The Existential Question of Death
Air Date: January 3, 2022
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HEFFNER: I’m Alexander Hefner, your host on The Open Mind. I’m delighted to welcome our guest today, Brandy Schillace. She’s the author of “Mr. Humble and Dr. Butcher: A Monkey’s Head, the Pope’s Neuroscientist, and the Quest to Transplant the Soul.” She’s also a podcast host of the Peculiar Book Club and the editor of the Medical Humanities Journal, an international publication, which she’ll tell us more about in a moment. Brandy, thank you so much for joining me today.
SCHILLACE: Thank you. It’s really wonderful to be on.
HEFFNER: Wonderful to have you. I want to discuss the book and it’s really a fascinating story that I would like you to share with our viewers and listeners. But before we do that, I just wanted to ask you about the Medical Humanities Journal that you run. What kinds of material do you publish? And what has that been like, thinking about the intersection of medicine and humanity during this pandemic?
SCHILLACE: Yeah, well, you know, when I took over the, it’s through the BMJ, the British Medical Journal has a number of publications. And when I took this over pre-pandemic, one of the things I really wanted to show is the way social justice intersects with medical humanities, because of course this is the human at the center of medicine, and that’s issues like accessibility, LGBTQ supports, looking at disability studies and things like that. So a lot of the material that we take in are, it’s from historians, social justice people, people in sociology, literature, also the medical professions. And a lot of times people collaborating in-between, like in the center of those that nexus. And that’s really exciting for us, because I think then you’re having, you know, a cardiologist talking to a historian, talking to a disability studies person. Now you’re starting to get really interesting conversations. In terms of COVID, access and justice have loomed really large. Especially I think it’s become clear in the rollout, the disadvantaged populations. Disabled people, not being able to get vaccines in a timely fashion. Also the way the rollout very uneven in terms of economic support and minorities were having trouble accessing it. So it’s been really interesting how that has not necessarily shifted our focus, since we were already there, but sort of crystallized it, I think for us and galvanized a lot more writers to, to come to our journal as a result.
HEFFNER: And you’ve been based in Cleveland right during the course of this pandemic and operate your podcast, book club series. What have been any of the strangest or most peculiar things that you’ve been witness to during this very unique period in history? We know that now COVID represents the most devastating health crisis and massacre in American history, not human history, but in U.S. history, relative to the 1918 pandemic.
SCHILLACE: Yeah, absolutely. We’re now not talking about, you know, I’ve lost someone but no one else in my near vicinity has. Now you have an entire culture that everyone, you know, has lost somebody now.
And that this is a collective trauma and a collective… we’re not really prepared to deal with death. We had been screened from it pretty well in the west. So you didn’t necessarily see death and dying on a regular basis the way we did once a long time ago in our history or the way it happens, say in other cultures or contexts. So you took a community, you took an entire country, a nation full of people, millions of people, not really well-prepared. And then suddenly all of us going through it at the same time, there’s nowhere to get away from it. It’s not like I can go home and it won’t be there. You know, it’s everywhere we look. So I think that it’s… one of the things we’re grieving is a loss of illusions. We had illusions that you could plan for tomorrow, that you could count on somebody being there next year, 10 years from now. And what I found out. And so this is peculiar interesting, fascinating is in speaking to disability, disabled people and people who are like Alice Wong, who are activists for disability. And what she told me is this is basically what it means to be a minority or a disabled person, is not to be able to plan for the future and not be able to count on certain kinds of things. And so all of a sudden, the entire community has been thrust into those spaces and that’s made them more visible for the first time.
And so it’s possible that though, I agree with you. I think that I don’t think this is going to end. I think this is going to become a cultural thing that we don’t just get beyond. I think that we are now a society that is going to come at and think about pandemics in a really different way and think about communicable natures of disease in a different way, and borders in a different way. But what I hope is that we come out of it thinking about accessibility in a different way. That suddenly we have made opportunities for people to access things online, like my book club, but also conferences and classes, things that disabled people or minority groups who are unable to do certain things because of finances have been asking for, for a long time and not getting, those accommodations. So if anything, I think that the COVID pandemic is a new era where it’s not as though the systemic vulnerabilities weren’t already there, but they’ve been exposed.
