George Plotkin, M.D., Neurologist

Interviewed in Tyler, Texas, December 9, 2007

Born: 1951, Brooklyn, New York

"The more firmly established, the more difficult to change.
That social organism is embryonic.
That firmly to believe is to impede development.
That only temporarily to accept is to facilitate."

—Charles Fort, in "The Book of the Damned, the collected works of Charles Fort" first published in 1919 (Tarcher/Penguin, 2008, p.13)

"The failure of technological medicine is due, paradoxically, to its success, which at first seemed so overwhelming that it swept away all aspects of medicine as art. No longer a compassionate healer working at the bedside using heart and hands as well as mind, the physician has become an impersonal white-gowned ministrant who works in an office or laboratory. Too many physicians no longer learn from their patients, only from their professors."

— Robert O. Becker, M.D., in "The Body Electric" (William Morrow, 1985, p.20)

GP:

I started reading very young. When I was 10 or 11 it was incredibly inspiring. I had a knack for absorbing things. My parents didn't have TV because they felt it wasn't a good thing. TV was bad. The TV was actually locked up in the attic. It was one of these things my father had built out of some sort of kit. He wouldn't let me touch it or look at it.

My father gave me my first book, which was Lewis Carroll's "Through the Looking Glass." It had the original Tenniel illustrations, really nice. I didn't get it. I thought it was cute at times, but it didn't do much for me.

So he said, "OK, why don't you read 'Treasure Island'." He hands me this really old copy of Treasure Island and says, "I really liked this when I was a kid." The second day he says, "So what do you think?" I said, "An utter waste of time. It stinks. I don't like it."

"All right," he says and gives me Mary Shelley's book "Frankenstein." I'm sitting in the back seat of the car, we're driving somewhere, and he said, "Read this." And I read the thing — I was probably around 9 or 10 — and I read the book in an hour. He said, "You couldn't have read it." I said, "I read it." So they start asking me questions and he said, "So, what do you think?" I said, "I liked the movie."

Years later I realized it was much more interesting than the movie, because I started to understand how Percy Bysshe Shelley had taken courses, and had been exposed to electrification, and how dissimilar metals had caused legs to jump when dissections were being conducted. And that he had interested him girlfriend, Mary Wollstonecraft, in reanimation, and he had challenged her to write something interesting. She generates this incredible story, which really is — depending on how you want to cut it — is a feminist tract. It questions a variety of things: the social Darwinist theories, all sorts of stuff. But I got none of that when I first read it.

The stuff that got to me was when I found my father's science fiction collection. There was "The Million-Year Picnic," by Ray Bradbury. It's part of "The Martian Chronicles" where they're stuck on Mars, and they're watching the Earth explode below them. This is at the end of the wars, and they're burning bits of papers, which are diaries and papers, in order to keep warm. There's a little stream and they look in it and see the Martians, which are themselves. And in the 1950's Post-McCarthy, cold-war, Cuban missile crisis environment, here is this book that encapsulates it. And suddenly I was, like, "This is great! I need more of this!"

I started to find other books: Sturgeon (Theodore Sturgeon), brilliant; Bradbury, a genius. These were people who could take the drama of earthly things into another realm where you handle it, sort of like it was decontaminated: clean, isolated. You didn't have to worry about the outcome meaning something that could get you in trouble, because it's happening on another planet. It's like "The Golden Compass" (by Philip Pullman) arguments right now: "Well, that's an alternate world. Yeah, so that's OK."

This stuff really captured my attention. But they kept talking about stuff that required enormous types of technology, and I didn't have any of that stuff, so I started building things. I got old ARRL Handbooks, I bought them at used book sales,"¦ American Radio Relay League.

I didn't have an allowance of any sort, but my parents would give me a couple of bucks every so often and I'd go to book sales. I would rummage through to find stuff that interested me: an old dictionary that looked really cool; science fiction, any time. I didn't like images, I was much more taken with the written word. I began to stockpile and read everything I could get.

The Radio Relay League stuff showed me that there were things that you could do to modify signals. So I started building radios. I'd electrocute myself 20 different ways with these power supplies. I was building tube equipment, and everything was 600 volt B+. I could make regenerative receivers and do wild stuff. I began to realize this was a language, just like the language in the books, except this was a language with materials, and I just started to manipulate materials. I was doing this all the time, not paying much attention to my schoolwork because I couldn't stand it.

