| Reflecting On Reality... Or Not Every Race Is Worth Winning |
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He knocked on the door. He was early and I asked him to wait in the waiting area. He paced back and forth. He knocked again. And again. All I could think of as I opened the door was Mr. Hare (The Mad Hatter, actually) from Alice in Wonderland singing: _option_option_option_option
I'm late; I'm late for a very important date. No time to say hello, good-bye, I'm late, I'm late, I'm late. I'm late and when I wave, I lose the time I save. My fuzzy ears and whiskers took me too much time to shave. I wish that I could fly. There's danger if I dare to stop and here's a reason why: I'm over-due; I'm in a rabbit stew. Can't even say good-bye. Hello, I'm late, I'm late, I'm late. "I'm Late," Lyrics, Disney's cartoon feature, "Alice in Wonderland." It was five minutes to our appointed time; the patient in the room was rising, and feeling "tza'ar ba'alei chaim" - the pain of an animal's pathos. I ushered Levi *(not his real name) into my office. Levi was in a car accident six years ago, when he was 20 and an Ilui - a brilliant Talmudic student at a Chassidic yeshiva. He went out for a break in the beautiful Jerusalem winter sunshine and the next thing anyone knew he was on the ground, not breathing. He showed no physical injuries, but by the time the ambulances came he had not been breathing for over 10 minutes. They revived him, but other major complications arose during his hospitalization (neither at Shaare Zedek nor Hadassah, the two main medical centers with first-class trauma care). Suffice it to say, he was left with severe physical and cognitive problems. Miraculously, and through very hard work and emunah, Levi today, is not the same person who was released from months of rehabilitation. Today he speaks, thinks, walks and does many other day-to-day behaviors we all take for granted, but he had to re-learn all that he "lost". Levi is back in yeshiva and works part-time, and if you saw him in Meah Shearim you would not see any differences between him and the thousands and other bachurim there. There are problems though, with his short-term memory. Whereas, he may not recall specifics of what we speak about, he does remember me - even after relatively long absences. Here he was though; very agitated and exhibiting a disquiet that I had not seen in the eight months we have known each other. "I am late, have to leave today; I have to go to the airport." What seems to have occurred was that Levi's brother came to Israel for a visit and was returning home later that day. It was never in the plan that Levi would accompany him on this trip; it was clearly "wishful thinking" - or was it? Levi kept insisting that he was told that he was leaving today. "Do you have tickets?" I asked. He searched his pockets and asked his flat-mate who was present. No tickets. "I may not have tickets but I know I am supposed to leave soon for the airport. Maybe my brother has my tickets?" All of a sudden another idea was percolating in my head: "Phantom tickets"maybe "phantom self." "Phantom limb pain" has been recorded almost as long as people have been losing limbs and surviving. As we can see on the motor cortex of the brain, specific areas function to map out specific parts of the body. Losing a part of the body doesn't necessarily stop the cortex from continuing to "map" the missing part. While not all amputees will experience phantom limb pain, there is evidence to suggest that the majority will, at least initially, continue to perceive the body part as still being present in some form. In the late 1980s, Vilayanur S. Ramachandran, the neuroscientist who was born in India, educated in England and living and teaching in the United States, turned his attention to Behavioral Neurology. Ramachandran is best known for his work on neurological syndromes such as phantom limbs, specifically his invention of The Mirror Box. Previous attempts at eliminating the phantom pains involved surgery to remove another inch or two from the affected limb/stump or even cutting through the relevant nerve root emerging from the spinal cord. These methods are very rarely found to be effective and generally end up with a surgical "game- without-end" in a manner described by Ramachandran as "chasing the phantom." He describes in detail, the behavior of phantom limbs that might not necessarily hurt, but will gesture, itch, twitch or even try to pick things up. He also describes that some people's representations of their limbs don't actually match what they should be, for example, one patient reported that her phantom arm was about "six inches too short." In order to alleviate phantom limb pain, Ramachandran developed The Mirror Box, in which patients place their good limb and the amputated limb, and imagine making mirror symmetric movements. Due to the visual feedback, patients feel their limbs to be moving, which helps alleviate phantom limb pain. Recent neuroimaging studies suggest that this may be a result of reversing the remapping that leads to phantom limb pain. Sitting opposite Levi, I had an idea. Maybe I could use a variation of The Mirror Box to help him out. I asked him if he looked like his brother. He replied that he did. I asked if his voice and that of his brother's were similar. Again, he replied that they were. I took a mirror out of my bag and showed it to him. "Does the image in the mirror look like your brother?" I asked, "It does," he answered. I went on, "We both know how much you want to go home. We also know how much you and your brother look alike and sound alike. Could you now look at the reflection in the mirror and say: 'I have to rush today, because I am late to go to the airport? I am going home today.'" Levi asked, "Do you want me to say my brother's words in the mirror to me?" "Yes," I said enthusiastically. He did this a few times. It was hard for him to humor me, but he did do it. "You see," I said, "I think that your neshamah knows how much you want to go home and so it 'convinced' your brain that your brother's words were your words." At that moment his brother called from the plane to say goodbye. With tears rolling down his face he wished his brother a Nesiah Tovah (good journey). He left the office slowly; he was no longer in a rush. My heart ached for him as I thought that frequently, achieving reality isn't a race we wish to win. Bibliography: V.S. Ramachandran: Phantoms in the Brain; Oliver Sacks: The Man Who Mistook His Wife for a Hat.
Originally published in the Jewish Press on March 21, 2007. |
