Fearfully and Wonderfully

by Dr. Paul Brand

  José, Reunited

  An encounter with a patient I’ll call José captures for me the importance of membership in the human body and what happens when damaged cells sever the body’s connections to the governing brain.

  José’s body had suffered much damage from leprosy by the time he traveled from Puerto Rico to our leprosy hospital in Louisiana for treatment. By then, research had proved that leprosy does its damage by affecting nerve cells, thus making patients vulnerable to injury. José’s insensitivity was so great that, when blindfolded, he could not even detect whether someone was holding his hand. Touch cells and pain cells had fallen silent. As a result, scars and ulcers covered his hands, face, and feet, bearing mute witness to the abuse his body had suffered because it lacked the warning system of pain. Mere stubs on his hands marked where fingers used to be.

  Since pain cells in his eyes no longer alerted him when to blink, José’s eyes gradually dried out. That condition, aggravated by severe cataracts and glaucoma, soon made him blind. My wife, Margaret, informed him that surgery might correct the cataract problem and restore some vision, but she could not operate until inflammation of the iris went away. Shortly after that, a terrible misfortune cut off José’s last link with the outside world. In a last-ditch attempt to arrest the sulfone-resistant leprosy, doctors tried treating him with a new drug, and José had a rare allergic reaction. In a final cruelty, he lost his hearing.

  At the age of forty-five, José lost contact with the outside world. He could not see another person, nor hear if someone spoke. Unlike Helen Keller, he could not even use tactile sign language because leprosy had dulled his sense of touch. Even his sense of smell disappeared as the leprosy bacilli invaded the lining of his nose. All his sensory inlets, except taste, were now blocked. Weeks passed and we watched, helpless, as José began to accept the reality of total isolation.

  José’s body responded with a pathetic mirroring of what was happening to his psyche: his limbs pulled inward toward his trunk and he spent his days curled into a fetal position on the bed. Unable to tell day from night, he would awake from sleep and forget where he was. When he spoke, he did not know if anyone heard or answered. Sometimes he would speak anyway, bellowing because he could not hear the volume, pouring out the inexpressible loneliness of a mind locked in solitary confinement.

  In such a state thoughts incurve, stirring up fears and suspicions. José’s body coiled tighter and tighter on the bed, preparing for death in the same posture as his birth. Most of us on the staff would pass his room, pause for a moment at the door, shake our heads, and continue walking. What could we do?

  Margaret faithfully visited José. Unwilling to watch him self-destruct, she felt she must attempt some kind of radical intervention to restore at least part of his sight. She waited anxiously for the infection in his eye to improve enough for her to schedule surgery.

  In order to follow government rules, Margaret faced a nearly insurmountable problem. She must obtain “informed consent” forms for the surgery, but who would sign for José? No one could penetrate through his isolation to ask him for permission. After painstaking research, the hospital staff finally located a sister in Puerto Rico, and the police department there visited her with a surgery release form. The illiterate sister marked an X on a paper, and Margaret scheduled surgery at last, with faint hope of success.

  José, of course, did not comprehend what was happening as he was moved to a stretcher and wheeled to the operating room. He lay passive throughout the eye surgery, feeling nothing. After a two-hour procedure, he was bandaged and sent back to his room to recover.

  Margaret removed the bandages a few days later, an experience she will never forget. Although José had sensed some gross movement and had probably reasoned someone was trying to help him, nothing prepared him for the result. He got the use of one eye back and could see again. As his eye struggled against the bright light and slowly brought into focus the medical people gathered around the bed, the face that had not smiled in months cracked into a huge, toothless grin.

  During that time of solitude, José’s brain had floated intact inside his skull, complete with memory, emotions, and instructions for directing his body. Suddenly human contact was restored. José made it known that he wanted his wheelchair parked at the door to his room all day long. He would sit there quietly, every few seconds glancing up and down the long corridors of the leprosarium. When he saw another person approaching, his face would break into that irrepressible smile.

  José insists on coming to our small church every Sunday, even though he can hear nothing of the service. With stubby fingers, he can barely grasp the control knob of his electric wheelchair, and his narrow tunnel vision causes him to bump into objects up and down the hospital corridors. Other attenders have learned to greet him by stooping down, putting their faces directly in front of his, and waving. José’s wonderful smile breaks out, and sometimes his bellowing laugh. Although he cannot see well, and still cannot hear or feel, somehow he can sense the fellowship of the church. He has rejoined the community, and for him that is enough.

  Chapter Four

  DIVERSITY

  The Richness of Life

  IN MY MEDICAL LABORATORY, one drawer contains neatly filed specimens of an array of cells from the adult human body. Lifeless, excised from the body, stained with dyes and mounted in epoxy, they don’t do justice to the churn of active cells inside me at this moment. Even so, when I parade them under the microscope some impressions about the body take shape.

  The cells’ diversity stands out first. Though they share a chemical makeup, the body’s cells are as different from each other as the animals in a zoo. Red blood cells, discs resembling Life Savers candies, have voyaged through my blood vessels bearing oxygen supplies for the other cells. The muscle cells that absorbed so much of that nourishment stretch out sleekly and supplely. Cartilage cells with shiny black nuclei look like bunches of black-eyed peas glued together.