I drifted off into this alternate world of exploring stuff, but there was no one to shape this. All the voices were distant voices. There was no one in the community. Like in 6th grade when I told my father I wanted to learn calculus, I said, "Look. I've done all this other stuff, and this is a book that you have here"¦" It was one of his calculus manuals from college. He said, "You really shouldn't read that now. It's above you, and they'll teach you that in college." There was always this organized, regimented attitude of, "That's not right for you now." It was clear that there were some things that no one was going to teach me. So I'd go off and do something else.

The transition occurred when I got sick with mononucleosis, and I was stuck at home. I was really sick. I had fevers everyday. I had a spleen the size of a bathmat, and the doctors were worried that if I went to school and fell down I'd get a ruptured spleen. It was either surgery or rest. So I stayed home for three quarters of a year, during which time they sent private tutors to work with me.

I had been a "D" student, at best. So here come these tutors figuring they're going to get a real piece of work. Mr. LaSalle was the history teacher, a very neat guy that introduced me to Chaucer — this was like 8th grade — he writes down:

"With his shoures soote, the droghte of March hath perced to the roote, and bathed every veyne in swich licour."
(First line of "The Canterbury Tales," Geoffrey Chaucer, 1342-1400)

I tried to read it. He reads it poetically, and I'm going, "That sounds great! What is that?" He says, "That's Chaucer. You do this American History, and I'll teach you Chaucer."

We had this great dialog where he'd bring stuff in and I'd absorb it. He would explain that liberty and all this stuff was not quite what everybody expected it to be, that there were a lot of issues, and nothing was clear-cut, but these were the answers that people wanted to hear.

He made it clear that, yes, there were hoops that I had to jump through, but there was a lot of other interesting stuff. So when I got to these various risqué tales, which were really titillating, I started absorbing history. I really got into it. I never thought of history as being a thing I'd be particularly excited about. He got me totally psyched.

One of the English teachers came by to teach me English, same thing. They realized I was willing to compromise, to do the work, if they would give me some insight into it in exchange.

They would say, "Why aren't you doing this in school? You never do anything in school." I was honest and I said, "There's no point to doing anything. It's of no purpose. It doesn't do anything. It's meaningless work." And instead of saying, "You idiot, there's nothing meaningless about it. It's our job." They said, "OK. This is what it's supposed to do. This is why we do these things."

It was the first time anybody had actually said to me, "Look, we're doing our job and we want you to meet the expectations of the system, but if you want to know what's going on, we'll teach you." I suddenly realized that I could do this stuff, and that there were things that were expected of me — just like in any other job — but that there were rewards. It was like this massive switch was turned.



LS:

But you'd never had a job before.

GP:

I'd never had a job before. Not like that. All of a sudden I was doing things. I knew none of my classmates — this was the weird thing and maybe it was goodwhen I suddenly showed up in all of these honor-track classes, after having been in the shop class hanging out"



LS:

You mean after you recovered at this point.

GP:

Yeah, I came back and they basically transitioned me. I'm now going to the library and requesting stuff by interlibrary loan, and the librarian would argue with me that that's "adult material." I'd get notes from the English teacher, and she would clear the stuff as "age appropriate." I took a course in art and started drawing nudes. And they'd say, "What's the kid doing? He's drawing Matisse nudes!" And the art teacher said, "He's good at it. Leave him alone!"

So, all of a sudden, I had protectors. It was this weird transition, I don't know what happened, but it happened suddenly.



LS:

So, in a sense, it was a good school. It was just that the teachers hadn't attended to you.

GP:

Most of the teachers were disinterested, but there were a handful of older, very gifted teachers who realized that I was a kindred spirit. When I came back years later to visit, they were very gracious. They were delighted to see that I'd actually tried to do something. I think they felt that I had the capacity to do something. One of them said, "I always thought you could do something if you put your mind to it." That sounds like a very trite thing, but that's what happened.

That mononucleosis was the biggest blessing, because otherwise I was just careening down, dwindling down, I was dying in that school. Getting sick and having people spend a little time with me, and recognize that maybe I did want to learn something, that I did have an inner life, because I certainly didn't have one at school.

When I came back, the kids in these H-tracks courses had nothing to do with me. I still hung out with kids who are now carpenters, and firemen, and policemen. Many have died of drug overdoses, or in Vietnam, but they were good people. I really liked them, and I thought they had some insight that made it worthwhile hanging out with them. More so than the kids who were doing this as a stepping stone to the right college, or to get the right husband, or to do the right job, or whatever it was they were going to do. That didn't do it for me.

I hung out with the two who seemed bitter and cynical. We were all bright, and we could do it in our sleep, but we had other things that we were interested in. At least we could speak the same language. It made it tolerable.