And I don’t think we can. I hope we don’t actually, put the blanket back over that again. I think there’s weaknesses we really need to look at in the way the system is put together. So all of that’s happening simultaneously right now, and that I think is new.
HEFFNER: Right. I mean, that, that is new, and the attitude towards the pandemic, even if there is the advent of Tylenol or Advil-like pill and we know that that Merck and Pfizer have both been exploring them, that is going to confidently, more confidently than a vaccine, a vaccine doesn’t have the purpose of preventing you from contracting the disease. It doesn’t have the purpose of treating the disease, it has the purpose of preventing you from contracting it potentially. But I do wonder if the PTSD will carry forward, and we have a habit of having amnesia as a country in a lot of ways. So the question and I mean, as a people, but that seems to be a relevant and specific American phenomenon right now. But I, I do wonder if, and when that medical innovation becomes available and you can pop a pill for a Corona virus and maybe not just COVID-19, but any coronavirus, if that will change what you’re saying, you know, that will, you know, either return those boundaries to where they were before, or I don’t know, but I suppose I’m being a little bit miraculous in thinking of potential medical solutions that may never be within reach.
SCHILLACE: It’s interesting. Um… I would almost compare this to the, the AIDS epidemic in the sense that everyone’s frightened of it to the, to almost in exceeding way. Like they’re so terrified of it, but not always in the most practical way. And so you have people very frightened of it and yet ignoring protocols that seemed like those would be the best solution, you know, wear mask wearing or whatever. And so I think I, even if we took a pill and tomorrow there was no COVID, I think this has changed us. I hope it has, actually. Because I think you can’t, if, if we hadn’t had the death toll, I think a magic pill maybe would just, you know, we’d muffle ourselves back up and ignore the systemic problems, but, there’s over, you know, there’s 500, well now I think it’s 600, 700,000 people. We’re talking close to a million people now in this country that we’ve lost. And so, you know back to my point about death and dying. When you lose somebody close to you, I try to tell people it’s not like getting sick and then getting better. It’s more like having a limb amputated. Your life never goes back quite the way it was before when you’ve lost somebody close to you.
And even if it gets close, it’s, there’s still this lingering sense that, that there’s no going back. And so my suspicion is even if we were able to banish this disease, the sheer amount of lives that have been lost, not because the numbers are great, but because they are familiar, this is localized. This is: I’ve lost two people. You may have lost people. Everyone I’ve spoken to has lost somebody because of COVID. I don’t know anyone who hasn’t. And so I think that just like those kinds of amputations we are not even, we haven’t even begun to go through the full grieving process yet. You know, this is going to be years creeping up on us when we aren’t expecting it. And so I think even if we could miraculously get rid of the actual disease, we can’t get rid of the grief. And the grief and our sudden sense of vulnerability to mortality. I think we’re really good at hiding from that, but we’re not great at dealing with grief. And I think that even if you, even people who seem to bounce back really quickly, oh, they lost their spouse, but they they’re doing so well. It’s still there, you know, it’s there and it’s under there and now you’ve got a whole bunch of other people interacting with each other who are in the exact same position. So I don’t know, I think at least the trauma of this is here to stay, I think.
HEFFNER: Right, right. And the, we don’t know the toll of the collective mental anguish and how that may materialize, you know, in destructive ways. Grief carries with it the potential for combat, for violence, how we reconcile those emotions you know, societally is an unknown which is, which is sort of the blowback or the fallout ultimately of all of that collective grief. And let’s be realistic about science. I mean, we know that if there’s a pill design for this, well, there are a whole host of potential bacterial diseases around the corner, and we know antibiotic resistance is a thing. And so, however you dice it up there is always going to be the potential for a next pandemic that is untreatable for a year or potentially a decade. And that’s, that’s what we have to accept. But I want to ask you how you think of the pandemic in the context of, of your really fascinating book, “Mr. Humble and Dr. Butcher,” to tell our viewers about the book and you know, now that you’ve had some time since publication, how you think about it, as it’s been published during this whole period human experience.
