from these things, calling them epiphenomena, programs running on a computer, tunes on a piano. This understanding can’t be ignored; not too much seems to get done on earth without a physical brain. But I know this understanding is not complete, either.
I see the mind have its way all the time when physical realities challenge it. In a patient stubbornly working to rehab after surgery, in a child practicing an instrument or struggling to create, a mind or will, clearly separate, hovers under the machinery, forcing it toward a goal. It’s wonderful to see, such tangible evidence of that fine thing’s power over the mere clumps of particles that, however pretty, will eventually clump differently and vanish.
Neuroanatomy is largely concerned with which spots in the brain do what; which chemicals have which effects at those spots is neurophysiology. Plan on feeding those chemicals to a real person’s brain, and you’re doing neuropharmacology. Although they are concerned with myriad, complex, amazing things, none of these disciplines seem to find the mind. Somehow it’s “smaller” than the tracts, ganglia and nuclei of the brain’s gross anatomy–but “bigger” than the cells and molecules of the brain’s physiology. We really should have bumped into it on the way down. Yet we have not. Like our own image in still water, however sharp, when we reach to grasp it, it just dissolves.
But many think the mind is only in there–existing somehow in the physical relationship of the brain’s physical elements. The physical, say these materialists, is all there is. I fix bones with hardware. As physical as this might be, I cannot be a materialist. I cannot ignore the internal evidence of my own mind. It would be hypocritical. And worse, it would be cowardly to ignore those occasional appearances of the spirits of others–of minds uncloaked, in naked virtue, like David’s goodbye.
Dr. Haig is an assistant clinical professor of orthopedic surgery at the Columbia University College of Physicians and Surgeons