I didn't realize that MIT would be the same way. I never realized the world doesn't change because you leave one school for another. It took people like Jerry (Jerome Lettvin) to bring it back, because I died again at MIT, for a few years.



LS:

Tell me about that that, because that happened to me too. Tell me about that illusion that it was going to get better.

GP:

My parents brought me up to Cambridge (Massachusetts) in an Oldsmobile '68, a bronze colored car with a black top and reddish interior. It was a boat and it seated all of us comfortably. My grandmother was not quite as demented as she was to become, and we were staying in a motel overlooking the Charles River.

We're standing there looking out the balcony and I say, "This is my future. This is a great new horizon." I figured it was going to be so amazing. Here are people who are really thinking.

My grandmother says, "What do you think you're going to accomplish?" She actually asked some very cogent questions back then, before she started talking to the TV. "So what are you going to accomplish?" "I'm going to just take it all in, and I'm going to figure out the meaning of everything." She looks at me and she says, "Good luck!"

So I go to MIT, and after the first few weeks I realize no one could give two hoots about the meaning of anything. There was a lot of drugs, a lot of alcohol, and then there were people getting through problem sets. "Yeah, you got to get these problem sets done." It's a lot of work, and you're chugging through them.

A lot of personality disorders. We lived in these quads and there were four people in a room. My first roommates were awful. One was in severe alcoholic, another was a psychopath, and the third was a terrorized Eastern European kid whose only interest in life was crushing communism, because it had destroyed his family. It was like, "Who dealt me this mess?"

I signed up for a whole batch of interesting stuff figuring, "I know this stuff, I'm sharp." Almost everybody there was just as sharp as I was, some were much sharper. We were doing this stuff and I'd go and talk to the TAs, the Teaching Assistants — the professors didn't want anything to do with us: we were freshmen, we were useless. But the TAs were often stuck with these jobs, and they didn't want to spend any time with us either.

I remember one Japanese physics TA who was tripping on LSD while trying to teach our section. He was out of his mind! It was hard enough trying to understand him since he was Japanese, but this was, like, way out there. I was getting this bad headache, getting this bad feeling about the whole thing, and I said, "This is garbage. I'm learning nothing. Why did I come to this place?"

And then there would be the lectures by Jerry and by other people, who would give talks around campus. People would say, "Oh, you don't want to go to that stuff. That's very political." I said, "It's a damn sight better than this stuff. This stuff sucks! This is terrible."

I started going to Jerry's lectures because they were popular, but they turned out to be much more subtle. There was exciting stuff going on. I came up and told him, "This is what I want to do!" That's when he told me, "Boychick, everybody wants to do that. Come back when you're ready."

We had a guy, Danny Kemp, who was a young professor just out of his fellowship at Harvard. Danny turned chemistry into something understandable, and we got along really well. He actually saved me from freezing to death when I was walking back form my girlfriend's dormitory. I walked her home from a party and the temperature had shifted 20 or 30 degrees and I was freezing, I was in a T-shirt. He stops his car and says, "Asshole, get in." And I look over and it's Doctor Kemp. He took me back to my dorm; I got pneumonia out of it.

He was a breath of fresh air, because Danny understood how chemical reactions could be conceived of in the way that Linus Pauling had written about them. Pauling was one of the other people who turned me on when I was in High School. That happened by accident, because the High School teachers couldn't tell me what chemical bonds were. They were terrible, they made the stuff up as they went along. They obviously knew nothing about valence, so I started to look for books on valence.

This is where I got lucky because there were people in the periphery, and if you nudged them a little, then you got things. There was a guy Sid Thompson, who was a black man who was a chemist on the uranium 235 project — the first African American to graduate from Notre Dame with a Ph.D. in chemistry — he developed the filters for the uranium hexafluoride. He was brilliant, he was also very radicalized: Stokley Carmichael's picture was up on his wall; a big picture. He and my father were long-standing friends from the old days. My father dragged me over to sit with Thompson because I'd asked him about chemistry. He said, "Well, go and talk to Sid Thompson. He's a chemist."

I was a teenager and Thompson drags me along to help out at this thing in Wyandanch, New York, which was an upward bound training thing to teach kids from the inner city. I was the token white, which was great. It was a great group of people. Some were very interested in learning, others who could care less. I don't think they'd seen white people either, where they lived; and I hadn't seen any blacks in my life. I'd never realized Sid was black, he was just like an uncle; he just hung around.

