Jay Kuten: Chance can alter one's life

So much of life is chance ...

Near the end of my medical school training, I had the good luck to be accepted to work for a term in the neuro-anatomy laboratory of the Warren Anatomic Museum of Harvard Medical School, under the guidance of Professor Paul Yakovlev.

My official job consisted of counting cells in the lateral geniculate body, a part of the brain which channels visual information.

Later, when Yakovlev published a paper which included my data, he did me the great and generous honour of attaching my name as co-author, a charming exaggeration of my contribution.

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Yakovlev was a dedicated scientist and, simultaneously, a great clinician, permitting him to have a broad view of the fields of his expertise - neurology, neuro-anatomy and neuro-pathology.

The lab itself was located within the Warren Anatomical Museum of which Yakovlev was also curator. The main floor was taken up with glass cases of exhibits.

As I was given free access to all of it, I can say with pride and awe that I've held in my hand the skull and the tamping rod of the famous Phineas Gage.

Gage is a prime exemplar of chance altering one's life.

In 1848, Gage, 25, was working on the railroad in Vermont. One day, as he was using a tamping iron to pack explosive powder into a hole, the powder detonated, sending the rod - 1.1 metres long, 3.2 centimetres in diameter and weighing 6 kilograms - up and through Gage's left cheek.

It ripped into his brain and exited through his skull, landing several dozen feet away.

His survival, itself, was miraculous but observations by his doctor John Martyn Harlow and his friends to the effect that "Gage was no longer Gage," and that, instead of the steady fellow he had been, he became impulsive and intemperate, spewing profanities, made him the most famous patient in the annals of neuro-science.

His case was the first to suggest a link between brain trauma and personality change, a result of his accidental "lobotomy".

In the collegial atmosphere of the laboratory, I had considerable time with Dr Yakovlev, both formally at brain dissections, and informally.

Yakovlev had been educated in Russia before the revolution. He read several newspapers, including Le Monde and the Frankfurter Allgemeine in their original languages as he was fluent in several.

His English was pronouncedly accented. One moment he might rush from his office to my lab bench and ask, charmingly: "Kuten, how you spell boot?" "Sir? as in ... ?" "As in telephone boot."

Yakovlev's clinical responsibilities included weekly neurology rounds at the local state psychiatric hospitals. These meetings took place in old amphitheatres, like those in the Eakins paintings, with everyone wearing white lab coats.

A patient's history would be recited by one of the staff and then the patient wheeled in on a gurney or wheelchair. After a brief exchange with the patient, Yakovlev would perform a complete neurologic exam.

After the patient was wheeled out, Yakovlev would localise the lesion in the patient's brain to account for the symptoms presented. After a few of these rounds, I asked Yakovlev how long it might take to develop a working anatomy of the brain in order to make such diagnostic statements.

He took the question quite seriously and said in thick Russian accented English: "About 30 years, I think."

I was happy to carry his medical bag to these clinical events. One day, as he was driving, he turned to me and said: "Kuten, today we are going to Wrentham State School.

"You know what is Wrentham State School?" "No sir." "It is hospital for children with severe neurologic disturbance, often with deformity. They may be anencephalic, and even appear monstrous [Zika children for example, today].

"Never forget Kuten, that the difference between them and ourselves, it is purely quantitative, never qualitative."

With the proverbial lightbulb over my head, I realised he had summarised all of medicine and psychiatry. The rest is merely commentary.