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A happy Easter to you all this Sunday and regardless of what the day means to you, at least have a chocolate bunny (bell if your French) and read the Easter story out of Me Talk Pretty One Day by David Sedaris. We went to a reading of this book by David with a bunch of our friends, and the Easter story had us all laughing till it absolutely hurt.

The introductory image is of the stained glass window in the front of the Cathedral of the Madeline. I’ve not regularly attended Catholic services for some time, yet this building has been a symbol of religious significance for me whose architecture and art are truly unique among religious buildings.

Construction began in 1899 and it was completed in 1909 with a gothic interior unlike any other cathedral in the world. It was restored in 1991 while retrofitting the structure to be more earthquake resistant. During restoration, all of the paint and artwork in the cathedral were cleaned revealing stunning colors that had faded and become dirty over the years. Both of the images above were taken before the cathedral was restored and unfortunately, now the view of the main stained glass window from the inside is obscured by the new organ. However, as can be seen in the photos below, the interior colors now are much more intense and while the building was beautiful before, now it can be seen as it originally appeared in 1909.

The Cathedral also houses the Cathedral choir school which teaches a curriculum of general and theologic education combined with teaching of the choral tradition.

In addition to Easter, this week has also proven significant because of two events experienced in the past week that have me thinking about another current controversial issue. One was a very close call for a colleague of mine discussed in the sidebar below and another was a conversation I had with an individual who is struggling with his religious beliefs, what he wants to do with his life and how through his education he is now beginning to question some of what he previously held as truth. Additionally, he is finding out that those individuals that he was always taught to avoid because they did not share his beliefs, are actually good people who may not hold what he values as truth, but nevertheless may have belief systems they hold to be just as valid as his beliefs. I tried to encourage him to understand that part of this experience is simply that of personal growth as one goes through the higher education system and becoming exposed to new and different ways of thinking. Furthermore, he is not alone as many of us in the sciences have gone through the same experiences as we fought with what we knew and new material that we begin to integrate within our existing understanding of the world.

Ultimately I suggested to my friend that he take it slow and urged him not to take any radical decisions. Read about it, think about it and even pray about it if he believed that would help him. He may find that there is peace and solace in the religion he is currently questioning, he may find that some of the dominant religious structure may or may not fit his needs and desires, or he may even find out that he does not need religion. When he asked me my beliefs, I explained that my religious beliefs are very personal and I do not share them without being asked first. He asked again and without going into detail, it was explained that I did have religious beliefs, I did believe in God and that I was a Christian. We talked about many more specifics that I will not go into here, but I hope that he understands that it is acceptable to possess a belief system that in no way takes away from ones science or work. But what is important is that we all understand that our individual beliefs, whether or not we believe in a higher power, cannot supersede those belief systems of others. They are no more valid and hold no more significance than those beliefs of anybody else.

The important thing about all of this for me however, was that it got me thinking about religious differences, how we perceive others and how that is becoming a critical issue in the United States with respect to our own politics and those in the rest of the world. Religious fervor and fundamentalism is an issue that we are facing in personal, social, scientific, diplomatic and military circles these days, and not all of it is coming from outside the United States. Certainly the west has become more acutely aware of religious fundamentalism in the name of radical Islamic elements, but there has been an almost equally extreme fundamentalist movement within our own country to integrate more religious practice in government and polarize the population into diametrically opposed camps. Certainly throughout history, these issues have developed into struggles reaching the boiling point in places and times like 1940’s Germany, sub-saharan Africa and in the Balkans and I am not ignorant of the great price that people have paid in those events. I am however, also beginning to worry about movements within the United States that are widening the rift between those individuals that are using religious beliefs to justify intolerance and anger towards those who do not share their beliefs. Cultural swings like this always begin with local events like the banning of books, censorship of movies or events like the current controversy with certain IMAX theaters refusing to show documentaries on volcanoes because they may challenge or offend some religious beliefs. It saddens and concerns me that the documentation of the search for truth is so dangerous to some people and I worry there is a defined movement towards anti-intellectualism that often precedes many events that ultimately end in societal disruption. I understand in the need for belief but also believe that there are truths in the universe that need to be revealed. Unfortunately, those truths threaten some people and institutions. However, events like these and the current controversy over Terri Schiavo (see sidebar below) are being played for political advantage and used like pawns in the growing religious rift in American politics. Certainly some in the Republican party are using religious issues to consolidate power as these are the same issues that allowed them to gain power in Washington D.C. and around the country. Some Democrats are now playing the same game in an effort to regain their political losses. The problem of course in addition to dissolving any unity that we may feel as Americans is that we are invoking a breakdown in the divisions of legislative, executive and judicial branches of government which were established to prevent any one branch of government from becoming too powerful. The politicians that are attempting these breaches and dragging the intensely personal issue of Ms. Schiavo into the political arena should be ashamed of themselves and their efforts at self aggrandizement. Certainly religious beliefs contribute to who we are and what we do, but it is more important now than perhaps ever before that United States citizens become more aware and more accepting of religious differences in ourselves and others.

Without some degree of moderation in politics and more mutual understanding and tolerance, our politicians who are elected to reflect our desires in Washington D.C., will continue to develop into an increasingly partisan government that becomes less and less effective in running the government and meeting the needs of its citizens.