Sid handed me a copy of Linus Pauling's "General Chemistry" and said, "This is what you need to read if you want to understand chemistry. This guy Pauling understands chemistry," so I read the book. I read it like you read a novel. I didn't realize that you're supposed to look at it like it was a year's work. I just absorbed it. This was really cool stuff, so I said, "I'll become a chemist. I'll do biochemistry because I want to do biology and chemistry, I'll do it all." I actually started to understand some of it. It gave me hope that there was something to do.

Danny Kemp understood that stuff and was kind of resonant, which is why I got sucked into doing biochemistry. The trouble was that I needed to make money. My parents didn't want to give me any money, and being an undergraduate at MIT with nothing to do except go to classes was getting me really down.

I took a job working with a professor of nutrition who was doing some rat feeding experiments. I worked for him and he eventually offered me a position in the lab, which I mistakenly took. As a result I ended up spending a number of years doing incredible drudge work.

I got my degrees very quickly but there was no content. I realized I was lost again. Here I had started to find something, and it disappeared because I was busy doing mindless laboratory work, day in and day out, 7 days a week, and all summers. I would just live in the lab. I didn't understand why I was doing it. I'd forgotten.

One day I woke up and I said, "I don't want to do this anymore. I'm going to go off and do something else. I don't care what my Ph.D. is in, I'm not doing this. I can't do this."



LS:

Were you in graduate school at this point?

GP:
I was doing biochemistry. I hated it. I could read the stuff, I could do the experiments, but I absolutely detested it.

Everything about it was wrong. It was like a religion. I didn't believe it. They would say, "This is how Vitamin A works." And I said, "I don't believe it!" And they said, "What do you mean you don't believe it?" I said, "It doesn't make any sense!" "Well, that's what we're researching!" I said, "No, why would God build a system this way? There is an engineer behind everything. It has to make sense. It has to be energetically efficient. It has to be reproducible. It has to be stable on a real-time basis." They looked at me like, "What are you talking about?" I said, "I'm giving you Aristotelian reasons for why this is not feasible." They'd say, "You're just crazy. You're on drugs!" I'd say, "I'm not on drugs! It's wrong! It doesn't make any sense."

This is when I started working with Jerry. Jerry's son needed to pass biochemistry, and I tutored him saying, "This is all you have to think about." I did my best Linus Pauling and the kid passes. The next thing I know Jerry's calling me into his office to interview me.



LS:

You had met Jerry before, but you never followed up?

GP:
I had never followed up because I figured he had no interest. I'm very easily rejected, at least I was. I learned later that you could be like Colin Powell (General Colin Powel) and if someone says "No," you can find someone else who says "Yes." It took a long time to learn that independence. I didn't have it then, and I'm sorry I didn't, but I think everything happens for a reason.

Jerry called me to his office; I didn't know what to expect. He was very inquisitive and he was trying to figure out what I wanted to do. I said, "I want to understand things. I just want to be able to do something, anything. I'm tired of wasting my time." And he says, "Well, I can give you a position. I can't pay you much, but you'll meet interesting people and you might learn something, because you don't know shit now." He was very straightforward with me.

That was when I began to transform into a person; that time was a remarkable chrysalis because the people who came into his laboratory would be people like Carleton Gajdusek who discovered the slow virus, the kuru; Benoit Mandelbrot who developed fractals; Mitch Feigenbaum who developed chaos theory. Person after person came in who had a vision and could explain themselves.

We even had the guy who wrote "The Structure of Scientific Revolutions", Thomas Kuhn. Tom Kuhn was my patient, I took care of Tom. Remarkable guy because you could sit and talk with him and understand what the crime of Galileo actually was. He had a brilliant style, strange man but brilliant, and you knew it instantly. He walked into a room and he was delightful. I loved him.

I started teaching physics, which was not my area, but I discovered that relativistics were really neat, what little I understood. What I tried to do was — in every lecture I ever did — I tried to have a point: one key point that the kids could hold on to.

First I'd tell them, "Where's your intellectual curiosity?" I couldn't give up on Mrs. Sullivan, my English teacher who always said, "Remember, it's curiosity that expands your horizon. It's what gives you your perspective, it gives you your insight, it makes you alive." I always think about that because she's one of those people in that original marsh who really had some substance to her. She really stood out; she was amazing. I didn't appreciate her enough.

Jerry populated my world with people who were on the cutting edge in everything they did. You could sit there and talk with them, and if you asked the right questions you got phenomenal answers. It lead to a transition from measuring things just because I could measure them, to thinking about why do we needed to make a measurement. What is the purpose of this? And then trying to understand, for instance, how do you encode data in a neural network, because that's what it was starting to come down to.

