Tag Archives: St. Augustine

by

In praise of an empty brain

How do I love thee, Age? Let me count the ways… Well, actually I’m not actually going to, because of late, I’ve fallen out with it. Perhaps it’s just my memory that’s falling, though: I was about to parody Shakespeare -it’s what I knew I knew, and yet I didn’t (it was Elizabeth Barrett Browning. I checked). A simple mistake, perhaps, and yet, once again, the hubris of my years led me along the wrong neurons. I feel embarrassed about it now, but suppose I had offered it to someone as a valid Shakespearean quotation and, out of respect for my age, I had not been contradicted? For that matter, what if I’d felt there was no need even to look it up?

Although I am now retired after a long career in medicine, people still ask for my opinion. I answer them, of course, but I do wonder if what I say is still up to date and correct. And often as not, I will look up the answer when I get home. Whether it be age or temperament, the assumption of knowledge I do not possess sits poorly with me. Nowadays, I am far more likely to shrug and admit that I do not know the answer to the question asked -or at least admit that I am uncertain.

However for an expert, I suppose it’s a matter of pride to speak with certainty, even if that confidence is apt to block, or even deride other viewpoints. It seems to me that knowledge is never a locked door -we can always learn by opening it from time to time.

Of course I have never been able to keep track of my keys, so I suppose I am particularly vulnerable. The other day while I was meandering through my apps, for example, I stumbled upon an intriguing essay in Psyche: https://psyche.co/guides/how-to-cultivate-shoshin-or-a-beginners-mind

The author, Christian Jarrett, a cognitive neuroscientist, writes that ‘The Japanese Zen term shoshin translates as ‘beginner’s mind’ and refers to a paradox: the more you know about a subject, the more likely you are to close your mind to further learning.’ He cites several historical examples of the inability to accept new findings, including one that promises my increasing years the hope of new clothes: ‘belief in the legendary Spanish neuroscientist Santiago Ramón y Cajal’s ‘harsh decree’ that adult humans are unable to grow new neurons persisted for decades in the face of mounting contradictory evidence.’

But, of course this is hardly confined to academia. Expertise in any field breeds hubris. ‘Merely having a university degree in a subject can lead people to grossly overestimate their knowledge… participants frequently overestimated their level of understanding, apparently mistaking the ‘peak knowledge’ they had at the time they studied at university for their considerably more modest current knowledge.’ In fact, ‘there is research evidence that even feeling like an expert also breeds closed-mindedness.’

Jarrett then suggests something obvious: ‘Approaching issues with a beginner’s mind or a healthy dose of intellectual humility can help to counter the disadvantages of intellectual hubris… being intellectually humble is associated with open-mindedness and a greater willingness to be receptive to other people’s perspectives.’

Good idea for sure, but how can a dyed-in-the-wool expert stoop to conquer their own hard-earned arrogance? One way that I thought was clever was ‘to make the effort to explain a relevant issue or topic to yourself or someone else in detail, either out loud or in writing. This exercise makes the gaps in our knowledge more apparent and bursts the illusion of expertise.’ It also makes me think of that famous quote from St. Augustine: What then is time? If no one asks me, I know what it is. If I wish to explain it to him who asks, I do not know.

But, I have to say there is another method that Jarrett suggests, almost as an addendum, that has to be my favourite: ‘deliberately invoking in oneself the emotion of awe. Several studies have shown that awe quietens the ego and prompts epistemological openness’. In other words, ‘Gaze at the night sky, take a walk in nature, or listen to a stirring symphony. Any activities that invoke in you the emotion of awe (wonder at the enormity and beauty of the world) will increase your feelings of humility, and inspire a more open-minded perspective.’