SCHILLACE: Yeah. Yeah. well, one of the fascinating things about the book coming out when it did, is of course I wrote it prior to the pandemic, literally months prior, you like I finished it. But it launched in the middle of this pandemic. And there’s nothing…. this book is really about the fuzzy edges between life and death. And now all of a sudden, we’re all living in the fuzzy edges between life and death in peculiar ways. So, you know, when I think about the fact that this book started, I actually have, I have a copy of it here. When I, the book begins in loss, coming out of World War II, the main character, his father goes missing in action in, oh, actually he’s a prisoner of war in the Pacific theater. And so you have this trauma, this child who’s been orphaned, who’s lost a caregiver.
And he then goes, joins the army and, joins the service himself, to be shipped over there to try and find this lost parent. So it’s odd that we already have some of these same kind of, these archetypes, right? This, that big uncontrollable, scary thing, war pandemic has come and taken away somebody that was important to us and how that influences and affects someone for the rest of their lives. So the main character of “Mr. Humble and Dr. Butcher” is Dr. Robert White, who ultimately practiced here in Cleveland. So in some ways I got to do quite a bit of local research for it. But he starts off seeing this massive loss of life and the dropping of the bombs, that’s really, on Japan, that affected him very deeply because he said to his daughter at one point, you know, I, as a doctor, I can fix bodies, but you can’t fix minds. You can’t, you know, what do you do if that’s gone wrong? What do you do? So he becomes really, really concerned with saving lives in a very specific and intricate way. In other words, it had to do, for him, with the brain. And how you were your brain. To Dr. White, he was like, the person is the brain. The person is the personality, but also the brain is the soul, because Dr. Wright was, he was Catholic and he believed very deeply that your brain and your mind was essentially equal to the soul that was inside. And your soul was all that was you. And so he’s trying to save lives and souls. And so much of that comes, I think, from these early experiences of his life, the war and the drama and the traumatic experience of losing so many people.
HEFFNER: The question that we are led to contemplate is can you transplant, can you transplant a soul, right? And that is the kind of seminal thought or consideration in your book?
SCHILLACE: It is, and it’s hard to get. It’s such a strange thing. It’s, you go around talking about head transplants, you know, taking the heads off of things upsets people, and they don’t want that to happen. And it makes, it rubs us the wrong way. What do you mean you’re going to take, that… that’s Frankenstein. Why would you take the head off of something? So I feel like I have to start a little bit further back. But Dr. White’s original concept was how do you prolong a life? And he was at, he was at the Peter Bent Brigham hospital when the very first successful kidney transplant happened between the Herrick twins. And that was done by, later won a Nobel prize, Joseph Murray. So he saw this and he thought, well, we can extend lives by giving them a new organ. And his next thought, and it wouldn’t have been my next thought, but his next thought was, what if we gave you all the new organs at one time?
And his thinking was, what if your body was dying? What if he liked to use Stephen Hawking, as an example. He liked to use Christopher Reeve as an example, what have you had a good mind, but everything else, you had cancer, you had to degenerative disorder and it was, it was all going, you know, it was corrupted and it couldn’t, couldn’t sustain you instead of giving you a kidney transplant. What if we give you a kidney and liver and hearts and lungs, and basically all still in the skin. What if we gave you a new body for that brain? And this was something that he thought of, right as that first kidney transplant was being done. So he was very forward thinking. It’s a bit of a leap. But believe it or not, it’s a good question. Because he slowly through the course of his experience and inventing lots of things we still use today, like therapeutic hypothermia which we use that to, to do brain surgeries and heart surgeries for stopped heart surgeries.