  Fat cells seem lazy and leaden, resembling overstuffed white, plastic garbage bags. Cut in a cross section, bone brings to mind the rings of a tree, its cells overlapping to provide strength and solidity. In contrast, skin cells arrange themselves in undulating patterns of softness and texture, giving shape and beauty to our bodies. They curve and jut at unpredictable angles so that every person has a unique fingerprint—let alone a unique face.

  The aristocrats of the cellular world are dedicated to reproduction. A woman’s contribution, the egg, is one of the largest cells in the body, its ovoid shape just visible to the unaided eye. It seems fitting that all other cells in the body should derive from this simple, primordial design. Offsetting the egg’s quiet repose, the male’s sperm cells, tiny tadpoles with distended heads and skinny tails, compete for position as if aware that only one of billions will gain the honor of fertilization.

  The nerve cell, the one I have devoted much time to studying, has about it an aura of wisdom and complexity. Web-like, it extends to unite the body’s parts with an electrical network of dazzling sophistication. Its axons, organic “wires” that carry far-flung messages to and from the human brain, can reach a yard in length.

  I never tire of viewing these oddly varied specimens. Individually they seem humble, yet I know these hidden parts combine their efforts to give me the richness of life. Every second of every day my smooth muscle cells modulate the width of my blood vessels, gently push waste matter through my intestines, open and close the plumbing in my kidneys. When things are going well—my heart contracting rhythmically, my brain humming with input, my lymph bathing tired cells—I rarely give my loyal cells a passing thought.

  The Spice of Life

  I believe these diverse cells in my body can also teach me about larger organisms: families, groups, communities, villages, nations—and especially about the community that is likened to a body more than thirty times in the New Testament. I speak of that network of people scattered across the planet who have little in common other than their
membership in the Body that follows Jesus Christ.

  It seems safe to assume that God enjoys variety, and not merely at the cellular level. Not content with a thousand insect species, the Creator conjured up several hundred thousand species of beetles alone. In the famous speech at the end of the book of Job, God points with pride to such oddities of creation as the mountain goat, the wild ass, the ostrich, and the crocodile. The human species, made in God’s image, includes pygmies and Nubians, pale Scandinavians and swarthy Egyptians, big-boned Russians and petite Japanese.

  Humans have continued the diversification, grouping themselves according to distinct cultures. Consider the continent of Asia. In some countries women wear long pants and men wear skirts. In tropical Asia people drink hot tea and munch on blistering peppers to keep cool. Japanese prefer their ice cream fried and their fish raw. Westerners puzzle over the common Indian custom of marriages arranged by parents; many Indians gasp at anyone entrusting such a decision to fickle romantic love. And when the British introduced the violin to India a century ago, men started playing it while sitting on the floor, holding it between the shoulder and the sole of the foot. Why not?

  On my international travels I am struck by the world’s incredible diversity, and churches reflect that cultural self-expression. For too long they mimicked Western ways so that hymns, dress, architecture, and church names were the same around the world. Now indigenous churches are adapting their own expressions of worship. I must guard against picturing the spiritual Body as comprising only American or British cells; it is far grander and more luxuriant.

  African Americans in the Southern United States shout their praises to God. Believers in Austria intone them, accompanied by showpiece organs and illuminated by stained glass. Some Africans dance their praise, following the beat of a skilled drummer. Sedate Japanese Christians express their gratitude by creating objects of beauty. Indians point their hands upward, palms together, in the namaste greeting of respect, which has its origin in the Hindu concept, “I worship the god I see in you,” but gains new meaning as Christians use it to recognize the image of God in others.

  The church of Christ, like our own bodies, consists of individual, unlike cells that are knit together to form one Body.

  A Motley Crew

  Just as my body employs a bewildering zoo of cells, no one of which resembles the larger body, so the spiritual Body comprises an unlikely assortment of humans. Unlikely is the right word, for we are decidedly unlike one another and the One we follow.

  The first humans disobeyed the only command God gave them. Abraham, the leader God chose to head a new nation known as “God’s people,” tried to pawn off his wife, Sarah, on an unsuspecting Pharaoh. Sarah herself, when informed at the ripe old age of ninety-one that God was ready to deliver the promised son, broke into rasping laughter. The harlot Rahab became revered for her great faith. And Solomon, the wisest man who ever lived, proceeded to flout every proverb he had so astutely composed.

  After Jesus, the pattern continued. The two disciples who did most to spread the word after his departure, John and Peter, were the two he had rebuked most often for petty squabbling. The apostle Paul, who wrote more books than any other Bible writer, was chosen while kicking up dust whirls in search of Christians to torture. Jesus had nerve, entrusting the high-minded ideals of love and unity and fellowship to this group.

  Little wonder cynics have looked at the church and sighed, “If that group of people is supposed to represent God, I’ll decide against God.” Or, as Nietzsche put it, “His disciples will have to look more saved if I am to believe in their savior.”