The essay reminded me of something that happened to me many years ago while I was in the thrall of my freshly earned medical degree. Nancy, my date and I had been invited to her uncle Arvid’s house for dinner, and I suppose I felt a little intimidated sitting across the table from a recently retired professor of history. I don’t know why I was uncomfortable. He was an absolutely delightful man who was so energetic when he spoke that his arms seemed to explode upward as if they were spring-loaded. He wore his snow-white hair long and each time his hands unfurled to make a point, a curly lock would roll onto his forehead and his eyes would twinkle in response as if he found the whole thing hilarious. Sophie, his wife, was all smiles, as well, although she wore her hair short and could only resort to smoothing it out each time she laughed.

It was clear from the start that they wanted to put me at ease, and Arvid was careful that he didn’t seed his usually witty remarks with historical references; he didn’t even mention the university position he had held. But I wanted to let Arvid know that I, too, was interested in history and knew something about his area of specialization: the French Enlightenment. Well, actually I only started reading about it when Nancy told me about the dinner.

During a lull in the conversation when we were helping ourselves to dessert, I decided to make my move. “Is it true that the Little Ice Age may have played a part in the French Revolution, Arvid?” I asked, as casually as I could manage.

Arvid smiled at me as he scooped some strawberries from a bowl onto his plate. “Climate was probably a factor, G,” he replied pleasantly. “But all of Europe was affected by that as well.”

“I suppose I was drawing a bit of a parallel with current climate change issues -although certainly not an Ice Age…”

“You mean the effects that major climate shifts may have on political stability?” He seemed genuinely interested.

I nodded and took my turn with the strawberries. “I suspect that our crop yields may suffer as they did in France with the climatic upheavals of the time…” I left the sentence open so he would know I was only offering it as a possible result.

Arvid seemed to think about it as he scooped some ice cream on top of his plate of strawberries. “That’s an interesting comparison, G.” He took a tentative sample of the dessert and studied the spoon for a moment. “I must say we historians sometimes content ourselves with the proximate causes of events: endemic corruption, increased taxes, and the unaffordable price of bread in the case of the French Revolution…”. He tasted the heaping spoonful and then attacked the dessert more seriously. “I think you have a point, G. I must look into that a bit more…” he added between bites, then glanced at his wife who had been largely silent so far.

Their eyes touched briefly and she smiled indulgently as she no doubt always did when hosting dinners for his many students over the years.

by

Tomorrow, and tomorrow, and tomorrow

What is Time, if not a river flowing ever onwards from now -or from an ill-remembered ‘then’ to the same now? Of course, we all know the quotation attributed to Saint Augustine: What then is time? If no one asks me, I know what it is. If I wish to explain it to him who asks, I do not know – but that doesn’t get us very far. It neither allows events to be situated in time, nor allows us to appreciate its passage. Perhaps that’s unfair to ask of a denizen of the fourth century -saint, or no- but an orderly historical conception of time’s progression began long before his birth.

To more fully acknowledge the extent of time, one must be able to measure it -not so much mechanically, as calendrically. And, as Paul J. Kosmin pointed out in an article in Aeon, ‘from earliest recorded history right up to the years after Alexander the Great’s conquests in the late 4th century BCE, historical time – the public and annual marking of the passage of years – could be measured only in three ways: by unique events, by annual offices, or by royal lifecycles. https://aeon.co/essays/when-time-became-regular-and-universal-it-changed-history

‘In ancient Mesopotamia, years could be designated by an outstanding event of the preceding 12 months’ -presumably this would make the time frame more easily memorable. The more distant in time events occurred, the more difficult it would be to appreciate any surrounding context. And it would be meaningful only to those living in the country, or region, so unless forced by conquest or a shared natural disaster, uninterpretable by others.

Finally, though, ‘In the chaos that followed the death of Alexander the Great in Babylon in 323 BCE, all this changed. One of Alexander’s Macedonian generals, who would go on to win an enormous kingdom stretching from Bulgaria to Afghanistan, introduced a new system for reckoning the passage of time. It is known, after him, as the Seleucid Era. This was the world’s first continuous and irreversible tally of counted years. It is the unheralded ancestor of every subsequent era system, including the Christian Anno Domini system, our own Common Era, the Jewish Era of Creation, the Islamic Hijra, the French Revolutionary Era, and so on… For the first time in history, historical time was marked by a number that never restarted, reversed or stopped… Most importantly, as a regularly increasing number, the Seleucid Era permitted an entirely new kind of predictability… to confidently and accurately conceive, name and hold in the imagination a date several years, decades or centuries into the future.’

