Advice from a Caterpillar: Reflections on Change, Uncertainty and Identity

 

Advice from a Caterpillar: Reflections on Change, Uncertainty and Identity

 

How might we navigate uncertainty in medical practice?

As physicians, we are constantly dealing with change and the uncertainty that comes with it. But we never seem to have the time to reflect on how we change as we try to navigate the uncertainty of medical practice.

We invite you to read this short essay by our member @Ricardo Ricci. Through a fictional conversation between Alice and the Caterpillar, we are invited to explore the foundations of uncertainty and the evolving nature of identity. 

 

 

Advice from a Caterpillar: Reflections on Change, Uncertainty and Identity

 

Mr Caterpillar, a few days ago you asked me, "Who are you?" with your arrogant tone. Your existential question took me by surprise, as I was feeling insecure about myself at the moment. I was having issues with my height and had no control over my body, which made my situation rather unstable. 

I had been going through a rough time and suffering all sorts of weird symptoms after drinking an unknown brevage; I went from being your height, Mr Caterpillar, about twelve centimetres, to growing tall above the treetops in a matter of seconds. Apparently, the instability of the body is necessarily followed by the instability of the mind. As you may already know, mind and body cannot be separated.

In this blurry, delusional situation, you dare to ask “Who am I?”

I knew who I was when I woke up that morning, but given the circumstances, I just wasn't sure anymore. Such was the transience and instability of my states. You remember, right?

Now that I am back at home, I am not sure whether I should laugh or feel angry about your nonsense. But I have convinced myself that it was not an illusion.

Mr Caterpillar, you provided me with the opportunity to face unresolved issues -- issues that I was not aware of in my certain and immutable sense of reality, a reality that I now realize is rather unpredictable.

Although, I wouldn’t say you are in the best position to preach about permanence and stability; caterpillars are not immutable beings, after all. When we met, you were a larva and soon you will become a butterfly. How confident do you feel about your identity? I wonder if you can call yourself a caterpillar while being a larva? Would you still be you when coloured wings grow on your back and you become butterfly? Can we even speak of a permanent identity?

Mr Caterpillar, much water has flowed under the bridge of identity as we discuss this existential matters. We used to think our development was only determined genes. But scientists discovered that it's not that simple. It turns out that our environment affects how genetic information is expressed. Did you know that? And it's not only the physical environment...the social environment also seems to play a role. I'm just amazed by the fact that social interactions can shape our identity.

Thus, my dear Mr Caterpillar,  I am not the same now as I was before I met you, and likewise the same happens to you. The process may be even faster than your much expected metamorphosis. By the way ... can you feel your cells changing at this very moment? I don’t, but even if I don´t turn into a butterfly, I know that I´m changing as quickly as you are. Old cells in my body are dying and new ones are born, and so on and so forth. The same happens to the human brain. Our neurons are constantly changing and making new connections. What is considered useful is nourished and what is considered obsolete is trimmed or modified. Connections between neurons hold our memory in the form of partially stable chemical complexes. That is the so-called long-term memory, the one that allows me to react when the Mad Hatter or The Queen of Hearts calls: Alice!

Now, my dear Mr Caterpillar: Can you see how fragile is the biological foundation of identity? Transience, insubstantiality, and subtlety are its characteristics. Our sense of self lives in the realm of the improbable, as does life itself. Yours, mine, the planet´s even.

I can´t believe you had the nerves to ask who am I?

I am Alice, the incredibly weak and fleeting Alice.

I am Alice, the one who, from that very unstable reality common to all humanity, aspires to conquer the stars.

I am Alice, the one who meddles into subatomic particles with the hope of understanding what happened before the Big Bang.

I am Alice, the one who with very limited resources aspires to bring some order to this world of nonsense where it is considered totally normal to see the smile of a cat after the cat is gone.

My dear Mr Caterpillar, now I will leave, hoping that tomorrow, when you become a butterfly, you will recognize me. And please don't forget to spread your wings when we cross paths so that I can recognize you.

