Fearfully and Wonderfully

  I was puzzled. “Were you afraid the operation would stop your breathing?” I asked.

  “No, no, you don’t understand,” she said with great excitement. “Now I can breathe for the first time in years and years. I can run up stairs! I feel like a teenager again. I can breathe!”

  Her condition became clear. That lump must have been growing slowly for fifteen years or more, gradually compressing her trachea, like a boa constrictor tightening its grip. The woman had adapted, at first by stopping frequently to catch her breath. It bothered her, but since she knew elderly people who became breathless and unable to climb stairs, she assumed she too had an aging heart. Over time she learned to walk very slowly and mount steps one at a time. In her eyes she had become prematurely old, and the hand tremors corroborated this doddery image of herself.

  Now, however, she could take great gulps of air and dash upstairs. Over fifteen years she had forgotten how good it felt to breathe deeply and freely. I was struck by the near-miraculous change in the posture, facial expression, and total attitude toward life of this woman with the retrosternal thyroid lump. Absolute ecstasy spread across her face as she swelled her chest and announced loudly, “I can breathe!”

  Spiritual Fuel

  Occasionally I try to savor the pleasure of God’s good gifts, like breathing, by imagining for a moment that I have lost them. I hold my breath and pretend my trachea is blocked. I sense the rising panic spreading throughout my body. I envision my red corpuscles turning blue. I hear a drumming in my head. Then suddenly I open my mouth and suck in a gulp of air. I blow out carbon dioxide and vapor and then distend my chest and let the air rush in. I feel a short burst of the relief and ecstasy experienced by the woman with thyrotoxicosis.

  The cells of my body need the fuel of oxygen to survive. Herbert Spencer expressed the scientific principle: whatever amount of power an organism expends in any form equals the power that was taken into it from without. The same principle holds true in the spiritual world. Christ’s Body needs breath, the inspiration of his Spirit. One epistle warns, “Do not quench the Spirit”—or “put out the Spirit’s fire,” as some versions have it (1 Thessalonians 5:19). We need the stream of life that comes from God, and only the Spirit can provide that.

  The Old Testament gives one striking example of spiritual renewal as performed by a Jewish official in the worldly government of Babylon. For Daniel, praying toward Jerusalem meant a public display of civil disobedience punishable by imprisonment or death. Disregarding the king’s edict, three times a day Daniel flung open his window and turned toward Jerusalem for his prayers. Surely when he did so, the reality of Babylon—the aroma of spices and produce from the bazaar, the strange language, the jumble of urban noise—blew in. Yet as Daniel prayed in the midst of that foreign culture, he also breathed in a kind of spiritual oxygen that reminded him of a different reality.

  Daniel’s practice of facing Jerusalem stemmed from a prayer articulated by Solomon at the dedication of the temple when he asked God to hear any call for help prayed toward the temple in Jerusalem. Jesus later discounted the notion that location mattered in worship (see his dialogue with a Samaritan woman in John 4), and most of us do not pray toward a geographical place. Still, the scene captures for me the concept of planting my feet firmly on earth while sighting along a line of spiritual direction. I need a time of day to orient myself, to bring heaven and earth together. In the midst of the clamor and tumult of this material world, I must find a place of quietness to listen to the still, small voice for guidance of my life.

  I too live in an alien culture that bombards me with false values of lust, pride, violence, selfishness, and materialism. To survive, I must pause to breathe in the power of the living God and consciously direct my mind to how God wants me to live. Spiritually, I cannot survive the foreign atmosphere of earth without live contact through the Spirit. Daniel looked out over the streets of Babylon, but his mind and soul were in Jerusalem. The astronauts walked in the cold, forbidding atmosphere of the moon only by carrying with them resources from another world to keep them alive. I need just that kind of daily reliance on the Spirit of God.

