Fearfully and Wonderfully

by Dr. Paul Brand

  Alexander Tsiaras, a professor at the Yale Department of Medicine, filmed a video of the fetal stages from conception to birth, using MRI techniques that earned the inventor a Nobel Prize. The video compresses nine months of growth and development into a nine-minute film and is available on YouTube. As the video of sped-up fetal development plays, this mathematician drops his objectivity, awed by a system “so perfectly organized it’s hard not to attribute divinity to it . . . the magic of the mechanisms inside each genetic structure saying exactly where that nerve cell should go.”

  One scene from the time-lapse video shows sixty thousand miles of capillaries and blood vessels taking shape where needed, following the genetic script built into a single cell. Aware of the intricate coding required to direct such a project, the programmer Tsiaras remarks,

  The complexity of the mathematical models of how these things are done is beyond human comprehension. Even though I am a mathematician, I look at this with marvel: How do these instruction sets not make mistakes as they build what is us? It’s a mystery, it’s magic, it’s divinity.

  A Child Is Born

  Finally, in the fullness of time a child is born. The umbilical cord stops pulsing and soon begins to shrivel. The drama of independent life is underway, and immediately the baby’s cells join together in a cooperative response to the new environment. The baby’s face recoils from the harsh lights and dry air; muscles limber up in jerky, awkward movements. Air rushes into lungs never before used, for oxygen filters through the lungs now, not the placenta. A team of bronchial passageways, diaphragm muscles, and all the other components of breathing must simultaneously lurch into motion.

  The baby, though free and independent, is still incapable of supporting its own life. Happily, the mother’s body has been readying itself for this new role since about age eleven. At puberty, a certain hormone present only in females begins to secrete at a gentle level. Today, in the body of every young woman millions of cells lie in wait, perusing the molecular structure of every hormone that happens by, much as one might scan one's email in search of an urgent call to action. All but a few of the body’s cells ignore the chemical. Breast cells listen. They multiply and enlarge to shape the symmetry of a mature breast and then wait, quiescent, until pregnancy calls them to active duty.

  The baby has no experience. It has never seen a breast and may, in fact, have never opened its eyes. Yet a baby instinctively knows what to do upon contact with a woman’s breast. The baby creates suction by closing its mouth over an area of compliant skin and then contracting its throat muscles, while also shutting off the glottis to avoid drowning in the fluid. Nutritionists study with amazement the remarkable broth of vitamins, nutrients, antibodies, and macrophages that compose mother’s milk. Oblivious, the baby knows only when and how to suck.

  Soon the marvel of cooperation will unfold within the growing infant, whose hormones regulate development. Some body parts double in size, some triple, and some enlarge to hundreds of times their original size. What handicaps would result if the kneecap grew 10 percent faster than the tendons, ligaments, and muscles surrounding it, or if the right leg grew slightly longer than the left? Each body part grows in proportion to supporting structures, supplied with lengthened blood vessels at every stage of growth. The body’s many parts work together in concert.

  One can hardly avoid words like miracle and marvel when speaking of childbirth. Yet the phenomenon occurs so commonly that seven billion proofs now live on this planet. Within that clay-colored package of cells lies the origin of the ecstasy of community. The infant’s life will include the joy of seeing his mother’s delight at his first clumsy words, the discovery of his own unique talents and gifts, the fulfillment of sharing with other humans. Though a product of many cells, he is one organism. All his forty trillion cells know that.

  Abbé Pierre and the Good Life

  I close my eyes and reflect on my life, sifting through memories to recall rare moments of intense pleasure and fulfillment. To my surprise, my mind passes by recollections of gourmet meals, vacations, and awards ceremonies. Instead, it settles on times when I have been able to work closely with a team in service to another human being.

  On occasion that teamwork has helped to improve sight, arrest the crippling effects of leprosy, or save a leg from amputation. Sometimes those acts involved stress and apparent sacrifice. I have performed surgeries outdoors in primitive situations on a portable table in 110 degree heat with an assistant beside me holding a flashlight. Yet those times of working together, when we focused all our concentration on the goal of helping another, glow with an unusual luster. I was privileged to experience the ecstasy of community.