I had always assumed, before sitting with Jerry, that the nervous system worked by the axon reflex, that the firing of the axon embodied information. But that's so far from the truth because the axon,"¦ if you measure the temperature of blood going into the brain and going out of the brain it's up by 0.5 degrees or some trivial amount. But if nearly a trillion cells were firing, then the temperature of the fluid coming out of the brain would be incredibly high.

The point is that there are many other things happening in nerves: there are transitions in the membrane, like in semiconductors, very low energy transitions that don't produce heat. And different things happen depending on how you pulse a membrane. In the case of a crab's claw, same nerve, if you stimulate it at one frequency it opens, and at another frequency it closes. This means that penetration of the different branches is time dependent, and not necessarily selected down a particular pathway.

Then you get into the business of Stentor and other protozoans. If they settle on the same stalk and you touch one, they all contract. Well, the speed with which this happens is the speed of sound, and if you do birefringent pictures of those little buggers sitting together, the refractive index of them changes and travels throughout the mass. It's as if you're changing the state of the membrane.

So that's the way the nervous system may be working — and this is turning out to be true 30 years later. It made sense when I thought about it back then, and Jerry got excited about it, that the membrane is constantly undergoing semi-conductor-like state changes. And this is not what we think of as the firing of neurons because, when I stick needles in people's brains, there is no firing. The brain is very quiet when you're awake, and I do people who are awake. I stick needles in their heads and electrically look at what's going on.



LS:

How do you look at it?

GP:
On an oscilloscope in the operating room. I'm back to doing what I did to animals! And what you discover is that there's not much signal. So here is the person sitting talking to me, and his brain's as quiet as a mouse.

Where is knowledge? Where is consciousness? It's not axons and axon reflexes, it's in state changes in the membranes, just like in our computers. The computer people were right all along and we never saw it. We're just a big hunk of semi-conductor firing phenomenally fast: microseconds per event. State changes that have no energy above kT (thermal) noise, just like the background noise of the Big Bang. We're operating off kT!



LS:

When you say we're operating above kT, you mean we're operating just above the noise?

GP:

Just above the noise.

When I realized that, I realized that Bridgman was right: there's no such thing as information without a transition at an interface. It was an epiphany! I realized that everything that I had learned was wrong. Everything was wrong.



LS:

Are you talking about biochemistry?

GP:
In biochemistry and in neurophysiology; I realized they were all absolutely wrong.

People argued with me and said, "No, it can't be any of that. You're crazy." They basically shunned me. This is what Tsaki (Ichiji Tsaki, now at National Institutes of Health, Bethesda, MD) is now publishing, this year, in his stuff about water layers, and the Zeta-potential kind of phenomenology, which is probably the informational circuits of the nerve. I think the nerve will end up being a very different structure than we imagined it to be.

It's not the tools you use, the tools are not important. Jerry would drive people crazy because they'd come and say, "I have a great idea for a research project." And Jerry says, "Well, what is it that you want to understand?" "Oh no, I've got this piece of equipment and now I can do this, and I can do that"¦" He'd look at them and say, "Fuck equipment. What is it you're trying to do? Suppose you had all the equipment in the world, what is it you want to know? If there's nothing that you want to know, then I don't care about the equipment. You have nothing to interest me."

I'd sit there and be privy to these things and realize that he was demanding that people go beyond thinking about their tools, which are very much period pieces. He demanded that they think about what questions would have been asked a thousand years ago, or a thousand years in the future.

I started to realize that my feelings had been right when I'd thought my work as a graduate student was worthless. Not because I wasn't motivated or wasn't clever, but because the work was uninspired, rote, and predictable. It was the wrong trunk of the tree I was crawling up, and I needed to find something else. Jerry understood that. He realized that, with a little bit of focusing, I could do something.

Jerry explained neurology to me. He said it was an area where you're trying to take a history from a sick device. You're trying to interrogate a faulty circuit by talking to it. He said, "How much more interesting can it possibly be?"

He took me to visit people in the ward. The first patient I saw was a woman who was 66 years old. She collapsed in the shower. Her husband comes in to see what's the matter, and she starts screaming. He calls the police, they come, and she claims this man had come in to the bathroom, that he was her husband's brother, and what was he doing there?

So she gets admitted to the hospital, she's in atrial fibrillation, she's introduced to people in the room, Dr. Gershman's there, and she says, "I know your brother." Everyone was duplicated. Everyone room in the room was duplicated, including me!