 

 

Written by Ricardo T. Ricci

Translated by Mariana Dittborn

Publicado en: https://www.ars-medica.org/

Con toda valentía y decididamente…

 

Con toda valentía y decididamente…

Ricardo T. Ricci 18/5/21     

riccirt@fm.unt.edu.ar

 

“…atrás quedaron las cercas de púas, descendí hasta el borde del bosque. De pronto, en la noche explotó el día: ¡sirenas, luces trazadoras, iluminación a pleno, gritos, ladridos! Corrí hacia la espesura, ya no era tiempo de elegir entre la incertidumbre y el infierno, estaba jugado.”

Echado en el suelo húmedo de rocío, masticando tierra y pasto, me sobrevino un miedo visceral, un miedo como la suma de todos los miedos, un pánico ancestral. Mi cuerpo se hizo pequeñito y mi alma se deshilachó; sentí que se volvía trémula, incompetente y derrotada.

Como pude alcancé a pararme a pesar de mis temblores, me expuse a la luz enteramente y coloqué ambas manos detrás de mi nuca. Humillado, me entregué una vez más.

Juanita. The colossal grief of a survivor.

 

Juanita. The colossal grief of a survivor.

 

My grandmother, Juanita (the first on the right), came to Argentina around 1920. Yes, ours was the promised land for the Galicians and the Tanos, also for the Catalans as was their case. Their emigration was forged around a dream, that of the promised land; the trip was made, however, to escape the terror.

Juanita, with only sixteen years, joined a group of civilian volunteers to fight against the so-called Spanish Flu. That simple decision changed her life forever.

In 1918, the world was at war; hundreds of thousands of men and women died, some from bullets and lethal gases, others from typhus in the trenches, and others from foreign viruses more effective than the bullets themselves. 

The exact place where the plague began is still a matter of dispute, but what is certain, is that it was not in Spain. These were times of military secrets, of biased news to avoid lowering the soldiers’ morale (unofficially, it is said that between fifty and one hundred million people died around the world). 

Be that as it may, Juanita's homeland was one of the worst affected areas with eight million people infected and 300,000 dead. Her own family was decimated; her parents, two of her younger brothers, her Aunt Elisa, and her Grandfather Paco, they all died. 

Juanita's senses were saturated with death. With a cry that knew no end, she told me that the smell of death, that hissing sound of the end, the metallic taste of her own saliva, and the cold rigidity of corpses, were all still present in her memory. 

Juanita was the kindest person in the world, tiny, silent, prudent, immensely prudent. I called her Abueli. I never saw her wearing anything else, other than her strict old mourning robe. Her eyes did not accompany her smiles; strangers, they looked at me without seeing. They were in a place where you don't need encouragement to cry, they were forever in the vast country of grief.

 

S.M. de Tucumán 24 de marzo de 2020.

Author: Ricardo T. Ricci 

Translation: Mariana Dittborn

“El liviano esfuerzo de la creatividad”

 

“El liviano esfuerzo de la creatividad”

Ricardo T. Ricci riccirt@fm.unt.edu.ar

Jane Hirshfield sobre la narración de historias, el arte de la concentración y la dificultad como fuerza consagrada a la acción creativa.[1]

Al ingresar al apretado estrecho de la concentración creativa, el mundo y el yo comienzan a cohesionarse, sus límites se tornan difusos, sus sustancias se confunden.  En ese estado se produce el acontecimiento de la unificación de lo que sé y puedo saber, lo que siento y puedo sentir, de lo que hago y puedo hacer.

La autora estadounidense, nacida en el ’53 como yo (información totalmente irrelevante para todos menos para mí), tiene una especial sensibilidad para describir el momento de la creación literaria. Ella, como poetiza, seguramente ha disfrutado intensamente de esos instantes - en ocasiones minutos – de inspiración creativa. El resto del tiempo del escritor se consume en efectuar los esfuerzos necesarios para lograr esos momentos de manifestación.