  When Jesus described a fulfilling life, often his invitation sounded more like a warning than a sales pitch. “Count the cost,” he said, and invited his followers to take on a yoke of service and to wash others’ feet with a towel. While that attitude used to puzzle me, I now believe he was underscoring the need for individual cells to offer their resources in service to the whole Body. As Viktor Frankl wrote in Man’s Search for Meaning, “Being human always points, and is directed, to something or someone, other than oneself—be it a meaning to fulfill or another human being to encounter. The more one forgets himself—by giving himself to a cause to serve or another person to love—the more human he is.”

  Although a spiritual Body following the Head may involve sacrifice, I have learned that service also opens up levels of personal fulfillment far exceeding any others. We are called to self-denial, not for its own sake but for a compensation we can obtain in no other way. Contemporary culture exalts self-fulfillment, self-discovery, and autonomy. In contrast, Jesus taught that only in losing my life will I truly find it. Only by committing myself as a “living sacrifice” to the larger Body will I find my true reason for being.

  We sometimes think of sacrificial service with a self-focused sense of martyrdom. In fact, denying ourselves leads to a more abundant life. In the exchange, the advantage clearly rests on our side: crusty selfishness peels away to reveal the love of God expressed through our own hands, which in turn reshapes us into God’s own image.

  The value of service is better shown than told, and a powerful memory edges into my mind of an odd-looking Frenchman named Abbé Pierre. Unannounced, he showed up one day at the leprosy hospital at Vellore. A homely man with a big nose and a scraggly beard, he wore a simple monk’s habit and carried a single carpetbag containing everything he possessed. I invited him to stay at my home, and there he told me his story.

  Born into a noble family, as a teenager Pierre renounced his inheritance and gave away his possessions to charity. After becoming ordained as a Catholic priest, he served in the French Resistance, helping to rescue Jews from the Nazis. He spent a few terms in France’s parliament until he became disillusioned with the slow pace of political change. With Paris still reeling from the effects of war and Nazi occupation, thousands of homeless beggars lived in the streets.

  During one unusually harsh winter, many homeless Parisians froze to death. Pierre could not tolerate the endless debates by noblemen and politicians while so many street people starved outside. Failing to interest politicians in their plight, Abbé Pierre concluded he had only one recourse: to mobilize the beggars themselves.

  First, he taught them to do their tasks more efficiently. Instead of sporadically collecting bottles and rags, they organized into teams to scour the city. Next, he led them to build a warehouse from discarded bricks and to start a business in which they sorted vast amounts of used bottles from big hotels and businesses. Then Pierre inspired each beggar by giving him the responsibility to help another beggar poorer than himself. The project caught fire, and within a few years an organization called Emmaus was founded to expand Pierre’s work into other countries. The movement became known as “Abbé Pierre and the Ragpickers of Emmaus.”

  Now, he told me, after years of this work in Paris, there were no beggars left in that city. Pierre believed h
is organization was facing a serious crisis. “I must find somebody for my beggars to help!” he declared. That quest had brought him to Vellore.

  He concluded by describing his dilemma. “If I don’t find people worse off than my beggars, this movement could turn inward. They’ll become a powerful, rich organization and the whole spiritual impact will be lost. They’ll have no one to serve.” As we walked out of the house toward the student hostel to have lunch, my head was ringing with Abbé Pierre’s earnest plea for “somebody for my beggars to help!”

  We had a tradition among the medical students at Vellore about which I forewarned all guests. Lunchtime guests would stand and say a few words about who they were and why they had come. Like students everywhere, ours were lighthearted and ornery, and they had developed an unspoken three-minute tolerance rule. If any guest talked longer than three minutes, the students would stamp their feet and silence the speaker.

  On the day of Pierre’s visit, he stood and I introduced him to the group. I could see the Indian students eyeing him quizzically—this small man wearing a peculiar old habit. Pierre started speaking in French, and a colleague named Heinz and I strained to translate what he was saying. Neither of us was well-practiced in French, and we could only break in now and then with a summary sentence.

