Temporal Mind

Free will becomes a more interesting concept the more you study neurology. How do you differentiate between the biochemical processes and architecture of the mechanics of thought and the spark that gives us life and light? How can you ascribe us complete freedom if any form of brain damage has the capacity to change, at its very root, who you are?

Take the mirror image diseases of Kluver-Bucy and Geschwind syndromes. A normal individual has full control over their engagement with the world. We decide what we think, how we think, and what we do. Or so we suppose. A Kluver-Bucy individual has had their amygdala damaged or removed on each side of the brain. They develop a placid manner, with a tendency towards hypersexuality and an oral fixation. It is bizarre, but this syndrome, typically caused organically by Herpes Simplex Encephalitis, literally domesticates independent human beings. They become disconnected, untied inside their own minds to the world of cause and effect, and willing to be pointed and directed, engaging only in base needs like eating, sleeping, and sex.

Geschwind syndrome is the opposite. Typically induced in epilepsy, Geschwind individuals display one of the most interesting diagnostic traits one might see, "Interpersonal stickiness." They lack the ability to read space in interpersonal relationships, developing theories of interconnectedness and unifying principles that bind them to anyone they meet. A Geschwind sufferer is typically hyposexual, extremely (and rapidly) religious, extremely verbose, and displays a pronounced tendency to write at extreme length about everything. It is a disease of over stimulus, a driven firing of the neurons of the Amygdala leading the individual to draw theories out of connections that only they can see.

This one portion of the brain, if over or understimulated, will drive your personality to opposite extremes. In a world of free will, how do you reconcile the ability of organic damage to make you into a docile sex slave or a hyperactive monk? I can't, at least not comfortably. It seems as though, when we function in that razor thin margin of acceptable, we make our own decisions. But that margin is a conceit we define ourselves. We are only ever a few chemical changes from being someone else, and to me, that is quite terrifying.

Icy Hot

In high school, a friend once took up a bet that he wouldn't slather icy hot over a most delicately indelicate region. He took the bet for money, a move made on the assumption that it wouldn't be that bad. Mere moments after slathering the viscous jelly on himself and he was clearly regretting his decision. His skin absorbed the active ingredients, menthol and methyl salicylate, and it was sending signals his brain interpreted as the damage of rapid freezing. His brain, convinced that he was somehow accidentally dipping his testicles in a vat of frozen water, was screaming at him that something was direly wrong.

The pain and temperature nervous system runs on different wiring than the rest. Temperature transmits more slowly to your brain, allowing a period of accommodation when changing one's climate. The nerves themselves lack the complicated mechanical apparatus of the somatic sensory, ending in uncomplicated open ports that merely change elements of biological function if the temperature becomes excessively high or low. The odd thing is that these sensors can also be triggered chemically.

The menthol and methyl salicylate of the icy hot had been absorbed by his skin, percolating into his system and encountering nerves dedicated to a purpose of discussing the weather. They bind to these nerves, triggering their activity, and sending a veritable tidal wave of information to the brain, all coded to mean the same thing: Cold. It is this mechanism that makes you feel the air cool when you take a cough drop (menthol), or burns the inside of your mouth when you eat a habanero pepper (capsaicin). For some reason we have an evolutionarily designed mechanism to interpret a chemical as hot or cold, to become sweaty when eating a burrito doused in hot sauce, or to feel a cool breeze merely by contacting menthol.

Perhaps it was a far sighted evolutionary attempt to teach my friend to exert better judgement.

Braincase

I've got the chisel and hammer in my gloved hands, fidgeting with each out of boredom. The anatomy lab is sparkling and nauseating as usual, the gleam of light off chrome given the lie by the pervasive smell of preservatives and sanitized death. We've been here so often by now that the disturbing juxtaposition no longer offends or impacts. The brain is a marvelous thing, adjusting us to our surroundings no matter how strange or unpleasant.

One of my partners holds the saw, the miraculous vibrating serrated edge that somehow can only cut tough material. Another is perched over Snake's head, scraping off those last tenacious bits of fascia from the top of the skull. We had removed the skin the day before, the sterile impersonation of a scalping done quickly and imperfectly, a casualty of dull scalpel blades. We have to remove the leftover soft bits so that the miracle saw can do its work, chopping swiftly and precisely through the skull, yet leaving the internal brain and dura intact.