En esa extrema brevedad el autor tiene una sensación de inmenso poderío; lo sabe todo acerca de su texto, siente plenamente lo que desea transmitir en ese texto y logra hacerlo de manera creativa y estética, porque puede hacerlo.

Ese instante, al que me gusta llamar: del acontecimiento, se percibe como mágico. Sucede que de pronto, en medio del esfuerzo, de la disciplina y de la dedicación concentrada surge, como una epifanía, eso que deseaba decir, eso que logra decirse a sí mismo de la mejor manera. Eso sí, diría don Zoilo: para ver el amanecer hay que salirse de la cama bien temprano.

Se percibe un instante así en estos versos de Rainer María Rilke cuando describe la infancia. ¿La suya acaso? 

“Y horas y horas, junto al estanque gris

arrodillarse, con un velerito;

y olvidado, porque otros semejantes,

y más bonitos, bogan por el círculo:

deber pensar en la carita pálida

que, hundida, en el estanque, aparecía...

Oh niñez, oh comparación que escapa

¿adónde? ¿adónde?”[2]

 

La disciplina de exponerse con determinación al texto que aún no se escribió, la obstinada voluntad de quien desea convertir su sensación en una sucesión de palabras con belleza.

En el caso de Hirshfield, es posible que su compromiso con la espiritualidad Zen haya matizado sus habilidades creativas. La meditación, la concentración plena, la armonía de la mente con el cuerpo, colaboran con la disposición para el acto creativo. Sin embargo, es cierto también, que hay muchos ejemplos de autores que lograron escribir maravillas en estados de enorme exaltación, en medio de adicciones lamentables, en situaciones de persecución ideológica, y con riesgo de perder la vida. Podemos concluir entonces que cada quien hace lo que puede cuando se ve impelido por el impulso de creación, por la promesa del acontecimiento. 

“La dificultad en sí misma puede ser un camino hacia la concentración: el esfuerzo gastado nos convierte en una tarea, y el compromiso exitoso, aunque laborioso, se convierte también en una labor de amor. El trabajo de la escritura aporta reposición incluso al escritor que trata temas dolorosos o resuelve problemas formales, y hay momentos en que el único camino abierto del sufrimiento es a través de una inmersión en lo que es. El poeta urdu del siglo dieciocho, Ghalib, describió el principio de esta manera: "Para la gota de lluvia, la alegría está en entrar al río - / El dolor insoportable se convierte en su propia cura".[3]

¿Será que para todo texto su destino venturoso y redentor será sumarse al gran río del lenguaje? Acaso la misión de la letra bella sea mantener la ecología sana del caudal. El agua clara, los peces vivos y las plantas lozanas. Asegurar la potabilidad para las bestias y los hombres. 

Hirshfield ha elaborado un arte sensualmente filosófico que impone una pausa en nuestros hábitos mentales avanzados. Sus poemas parecen simples, y no lo son. Su lenguaje, en su limpieza y transparencia, plantea enigmas de una naturaleza tranquilamente metafísica... Cláusula por cláusula, imagen por imagen, en un lenguaje a la vez misterioso y común, los poemas de Hirshfield despejan un espacio para la reflexión y el cambio. Invitan a la conciencia ética y establecen un delicado equilibrio.” ^[4] 

Si uno, una tarde cualquiera, ve pasar una escritora como ésta por la calle, debe disponerse a seguirla, a comprar todos sus libros, a leerla siempre y a dejarse guiar mansamente. El camino de la sensibilidad a la sabiduría está consolidado, no todos los días aparecen maestros con tanta claridad de objetivos.

Que un escritor, sin dejar de lado la estética, se deje seducir por la metafísica, ya es fenomenal. Si a eso se agrega que sus construcciones sean simples y llanas, hemos encontrado un tesoro de insospechado valor.

