From Humble Beginnings. Part Two

When we left our troubled Charles Edouard Brown-Séquard at the end of the previous column, he was busy gaining eponymous fame for his description of spinal cord hemi-section. What’s that, you say? There was no mention of trouble last time? Well, it appears we’ve only heard half of the Brown-Séquard story.

His is also the tale of a man deeply unsatisfied and increasingly unsettled – feelings which may, for all of us, have the whiff of uncomfortably familiar. He barely stayed in one place for long, making sixty crossings of the Atlantic and spending six years rootless, at sea. Despite his earlier painstaking observations of the neurological system he grew impatient, falling more and more into self-experimentation, which is the peripatetic way this column is heading.

Self-experimentation in medicine has a hallowed history, but Brown-Séquard turned it into an art form. His most impressive (or perhaps outlandish) feat was injecting himself with a self-titled elixir; a mixture of blood, semen, and the juice extracted from crushed testicles. He wrote up the results, which included an increase in physical stamina, a markedly longer jet of urine, and unarguably improved expulsion of fecal matter. Let us take a moment to be glad we were not his research scribe. Other substances from a smorgasbord he introduced into his person were: the vomitus of cholera patients (swallowed to demonstrate laudanum’s superior therapeutic use), and varnish (completely covering his skin to explore the side effects). In reverse, he regurgitated food he had just eaten so he could examine the action of gastric juices upon various foodstuffs.

Of course, the results of self-experimentation are the ultimate N=1. Excellent to springboard further research, but of limited value in terms of evidence. It is, however, undoubtedly bold. Other heroic self-experimenters were: Marie Curie, who so exposed herself to radium that her marrow gave up in protest, Jonas Salk, prevented from releasing his polio vaccine until he had tested it on himself and his family, and Western Australia’s only Nobel prize winner, Barry Marshall, who guzzled a mug full of Helicobacter to prove to the naysayers that peptic ulcers have a microbiological basis.

Often self-experimentation occurs at the tail-end of desperation – where researchers have been stymied, blocked, frequently frustrated, and where sometimes good sense is asked to stand aside for courage.

Frustration is front page news for emergency clinicians. It’s everywhere. It is a staple at the buffet of modern day discontent. One can’t turn an electronic page without coming across a piece on burnout. Burnout is a god with many faces (moral injury, moral distress, battle weariness), wearing multiple costumes (thinning resilience, unhappiness, grinding dissatisfaction, fracturing of one’s internal world), and with copious causes (a system problem, a societal problem, bureaucracy, inhuman rules, inhuman computers, the yawning chasm between expectations and reality). This means that although burnout’s boundless universe is recognisable to everyone, the experience of it is often entirely unique. The depth to which it pierces also varies widely. No single root cause analysis and no single solution fits all. This is our own N=1, and thus maybe requires our own self-experimentation.

There are bodies of excellent literature on burnout around, reaching into every specialty, profession, country and culture, and it is worth reading broadly. My own collision with burnout was slow; a restless misery, a deep smouldering core of disappointment in myself that I was not better, that I could not excel or reach the goals I believed I ought. It was the result of cumulative exposure, a growing pyre of slings and arrows. Death, abuse, overcrowding, criticism, circumferential pressures, the usual. I wondered if I might be broken. And the only way through the dark was a reset. Nothing magic. Or perhaps it was a little. Mostly, it came down to the simple act of love. No matter how small, in what tiny quantities, in what strange guise, for what odd recipients, even if as fleeting as a heartbeat, on a phone, to a junior, to someone who needed it, to myself, even when I thought I was incapable of it; just one more moment of the insistent, progressive match-flare of love with its inherent, surprising magic. My own N=1. This miniscule thing within my control, unlike the behemoth of bureaucracy. And love, and this is a singular truth, begets love. But as a solution, this will appear infuriatingly trite to some – after all, what good is love in the face of the callous understaffing of the NHS, or the brutal EMR and HMOs of the US, or the ubiquitous foaming horsemen of the administrative apocalypse? I can’t answer for any of this, just myself. This tiny four letter word is sometimes all that gets me through. If nothing else, it’s a start.

Not at all what Charles Edouard Brown-Séquard had in mind when peering intently at his own gastric juice soaked rumination. Or was it? We’ll never know.

I read a hundred Leonard Cohen poems to get the right coda for this piece. And it is this one, with its quiet, unshakeable refrain that sings to it most:

‘Dance me to the children who are asking to be born

Dance me through the curtains that our kisses have outworn

Raise a tent of shelter now though every thread is torn

Dance me to the end of love.’

A return to humble beginnings, to end.