Her EEG showed hiccupping in her left temporal lobe. She'd gone into atrial fibrillation due to a small embolus from the heart that's lodged in her temporal lobe, an area where she is reduplicating objects in her memory. And since her brain couldn't understand why there were two of things, it explained the second one as being the relative, or the cousin, or whatever: "You're his twin."

And I'm sitting there as an engineer — as that's essentially what I am at this point — realizing that this is wild, this is unbelievable! I turn to Jerry and I say, "Have you ever seen anything like this before?!" And he says, "No, never." Just matter-of-factly: "No, never."

I said, "You've never seen this before, but you've dragged me in, and this is what they bring in?" He said, "Well, anything can happen. It's the nervous system." He looks at me and says, "I don't understand the nervous system," very matter-of-factly. He says, "I don't expect you to, either. It's an adventure." And I realized that this is what I was looking for, and it's been like that ever since.

I get to write about this stuff, I get to teach about it in the community here. They love it. I can give them vignettes. I can encapsulate and simplify the vignettes so that they get the bare bones of what it is that the person presented with, and they can take something away from it.

I just wrote this thing (he shows a recent publication), take a look at vignette number zero. These vignette are little stories to show doctors that they often don't know what they're looking at. This was a fashion model whose boyfriend was a Mafiosi, and who brings her to the emergency room because she can't wear her high heels. I was a resident and I thought that was the wildest complaint I'd ever heard.

There's this beautiful model with this heavy Tony Soprano-kind of boyfriend, and she can't walk in high heels, and it's pissing him off: she can't walk in high heels and look good. And sure enough, she couldn't walk in high heels.

The first thing I learned from Jerry was that when somebody says they can't do something, look at what they're doing. Figure out why they can't do it. So instead of doing what my chief resident wanted me to do, which was get this person out of the ER, I ignore him — we later became fast enemies because I showed him up and he hated that intensely — and I asked the woman to walk, and she couldn't walk in high heels. She takes them off and she's walking fine. And I do her exam and she has no ankle jerks.



LS:

What's an ankle jerk?

GP:
A tap on the tendon, I did this (he demonstrates), but there were no reflexes. This is a young woman and her intoxication screen is negative, and I said, "This doesn't make sense." So I did the only thing I knew to do, which is to say, "We have this machine here and we can look at the nerves in your body. I'm going to hook you up to see what your nerves are doing." Her brain looked fine, she was just a little anxious.



LS:

Which nerves were you looking at?



GP:
I looked at the nerves in the foot and the hand. There were no reflexes off the lower spinal cord in the lower extremities, we couldn't get anything; that's not normal. I'm actually looking at an electrical reflex, I can "ping" the nerve off the spinal cord, which is really cool. I'm doing this and I'm going, "This woman's got Guillain-Barre!"

I call the head of neurophysiology, who was this really anal-retentive guy. We later had a falling out, but at the time he was impressed that I called him about this. He says, "Well, what do you got?" I said, "I think I have something odd. I want you to come and look."

He comes and looks at the data and he says, "This is Guillain-Barre." And I tell him, "You're never going to believe this story." And I tell him this story and he starts laughing, "That's a great story! Let's admit her to my service." He says, "This woman's going to get really sick."



LS:

Oh, really? What is this disease? Is it a degenerative disease?

GP:

No, it's an ascending auto-immune disorder where you denervate all of your muscles and become paralyzed. She was on a ventilator for three months. She ascended over the next week, lost all her function, lost all of her reflexes. Basically, if I'd sent her home she would have died.



LS:

Bizarre.

GP:
I see it all the time.



LS:

It's common?

GP:
It's misdiagnosed. That's the reason for this article. I see so many cases of this in the community, which are sent away from the emergency rooms. I had one just recently that was sent out of three emergency rooms because they thought he just had back pain. They thought he was a crank. He's sucking on a respirator as we speak. He's been in the hospital for 7 months; he's slowly recuperating.



LS:

What causes it?

GP:
It's an auto-immune reaction against the myelin coating on the nerves. It's pretty impressive. It's MS (Multiple Sclerosis) of the peripheral nerves, that's exactly what it is. The physiology of it is fascinating.

This experience did two things: it got me an offer to stay on at Harvard, and it polarized me against this resident who basically just spent all his time being pissed off at me. This guy is now at the University of Rochester. He's very bright, there's no question that he's very gifted, but he's a very rigid individual.

He was interested in publishing anything that could get published. There was no interest in the quality of the work, he published a lot of crap. I got sick of it to the point where I actually avoided him like the plague. I thought I was getting sucked back in to what I just escaped!