Que con ese lenguaje de misteriosa llaneza logre despejar el camino a la reflexión y a la conciencia ética, es un lujo. Veamos una pequeña muestra:

 

“En mi cartera llevo una tarjeta”

 

En mi cartera llevo una tarjeta que declara que tengo el poder de legalizar un matrimonio. 

En mi cartera llevo una tarjeta que declara que puedo conducir.

En mi cartera llevo una tarjeta que le dice a los comerciantes que deben confiar en que les pagaré.

En mi cartera llevo una tarjeta que asegura que puedo tomar prestado un libro en la ciudad en la que vivo.

 

En mi mano llevo una tarjeta.

Sus líneas declaran que no tengo tarjetas, ni coche, ni estado, ni dinero.

Es liviana y sin aristas.

Me nombra miembro de la Orden de Cuantos Morirán.

Nuestra experiencia carente de tanta riqueza, pero conocedora de las primicias, nos impulsa a valorar sus palabras como un estímulo para intentar, nosotros mismos, nuevas y profundas experiencias literarias.

Repitámoslo una y otra vez: la literatura es mucho más que hacerle llegar un mensaje al lector, ese mensaje debe ser bello, profundo, sugerente, ético, apasionado, vital, desafiante…

El lector seguramente tiene otros adjetivos para agregar a esta lista. Todo adjetivo que implique que el hombre, con sus pies bien metidos en el barro, atine a levantar la mirada para ver las estrellas, es adecuado para referirnos al arte laborioso y consolador de la escritura. 

“Grandes barridos de pensamiento, emoción y percepción se comprimen en formas que la mente es capaz de contener: en imágenes, oraciones e historias que sirven como símbolos de entrada a grandes y a menudo resbaladizos reinos del ser ... Las palabras se aferran a la mente, sembradas con el excedente de belleza y significado que es la marca de concentración.”[5]

 

---

[1] https://www.brainpickings.org/2016/07/21/jane-hirshfield-concentration/

[2] María Rilke, R. (2004). Poesías. Santa Fe, El Cid Editor. Recuperado de https://elibro.net/es/ereader/untbcbiblio/98245?page=189. Fragmento del Poema “Infancia”

 

[3] Idem 1

[4] Rosanna Phelps Warren (born July 27, 1953) is an American poet and scholar.

N del A: También nacida en el ’53, para más datos.

[5] Idem 1.

Could it be that we were all in Kronborg?

Ricardo T. Ricci

riccirt@fm.unt.edu.ar

There is a beautiful construction at the mouth of Oresund, the strait that separates Denmark from Sweden. Properly speaking, the great island of Sealandia (Denmark) is off the Swedish coast. 

This is a strategic place, of great economic value, where taxes had to be paid to enter into Malmö, one of the most famous ports in the south of Sweden. The strait must also be traveled to access Copenhagen, the Capital of Denmark, opposite to Malmö. Both cities are today connected by an important bridge.

There, in this crucial area, the imposing Kronborg Castle has stood since the Middle Ages. Shakespeare does not mention it directly, but instead, he refers very precisely to the area in which the castle is located. To delve us into the drama, Shakespeare places us in Elsinor.

Kronborg Castle on Elsinore, engraving from around 1688.

Two of the most important physicists of the 20th century, founders of Quantum Mechanics, Niels Bohr and Werner Heisenberg, at some unknown point around the 1930s went out for a walk in the Danish countryside and suddenly found themselves in front of the famous castle. Both were members of the strictest mainstream scientific thought of Theoretical Physics, and without a doubt, stellar representatives of hard science and strict rationality. Suddenly, standing in front of Kronborg Castle, Bohr said to Heisenberg:

“Isn't it strange how this castle changes as soon as one imagines that Hamlet lived here? As scientists we believe that a castle consists only of stones, and admire the way the architect put them together. The stones, the green roof with its patina, the wood carvings in the church, constitute the whole castle. None of this should be changed by the fact that Hamlet lived here, and yet it is changed completely. Suddenly the walls and the ramparts speak a quite different language. The courtyard becomes an entire world, a dark corner reminds us of the darkness in the human soul, we hear Hamlet's "To be or not to be." Yet all we really know about Hamlet is that his name appears in a thirteenth-century chronicle. No one can prove that he really lived, let alone that he lived here. But everyone knows the questions Shakespeare had him ask, the human depth he was made to reveal, and so he, too, had to find a place on earth, here in Kronberg. And once we know that, Kronberg becomes quite a different castle for us.” 

