MICROCOSM IN A BOTTLE Remembering his days as a young pathologist, an essayist ruminates on the deadly paradoxes of biological life
Gonzalez-Crussi, F
MICROCOSM IN A BOTTLE
The silk rope of life & death F. Gonzalez-Crussi
As a young intern assigned to the pathology laboratory of a Catholic hospital run by a monastic order, I was ill-prepared for...
...I was less clear as to the nature of these ministrations, their instrumentality and function...
...It functions as a lung, since it establishes gas transfer before the fetus emerges to the ambient air...
...These were bottles identified as "products of conception" on the respective labels...
...Two thousand years ago, Thales recognized water as the reservoir of all potentialities of existence...
...These specimens were the first I chose to take care of...
...But patience and perseverance will bring future rewards...
...Who will tell them that the nectar of life comes dashed with flecks of death...
...as endocrine system, in secreting hormones...
...However, these similes would be inadequate, because they imply that the expressions of nature are univocal, and the message is distorted by the interpreter...
...But look at this specimen in a jar: in its listless wanderings the fetus has looped the cord about its neck, and fashioned a constricting "figure-of-eight" knot that squeezed out its lightless existence forever...
...The placenta is the fetus's "double...
...Bloody, ill formed, insignificant, and clot-like as they seem to the viewer, they must be treated with special regard: not as castoff fragments of a perishable body, but as beings potentially capable of independent life and possessed of immortal souls...
...I was on the second or third specimen, reciting into the dictating machine the accustomed formula: "The specimen is received wrapped in saline-moistened gauze, and consists of multiple, irregular, crumbling fragments with the appearance of blood clots"-when I felt a tug on my arm...
...The subtle philosopher concludes that this reasoning cannot apply to the workings of the Creator, but all his casuistry leaves us still doubting...
...Nothing in conception and birth speaks to us about death, yet all in conception and birth speaks to us about death...
...Eternity seems at hand...
...One does not will his death any less in using the first means than the two others: it seems, rather, that one wills it with greater malevolence, since he is left with both the fault and the reproof for his perdition...
...The products of conception symbolize life's eclosion, its fruitfulness and unflagging, victorious increase...
...The mother who senses a new life stir in her womb also experiences dramatic changes in her entire body, and therefore a heightened sense of the precariousness and fragility of life...
...In some, bits of placental tissue could be subsequently identified with the aid of the microscope...
...and she looked at me with a reproachful and impatient gaze from thickly bespectacled, cool gray eyes that dominated her gaunt face...
...Behind me stood the "lab sister," clad in full monastic regalia head to toe, rosary at the belt and emblazoned insignias of her order on the large cloth that fell in front of the bodice...
...sometimes under a tree, to ensure the fertility of the fields...
...Truth to tell, most of the bottles had nothing but blood clots inside...
...Here it is buried promptly, lest it trigger dreadful plagues...
...Water is at one time cradle and tomb...
...The intervention of the physician may be required when retained remnants cause persistent bleeding and other complications...
...Mark that it, too, is a living presence, since it can develop alone in the absence of an embryo...
...Incise the cover with infinite care, and a viscid fluid oozes out: an embryo is nowhere in sight...
...It is well that this be so, for in the embrace of lovers about to become parents there is something like an obscure, formless yet insistent promise of immortality, so the Diotima could define man-woman love, in the Banquet, as "love and immortality...
...there only after elaborate ceremonies...
...Or I could invoke the Spanish verse: Todo es segun el color/Del cristal con que se mira, claiming that "things take the same color as the viewer's colored glasses...
...The slightest misstep, the most trivial omission, asynchrony or incorrect performance, and the price is death...
...MICROCOSM IN A BOTTLE The silk rope of life & death F. Gonzalez-Crussi As a young intern assigned to the pathology laboratory of a Catholic hospital run by a monastic order, I was ill-prepared for some of the routines...
...Nothing symbolizes better the bivalence of nature than those bottles containing the products of conception, which one sees in pathology laboratories or in collections of natural history museums...
...Because in the Catholic creed baptism is indispensable, I realized that the sister baptized the products of conception, and I could only reflect with sadness on the number of immortal souls to whom this benefit is denied...
