All over the world people like Dr. Pfau are fulfilling Christ’s command to fill the earth with God’s visible presence. They do so by exhibiting the properties of skin in the Body: beauty, sensitivity to needs, and the steady, fearless application of divine love through human touch.
Chapter Ten
BONE
A Necessary Frame
THE DANISH SETTING was worthy of a horror movie. Each morning I passed through a dark, narrow corridor and mounted creaking stairs that led to an ancient attic. There I found rows of boxes, layered with dust, filled with the moldering remains of six hundred skeletons. The rest of the day I hunkered over those boxes in the dimly lit room, sorting through bones. In all, I spent seven days crouched in the attic of that musty, old house in Copenhagen.
Shakespeare wrote, “The good [that men do] is oft interred with their bones.” More than good is interred there. After a week I left that eerie place feeling as though I had watched a documentary on an ancient civilization. My only clues, tiny projections and furrows on the surfaces of bones exhumed from the dust of history, taught me much. Surfaces—skin, hair, and clothes, which consume so much human energy—had rotted away, leaving bones as the only mementos of those who had worn them.
The house served as a museum for Dr. Vilhelm Møller-Christensen, a medical historian, who invited me there because the skeletons had belonged to people with leprosy. After studying the bones, which he had discovered on an island off the coast of Denmark, Dr. Møller-Christensen wrote an extraordinary book on leprosy. Those of us who worked with the disease could hardly believe that he had learned so much without ever observing a living patient. All his insights came from poring over the five-hundred-year-old skeletons in his attic.
Picking over his clattery bones, much as a child rummages through a box of precious toys, Dr. Møller-Christensen would locate certain favorites and point out to me their features. “See this skeleton with missing front teeth,” he said. “It demonstrates that leprosy first attacks the body’s cooler parts.” Together we examined the bones of feet and hands, speculating on what injuries might have caused their deformities.
I once heard a lecture by anthropologist Margaret Mead, who asked the question, “What is the earliest sign of civilization?” She suggested several possible answers. “A clay pot? Iron? Tools? Agriculture?” No, she said. “This is the evidence of the earliest true civilization,” she declared as she held up a femur, a leg bone, that showed evidence of a healed fracture. Mead explained that the skeletal remains of competitive, savage societies never showed such signs of recovery. Clues of violence abound: ribs pierced by arrows, skulls crushed by clubs. But the healed femur shows that someone must have cared for the injured person—hunted on his behalf, brought him food, and served him at personal sacrifice.
Working alone in the attic one morning, I came across a large box of skeletons that showed such evidence of healing. I learned that Dr. Møller-Christensen had retrieved these particular bones from a monastery churchyard. An order of monks had ministered among leprosy patients, and now, half a millennium later, their compassion was manifest in the thin lines of healing where infected bone had cracked apart or eroded and then grown back together.
Hidden Strength
TV crime shows such as CSI celebrate the feats of forensic scientists, who unravel the clues hidden in bones. Experts can determine a skeleton’s age by how hard or ossified the cartilage has become. By age fifteen, the foot has fully formed, at twenty-five the collarbone has fused to the breastbone, and by age forty most of the seams in the skull have joined.
The bulky pelvis betrays the sex of the person who owned it. A broad and shallow pelvis with a smooth inner ring belongs to a woman, its oval opening precisely matching the size and shape that a baby’s head needs to squeeze through. A man has a more narrow, heart-shaped pelvis, formed of heavier bones. The thickness of a bone may reveal more. Discus throwers and weight lifters have the densest bones because an exercised bone collects more calcium for needed strength. A horseback rider leaves clues in the stress lines of leg bones and pelvis; a furniture mover will show the effects in hip and shoulder bones.
No one has yet devised a material as well-suited for the body’s needs. The only hard material in the body, bone possesses strength enough to support every other cell. Sometimes we press our bones together like a steel spring, as when a pole vaulter lands; other times we nearly pull a bone apart, as when lifting a heavy suitcase. In comparison, wood can withstand even less pulling tension and could not possibly bear the same compression forces. Steel, which can absorb both forces well, has three times the weight of bone and would limit us.
The economical body, using a weight-saving principle of architecture, hollows out this frame and fills the vacant space with a red blood cell factory that turns out seventeen million new cells in the time it takes to read this sentence. Bone sheathes life.
I find bone’s design most impressive in the small, jewel-like chips of ivory in the foot. Twenty-six bones line up in each foot, about the same number as in a hand. Over the course of a match, a soccer player may subject these small bones to a cumulative force of a thousand tons. Not all of us leap and kick, but we do walk—on average, some sixty-five thousand miles, or more than two-and-a-half times around the world, in a lifetime. Reliable bone serves us without fanfare and grabs our attention only when we encounter a rude, fracturing force that exceeds its high tolerance.
Much of our planet’s sedimentary rock consists of microscopic creatures that died, their skeletons cemented together to form rock. The ocean is a hungry place, and marine skeletons serve as much for protection as for movement. For mollusks, scallops, nautiluses, crabs, lobsters, and starfish, an external skeleton provides a suit of armor. The vast insect world also retains external skeletons, but these land-based species have size limits lest the burden of armor becomes insupportable.