  Chapter Fifteen

  BODY in MOTION

  A FRAIL MAN with a more-than-prominent nose and a face seamed with wrinkles crosses the stage. His shoulders slump slightly and his eyes seem sunken and cloudy; he has, after all, passed his ninetieth birthday. He sits on a stark black bench, adjusting it slightly. After a deep breath, he raises his hands, which, trembling slightly, hang poised for a moment above a black and white keyboard. Then the music begins. All hints of age and frailty slip away from the minds of the four thousand people gathered to hear Arthur Rubinstein.

  He has chosen a simple program: Schubert’s Impromptus, several of Rachmaninoff’s Preludes, and Beethoven’s familiar Moonlight Sonata, any of which could be heard at a music school recital. They could not, however, be heard as played by Rubinstein. Defying mortality, he weds a flawless technique to a poetic style, producing music that provokes prolonged shouts of “Bravo!” from the wildly cheering audience. Rubinstein bows slightly, folds those marvelous nonagenarian hands, and pads offstage.

  A bravura performance such as Rubinstein’s engrosses my eyes as much as my ears. Hands are my profession, and I have studied them all my life. To me, a piano performance is a ballet of fingers, a glorious flourish of ligaments and joints, tendons, nerves, and muscles. I must sit near the stage to watch their movements.

  I know that some of the passages, such as the powerful arpeggios in Moonlight’s third movement, require responses too fast for the pianist to accomplish consciously. Nerve impulses do not travel fast enough for the brain to sort out that the third finger has just lifted in time to order the fourth finger to strike the next key. Months of practice pattern the brain to treat the motions as subconscious reflex actions—“finger memory” musicians call it.

  I marvel too at the slow, lilting passages. Rubinstein controls his fingers independently, so that when striking a two-handed chord of eight notes, each of the fingers exerts a slightly different pressure, with the melody note ringing loudest. A few grams more or less pressure in a crucial pianissimo passage has such a minuscule effect that only a sophisticated laboratory could measure it. The human ear contains just such a laboratory, and musicians like Rubinstein gain acclaim because discriminating listeners can savor those subtle nuances of control.

  Often I have stood before a group of medical students or surgeons to demonstrate the motion of one finger. I hold before them a dissected cadaver hand, almost obscene-looking when severed from the body and trailing strands of sinew. I announce that I will move the tip of the little finger. To do so, I must place the cadaver hand on a table and spend perhaps four minutes sorting through the intricate network of tissues. Finally, when I have arranged at least a dozen parts in the correct configuration, with care I can maneuver them so the little finger bends without buckling the proximal joints.

  In order to allow dexterity and slimness for actions such as piano playing, the finger contains no muscles; tendons transfer force from muscles in the forearm and palm. In all, seventy separate muscles contribute to hand movements.

  I could fill a bookcase with surgery manuals suggesting various ways to repair hands that have been injured. Indeed, I have written one myself: Clinical Mechanics of the Hand. Yet in forty years of study I have never read a technique that succeeds in improving a normal, healthy hand. Computer scientists have developed programs that can defeat grand masters at chess, but the most sophisticated robots cannot come close to duplicating the fluid motions of a four-year-old at play.

  I remember my lectures as I sit in concert halls watching slender fingers glissade across the keyboard. I revere the hand; Rubinstein took its function for granted. Often he closed his eyes or gazed straight ahead and did not even watch his hands. He was not thinking about his little finger, he was contemplating Beethoven and Rachmaninoff.

  Scores of other muscles lined up as
willing reinforcements for Rubinstein’s hands. His upper arms stayed tense, and his elbows bent at nearly a ninety-degree angle to match the keyboard height. Shoulder muscles rippling across his back contracted to hold his upper arms in place, and muscles in his neck and chest stabilized his shoulders. When he came to a particularly strenuous portion of music, his entire torso and his leg muscles went rigid, forming a firm base to allow the arms leverage. Without these anchoring muscles, Rubinstein would topple over every time he shifted forward to touch the keyboard.