...I turned to mush instantly...
...Little wonder that in many cultures this organ is viewed as the fetus's twin...
...And it has a tail...
...Consequently it becomes a universal concern to determine the best manner to dispose of this organ once it is expelled...
...And therefore I stayed away, looking contrite, while the "lab sister" prayed, and repeated invocations, and sprinkled holy water with a makeshift aspergillum over rows of glass bottles labeled "products of conception...
...and so on...
...Sooner or later, though, the dissector will be rewarded: the bounty of an intact human embryo, at last...
...And when conception occurs, at the very instant of its realization when the flame of a new life is kindled, it seems as if countless sublime possibilities were suddenly mobilized, and the speed of the wheel of time accelerated...
...Yet all in hope, life, love, and the future proclaims death, and nothing but death...
...or like a cylinder, up to one-third of an inch tall, in no way reminiscent of a living creature...
...Nor could I see the road to atonement when I hesitated between addressing her as mother or sister, and between bowing, curtsying, or kissing her ring with one knee bent to the ground, as I thought the humble always did to those invested with the majesty of the church...
...at the end of this time toes have sprouted and eyelids are well formed...
...It lives on, calm and serene in the depths of the mother's womb-"that other world, the truest microcosm" in the words of Sir Thomas Browne...
...My duty was to scan them looking for evidence of placental tissue and, haply, an embryo or its parts...
...Earth is solidity, the abutment for our bodies and the seat of our sustenance...
...The excitement of anticipation then seizes you: does a homuncu-lus lodge inside...
...This proposition is discussed by Leibniz in his Theodicy (Part, 2,121, VI): To deprive a man of his life by giving him a silk rope knowing that he will use it to strangle himself, is as much a murder as to stab him ourselves, directly or through paid assassins...
...other times near the homestead, to secure the undeviating attachment of the individual to family and country...
...Popular accounts of conception and embryo-fetal development easily lapse into rapturous odes to the invincible powers of nature...
...I withdrew to respectful distance, as she motioned me to do, and thence appreciated the cause of her displeasure...
...Its look is distinctly amphibian...
...Neither palindromes, in which the sentences read the same backward and forward, nor single texts that can be made subservient to the temperament of the reader, but twin texts, each as forceful and impressive as the other-and both equally truthful...
...Elbow regions become recognizable between forty-four and fifty-seven days...
...Did a maleficent deity think of both the protection and the danger...
...and the containers should be well closed to avoid dryness...
...No trials are allowed: genes must be activated at exactly the right time, enzymes released as preordained, and all this under perpetually changing conditions...
...At thirty to thirty-eight days the fin-like limbs show swellings for the hands (hand plates), and its whole size has doubled...
...But specific protocols, not metaphysical considerations, enjoin the pathologist to approach the products of conception with delicacy and circumspection...
...At this time it has begun to curve, and soon will be C-shaped...
...air is immateriality and indefinite expansion...
...Every day, over 500,000 conceptuses live beyond the first week, and are thus brought to the very threshold of implantation in the maternal womb, but fully one-half are lost...
...From then on, these specimens I would leave untouched, until after the nun assigned to the laboratory had performed the appropriate rituals...
...The entire process of organogenesis is complete by the end of the eighth week...
...At twenty-six days the embryo shows rudiments of upper limbs, which are first like confused protuberances, then like fins...
...Physiologists tell us that the placenta subsumes the functions of all the major organs before birth, thereby lending a certain air of scientific respectability to the wildest contentions of myth and folklore...
...Yet the products of conception symbolize fruitlessness, shriveling, ashes, and death...
...cardiac activity may be discernible by ultrasonography...
...But somewhere in those bottles there could be a human embryo, a fully formed, albeit incipient human being, claiming for itself the rightful spiritual dues that the church magnanimously extends to all its brethren...
...The scientist who scrutinizes the development of new life knows it for an incredibly complex welter of permutations, combinations, chemical reactions, and exchanges that must take place in an exquisitely orchestrated fashion...
...It is regeneration through rebirth, but in order to be reborn one must die first: the old self dies, and the new self emerges to life...
...or thrown into the sea to propitiate a bounteous harvest of fish, as in the Marshall Islands...