So, no matter what else happened, the year and all that happened in it was stable -and traceable. Nowadays that may not seem so amazing, but if you think about it, the perception of time itself changes when that happens: ‘Every event must be chained to its place in time before it becomes an available object of historical articulation. And the modes by which we date the world, by which we apprehend historical duration and the passage of time, frame how we experience our present, conceive a future, remember the past, reconcile with impermanence, and make sense of a world far wider, older and more enduring than any of us.’

Of course that’s not to imply the ancients had no concept of travelling through time, but with only remembered time posts as a guide, it made the journey more fraught -more circumscribed. And for many, it must have seemed like they were confined in a room whose walls were events they may not themselves have witnessed. Kosmin quotes a paragraph written by the Norwegian author Karl Ove Knausgård about the introduction of numeric time that describes it nicely: ‘It was as if a wall had been removed in the room they inhabited. The world no longer enveloped them completely. There was suddenly an opening … Their glance no longer met any resistance, but swept on and on through more of the same.’ We take the view for granted.

I remember visiting my grandmother in her final days in hospital. She was approaching her 100th year, and becoming increasingly lost as she wandered along the ever winding trail she’d taken through time. It was often difficult for her to pin down the order of some things, and yet her memory of other details seemed impeccable.

She recounted tales about her early life I had never heard before, but at times they seemed metaphorical -believable only in translation. She meant well, but I suspect that because she found dates elusive, she was trying to compensate with word pictures, and comparisons to tell her story. And then, like pre-Seleucid times, she would necessarily tack her story to past events.

When, ‘Do you remember when…?’ didn’t work because the incident was well before my time, she would resort to things like ‘When your mother was a little girl…’ or ‘The year Joe and I got married…’. Then, with no need to worry about correction, she would recount her version of what had happened.

I found it a delightful, albeit opaque, excursion along her personal timeline, but one I could never even hope to verify without considerable effort. Her description of their journey across the country to the west coast on a ‘pioneer train’ as she called it, was a good example.

“Whenever the train would stop to pick up water for the engine,” she said, “ it was our signal for the men to jump off the cars and search for firewood…”

I remember her eyes twinkling at the memory. “There were stoves in each car for cooking, so while the men were away, the women would rummage around in their trunks for the rice and beans we were told to pack for the trip.”

I remember being surprised at them having stoves on a moving train -I come from a railway family, and I’d never heard of such a thing. “When did you travel across the country, grandma?” I remember asking her, thinking maybe she meant the train would stop long enough for people to cook at the station, or wherever.

Her eyes looked inward for a while -whether to remember, or relive the experience, it was difficult to tell. “I remember seeing soldiers wandering around on some of the platforms, so maybe it was during the war…” And she shrugged.

That didn’t sound right. “But grandma, soldiers would have been going to the east coast -to Montreal or Halifax -not west to Vancouver…”

Her eyes cleared for a moment and she sent them to reprimand my face for its expression, all the while shaking her head at my inability to follow her story. “The soldiers didn’t get on our train. They were waiting for the next one, G… Try to pay attention, eh?” she added and then sighed like the woman I used to visit when I was young.

I shrugged, embarrassed for doubting her. “So, I suppose that was early in the First World War,” I said, mostly to myself, I suppose. I was trying to establish a time frame that made sense to me -a picture that I could pass on to my own children about her life.

Her eyes, though, were the real storytellers, and at times they seemed impatient as they watched from their increasingly bony redoubt. “I don’t remember the year, G, but you asked me to describe our journey across the country; the year’s not as important as the story, is it?”