Suddenly, the advancement of fiction over reality, of dreams over wake, of the ancestral over the conjunctural, of the emotional over the rational, are all present. In the 'real' Kromborg the words of Hamlet resonate:

To be, or not to be, that is the question:

Whether 'tis nobler in the mind to suffer

The slings and arrows of outrageous fortune,

Or to take Arms against a Sea of troubles,

And by opposing end them: to die, to sleep;

No more; and by a sleep, to say we end

The heart-ache, and the thousand natural shocks

That Flesh is heir to? 'Tis a consummation

Devoutly to be wished. To die, to sleep.

(Act three, scene four).

These stones, these walls, these courtyards simply pose to us the crucial question of the human intellect, the access to reality. The imagined presence of Hamlet roaming the galleries and battlements. The vicious picture of Gertrude, Queen of Denmark and mother of Hamlet in licentious agreement with Claudius, current King, and uncle of Hamlet. Behind one of these curtains is the corpse of Polonius, whom the prince of Denmark mistakenly kills. We perceive Ophelia, maddened with grief, drowning in the river when she believes that Hamlet deliberately murdered her father. Rosencrantz and Guildenstern circulate silently there, showing themselves friends and executing treasons.

In Kronborg, throughout both day and night, human miseries occupy every space; passion, shame, anger, jealousy, and thirst for revenge permeate the ornaments. Desires for power give an everlasting luster to every physical object in its immediate vicinity. An innocent stone found on the side of the path we are walking on is both an inconsequential piece of mineral and a symbolic memory of our presence within those walls, of our participation in the drama.

These are the reasons that enable me to maintain that the so-called reality is the hidden and imperceptible sum of what occupies a place in space and the intangibility of the sign. Elsinor, Hamlet, Oresund, and ourselves are that inseparable mix of nature and culture, of flesh and symbol, of the definite and the imprecise.

I have never been to the castle myself, yet I can taste every emotion, every feeling, every passion. Plot and betrayal alienate Hamlet. I can understand it, it impacts me, it irritates me. I can even imagine myself crying, I can feel my irrepressible helplessness and anger, in a cold and dark corner of that mass of stones.

Yes, somehow, we were all in Kronborg! Humanity was there.

Author: Ricardo T. Ricci 

Translation: Mariana Dittborn

Publish in: https://ars-medica.mn.co/posts/could-it-be-that-we-were-all-in-kronborg

Crossroads

CROSSROADS

My body, now that we will not be traveling together much longer
I begin to feel a new tenderness toward you, very raw and unfamiliar,
like what I remember of love when I was young —

love that was so often foolish in its objectives
but never in its choices, its intensities
Too much demanded in advance, too much that could not be promised —

My soul has been so fearful, so violent;
forgive its brutality.
As though it were that soul, my hand moves over you cautiously,

not wishing to give offense
but eager, finally, to achieve expression as substance:

it is not the earth I will miss,
it is you I will miss.

Louise Elisabeth Glück

The most varied flowers can be found in the vast garden of poetry. In the everyday self-absorbed walks, we pass by the most beautiful gardens without even noticing them, sometimes even through them without realizing that they are something radically different from the stiff and impersonal cement that covers our cities.

From time to time, a flower of extreme beauty knocks intensively on the door of our senses and makes the needle of our perceptions jump. This is what happened to me when I came across the poem “Crossroads”. It caught my attention because it reminded me of the great story by Jorge Luis Borges: "The Garden of Forking Paths". It attracted me, even more, when I realized its author was Louise Glück, who had been recently awarded the Nobel Prize for Literature 2020.