On land, more subject to the incessant tug of gravity, movement is key to survival. The fastest rabbit evades the coyote, and the fleetest African cat dines on gazelle. An internal, living skeleton makes a dramatic improvement. An animal no longer needs to outgrow its home and risk a vulnerable molting period; rather, the skeleton now grows with the animal. And the design of muscles and ligaments attached to an internal scaffolding of bone allows heretofore unthinkable feats of movement.
Only with an internal skeleton can an animal the size of a condor support a ten-foot wingspan and soar on thermals for hours, or an elephant charge like thunder across the Serengeti, or a bull elk hoist his rack of antlers proudly toward the sky. Boneless locomotion tends to revert to the most primitive: the segmented scrunching of an earthworm or the lubricated slide of a slug.
Bones do not burden us; they free us.
The Feature of Hardness
Although no babies are born without bones, some inherit a genetic disorder called brittle bone disease. Their bones consist of deposits of calcium without the organic material of collagen that welds them together—the grit without the glue. A baby with this disorder may survive the pressures of birth, but with half its bones broken. Just diapering such a child may fracture a fragile hip or femur; a fall could break dozens of bones.
At our Carville hospital a patient taking steroids for treatment of her leprosy developed soft bones. She could break her foot bones by walking too briskly. Whenever I checked her x-rays for fractures, I was reminded that the most important feature of bone is its hardness. That property distinguishes it from all other tissue, and without it, bone is virtually useless.
Inside a spiritual Body, too, lives a core of truth that never changes: the frame supporting our relationships to God and to other people. Our age smiles kindly on musings about unity and diversity and sensitivity. We highlight other parts of the body—the heart on Valentine’s Day, the face and skin in magazines and fashion, the hands in sculptures—and relegate the skeleton to Halloween, a spooky remnant of the past. I believe the quality of hardness deserves another look.
; In some areas of my life I gladly accept restrictive rules. For instance, traffic laws inhibit my freedom—What if I don’t want to stop at a red light?—yet I accept the inconvenience. I assume that some skilled engineers planned out the need for stoplights, and I prefer traffic laws to vehicular anarchy. Still, something within us rebels against the notion that someone else has determined how we should live.
In recent years, the democratic societies of the West have been enlarging the boundaries of acceptable behavior. The hookup culture recast sex, not as an expression of personal intimacy but as a way to experiment with multiple partners. Rock stars and college professors alike began advocating the use of hallucinogenic drugs. Pornography came out of the closet and grew into a multibillion-dollar industry. Binge-drinking swept across college campuses. Gender became fluid, more social construction than biology.
Those who opposed the new trends all too often came across as finger-wagging spoilsports. As it turned out, however, the traditions were right about many of those issues, at least in terms of their effect on physical health. The sexual revolution fostered the spread of venereal diseases, HIV/AIDS, and numerous other health problems. Now secular activists and public health officials are warning of the dangers associated with unprotected sex, binge-drinking, and drug use.
I once attended a conference that convened government agencies involved in health matters, including the Public Health Service, the Centers for Disease Control, the National Institutes of Health, and the Food and Drug Administration. Together, we set the goal of identifying the top ten health issues facing the United States.
I began jotting down the health concerns being discussed. It occurred to me that almost all of the primary health issues were lifestyle-related: heart disease and hypertension connected to stress; cancers associated with a toxic environment; AIDS contracted through drug use and sexual activity; sexually transmitted diseases; emphysema and lung cancer caused by cigarette smoking; fetal damage resulting from maternal alcohol and drug abuse; diabetes and other diet-related disorders; violent crime and automobile accidents involving alcohol or drugs. These were the endemic, even pandemic, concerns for health experts in the United States, and with the increase in opioid addiction and obesity the trend has only accelerated. Studies show that two-thirds of deaths prior to age sixty-five can be traced to behavioral choices.
I had attended comparable medical conferences in India, and the difference was striking. There, infectious diseases dominated the list of health concerns: malaria, polio, dysentery, tuberculosis, typhoid fever, leprosy. If I had suggested to Indian health experts the possibility of eradicating their top ten diseases, they could hardly imagine such a paradise. Yet look what has happened here. After conquering most of those infectious diseases, the United States has substituted new health problems for old, the majority of them stemming from lifestyle choices.
We have learned that what seems attractive and alluring may in fact prove damaging, and that some guidelines on behavior exist for our own good. As one researcher concluded, “In essence the studies empirically verify the wisdom of the book of Proverbs. Those who follow biblical values live longer, enjoy life more, and are less diseased.” The state God desires for us, shalom, results in a person fully alive, functioning optimally to the Designer’s specifications.
Restraints That Free
He came to me as a patient in England: a burly Welshman who spoke with a workman’s vocabulary. “Mornin’, doctor,” he growled. As he removed his wool, plaid jacket, I saw the reason for his appointment. The upper part of his right arm was not pink skin but grimy steel and leather—an awkward, brace-like contraption coated with black coal dust. I removed the brace, expecting to find evidence of a mining accident, and the puzzle deepened. His intact forearm led to a long section of flaccid flesh from elbow to shoulder. A section of bone appeared to be wholly missing.