Then, she smiled at the scolding and the grandmother of my childhood returned briefly. “You have to open a book to see what’s in it -the cover it’s wrapped in is irrelevant…”

I think my grandmother would have done just fine without the encumbrance of the irreversible tally of counted years.

by

For my Pains, a World of Sighs

What does pain look like? An intriguing question to be sure, but one I hadn’t even thought to ask until recently. Pain is one of those things that, like St. Augustine’s quandary over Time, presents a similar difficulty in defining. The International Association for the Study of Pain made a stab at it: ‘Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage,’ but somehow, it seems to lack the immediacy of its subject matter –it stands, like an observer, outside the issue. Poets have done a better job, I think. Emily Dickinson, for example: After great pain, a formal feeling comes. The Nerves sit ceremonious, like tombs’; or Kahlil Gibran: ‘pain is the bitter potion by which the physician within you heals your sick self’; or even Oscar Wilde: ‘Pain, unlike Pleasure, wears no mask.’

But I was reminded of another of Wilde’s observations -‘We who live in prison, and in whose lives there is no event but sorrow, have to measure time by throbs of pain, and the record of bitter moments.’- when I read a CBC article from November, 2016 entitled ‘Indigenous children, stoic about their pain, are drawn out with art’ http://www.cbc.ca/news/health/aboriginal-youth-art-pain-hurt-healing-1.3852646

‘”Aboriginal children feel and experience pain just like anyone else. It’s just that they express their pain very differently,” said John Sylliboy, community research co-ordinator with the Aboriginal Children’s Hurt and Healing Initiative.

‘”They don’t necessarily verbalize their pain, or they don’t express it outwardly through crying or through pain grimaces,” he told CBC News.’

‘These children are socialized to be stoic about their pain, to hold in their pain.’- Margot Latimer, Centre for Pediatric Pain Research, IWK Health Centre in Halifax. ‘”We noticed we weren’t seeing any First Nations youth referred to our pain clinic at the IWK hospital and wondered why that was so.”‘ It didn’t make sense, she thought — especially since research shows that chronic illness in First Nations communities is almost three times higher than in the general population. Aboriginal children are especially vulnerable, says Latimer, with higher rates of dental pain, ear infections, and juvenile rheumatoid arthritis.’

I found it very moving, and yet disturbing, that ‘[…] cultural traditions, and lingering effects from the residential school system, are some of the reasons Indigenous kids pull on their suit of armour against pain and hurt.’ But they’re children, and perhaps not yet completely shackled to all the subtleties of culture. ‘A group of Indigenous children and teenagers from four First Nations communities in the Maritimes were asked to paint their pain, to express their hurt through art. Researchers were hoping to tease out emotions from a population more inclined to show resilience to pain.’ But soon after, the children began to depict not just physical pain, but emotional pain as well. As Sylliboy points out, ‘”These kids told us about loneliness, sadness, darkness, bullying, hopelessness. It’s not the typical anxiety [or] depression. It is more complex than that.” “To these clinicians who are just asking about physical pain and not looking at emotional pain as well, it is important, because Aboriginal kids are showing us that there is no difference between emotional and physical pain”, said Sylliboy. “It’s just pain.”‘

And I learned another thing about pain –or maybe about children – ‘It’s all about creating a safe space for the children when they come to the hospital, says Latimer.  She says it’s about learning a bit about them and gaining their trust. “When they come to the health centre, or a physician or a nurse practitioner, they want to tell their story, but we do not train health professionals to assess pain that way.”’

It reminded me of a patient I first met in the Emergency Department at the hospital when I was the gynaecologist on call one night. Edie, an aboriginal woman arrived with heavy bleeding –she was  apparently in the throes of miscarrying an early pregnancy- and had brought her eight year old son to the hospital because she had no one to take care of him at home. The bleeding settled shortly after her arrival and an ultrasound in the department revealed that there was no further tissue left in the uterus, so fortunately we didn’t have to take her to the operating room. But the process of diagnosis and decision was not instantaneous. Although the little boy, Timmy, was clearly frightened, his face stayed neutral. And yet it seemed as if he was peeking through hole in a fence, and I could see his eyes carefully following my every move. One of the nurses volunteered to sit with him in the waiting room while I examined his mother, but I was the last one he stared at before leaving; I was the thing he didn’t understand.

