A Transformative Experience

A Transformative Experience

This article was originally featured in the BWH Bulletin.

Written by Martin A. Samuels, MD, chair of the department of neurology, director of the Brigham and Women’s Institute for the Neurosciences, and the Miriam Sydney Joseph Professor of Neurology at Harvard Medical School

On February 22, 2017, a meeting was convened in the Brigham’s new Building for Transformative Medicine, a meeting that could not have occurred anywhere else on earth.

Science has become progressively more reductionist—meaning dependent on very detailed biological mechanisms. Those who are best at science often work in disciplines that are remote from clinical medicine; yet in an academic hospital like ours, the goal is the relief of human suffering. Virtually everywhere else in the world, including here until a few months ago, scientists are isolated from clinicians. For the first time, scientists working on the basic mechanisms that underlie disease are working in the same building as physicians who care for patients with those diseases.

A simple announcement was placed around the building: Clinical Neurology Conference for the Neuroscientists. Without prodding, over 50 people appeared in the Building for Transformative Medicine’s third-floor conference center. A patient arrived without preparation. It was live theater complete with the anticipation, tension, and unpredictability that is only present in such an environment. No one knew exactly what to expect. The patient, who volunteered because he wished that his experience would inspire the physicians and scientists to solve important clinical problems like his, was articulate and poignant. He had begun bumping into things on his left side. His wife told him about this. He initially couldn’t believe it, but in time he came to realize that something was wrong, although he could not say what it was. He had had a lung cancer treated some four years earlier, and now there was a metastasis in the right parietal lobe, the part of the brain that gives us our “mind’s eye.” The left side of visual space was absent to him. And he could not describe a giraffe or zebra, nor could he explain how he would travel from Boston to New Orleans using a mental map of the United States. He was not paralyzed or blind, and his language was completely normal, with it arising from the intact left side of his brain. It became clear to all that we were actually in the presence of two people: the intact left-hemisphere person with his language and the ill right-hemisphere person who had lost his capacity to imagine the left side of the world.

The patient exited to a rousing spontaneous ovation, after which the room exploded with comments, observations, and questions. What was consciousness and agency? Did we all, in fact, live in a world of virtual reality, dependent on what our brains tell us about the outside world? The inspiration for all those present was palpable. No one wanted the conference to end, and afterwards, numerous emails were exchanged with further questions and observations, and there was sharing of literature. Everyone had one particular question: When would be the next conference? My answer is: As often as necessary. At first we’re starting with monthly meetings.

One talks about the “water cooler effect,” but what we experienced was much more profound than that. The patient was, in fact, at the center of our consciousness, and all of our various tools, clinical and scientific, were honed to solve the patient’s problem. It is our privilege and duty at the Brigham to deal with these human issues. The Building for Transformative Medicine is a shining icon, a symbol of how the Brigham is really essentially different. We are committed to breaking down the artificial barriers and working together to make real progress against the greatest sources of human suffering: paralysis, pain, cognitive failure, and many more. These are daunting problems, but everyone in the world is depending on us to make headway. On February 22, a real conversation aimed at that end had begun in earnest.

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