People keep trying to trap you on the flypaper of mediocrity because it's do-able: just roll up your sleeves and shovel. And you can do it. The journals full of it, and I find it utterly uninteresting.

I want to know something that actually changes things, and that gives me a reason to do X or Y. We're talking about modifying human beings. If we're going to do that, then maybe we should have some solid material, versus, "Should we measure the conductance of the ulnar nerve with the bent arm or the straight arm?" This is what people publish, again and again. And your point is? Who cares!

I end up battling the same stuff. I'll tell people that something's clinical and we don't need all of these different tests, and they get offended because I'm not ordering tests. Since when did we replace reasoning and physical exams with tests? When did putting up a CAT scan mean more than actually examining the patient?



LS:

Is there an answer to that question?

GP:
There never will be. The companies that are comforted by management bean-counters would like to see medicine reduced to numbers. Now, statistically we can make errors, and if we miss a few it's within a statistical range that doesn't matter. We can lose those people because we would have lost a few anyway.

I've started ignoring a lot of the medical literature because people don't do the clinical work, they're just quoting other people who also don't do clinical work. So those of us who are actually clinicians, who know better, go to conferences and make this known. This is what irritates me, this is why I do what I do: the gentle vengeance aspect, which means getting even with the jerks who spend their lives filling the world with misinformation because it's expedient, it's convenient.

It's very important to have a notion of what you're looking at. It's what Jerry used to call "the Aunt Tilley effect." Most of us don't know what our Aunt Tilley looks like, we couldn't draw her, but once she shows up, then no matter what she's wearing we know it's Aunt Tilley. It's the same way that we can all type, but we can't draw the keyboard because my cortex has no care or interest in the keyboard, it's long since given it to the thalamus to manage, which means the subconscious.

The subconscious doesn't get enough credit. That's where most of us live 90% of the time. The thalamus is the flashlight in the attic. It decides where you're going to look because I'm taking in a billion bits of information per second. It's that old thing: you stare across the parking lot at a sea of cars and you can see a guy breaking in to your car, you can see what you've left on your seat. But you've never changed your gaze. It's all the same picture, all that's different is how you process the data.



LS:

So tell me then, what do you think teenagers should do to get on the right track?

GP:

I think everything is about conflict and its resolution. Resolution is a bad thing. I think about this every day. Most of the time when things are calm we're satisfied, and nothing is happening.

The beginning of "Finnegan's Wake" (by James Joyce) goes:

"River run, past Eve and Adams, from swerve of shore to bend of bay, brings us by a commodius vicus of recirculation back to Howth, Castle and Environs."

"Howth, castle and environs," means "here comes everybody," the whole world. "Commodius vicus" comes from the Renaissance where Vicus proposed the notion of the recirculation of history; that history repeats itself, and that all of life is this constant being born and dying, rising and sleeping, which is all about Finnegan's reawakening. Marvelous work.

There are things to be done, there's danger, there's excitement, there are errors, and there are people who get hurt, and there are people who don't come back. But it's in those ages that great things are built.

This turbulence is exciting because it's a time when you have things that are not yet resolved. When things are resolved you end up with times like the Middle Ages, where people spent a lot of time putting filigree, and curlicues, and baroque forms onto staid items because there's nothing else to do, because they didn't know what to do next.



Kid's are faced with the fact that there is so much to be done in so short a time, and they're not sure for what purpose. They have the internet, which tells them about horizons, but again, there's so much information that there's no information. If I was a kid going on the internet and typed in "what's the meaning of things," the crap you're bombarded with!

The first thing I did when I finally got "internetted" back in the early "˜90s — because I was a late adopter — was that I went around the world. I basically hopped different countries just for the hell of it. Just to see what this thing would do.

I was just astonished. I began to look at museums. And then I began to look at things, and pull up documents. I didn't have a passkey but security was very weak and even a novice like me could break in. So I was looking at different libraries, and I was having a ball. I never imagined you could do that. I realized that this completely changes my need for libraries. This changes so many things.

I guess the way to look at that is,"¦ have you ever read Borges, Jorge Luis Borges? Do you remember "Funes the Memorious"? Funes: he knows everything, and he knows nothing. Because every time a tree looses a leaf it's a new tree. And this is Borges' point.

When there's so much information, then there's no information, and direction again becomes critical. So while we had stacks of libraries to curl up in — which is what I did when I needed solace in undergraduate and graduate school. I would go into the library at Harvard and hide. I would get a cubical, I'd lock myself in, and I'd say, "Today I'm going to try to understand X." — you can fill in what X is — and I'd go and pull the stuff on that and see if it meant something. And I might stumble on something else and realize connections, which would be exciting.