Sidebar: Terri Schiavo

Aside from the issue of not knowing what Ms. Schiavo would want in terms of her health care management, the issue with the unfortunate case of Terri Schiavo that everybody besides Ms. Schiavo is struggling with comes down to the issue of ensoulment. In other words what is life and what makes one a person? The problem with this issue is that defining consciousness is a continuum problem and continuum problems are notorious for their ability to change definitions depending upon technology. When is someone dead? Historically speaking, before we understood cardiovascular physiology, death was defined by cessation of breathing. Later still, we understood death to occur when the heart stopped beating. Technology has changed this definition which, despite its problems most embrace. I certainly do because the other significant event this week would have taken a colleague due to cardiac arrest were it not for a relatively simple technologic development called cardiopulmonary resuscitation (CPR) and later more involved care in an intensive care and cardiac monitoring unit. Going further still, we have a whole set of technologic developments that allow us to preserve physiologic functioning when even vital organs such as the heart, lungs, kidney or liver cannot maintain their function. We can perform this function for almost all organs with the notable exception of the brain which most would consider to be the seat of consciousness and the location of our “identity”. Those who adopt this perspective believe that without the brain, we are simply a collection of tissues that approximate an empty container. By extension, because the brain “holds” our personalities and consciousness, it could be considered by some to be the location of the soul. Of course not everybody believes this as some hold that ensoulment begins with with conception which neatly gets around any issues related to defining a point at which consciousness and ensoulment can be maintained. However, this perspective rapidly begins to break down when one considers definitions of death. If one were to believe in the concept of a soul, one might wonder about when the soul leaves the body? It used to be thought that the soul left at the moment of death giving rise to experiments designed to “weigh the soul”. Specifically in these experiments, individuals on their deathbed were placed onto scales and at the moment of death, the weight was noted to……..not change. Of course because the definition of death has changed over time, the definition of when the soul leaves changes. Furthermore, what about people who have died by all appearances clinical and technical and are yet revived? Do their souls leave and then re-inhabit their bodies? Most individuals who believe that our identity and personalities are dependent upon our brains remaining intact (including this scientist), believe that life and ensoulment are over when the brain has died. For most processes that result in death, we have endeavored to define a point at which we can decide when death has occurred. A commonly accepted technique involves the use of the electroencephalogram (EEG) measuring brain electrical activity arising from populations of individual neurons and defining death as a point where the brain can no longer maintain electrical activity. This isoelectric status allows us to create a clinical definition of brain death that allows us to make further medical, legal and emotional decisions. This definition of course has its own grey areas most commonly found in progressive degenerations of the central nervous system, but are also found in certain traumatic circumstances such as cardiac arrest resulting in global cerebral ischemia. Circumstances like this are found when there is a slow cerebral degeneration that does not support consciousness, yet allows for maintenance of vital functions such as cardiac and respiratory function which are very basic brainstem level functions. Indeed many brainstem reflexes can appear to indicate consciousness, but in actuality are the most basic of neuronal circuits that are hard wired into our most primitive portions of the brain and have nothing to do with a consciousness. With Terri Schivo, we know that she did have a cardiac arrest which resulted in a global ischemic event. We also know that she cannot maintain a normal state of consciousness and many physicians maintain she is in a persistent vegetative state. An examination of a CT scan taken in 1996 indicates there is significant loss of cortical tissue in this brain.

The dark butterfly shaped form in the center is a massive expansion of the ventricles of the brain that have dilated due to loss of cortical tissue surrounding them. In addition, there appears to be significant widening of the sulci particularly on her left side (right side of the image). When I was working in a clinical environment, I had seen CT scans that resembled Terri’s, but these patients were either comatose or were typically profoundly senile and very aged. Given that it has been almost a decade since this CT was taken, I would be very interested in seeing a followup study. Would it document a progressive degeneration and continued loss of cerebral cortex? I would predict that indeed this is what one would find bringing into consideration a precedent setting case some years ago, the Karen Ann Quinlan case. This young woman succumbed to an unknown disorder and stopped breathing for a period of time back in 1975 suffering a global cerebral ischemia. She was given a diagnosis of coma with signs of “decortication” which describes a state of deranged cortical function that essentially disconnects her higher cortical functions. Her parents requested that she be removed from the respirator allowing her to die. Her physician refused sparking a court case that ultimately like the Schiavo case, reached the Supreme Court which sided with the parents. When they did remove the respirators, Karen’s body continued breathing on its own which can occur with a very rudimentary brainstem. She was then given a feeding tube and over time exhibited some signs traditionally associated with improvement from coma such as the emergence of circadian rhythms, but never progressed beyond blinking and crying out on occasion. However, her body was never able to regain or posses any cognitive function. Her body persisted in this state for over 10 years before experiencing heart failure in 1985. Ultimately an autopsy revealed that Ms. Quinlan had an atrophy or substantial loss of neurons (in fact much less than Terri Schiavo) in the thalamus of the brain which essentially had the effect of disconnecting functions important to consciousness. This leads one to wonder just what future Ms. Schiavo has and what prospects she faces if she were to remain “alive”. The real question is, would Terri want to be preserved in her current state in perpetuity? She already has “died” once and if it were not for technology reviving her corporal body, this controversy would not exist. Given the co
ndition of her brain, one might suspect a continued degenerative condition, but even if this were not the case, and she maintained her current status, Is that what she would have wanted? Given the results of the CT scan taken almost a decade ago, which show much more degeneration than Ms. Quinlan had at death, I would doubt there is much of a chance for recovery of function and
that one might suspect, is precisely what would matter most to Ms. Schiavo. In all the political bickering going back and forth, please remember Ms. Schiavo and what she may have wanted if we could have asked her.

Update: Terri Schiavo died this morning (03/31/05).

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