I decided to let Edie rest on the stretcher for a while before discharge, and I thought I’d reassure Timmy before I left. He was sitting on the too-big chair as quietly and unmoving as an adult and when I approached, he stared at me like a deer hiding in a forest.

“Your mom’s going to be okay, Timmy,” I said with a big smile.

But he still seemed just as frightened, and stayed silent for a moment. “There was blood on her pants,” he mumbled, perhaps making sure I’d noticed. He allowed his eyes to venture out further into the open and he examined me again. “And she was hurting…”

What do you tell a little boy about his mother’s suffering? I knelt down on one knee in front of him so our eyes were on the same level and put a hand on his knee. I couldn’t  think of anything else to do. “She’s not hurting now, Timmy,” I said and smiled again.

He looked at my hand and then he finally smiled. “Can she go home now?” When I nodded, he reached out and carefully touched one of my fingers, and then when I didn’t pull away, he patted my hand.

I never saw little Timmy again, but a few weeks later, Edie came to my office for a follow-up visit and to thank me for seeing her in the hospital in the middle of the night. “Timmy was really impressed,” she said and smiled. She ruffled through her purse and brought out a rumpled piece of paper she’d nonetheless folded carefully. “He drew this for you, doctor,” she said proudly, and handed it to me.

When I opened it up, it was a drawing of a hand in red crayon.

“He said it was to thank you…” She seemed embarrassed, and hesitated before continuing. “I asked him why he drew it in red…” she said.

She still seemed embarrassed, so I stayed silent until she felt ready to continue.

Edie studied me for a moment with her big brown eyes, still uncertain. Then her face relaxed and a big smile appeared. “He said maybe you were one of us, now…”

I could have cried.

by

Grapple them unto thy soul with hoops of steel.

What is a friend? I think I could parallel St. Augustine’s answer about Time: ‘What then is time? If no one asks me, I know what it is. If I wish to explain it to him who asks, I do not know.’ Friendship is such a universal concept, such an acknowledged need, I’m not sure why it is difficult to define. Perhaps it is so much a part of our Umwelt that the only aspect of it that becomes consciously discernible is its absence. It is our air…

But of late, it seems to me that its meaning has been further eroded, further diluted, by its use in social media. It is now a verb as well as a noun –all well and good if we are willing to enrol people as friends much as we might solicit them to join a political party, or consider anybody that smiles at us as worthy of the designation.

Obviously, friendship is a spectrum and simply because we use the same word to designate the entire range does not reveal much about the meaning or the importance of its constituents to us. In a sense, if used generically and without a more descriptive adjective, the word is an empty shell –‘Full of sound and fury, signifying nothing’ as Macbeth said of Life. And that life is actually not so full of friends -‘Which the poor heart would fain deny and dare not.’ to quote Macbeth out of context once again. We do not have as many friends as we think –nor is it even possible to sustain the emotional effort necessary to acquire and succour more than five, or so, close friends. http://nyti.ms/2baJQPL

So, I suspect we should be careful how we use the term and in what context –for what purpose. The number of ‘friends’ we think we have are akin to the denominator of a fraction. It’s the numerator –the number of close friends- that determine the size. The value… I would have thought this was so obvious as to be almost trite. Uninteresting. But maybe the idea that a friend is someone requiring at the very least, an ongoing personal, non-virtual, interaction is a generational thing. Am I just having a semantic argument with myself; am I merely a Cassandra unable to understand that it is only my opinion that is being contested, and that its tenets have already been superseded? Food for thought…

And yet, there are consequences. Sometimes it is best to check in the rear-view mirror from time to time.