Kids now have their school requirements, but they have this thing, this wide net, which is enormous. I have no idea how they can manage it. They are obviously very good at it — more so than most of my colleagues — but without direction from teachers, who have some sense of it, I think they could easily get lost.

I remember reading Descartes' (René Descartes) book on reason where he explains that he'd been a bit of a neer-do-well, had to leave France, and go to Amsterdam because he'd gotten into trouble with the cops. And then he suddenly decided that he had to do some work.

Now, I never noticed that when I read it the first time. It wasn't until years later, reading it again, that I realized he was trying to tell me something. Something I never would have heard when I was his age, when I was young, because at that time it wasn't an issue. The issue was being drunk and disorderly. The issue was disassociating from the system. But now the issue is focusing on the realization that, "It's not about me."

There is some transition in every educated person's life — everyone who has some responsibility to his society, whatever that society entails, a political society of some sort, a righteous society where there is some ethical reason — there's some point at which you realize it's no longer about you. It's about society.

This is something that Jerry kept telling me, and I finally heard, which is that it's not about me, it's not about my creature comforts. Those are important but that's not the main thing, because that's not eternal. What's eternal is knowledge. And it's not that I want to make a name for myself, it's that I want to contribute to that web that grows and keeps extending to the horizon. The horizon that we can see goes further still; it's an infinity that you cannot even approximate. It is beyond logic, and it's out there.

Kids can't possibly understand that. They can't understand it at that level, but what they can understand is that it is an adventure. We're all Columbus. We're all setting out. The risk of drowning is real, and the risk for success is real.

I think of having made numerous false starts, and I felt reassured when Jerry said, "Well, there were mathematicians who started in their 50's. Why are you worried? You're not old." And I'm going, "Oh gosh, I've been doing this so long, it's a mess." And he says, "No. Step back and look at what you want to do, and start over." He says, "Always reinvent. That's what you're good at. Do it."

As I get older, what delights me is that I have a thousand more questions than I have possible answers to. That keeps me amused at this point.

My patients always offer me such complicated things that I struggle every day to figure out what they're talking about, number one, and number two: can I fix it. The business of being able to plug in to the human brain and reprogram it, which is somewhat akin to listening to electrical discharges on telephone lines and intuiting what's happening at the local civic center. It's still very intriguing to me. I have to admit that I enjoy it. I do it at least once a week.



LS:

Are you talking about looking at an EEG (Electroencephalograph)?


GP:
No, I'm talking about drilling holes, putting electrodes in people's heads, and turning it on. We can actually go in and interrupt pathologic circuits. Do we really know what we're doing? No. Can we make people better? Absolutely.

There are about 100 centers in the United States that actively correct Parkinson's electrically, through deep-brain stimulation. I couldn't do it at Harvard because I wasn't one of the select, delegated few. I had all these patients who needed it, but the people who could do it were not interested because it was risky.

We've had people who were 40 years old and who couldn't get out of a car, couldn't walk independently, were on medicines 24 hours a day, and who now have an independent life with electrical generators in their brains, pacing their deep structures.

Deep-brain stimulation has very odd effects on some other things, which is what we're trying to understand. It can cause impulse disorders, and that gets interesting. I don't have any answers anymore. I've learned that answers are things you just make up as you go along. And until it falls apart, it's reasonable enough.

There is a book called, "Who Goes First?" (by Lawrence Altman) that is about famous risk takers in the history of medicine, such as Forssmann who was a surgical intern in Germany back in the late 20's.

Forssmann was an interesting guy. He wondered why we couldn't look at the heart using dye. He was told this could not be done because if you put dye into the heart the coronaries would fill up and the person would die. Evolutionarily we have the heart of a fish, it doesn't have very good vasculature. It was never meant to be a high power, energetic kind of thing, so it's got crappy circulation. If you squirt dye into it, it's going to seize up and die.

Well, he didn't buy it. So he took a Foley catheter, which is a thing you put into the urethra for keeping the bladder open, and he stuck it in his antecubital vein, pushed it back up into his heart, squirted himself with dye, and took X-ray pictures of it. He brings this picture — the first picture of angiography of the heart — to his attending physician, who promptly discharges him from practice for having done this: "You did the impossible. You're fired!"

He later gets the Nobel Prize in medicine for developing angiography, which is the basis of all modern technique. And the question is always: "So, who goes first?"