Conscious Living, Pain Included 3-21-12

Anderson, South Carolina

Research neurologists have some of the most interesting jobs in the world. They are able to study the most complex piece of machinery found in the universe – the central nervous system of Homo sapiens. Having been through the challenges of neurosciences and clinical neurology in medical school I had opportunity to learn firsthand of the astounding capabilities of this automated system, one requiring no oversight on our part. I think we would all agree we’d go nuts if we had to think about dilating our pupils when going into a dark room, of down shifting olfactory sensitivity upon entering a musty basement. Worse would be having to consciously shift blood flow to regulate core body temperature. Tormenting would be staying awake, remembering to draw our next breath. The list goes on endlessly. In First Year basic sciences we studied normal operating procedures for this neurologic wonder keeping us alive and happy. In Second Year we developed a staggering appreciation for this by observing catastrophic consequences arising when any of a hundred nervous system failures occur. British neurologist Oliver Sacks became a bestselling author of the highest order with his The Man Who Mistook His Wife for a Hat and The Anthropologist from Mars. He took many amazing literary journeys into the world of neurologic disease and the astounding ability of patients to adapt to their daunting deficits.

We’re so often obsessed with avoiding pain in all its forms, leading many of us to high levels of anxiety and addiction. The late Paul Brandt made huge contributions to the advancement of medicine in his lifework with patients suffering from leprosy. As an orthopedic surgeon working in India for forty years he developed amazing tendon grafting procedures, enabling patients to regain use of hands and feet destroyed by the progression of leprosy. He made the astounding discovering that the entire progression of leprosy and its hideous disfigurement derives from a single cause – the inability to feel pain. It became clear pain functions in ways we never dreamed of. When the organism causing leprosy takes up residence in nerve cells, cells lose the ability to transmit pain signals. With the absence of these signals, patients lose awareness of cuts, nicks, burns, strains, and accumulated insults to fingers, toes, ears, noses, ad infinitum. Resulting infection and trauma causes the erosion and loss of appendages. Brand went on to write a hauntingly beautiful book called Pain: The Gift Nobody Wants. I had the good fortune to meet him in a Medical Society meeting after his compelling lecture on the blessings of pain.

A fellow I met thirteen years ago is an accomplished musician and music therapist. This gentle soul has become one of Oliver Sacks wunderkind, overcoming massive neurologic deficits inflicted by the inexorable advance of Parkinson’s Disease. Parkinson’s involves the malfunction and death of vital nerve cells in the brain. Parkinson's primarily affects neurons in the substantia nigra, an automated center in the brain. Some of these dying neurons produce dopamine, a chemical sending messages to brain regions controlling movement and coordination. As PD progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally. Catastrophic consequences ensue. Steve lost the ability to play his flute. He also gained the ability to play his flute for the first time again. Listening to him play a couple of days ago I knew he had overcome. He discovered he could retrain his embouchure, utilizing the plastic adaptive nature of his remaining neurons. He also rode his bike 4,224 miles across the country with three climbs above 10,000 feet, solo with no support following him, pulling a hundred pounds of gear on a trailer. He is doing things most people have no conception of. In two weeks he is going to ride to the Pacific Ocean once again from Edisto Beach in South Carolina, traversing the Cascade Mountains – again solo with no support team. He’s taught me things I never learned in medical school.

In the post-war era there was an explosion of books on positive thinking. A run-away best seller for more than half a century was Norman Vincent Peale’s The Power of Positive Thinking. Its publication brought much criticism and some of Peale’s closest colleagues distanced themselves from him. Seven million copies and sixty years later, Peale appears to have had the last word. Countless other books have emulated Peale’s work. Much recovery literature dating from the late 1930s offers similar advice about ‘staying in solution’ rather than dwelling in problems. For the millions of people struggling daily with massive neurologic deficits or the extreme challenges of thousands of disorders we studied in Second Year General Pathology and Neuroscience, positive thinking, conscious thinking has been transformative.

A dear friend of mine has been diagnosed with Parkinson’s for five years. Her response has been to make daily journeys to the university swimming pool and to travel extensively. No one told Paula she could not climb pyramids with us all summer in torrid tropical heat. In the years since diagnosis, Paula has climbed just about everything the Mayans ever built and is slated to do it again this summer. She just returned this week from a sixty-day wandering in the Yucatan and Mexican Highlands, still making music every day.

What’s clear is Steve’s a musician, a long distance cyclist of the ilk of Lance Armstrong, a compassionate therapist, not a victim of Parkinson’s. As he states, “Steve has Parkinson’s, but Parkinson’s doesn’t have Steve.” I introduced Paula to Steve a couple days ago. I think the two will have a lot to share with each other. My guess is they won’t talk about Parkinson’s as much as tell stories about their most recent climbs to the summits of conscious living.

Those with leprosy, facing the emotional pain of disfigurement and social isolation learn to embrace pain as a blessing. Those with Sacks’ wide array of neurologic torments engage their pain with often miraculous results. Those with Parkinson’s learn to turn progressive shortcomings into transcendent experiences. As leprosy patients wish they could have, Steve and Paula embrace their pain. At the top of his climb to Loveland Pass at 11,990 feet, Steve’s pain and discouragement had fallen on the wayside. His Parkinson’s grimace gave way to the elation of conscious living – even with its pain. At the top of the steep climb up the pyramid known locally as el Templo de Las Manos Rojas in Yaxha, Guatemala, Paula had forgotten her limitations and pain. Her Parkinson’s grimace gave way to the elation of conscious living – even with its pain.

Thought in the mind hath made us. What we are
By thought we wrought and built. If a man's mind
Hath evil thoughts, pain comes on him as comes
The wheel the ox behind . . . If one endure in purity
of thought joy follows him as his own shadow - sure.

Cherish your visions. Cherish your ideals.
Cherish the music that stirs in your heart,
the beauty that forms in your mind,
the loveliness that drapes your purest thoughts,
for out of them will grow all delightful conditions,
all heavenly environment, of these,
if you but remain true to them your world will at last be built. - James Allen