...Products of conception are not surgical specimens like any others...
...Yet the sign of water is both positive and negative...
...Life is bodied forth from water, but water can kill...
...The nuns administered the place with exemplary efficiency...
...not a copy of a developing human, but its shadow...
...I understood that the pathologist must handle certain surgical specimens that deserve/merit greater respect, compared to others, by virtue of an intrinsic metaphysical status...
...fire is pure energy, approaching us as welcome light and warmth, or as wind-driven, hissing devastation...
...Scholars surveying over 300 different cultures found that only 7 seemed unconcerned about the manner of disposal of the placenta...
...This is a daily routine, utterly familiar to pathologists: diseased organs, biopsied tissues, and even inert foreign bodies extracted from the interior of the body must be carefully inspected, weighed, measured, described, and sampled for microscopic examination in the manner most likely to document the existing pathology...
...Anthropologists and ethnographers have yet to compile the entire catalogue of local customs for placental disposal...
...Only water can impart that total, warm caress that lulled us all into the hypnotic trance of prenatal life, where no thoughts of finitude and decay, no pangs of contradiction and want, intrude in the consciousness...
...as an intestine, in absorption of nutrients...
...as a liver, for metabolism and detoxification...
...But only water is cradle...
...Christian writers, like Tertullian, saw in it "the seat of the divine Spirit," since to it alone among all primeval substances was given the order to produce living creatures (De Baptismo, III-V...
...Two to four days later it measures 2-5 mm and evinces rudiments of eyes, in the form of little black specks...
...The membranes of the sac screen the developing being from noxious influences, but pathologic specimens tell us that sometimes they tear, and their torn strands float waving in the amniotic fluid, encircle the fetus, constrict its limbs and may amputate its parts...
...Such a specimen begins to be discernible with the naked eye at about twenty days postconception, when it measures 1 mm from crown to rump...
...Or else the embryo is there, but in a disappointing guise: looking like a tiny pale nodule in which it is impossible to distinguish front from back, top from bottom- "nodular" embryos are soon aborted...
...as a kidney, connected with regulation of water and the acid-base balance of the organism...
...It is doubtful that anyone can prompt it to paddle away, as Hippocrates allegedly succeeded in doing, by immersing it in cold water...
...led "products of conception...
...The parents who exult at the life of their child are thereby reminded of the passage of time, and handed an obscure premonition that a new generation approaches, like a tidal wave, to replace them...
...The symbolism of baptism implies submersion into the life-giving waters of the sacred...
...An odd presence, the placenta, shares the fetal living space...
...Each one, in due course, will come to realize the life-death bivalence of human existence...
...Products of conception" is common medical terminology that, for once, means precisely what it says: if there is reason to believe that a woman has conceived, and subsequently tissue exits her uterus spontaneously (in a Catholic hospital one is not likely to see any but spontaneous abortions), such tissue may reasonably be regarded as the product of the conception...
...The lover who feels transfigured by the power of love salutes in himself "a new man," yet mourns the death of his former self...
...We read the one most frequently, because we find it soothing...
...either the embryo never formed or it was blighted very early in development and resorbed...
...Nothing in hope, life, love, and the future expresses death...
...At each key post an overseer or coordinator (may the youthful levity of those who said "spy" be forgiven) saw to it that cleanliness, order, punctuality, and systematic avoidance of waste prevail throughout the establishment...
...What will you see...
...Therefore a liturgical service was appropriate...
...I spotted it in formalin-containing bottles labeled "products of conception...
...The fetus is there suspended in a liquid, but this liquid is not the cleansing, vivifying water of its original existence: it is a fixative to preserve its structure in death...
...I could conclude that, as in the American saying, the same glass is half-full or half-empty according as to whether the viewer is an optimist or a pessimist, respectively...
...Moored to the placenta by the umbilical cord, like a vessel to the pier, a fetus rocks to and fro, now rising, now falling, ever so slowly, in its watery environment...
...As its multifarious protection is plain, the myth-making imagination-Gaston Bachelard was fond of saying "the material imagination"-has no trouble seeing a simultaneous power to inflict harm...
...The lesson was not lost on me...
