The Most Feeble Thing

photo by Josh Scholten

Man is but a reed, the most feeble thing in nature, but he is a thinking reed.
Blaise Pascal

I’m not sure which is getting flabbier faster–my biceps or my brain.  As I advance in middle age I tend to avoid overworking both to just get by with only occasional heavy lifting:  a hay bale here, a challenging abstract philosophical commentary there.   Hard work, whether physical or mental, is getting harder.  As a naturally lazy person, I have to be forced into manual and central nervous system labor out of necessity.  Necessity happens less and less often unless I go looking for it.

Given the choice between a physical task and a thinking task, I’ll opt for thinking over lifting any day.  Even so, I find my mental strengths are ebbing.  My brain is less flexible, I can tend to be stiff headed when trying something new, it starts to feel strained if I push it too fast.   There are times when it feels like it just goes into spasm and I need to sit down and rub it for awhile.  Feeble suddenly doesn’t sound like it just belongs to the aged and infirm.

The only remedy is to use it or lose it, whether muscles or gray matter.   So I dig a little deeper each day, even when it hurts to do so.   I purposely stretch beyond the point of comfort, just so I know it can still be done.  I lift a little higher, heft a little heavier, push a little harder.  Being the most feeble thing in nature may mean being easily broken by the smallest effort, but at least I’ll have thought my reedy limitations through thoroughly, chewed on it until there was nothing left and digested what I could.

Eventually I’ll come to accept that my greatest strength is to know what I don’t know.

“I have come to think that if I had the mind, I have not the brain and nerves for a life of pure philosophy. A continued search among the abstract roots of things, a perpetual questioning of all that plain men take for granted, a chewing the cud for fifty years over inevitable ignorance and a constant frontier watch on the little tidy lighted conventional world of science and daily life–is this the best life for temperaments such as ours? Is it the way of health or even of sanity?” C. S. Lewis (in a letter to his father, Aug. 14, 1925)

Hitchhiking Right Out of the Classroom

His reputation was well known and all the medical students had heard the stories about Dr. Rosse. As the Anatomy Professor, his class would become the primary focus of student energy in the first year of medical school, with other classes seeming like so much background noise.

Dr. Rosse believed in active student participation in class, in the cadaver lab, on oral tests. He told us from the first day on: ” You will learn to THINK in this class like you’ve never thought before! Your patient’s lives depend on this. You will be prepared for my class each and every day, just as you must be prepared for whatever your patients will need from you.”

He was correct.

There were 110 of us in the lecture hall that first day, looking nervously at each other and at the empty podium down in front. We had been assigned three chapters in the anatomy textbook before Dr. Rosse’s first lecture and were expected to know the names of the bones and major blood vessels.

Dr. Rosse’s assignment for himself was to memorize our names and faces from a photo directory provided to him two days previously.

He began his lecture in the barely darkened room, running quickly through a carousel of slides of graphic photos and drawings of body parts. Within five minutes, he stopped and in his thick European accent, pointed at a student in the second row said: “Mr. Davis, can you tell me the name of this blood vessel on this slide?”

The student sat up startled, and sat silent, gathering his wits. Dr. Rosse looked pointedly at his wrist watch and started saying, “Drip. Drip. Drip.”  The student started to sweat.

“Drip, drip, drip, your patient is losing blood, Mr. Davis.”

The student, in a moment of enlightenment asked,” the inferior vena cava?” and Dr. Rosse said, “Very good, Mr. Davis!” and made a notation on the tablet on the podium in front of him.

The rest of our hearts immediately were in our throats, something that Dr. Rosse would later tell us was an anatomic impossibility, no matter how much it felt like it. There would be no dozing off, daydreaming or not preparing for this class.

My turn came the following week as he called out my name, his steely eyes fixed on only me. I got off fairly easy with a question from Dr. Rosse about the attachments for the extensor pollicis longus. I had memorized all the arm muscles the night before so was prepared.

“Yes, very good, Miss Polis.  Now tell me, if I were to fall off this podium right now, land on my outstretched arm and rupture my extensor pollicis longus, what would I not be able to do with my arm?”

I had no idea. I looked at him somewhat aghast. I thought I had done the necessary preparation to be ready for his questioning. My memorizing names and locations of muscles and tendons had only taken me so far. I had not really thought about the functionality of what I was learning and how it might be relevant to my future patients.

“Think now Miss Polis! This is not so very hard that you can’t THINK it out!”  Dr. Rosse demanded from the podium.

So I guessed. “Uh, you can’t grip?”

“Exactly wrong! Take a hike back to your study carrel, Miss Polis.  You have not prepared yourself well enough. Go back to your book, and with each muscle you memorize, you must feel it on yourself or your study partner and think about how it works. Your patient will thank you for that someday.”

I was mortified that day, but survived that anatomy class, survived six oral exams over the cadaver with Dr. Rosse, and although I didn’t get an A in his class, I was very relieved to get a B+. As a student, I had never been asked before to actually apply what I was learning to make it relevant to my future work. Dr. Rosse was right. I had learned to not just memorize, but to think.

And when I saw my first extensor pollicis longus rupture seven years later in my practice, I was absolutely confident of the diagnosis because my patient could not lift up his thumb when asked to act like he was hitchhiking.  And my patient did thank me.  Dr. Rosse was right again.