*

I’ve always liked Jennifer. She is a twenty-something year old woman I have known for several years now. I first met her because of a minor abnormality of her pap smear, and have seen her every year or so since then. I think she sits in the same place in the waiting room each time, too; I always associate her with the seat in the corner by the window –the one partially hidden by the Areca palm. She’s a small person, and her never-varying outfit of jeans and sweatshirt seem to blend beautifully with the green of the plant. Even her dark, shoulder-length hair sometimes resembles the type of shadow I imagine the plant would cast if it could… I don’t know why I think that; maybe because they’re both quiet. Both still. Both background.

The other day when I saw her in her usual spot, she was typing away furiously on her cell phone. She looked on edge, and the troubled expression did not disappear even when she saw me smile and walk across the carpet to greet her.

There’s often an easy-to-spot anxiety in some patients –the kind I usually can’t hide when the dentist ushers me into his chair- but I knew Jennifer, and the referral note just said she was back for a repeat pap smear.

“You look worried today, Jennifer,” I said when we were both seated in my office. “Are you concerned about the pap smear?”

She’d put the phone in her pocket and was staring absently at a terra cotta woman sitting on an oak stand with her begging bowl. I’d had it there for years, so Jennifer had certainly seen it before. She shook her head, but left her eyes gently stroking its contours. “She always makes me relax… I’m glad she’s still here.” I could see her trying to disguise a sigh. “It’s nice that some things stay the same…” She was quiet for a moment as she thought about it. “…Stay the way they’re supposed to be,” she added to herself as she moved her eyes slowly over to my desk like sleeping birds and left them lying there. They didn’t see me, I don’t think.

I waited for her to continue, but she merely repositioned her attention onto her lap. “What do you mean?” I asked, when it became clear that she needed to talk about it.

Up flew the eyes to the box of tissues on the desk and she grabbed a handful to wipe away some tears. “It’s nothing about my pap smears,” she said in a hoarse voice. “I don’t need to take up your time…”

“The pap smear talk can wait for a bit, Jennifer. Tell me what’s upsetting you.” I smiled reassuringly, but her eyes never reached my face.

She took a deep and stertorous breath and then decided to send them on a reconnaissance flight in my direction. “Oh, it’s just my ‘friends’,” she said, making sure I understood that there were quote marks around the word. “I invited all 147 of them to like a business website that I’m starting…”

I have to admit that I was a bit confused. “Like? As in Facebook ‘like’ you mean?” I had no idea what message that sent. A friend had once asked me to ‘like’ her barbershop on Facebook and I had duly complied –it seemed simple enough… and if it made her feel good, what the heck, eh?

She nodded, although I could tell by her face that perhaps I shouldn’t have needed to clarify such an obvious point.

“And…?”

She took a deep breath and shrugged. “And, well I guess I don’t really have 147 friends.”

I didn’t ask her how she knew -I figured that was probably obvious, too. But I must have looked surprised, because she giggled at the notion. “I mean I didn’t really think they’d all like the page, but…”

I had to chuckle –I couldn’t help myself. “I don’t even know that many people, Jennifer. I mean not counting patients…” I quickly corrected, as her face interrogated me in disbelief.

“How many friends do you have on Facebook, doctor?”

I shrugged. “I don’t know… I mean, counting my kids and a few close friends… twenty, maybe…?”

She thought about that for a few seconds. “I don’t know how I got so many.” She glanced at the statue again. “Sort of like collecting tee shirts, I guess. They look so nice in the store, but I hardly ever wear them.”

A thought suddenly occurred to me. “Do you know how many ‘liked’ your… uhmm, page?” I tried to sound knowledgeable about the words, but to tell the truth, I was on slippery ground and I think it showed.

She caught her eyes, before they completed a roll and managed to salvage a serviceable smile out of what I’m sure was headed for a smirk. Then her eyes twinkled without her planning on it, and she giggled with delight at my expression. “Only seven, so far…”

It was my turn to nod, and I sat back in my chair as I did so. “Well maybe you come out the winner, then…”

She tilted her head, as cute as a button, and I could see the adult stirring behind the mirror of her eyes.

“Now you know what ‘friend’ really means…” I said, smiling.

Her eyes hovered around my face for a moment before they returned to their owner, and I think she blushed.