...Or else it must be placed in a pot and washed, as in some rural Thai communities, to ward off the baby from skin diseases...
...The day's allotment of tumors and inflamed viscera had already been arrayed on the counter-spoils of the unending mayhem between scalpel and disease, daily enacted in sterile battlefields worldwide-when I caught sight of a batch of containers set aside...
...About 3 percent of perinatal deaths are due to loop-ings, torsions, twistings, and other accidental entanglements...
...Crumbling, crimson-blackish blood clots, in which fibrin threads or bits of endometrium add an iridescent fringe...
...or in a tray bedecked with flowers and floated down the river, at night, to please the crocodiles, as in Java...
...The surgeon scrapes off the interior of the uterus in the operating room, and sends all tissues recovered to the pathology laboratory...
...Beneath the vault of its cavern, it is yet encapsulated in a system of membranes of "chorionic sac," only a restricted area of which develops into the placenta, the complex structure that permits close inter-digitation between fetal and maternal tissues...
...The experts are clear in their admonishments: use not formalin, which brutally hardens structures and alters their color, but sterile saline...
...Perhaps no one has to say this...
...I assumed this to be one more example of the unswervingly methodical ways of the good sisters: specimens of like character were grouped together to facilitate my task...
...Often this is all, the products of conception having been previously lost...
...Gently tease the specimen under saline, and view it with a camera-equipped dissecting microscope, ready to photograph the slightest detail...
...I was obscurely conscious that I was at fault, but uncertain as to the nature of the gaffe...
...Empty, "anembryonic" sacs are not uncommon...
...On occasion you will come across a tiny, translucent sac, thin as a grape's skin and full of watery contents...
...Conception is often celebrated in Anacreontic stanzas where all is mirth, and hope, and rejoicement...
...The umbilical cord conveys the nourishment to the fetus as it rocks voluptuously, languorously, in the bosom of its mother...
...Mesmerized by her gaze, whose strength seemed as if concentrated by the suppression of all other details in the wimple-framed head...
...In truth, you cannot tell if you are looking at the 4 to 5 mm embryo of a bird, a mouse, a lizard, or a human: so great is the homogeneity that early life imprints on all creatures...
...An organ anatomically and physiologically tied to the fetus by the umbilical cord, and on a mystical plane capable of influencing its whole future life-course, must be handled with extreme care...
...the other one brings no solace, but may be read in many objects around us...
...Inside the tight-lidded containers there seemed to be blood clots...
...unable to understand her speech, couched in a language still largely unfamiliar to me, I stood still, looking like the personification of the most abject idiocy...
...She ordered me away from the workbench, availing herself of peremptory gestures and the peculiar increase of voice volume and pitch with which some people address foreigners, as if convinced that conceptual impasse can be made to tumble, like the walls of Jericho, by the simple expedient of increasing sound volume...
...To the elementary imagination all that is liquid is water, and it is fitting that the embryo and fetus be suspended in this milieu, itself the seedbed of life...
...Spontaneous abortion may then occur in 8 to 33 percent of pregnancies after implantation, as diagnosed by a sensitive hormonal method (assay of HCG, or human chorionic go-nadotropin), often before the mother is aware of being pregnant...
...When the bottles of champagne are uncorked to salute an infant's birth, who will dare tell the celebrants that on the topmost froth of their drink there is a flavor of death...
...One afternoon, upon the unexpected absence of a regular worker, I was put in charge of describing the gross appearance of the specimens removed at surgery and submitted to the laboratory...
...But I do not believe that the message of nature is one, which is made to sound gladdening when read by Doctor Pangloss and ominous when the scholiast is Doctor Gloom-and-Doom...
...Not that the vices that stand in opposition to these virtues held me in their grip, for as a newly arrived immigrant in the United States I was perhaps overly conscious of the need to produce a good impression through meticulous respect for the rules, but I still felt anxious and insecure...
...Rather, the texts of nature are double, like palimpsests that may be read right-to-left or left-to-right, and each reading delivers a different and contrary meaning...
...Later, when pregnancy is recognized clinically through physical examination, the incidence of spontaneous abortion is still 10 to 25 percent of all pregnancies...
Vol. 122 • October 1995 • No. 18