  I have visited facilities that produce radioactive materials. With great pride, scientists show off their expensive machines that allow them to avoid exposure to radiation. By adjusting knobs and levers they can control an artificial hand whose wrist supinates and revolves. More advanced models even possess an opposable thumb, an advanced feature reserved for primates in nature. Smiling like a proud father, the scientist wiggles the mechanical thumb for me. I nod approvingly and compliment him. But he knows, as I do, that compared to a human thumb his atomic-age hand is clumsy and primitive, a child’s Play-Doh sculpture compared to a Michelangelo masterpiece. A Rubinstein concert proves that.

  Learning to Move

  Six hundred muscles, composing 40 percent of our weight (twice as much as bones), burn up much of our energy in order to produce motion. Tiny muscles govern the light permitted into the eye. Muscles barely an inch long allow for a spectrum of subtle expressions in the face—a bridge partner or a diplomat learns to read them as important signals. A much larger muscle, the diaphragm, controls coughing, breathing, sneezing, laughing, and sighing. Massive muscles in the buttocks and thighs equip the body for a lifetime of walking. Without muscles, bones would collapse in a heap, joints would slip apart, and movement would cease.

  Human muscles are divided into three types: smooth muscles control the automatic processes that rumble along without our conscious attention; striated muscles allow voluntary movements, such as piano-playing; and cardiac muscles are specialized enough to merit their own category. A hummingbird heart weighs a fraction of an ounce and beats eight hundred times a minute; a blue whale’s heart weighs half a ton, beats only ten times per minute, and can be heard two miles away. In contrast to either, the human heart seems dully functional, yet it does its job, beating 100,000 times a day with no time off for rest, to get most of us through seventy years or more.

  Muscles pack enough potential to allow the Bolshoi Ballet and the graceful sports of ice skating and gymnastics. On TV the performers seem models of weightless beauty, gliding through the air, pirouetting on a single toe, dismounting from a high bar with a light spring. Up close and in person, though, motion seems more like hard work. It is noisy there, all shocks and thuds and creaking boards and panting, sweating bodies. That humans can transform such strenuous activity into fluidity and grace testifies to the dual nature of motion: robust strength and masterful control.

  The movements of a Rubinstein or a Michael Jordan do not come cheaply. The motor cortex of the brain, on which will be written all the coding for intentional movement, starts out as blank as a washed chalkboard. An infant, dominated by gravity, cannot hold her head or trunk upright. Her hand and leg movements are abrupt and jerky, as in an old silent movie. She learns fast, however. In seven months, if all goes well, she will sit upright without support. A month later the infant can stand unassisted, but on average it takes seven more months for her to walk smoothly without consciously thinking of the action.

  For the toddler to stand, the muscles that oppose each other in hips, knees, and ankles must exert an equal and opposite tension, stabilizing the joints and preventing them from folding up. “Muscle tone” describes the complex set of interactions that keeps all the infant’s muscles in a mild state of contraction, making her erect posture as active and strenuous as the movements that follow it. The toddler’s body crackles with millions of messages informing her brain of changing conditions and giving directions to perform the extraordinary feat of walking.

  The brain stores our movements in a kind of hard disk in the lower brain. Repeat an action often enough and it becomes a subconscious reflex so that, for example, I can walk without thinking about it. This act of delegation explains Rubinstein’s finger memory: the reflex response permits him to move his fingers faster than his higher brain could order them. It also explains the “waiter effect.” Experienced waiters or flight attendants will not allow you to pick up a heavy coffee thermos from the tray, or the reflex would cause the hand holding the tray to jerk upwards, spilling the tray’s other contents. On the other hand, they can lift the thermos without any danger of spilling, for the stored memory has learned to control the reflex. Predictability is the key. The same principle explains the tickling reflex: I cannot tickle myself because my own actions—though not someone else’s—are predictable, drawing from this stored memory.

  A Muscle Choir

  Muscle cells perform just one action: they contract. They can only pull, not push, as their molecules slide together like the teeth of two facing combs. Cells join together in strands called fibers, and the fibers report to a further hierarchy called a motor unit group.