An American, born in 1943 in New York City, she has an enormous career in letters and has received the most important awards during her long and very fertile career. She is said to be the poet of everyday things, of the simple events of every day, an explorer of the beauty of everyday life and simple emotions. One of those people who, following my previous metaphor, never passes through the gardens without perceiving the flowers, never ceasing to be stunned by the beauty, without evading sadness, without fear of emotional storms.

This poem shows us a crossroads; the inevitable forced bifurcation from which soul and body will forever follow different paths. Let's avoid observing it from our own beliefs, ontologies, and epistemologies. Let ourselves be impressed by the acknowledgments, the apologies, and the intensity of the farewell of these two dear friends - perhaps the most endearing friendship of all. So betrothed, that we walk through life without recognizing its limits, but rather seeing them as a single and unique entity that is not even apparent to our eyes due to its extreme familiarity.

Aware that the moment of the farewell is imminently close, Glück values the body as the material reality of being in the world and does so by evoking the youthful loves, full of passion and excess. She acknowledges the limitations imposed by nature and culture to that unconditional and passionate love that often suffers from the pruning of what "should be", "what is used" and what "for now is not accepted".

My body, forgive the brutality of my soul, its ancestral fears, its extreme limitations. In these conditions of vulnerability, my soul has exercised violence against you, demanding from you beyond your possibilities, or beyond your potential. She subdued you, disciplined you, rationalized you. Now she doubts that this has been the most convenient, the most appropriate.

That combative and demanding soul, belatedly valuing you and glimpsing your absence, now approaches you solicitously, softly, carefully to confess that what life is to miss is not to stop being, but not to be able to count on you.

By Ricardo Teodoro Ricci

October 2020

Baltimore, MD·Posted Thu, January 14

Publicado en: https://ars-medica.mn.co/posts/crossroads

La homeostasis humana.

 

La homeostasis humana.

Ricardo T. Ricci

Tucumán, ARGENTINA, 5/11/20

 

 

El término homeostasis, que nos recuerda a Walter Cannon (1871 – 1945) y al mismísimo Claude Bernard (1813 – 1878), se refiere a esa capacidad de los organismos vivos de mantener una condición interna estable, equilibrada, que resulte compatible con la vida. Por medio de mecanismos servo regulados, el sistema vivo intercambia energía, nutrientes e información con el entorno, logrando que de ese modo su fisiología se mantenga constante.

Todos los organismos vivos tenemos entorno, nuestras vidas se desarrollan en un medio ambiente que nos rodea por completo. Los Seres Humanos además, tenemos un Mundo. Eso significa que nuestro entorno, cargado de sentido y de significado, haga que nuestra homeostasis sea incomparablemente más compleja, propiamente un salto cualitativo notable. El ser humano, además de ejercer los mecanismos fisiológicos que le permiten la homeostasis y la vida, necesita lograr equilibrio en otras áreas que le son exclusivamente propias. Nos referimos a la psiquis y los procesos mentales, la espiritualidad, la cultura, el mundo social, los aspectos emocionales y afectivos, lo político (vida de la polis), lo ético, lo estético y tantos otros aspectos de nuestra vida.

Esto nos permite afirmar que la homeostasis en el sentido ampliado a lo humano es un proceso extremadamente rico y de una variabilidad ilimitada.

Los médicos, con frecuencia advertimos la necesidad de reflexionar periódicamente con el fin de enriquecer y abonar nuestro mundo interior. Es que nos debemos a nuestros pacientes, un cuidado equilibrio personal redundará en beneficio de aquellos que acuden a nosotros en busca de soluciones para sus propios conflictos y desbalances. Además, esos momentos de introspección necesariamente colaboran con el mantenimiento de nuestra propia homeostasis, ese precioso equilibrio, que por ser parte misma de la vida, debe ser siempre resguardado y enriquecido con trabajo, dedicación y entrega.