They use it on heart attack victims. But he nonetheless was using those techniques to try and find out if your brain could outlive your body. And I have to put this in context, we’re in the Cold War period. We’re starting to do organ transplants. And if you’re going to take an organ out of someone’s body and give it to someone else, and it’s an organ they need, like a heart, you have to make sure that that person is dead enough to take the heart, but alive enough for the heart to still be useful. So the question everyone was asking is can your body outlive your brain? Can you be brain dead? And does that make it okay to take your organs? Dr. White’s question was, what happens if your brain outlives your body? And then he managed to prove that it could. And that to me is the most mind-blowing part of my research was discovering that all the way back in the sixties, he was doing something called a brain isolation experiment, where he was essentially taking primates, macaque monkeys and getting their brains out, without killing the brain. So the brain is still being, it’s being flushed with blood and fluids from another donor monkey. It’s hooked up to EEG and just this brain, it’s just a brain. And it’s thinking it’s, it’s sending off signals on the EEG. And I just had to take a step back and think, this is real, it’s real and it happened in the sixties. And I didn’t know. So I think that’s, that’s the part of this story that seems like science fiction, but it was driven by this desire to prolong life.
HEFFNER: And what about the human extension of that? I mean, what is the good doctor, what has he contemplated observe that work with monkeys? It’s anything ethical that ever could be considered in that realm?
SCHILLACE: Yeah. Well, one of the problems was when he started doing these experiments and then he, he wanted to prove that the brain was really, really thinking just in case anyone was not sure. So he left it inside the head and that’s when he transplanted a head onto a different monkey’s body and it woke up and it lived for nine days, roughly. And there were lots of upset people about this. Animal rights activists, groups. And the reason was partly, they were like, why are you doing this? There’s no human application. Why would you want, why would you even do this to monkeys? And Dr. White’s response was, what do you mean there’s no human application. He meant to use it on people. He thought that. He actually, like I said, he really thought Stephen Hawking should get a, well, a body transplant. Let’s say Stephen Hawking did not, did not agree, but he thought that would be a good person to, to want that.
And I just thought at first, you know, it sounds like, it sounds like hubris. It sounds like something. Why would you want to do this on a person? Because essentially you’re paralyzed. If we sever your spinal cord and we put your head on another body and you wake up, you can’t control the body. You’ve become attached to. The blood is there and everything, and all the other stuff that they can hook back up. But a severed spinal cord is a severed spinal cord. So people thought, why would you bother? And Dr. White’s response was, because people who are already quadriplegic, who might need a new body, deserve to live too. And it really came home for me, when I found out about his potential patient, he had a patient lined up, Craig Vetovitz who actually approached Dr. White rather than the other way around. And he’d been tetraplegic or quadriplegic since he was 19 or 20 years old, from a diving accident. And as sometimes happens with people who are tetraplegic so long, their organs begin to shut down on them. And his kidneys were starting to fail. And as a result, he wanted a kidney transplant, but because he was quadriplegic, they told him he wasn’t a good candidate. Now you’d have to understand Craig Vetovitz had a big personality, too. He was right up there with Dr. White in terms of, you know, wanting to fight for these things. And he said, why is my life not worth anything to you? I’m married. I have my own business. I have children. I just happen to be paralyzed, you know? And he was really upset. He felt like it was as though medicine was saying, we don’t want to help you because we don’t think this life is worth living.
And so when he approaches Dr. White and says, I want to be able to live beyond my body shutting down. It’s shutting down too early. I want to, I volunteer. So Dr. White literally had a human patient willing to go through the surgery to try and prolong his life. And Craig Vitovitz’s arguments make some sense. I mean, when you, when you look at it from the perspective of the person who’s disabled, who says my life is worth living, whether I am, you know, paralyzed, disabled or not, it takes us right back to kind of what I was saying earlier about disabled rights and about how we live in a culture that has a tendency to behave as though those with disabilities are somehow not as worthwhile or that their lives aren’t as aren’t as worth living. And so in a strange way, White’s head transplants were, you know, they were anti-ableist, I’m not saying they were a good idea, but they certainly had elements to them that I think it certainly challenged my own understanding of exactly where the ethics are in these kinds of fringe surgeries.