  One motor nerve controls a motor unit group, wrapping itself around the muscle group as an octopus would encircle a pole. When that nerve gives a signal, all of its muscle fibers contract, becoming shorter and fatter. Muscles operate with an “all or none” principle. They have no throttle, rather a simple on-off switch. Strength varies, as when a pianist lightly taps a key or pounds it mightily, because of the number of motor units firing at any moment.

  Conductors of large choirs warn their singers not to take breaths at the end of a pianissimo measure since the sound of many singers inhaling would be audibly distracting. Rather, they should suck in air in the middle of a measure, staggering their breathing so that the choir continues singing while just a few members inhale at any given instant. Similarly, the motor nerve directs some of a weightlifter’s motor units to take a rest when needed, while the biceps’ overall strength stays steady.

  Rarely will all the motor units in a large muscle fire simultaneously. In an emergency, adrenaline may induce feats of great strength, called hysterical strength, such as a mother lifting a car off her child—perhaps then we galvanize all the motor units into simultaneous action.

  I have literally heard the muscle “choir” by inserting a needle into a muscle and attaching it to a machine that transforms electrical energy into sound. Click-click-click: a constant stream of messages reports the activity of muscle tone. Slowly flex the biceps, and the volley of clicks accelerates. Move the arm abruptly, and the clicks crescendo to machine-gun frequency. The cells never stop clicking, and they adjust instantly, in a fraction of a second, when the brain calls for sudden movement.

  As the meter records the stream of static flowing from just one muscle area the size of a needle point, hundreds of other muscles go undetected. A large and crucial group of them fire off whether or not we think about them: the automatic muscles controlling our eyelids, breathing, heartbeat, and digestion. The wise body does not trust our forgetful selves with these vital functions. So reliable are they that we cannot voluntarily stop our heartbeat or breathing. No one can commit suicide by holding their breath; accumulating carbon dioxide in the lungs will trigger a mechanism to override conscious desire and force the muscles of ribs, diaphragm, and lungs to move.

  Consider the electrical network linking every home and building in a city like Beijing or New York. At any given second lights switch on and off, toasters pop up, microwave ovens begin their digital countdowns, water pumps lurch into motion. A far more complex switching system is operating in your body at this second, and it performs harmoniously, much of it at a subconscious level. When you reach the end of this page, you will turn or swipe it with your fingers, only vaguely aware of the elaborate systems that work together to permit such an act.

  Balancing Act

  In the physical body, as well as the spiritual, a muscl
e must be exercised. If a person loses movement through paralysis, atrophy will set in and muscles will shrink away, absorbed by the rest of the body. Similarly, the corporate Body of human beings shows its health best by acting in love and service to others. When it ignores cries of pain and injustice, and fails to respond, it begins to waste away.

  As a Christian, I am struck by the disorderly way in which that particular Body moves. Study any century, and the history of the church then will include splits and divisions, heated debates about the role of social concern, and sadly excessive reactions. Because church history includes these spasms, we easily discount the effectiveness of the Body’s motion.

  As I look closer at the biology of motion, though, I can better grasp how seemingly disconnected spurts of energy can contribute to progress. In the human body every action has an equal and opposite reaction. Muscles pair up antagonistically so that when the triceps contracts the biceps relaxes, and vice versa. One of the pioneers of neurophysiology, Sir Charles Sherrington, demonstrated that all muscular activity involves inhibition as well as excitation. Every muscular sentence includes a clause with a balancing “but.”

  The knee-jerk reflex, which involves only two muscles, illustrates Sherrington’s principle. When a doctor taps a patient’s knee, muscles on the front of the thigh spring into action, excited. That response only occurs because muscles on the back of the thigh, which keep the knee bent, do not contract, an act of inhibition. The knee jerk relies on two equally powerful stimuli, one of which leads to action, the other to inaction. In complex movements, like walking or kicking a ball, hundreds of opposing reactions occur simultaneously. All muscular action follows this principle of give-and-take.