  Abbé Pierre began slowly but soon sped up, like an audio file playing too fast. I was on edge because I knew the students would soon shout down this great, humble man. Worse, I was failing miserably to translate his rapid-fire sentences. He had just visited the UN headquarters where he had listened to dignitaries use fine-sounding, flowery words to insult other countries. Pierre was saying that you don’t need language to express love, only to express hate. The language of love is what you do. He spoke even faster, gesticulating all the while, and Heinz and I looked at each other and shrugged helplessly.

  Three minutes passed, and I stepped back and looked around the room. No one moved. The students gazed at Pierre with piercing black eyes, their faces rapt. He went on and on, and no one interrupted. After twenty minutes Pierre sat down, and immediately the students burst into the most tremendous ovation I had ever heard in that hall.

  Completely mystified, I questioned the students afterward. “How did you understand? No one here speaks French.”

  One student answered me, “We did not need a language. We felt the presence of God and the presence of love.”

  Abbé Pierre had learned the discipline of loyal service that determines the Body’s health. He had come to India in search of people more needy than his former beggars. He found them, some five thousand miles from his home, among our leprosy patients, many of whom were of the Untouchable caste and worse off in every way than his followers in France. Some visitors shied away from our patients; Abbé Pierre embraced them.

  When he returned to Paris, the members of Emmaus worked with new energy, donating the proceeds to fund a ward at the hospital in Vellore. “No, no, it is you who have saved us,” Pierre told the grateful recipients of his gift in India. “We must serve or we die.”

  In a fundamental human paradox, the more we reach out beyond ourselves, the more we are enriched and the more we grow in likeness to God—the Father of all good gifts. On the other hand, the more a person “incurves,” to use Luther’s word, the less human he or she becomes. Our need to give of ourselves in service to the whole Body is as great as anyone’s need to receive.

  Chapter Seven

  SKIN

  The Organ of Sensitivity

  AS AN INTERN IN LONDON I had the great privilege of training under Dr. Gwynne Williams, a surgeon who emphasized the human side of medicine. He strolled through the halls of our poorly heated hospital with his right arm Napoleonically tucked inside his coat, which, unknown to his patients, concealed a hot water bottle.

  “You can’t rely on what patients tell you about their intestines,” Dr. Williams would admonish us interns. “Let their intestines talk to you.” The hot water bottle made his hand a better listener. He taught us to kneel by a patient’s bedside and gently slip a warm hand under the sheets onto the person’s belly. “If you stand,” he explained, “you’ll tend to feel only with the downward-pointing fingertips. If you kneel, your full hand rests flat against the abdomen. Don’t start moving it immediately. Just let it rest there.”

  We learned to anticipate a sudden tightening of the patient’s abdominal muscles, a protective reflex. A cold hand guaranteed that those muscles would remain taut, whereas a warm, comforting hand coaxed them to relax. We gently caressed the abdomen, earning tactile trust. Once the muscles had slackened, we could sense the organs’ movement in response to the simple act of breathing.

  Dr. Williams was right. A trained hand exploring the abdomen can detect inflammation and the shape of tumors that more complicated procedures merely confirm. Touch is my most precious diagnostic tool.

  Later, in India, I was asked on several occasions to examine female patients in Hindu or Muslim households that observed strict purdah. A woman would put her arm though a curtain and allow me to take her pulse; otherwise I could not see or touch any part of her body. From my four fingers resting on her wrist alone, I was expected to make a diagnosis. I felt handicapped, unable to listen directly to internal organs through my fingertips.

  Ever-Adapting Skin

  Every small patch of skin has a different degree of sensitivity, and scientists have mapped the nerves as meticulously as Google has mapped the world. The physiologist Maximilian von Frey measured the threshold of touch, the amount of weight it takes for a person to sense that an object has come in contact with the skin. The soles of the feet, thickened for a daily regimen of abuse, do not report in until a weight of 250 milligrams is applied. The back of the forearm is triggered by 33 mg of pressure, the back of the hand by 12 mg. The really sensitive areas are the fingertips (3 mg) and the tip of the tongue (2 mg).