The girl with the saw moves up to Snake's head, and turns it on. A high pitched buzzing fills the room, and as she lowers the saw to the skull, a small burst of bone dust and smoke plumes upward, bits of burning hydroxyapatite creating another odor in a nostril already at standing room only capacity. She moves awkwardly around the dome of the skull, creating a continuous separation. Now its my turn, and I move in with the hammer and chisel. I place the chisel in newly generated space in the bone, and use it to lever the skull upwards. There is a pop, and the bone falls off, a ragged skull cap in the most literal sense.

The brain is not yet exposed, still wrapped in a covering of thick fibrous tissue. In a live person, the skull would be full of fluid, a protective cushioning and gravity negating layer designed to protect an organ nearly devoid of strong structural components from its own weight. With Snake, there is barely any drainage as we section the dura, revealing at last the former seat of his personality. I take my chisel and i move it down the front of the skull, moving it in a lazy arc to rupture all the attachment points, where his cranial nerves used to tell his face who it was. I use the chisel to sever the brainstem, and with another liquid pop, the brain comes loose.

I reach a hand into a human skull, ignoring the unreal implications of my action, and pull out his brain, a cacophony of most unseemly squishing noises serving in lieu of a drumroll. I am holding the seat of a man's being in my hands, inspecting it incredulously, wondering how this situation just came to pass. The contents of my hand seem such a small thing to loom so large. I remove the falx cerebri from between the cerebral hemispheres, and toss it aside into the debris bin. We set the brain aside, leaving it afloat in its own bath of chemicals, waiting patiently for a neurology lab months away. Turning back to the empty skull, a dissected face staring at us with an empty grin, we dive right back in, searching for the cranial nerves in a space that once held a man's soul.

All the World's a Stage

He sits slumped in his chair, hair streaked with a gray that is almost dirty, a rime of age showing on a weathered head. His movements are erratic, jerky, as if he can't quite decide what he his telling himself to do. He is still wearing his sunglasses, but seems to have forgotten that, constantly reaching up to rub his eyes and starting in quick surprise. The red bulb of his nose gives away his alcoholism, an unfortunate beacon of failure and difficulty.

We ask him his name once, and after a brief pause, he informs us that he goes by the handle of Woody. He tells us a story then, about how he got the nickname because he used to love woodworking when he was younger, he used to make wooden chairs. We ask what brought him to the hospital, but all he will say is that he is sick. We ask him about his youth, his interestingly offbeat habit of carpentry, but he looks at us blankly, slight confusion in his eyes. We ask him his name again, and he looks directly at my badge before responding: "Tom."

He came in two weeks ago, having been picked up by the police for a drunk and disorderly. He was confused, and walking erratically even after the drunk wore off, so they brought him into the hospital. They hoped it was just Wernicke's Encephalopathy, a temporary condition brought on by an alcoholics tendency to substitute beer for bread, so they hooked him into a supply of vitamin B12. It didn't help. He has Korsakoff's Psychosis, a permanent damage to the titillatingly named mamillary bodies of the hypothalamus, the two round protuberances of the bottom of his brain. The damage is done by a long term lack of B12, a crucial compound for biological functions from energy metabolism to oxidative damage protection. He must have spent years trading his daily bread for booze, depleting his bodies stores of this crucial resource.

His disease has robbed him of himself, and of his future self. He has amnesia, anterograde and retrograde, forwards and backwards. Its a bad case. He doesn't know who he was, what he was. He wont remember this interview for long. It comes with confabulation, the remarkable ability to develop a semi-coherent story based on minimal cues. He became Woody based on the wooden chairs in the office (actually a molded wood-stain plastic, but who wanted to argue). He developed a whole story about his youth, based only on one visual cue. His life is bound eternally in the now, constantly redefined as he sees fit, according to a logic that no one will ever know.

We tell him his real name, and he responds like he has known that all along, glossing over the stories of the past few minutes as if they had never been uttered. Of course, to him, they hadn't.