  The church contains a collection of people as diverse as the cells in the human body. I think of the churches I have known: Is there another institution encompassing such a human mosaic? Young idealists wearing T-shirts and sporting tattoos share the pews with executives in suits. Bored teenagers tune out the sermon even as their eager grandparents turn up their hearing aids. Some members gather as methodically as a school of fish, then quickly disperse to return to their jobs and homes. Others migrate together like social amoebae and form intentional communities.

  During my life as a missionary surgeon in India and now as a member of the small chapel on the grounds of the leprosy hospital in Louisiana, I have seen my share of unlikely seekers after God. I must admit that most of my worship has taken place among people who do not share my tastes in music, sermons, or even thought. Still, over those years I have been profoundly—and humbly—impressed that I find God in the faces of my fellow worshipers, people who are shockingly different from each other and from me.

  C. S. Lewis recounts that when he first started going to church, he disliked the hymns, which he considered to be fifth-rate poems set to sixth-rate music. Then, he writes, “I realized that the hymns (which were just sixth-rate music) were, nevertheless, being sung with devotion and benefit by an old saint in elastic-side boots in the opposite pew, and then you realize that you aren’t fit to clean those boots. It gets you out of your solitary conceit.”

  A color on a canvas can be beautiful in itself. The artist excels, however, not by slathering a single color across the canvas but by positioning it between contrasting or complementary hues, so that the original color derives richness and depth from its surroundings.

  The basis for unity within any human community begins not with our similarity but with our diversity.

  Bodily Status

  In a leprosy patient, the millions of healthy cells in a hand or foot, or the watchful rod and cone cells in the eye, can be rendered useless due to the breakdown of a few nerve cells. Similarly, in sickle cell anemia or leukemia, the malfunction of a single type of cell can result in death. And if the cells assigned to keep kidney filters in repair fail, a person may soon die of toxic poisoning. These targeted diseases prove that the body needs each of its many members in order to thrive.

  In medical school I learned about crucial cells that make their entrance for one dramatic act, then disappear. Before birth, only a third of the fetus’s blood—the amount needed to nourish developing lung tissue—travels to the dormant lungs, since the fetus receives its oxygen through the placenta. A special blood vessel, the ductus arteriosus, shunts most of the blood to the rest of the body. Suddenly, at the very moment of birth, all the blood must take a new route through the lungs for oxygenation. The midwife or doctor waits anxiously for the baby to take its first breath.

  To accomplish this change, an amazing event occurs. A flap descends like a curtain, deflecting the blood flow back to the aorta. Over the next few days a customized muscle squeezes shut the ductus arteriosus. The muscle exists only for this essential act. If it fails to perform its designated task, the baby may die, apart from surgical intervention. If it succeeds, the heart permanently seals the ductus arteriosus and the body gradually absorbs it. On this little-known group of transitory cells, every human life depends.

  Appropriately, the Bible stresses this very quality, the worth of every member, in its imagery of the body. Listen to the mischievous way in which the apostle Paul presents the analogy in 1 Corinthians 12:

  Those parts of the body that seem to be weaker are indispensable, and the parts that we think are less honorable we treat with special honor. And the parts that are unpresentable are treated with special modesty, while our presentable parts need no special treatment. But God has put the body together, giving greater honor to the parts that lacked it, so that there should be no division in the body, but that its parts should have equal concern for each other. If one part suffers, every part suffers with it; if one part is honored, every part rejoices with it.

  Paul’s point is clear: the body needs every single member for its proper health and function. More, the less visible, “unpresentable” members—I think of organs like the pancreas, kidney, liver, and colon—may be the most valuable of all. Although I seldom feel consciously grateful for them, they perform vital tasks that keep me alive.

  I need this reminder becaus
e human societies tend to assign worth based on a hierarchy of value. For example, airlines reward highly trained pilots with fine salaries and fringe benefits. Within the corporate world, such symbols as titles, office size, and stock options signal the worth of any given employee. In the military, a sergeant salutes superior officers and gives orders to those of lower rank; the uniform and stripes alert everyone to the soldier’s relative status.

  Living in such a society, my vision gets clouded. I begin viewing janitors as having less personal worth than software developers. When that happens, I must turn back to the lesson from the body, which the apostle Paul spells out. Human society confers little status on janitors because their position is considered unskilled. The Body, however, recognizes that lowly janitor cells are indispensable to overall health. If you doubt that, ask someone who must go in for kidney dialysis three times per week.

  In my own field of medicine, I marvel at the valuable contributions of nursing aides, orderlies, and nurses, whose salaries are much lower than the physicians’ and administrators.’ Oliver Sacks writes of a time when these lesser-paid staff went on strike at his hospital and he organized medical students to fill in for the sake of the patients:

  We spent the next four hours turning patients, arranging their joints, and taking care of their toilet needs, at which point the two students were relieved by another pair of students. It was backbreaking, round-the-clock work, and it made us realize how hard the nurses and aides worked in their normal routine, but we managed to prevent skin breakdown or any other problems among the more than five hundred patients.