  A wise mosquito will land on the forearm, not the sensitive hand, to go undetected. And only a foolhardy insect would attempt a stealth landing on soft lips.

  The degree of sensitivity fits the function of that body part. Our fingertips, tongues, and lips are the portions of the body used in activities that require the most sensitivity. However, all touch sensors seem sluggish compared to those in the cornea of the eye, transparent, deprived of blood and thus extremely vulnerable. The cornea fires off a response if just two-tenths of a milligram of pressure is applied.

  Moreover, the perception of touch changes constantly, based on context. A researcher lowers a 100 mg weight onto my forearm. Blindfolded, I realize that something is touching me. The sensation remains for four seconds, then fades. My brain now ignores the messages coming from nerve endings on my forearm, having decided there is no evident danger and no need to clog the circuits with useless information. I lose any awareness of the weight—that is, until the weight is removed, at which time my brain will draw attention to the change. Apart from this volume switch through which sensations pass, I could not wear wool or other coarse clothing; my body would incessantly remind me of its scratchy presence, and I could hardly concentrate on anything else.

  I experience skin’s adaptation whenever I lower myself into a hot bathtub. I run the water so hot that I can barely stand it and gradually lower my body, feeling at first as though I am easing myself into a bed of stinging nettles. Within ten seconds my skin adjusts, and the same water feels soothing and comfortable. I can continue raising the temperature of the water, and my body will adapt—up to a maximum point of 115°F, beyond which I will feel constant, nonadapting pain.

  Bioengineers use the word compliancy to describe a material’s capacity to mold to the shape of another surface, and skin exhibits this quality remarkably well. While trying to design shoes and tools for the insensitive feet and hands of leprosy patients, I have spent hundreds of hours studying the anatomy of living skin. Underneath the skin in the palm of the hand lie globules of fat with the look and consistency of tapioca pudding. So soft as to be almost flu
id, fat globules cannot hold their own shape, and so they are surrounded by interwoven fibrils of collagen, like balloons caught in a rope net. The cheeks and the buttocks have more fat and less collagen, as anyone who has struggled with a double chin or sagging figure knows. In areas of stress, such as on the palm of the hand, fat is tightly sheathed by fibrous tissue in a design resembling fine Belgian lace.

  I grasp a hammer in the palm of my hand. Each cluster of fat cells changes its shape in response to the pressure. It yields, yet cannot be pushed aside because of the firm collagen fibers around it. The resulting tissue, constantly shifting and quivering, becomes compliant, fitting its shape and its stress points to the precise shape of the handle of the hammer. Engineers nearly shout in awe when they analyze this amazing property, for they cannot design a material that so perfectly balances strength and pliability.

  If my skin tissue were tougher, I might insensitively crush a goblet of fine crystal as I hold it in my hand; if softer, it would not allow a firm grip. When my hand surrounds an object—a ripe tomato, a hiking pole, a kitten, another hand—the fat and collagen redistribute themselves and assume a shape to comply with the object being grasped. This response spreads the area of contact, which prevents localized spots of high pressure.

  In contrast, I have taken the hand of a human skeleton and wrapped it around a hammer. Against such a hard surface, the hammer handle will contact only about four pressure points. Without my compliant skin and its supporting tissues, those four pressure points would inflame and ulcerate after a few hammer blows. Because of compliancy, my entire skin-covered hand will absorb the impact.

  Compliancy, a word with special meaning to my engineering colleagues, is a meaningful word for both the physical body and the spiritual Body. Compliant tissues covering my bones assume the shape—awkward or smooth—of whatever I am grasping. I do not demand that the object fit the shape of my hand; my hand adapts, distributing the pressure. The art of Christian living, I believe, can be glimpsed in this concept of compliancy. As my shape moves into contact with other, foreign shapes, how does my skin respond? Whose personality adapts? Do I, as does my grasping hand, become square to those things that are square, round to those things that are round?