Sweet Pee

The truck slams into the wall over and over again, grasped firmly in the hyperactive hands of an overly energetic six year old boy. His declarations of a monster in the room have driven the putative occupants of the truck mad with fear, and his attempts to lead them into safety end only in repetitive disaster. His mother brought him in years ago, referred by a pediatrician after an offhanded comment. It's how most of them come to the genetics clinic, always for the subtle things. The major things get caught at birth, as they are usually sort of hard to miss.

She had remarked that her infant's urine smelled sweet. Smelled like maple syrup. Thats not normal, she probably asked, assuming, like most new mothers, that the Doctor would reassure her. But they didn't reassure her. They sent her here. Her son has Maple Syrup Urine Disease, the aptly named syndrome describing an enzymatic failure leading the urine to reek of a thousand McGriddles. Her child is missing a functional copy of the less fortuitously (but equally aptly) named branched chain alpha keto-acid dehydrogenase complex, the enzyme allowing us to break down the amino acids leucine, isoleucine, and valine. Her son can't clear these compounds (readily found in most protein) from his body, so they build up, increasing quantities generating neurotoxicity, neurotoxicity causing brain damage. Unmonitored, a healthy diet will leave her son mentally damaged, a slowly developing crescendo of diminished function.

It is one of the classic metabolic disorders, trailing only phenylketonuria in commonality. We don't know how it was missed in the neonatal screen, but its a great development that they caught it as soon as they did. Her son will be normal, so long as he watches his diet, staying away from milk, meat, and eggs. We have to test his blood frequently, monitoring the buildup of these normally crucial building blocks. Its a wonder, at age six, that he doesn't hate these visits more, the cruel men and women in the white coats, controlling his life and sticking him with needles. His mother, on the other hand, looks to us for quiet reassurance. She is doing her job well, we tell her. She is giving her son the chances he needs.

It most be odd, I think, to dread the smell of pancakes.

Two Point Discrimination

We live in a bubble of interpretation, building a world around us piecemeal from the myriad of detective devices built into our frames. Information is recorded via physical or electrical media, interpreting pressure, chemicals, or light into coded patterns, messages which our brain instinctively interprets.

We feel the outside world via a series of pressure sensors. These sensors read vibrations and force, interpreting the combination into an understanding of texture and position. They combine with internal architecture, stretch receptors reporting the position of your joints. The brain synthesizes the feeling of pressure against your fingertips with the position of your muscles and bones, painting a picture by numbers of what it is you hold.

Your brain portrays the illusion of continuity, of a physical understanding of what you touch, and what is touching you. The distribution of nerves controls how precisely you can feel, allowing your fingers to read braille, while your legs can barely report more than contact. The phenomenon of sensory acuity is described by the phrase "two point discrimination." In the finger tips, you can feel two different points of contact at minute distances. In the back, the distance goes up to centimeters. I can hold two pens in my hand, touch them to your back at the same time, and your brain will report only one touch. The astonishing nature of this is not in your inability to discriminate, its in your brain's absolute conviction that there is only one pen. Even knowing full well that someone is holding two pens to your back, the only result is a cognitive dissonance between known and observed reality.

I marvel at this, the fact that your body and perception can so convincingly lie to you. It is very mystical in its implications, the idea that the physical, the body, cannot be trusted.

Snake

You spend a lot of time with your cadaver that first year of school. Which is weird, when you think about it. You build your day around anatomy lab, hours spent in a brightly lit room, reeking of formaldehyde. You huddle around this guy, a generous man who donated his body to the advancement of your knowledge, marveling at the structures inside, and tsk-tsking at his imperfections.

We named him (most groups do). It only seems right. You spend so much time with them, refer to them in so many ways. You explore their bodies in ways that nobody ever does, (or can without significant jail time) and a partner in that kind of intimacy deserves an appellation. His salient feature, his key identifier, was the giant chinese dragon tattoo on his right arm. Bright and colorful, the tattoo had survived the chemical fading of the rest of his skin, the forced de-vivification necessary to prevent decay. It stood there, immediately jumping out to us as we began the process of opening up the arms. He must have had it for years, we assumed, as it had sagged a bit from what must have been a once glorious presentation.

That first week we named him Snake. And when the time came, we kept the tattoo intact, keeping it with him in the the chrome case of preservatives. It would have been a shame to do anything else.