HEFFNER: It takes two to tango in the event of this surgery, right? So where was the patient left in terms of the prospect of actually doing this? I mean, it would take either the permission of someone who’s already dying…
SCHILLACE: It’s a really complicated. So it takes some there’s four things that you need. So Dr. White, basically he had to have a willing patient and I would have thought that was the hardest thing to get. So I’m a little surprised. That was like, the first thing he needed to get. The second thing is you need a donor body, right? And that donor body, again, this goes back to that con this story covers like 60 years of, of our medical ethical shifts around civil rights, around animal rights, all kinds of things that. You still need a body that is brain dead, but still alive enough to donate the rest of its organs.
HEFFNER: And preserved in a certain time period, most likely,
SCHILLACE: Well, he still has to be alive, essentially. The body has to be alive, right. Brain, brain
HEFFNER: Right, Can’t be six feet. Right, right.
HEFFNER: You really need the is permission of two people in order to make this work.
SCHILLACE: In a lot of ways, he had like, that that body would have to, you know, it could be an organ donor or, you know, qualify in various ways. They would have to have been in an accident that preserved the body but destroyed the brain. So maybe a stroke or head injury, or something like that. And then, so you have to have the donor body, you have to have patient, then you have to have permission. So some hospital has to agree that you can take heads off of things and swap them around. And it’s not, the funny thing is it’s not illegal in the, in the main sense. Isn’t like, there’s a law on the books federally that says no swapping heads. Cause there’s not, but, but an individual hospital has to be like, yes, I’m willing to let you do that here.
HEFFNER: We’re running out of time, unfortunately, as we get to the most peculiar part of this peculiar conversation. But, but the last thought that occurs to me, it hadn’t been occurring to me as I was asking you these questions there is then that existential question about who is experiencing life.
HEFFNER: But do we, do we know anything about from the monkey study? Did the monkey know that it was still that same monkey? Just, I mean, in living ably.
SCHILLACE: Yeah. It’s, it’s very strange question because it requires us to ask, where are we in this composite of body and brain? You know, you either have to decide it’s all up in the brain, but is it, because I have neurons in my gut and I, you know, I know one thing the LGBT movement has taught us that identity is very much a kind of embodied experience. And so if I’m just a brain, do I still, am I still me, even if it’s my brain and I’m still thinking?
HEFFNER: And, and would that person actually feel like they are still themselves? I mean, like actually, and have the consciousness and so was there anything that, that informed the doctor and we can’t interview the monkeys? I mean, was there any sense of, of that monkey’s self-awareness, if that monkey knew it was, it was extending its life and was that monkey for those days able to live without disability?
SCHILLACE: And, and like basically, no, I mean, we have no way of knowing what was going. I believe the monkey was quite unhappy. Dr. White felt that the monkey was the same monkey, partly because it hated him both before and after the surgery and attempted to bite him repeatedly whenever he got near.
HEFFNER: But it wasn’t disabled after the surgery?
SCHILLACE: It couldn’t move its body below the neck, because of course, again, spinal cord severing. But it was, it was, it could look around, it could eat, it could, it could move its face. It could here, it could see. But does that make you, you like, what part of, of us is really, I don’t, you know, it’s kind of a question of the Cartesian dualist idea that you’re all up in your head and Dr. White totally believed that. He thought you put your brain anywhere else, that’s still you. I’m not so sure, because I think that I think a lot more is important to us understanding ourselves as selves. And I personally find it, you know, it’s such a philosophical question because it, it almost requires us to ask, what is life? Where is life? When is it my life and not someone else’s life, if I’m in some other body, is that, you know, am I now experiencing their neurons and their hormones, am I now a composite creature? And of course that brings us right back, right back to the Frankenstein myth.
HEFFNER: Fascinating stuff. We are out of time Brandy, but I look forward to continuing this conversation. Thank you for your time. Stay well.
SCHILLACE: Thank you. It was so good to be here and I love your show.
HEFFNER: Thank you.
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