After I studied the miner’s records and x-rayed his arm, the answer fell into place. Years before, a bone tumor in his upper arm had led to a serious fracture, which splintered large pieces of bone. His doctor had deftly removed an eight-inch pipe of living bone and sewed back the tissue and skin around the space. As the miner lay recovering, his boneless upper arm seemed perfectly normal on the outside. Who would know the interior landscape had changed?
Everyone would know, the first moment this miner used the muscles still attached to remaining bone. Muscles work on a triangle principle, with a joint providing the fulcrum. To raise the hand, for example, the biceps muscle attached to the upper arm pulls up on the forearm. The arm bends at the elbow, completing the triangle. One muscle and one forearm bone do not make a triangle, however, and this coal miner lacked the third element, the humerus bone of the upper arm.
After his surgery, whenever the miner flexed his biceps muscle his entire upper arm shortened like a caterpillar contracting toward its middle. The space that should have housed a fixed bone between elbow and shoulder had become soft and collapsible, canceling out the triangle that would transfer force to his forearm. To compensate, the inventive Welsh doctor had fitted the miner with a crude exoskeleton, the leather and steel contraption. Now, when his biceps muscle contracted, these steel rods prevented his upper arm from shortening, thus allowing his forearm to lift upward.
I, too, have surgically removed humerus bones, though now we avoid the awkwardness of an external skeleton by inserting titanium or a bone graft into the vacant space. Nevertheless, this man’s crude external brace had served him well for years, allowing him to work as a miner. He came to me asking for a new bone mainly because he had grown tired of having to buckle on his exoskeleton every day.
Because of its hardness, and susceptibility to fracture, bone can be seen as a constraint on human activity. It does, after all, keep us from squeezing into small spaces and from sleeping comfortably on hard ground. And what limits winter Olympians from adding twenty meters onto the graceful ski jump and keeps the slalom course in the domain of a few experts? The threat of broken bones. A person who breaks a leg in winter sports might wish for stronger bones, but stronger bones would be thicker and heavier, making skiing far more limited or impossible.
No, the 206 lengths of calcium that frame our body free rather than restrict us. Just as the Welsh miner’s arm needed a proper scaffolding, whether external or internal, our ability to move effectively depends on bone—rigid, inflexible bone.
A Dependable Skeleton
I see a close parallel in the spiritual Body, where rules governing behavior function much like dependable bones. Moral law, the Ten Commandments, obedience—a “thou shalt not” negativism taints the words, and we tend to view them as opposites to freedom. As a young Christian, I cringed at such words. Later, though, especially after I became a father, I gave thought to the very nature of law.
I now see God’s rules governing human behavior as guidelines intended to help us live the very best, most fulfilling life on earth. Rules may prove as liberating in social activity as bones are in physical activity.
Consider, for example, the Ten Commandments. The first four of those commandments set out rules governing a person’s relationship to God: Have no other gods before me. Don’t worship idols. Don’t misuse my name. Remember the day set aside to worship me. As I contemplate these once-forbidding commands, more and more they sound like positive affirmations.
What if God had stated the same principles this way?
I love you so much that I will give you myself, the only God you will ever need.
I desire a direct relationship with you. Representations are inferior. You can have me.
You will be known as “God’s people” on the earth. Value the privilege; don’t misuse it by profaning your new name or by not living up to it.
I have given you a beautiful world to work in, play in, and enjoy. As you do so, set aside a day to remember where it came from. Your body needs the rest; your spirit needs the reminder.
The next six commandments govern personal relationships. On
e is already stated positively: honor your father and mother, a near-universal principle of family loyalty. The next five can be worded as follows:
Human life is sacred, for human beings express my own image. You must honor the sanctity of life.
Marriage can cure the essential loneliness in the human heart. Reserve physical intimacy for its rightful place within marriage lest you devalue and destroy that relationship.
I am granting you a great privilege: the ownership of property. Stealing violates that right.
I am a God of truth. A lie destroys contracts and promises, and undermines trust. You are worthy of trust: express it by not lying.
I have given you good things to enjoy: cattle, grains, gold, music. Love people; use things. Do not use people for your love of things.
Restated positively, the commandments emerge as a basic skeleton of trust that links our relationship with God and with other people. By following them, we express something of God’s image in us. God has given laws as the guide to the best life, whereas our innate rebellion tempts us to believe that God’s laws are restricting us from something better.
Higher Law
Yes, one might reply, perhaps the Ten Commandments can be manipulated with a positive spin. Why, then, didn’t God state them that way? Why say, “You shall not murder. You shall not commit adultery. You shall not steal”?
I suggest two answers. First, a negative command actually proves less limiting than a positive one. “You may eat from any tree of the garden except one” allows more freedom than “You must eat from every tree of the garden, starting with the one in the northwest corner and working along the outer edge of the orchard.” “You shall not commit adultery” is more freeing than “You must have sex with your spouse twice a week between the hours of nine and ten in the evening.” “Do not covet” is less restrictive than “I am hereby prescribing limits on ownership. Every person is entitled to one cow, one ox, and three gold rings.”
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