The Holy Grail of Plasticity

In the spirit of "Taking my Friday motivation and running with it", I just completed a series of lectures on my online Early Child Development course on Coursera, including a fascinating write-up by Dr Hensch, a Harvard Professor, way back in 2016, in SA magazine and lo-and-behold, my dormant volcano of creativity started bubbling at the surface ready for a huge expulsion (forgive the poor metaphors). What really instigated me was his portrayal of neuronal plasticity (newly ground-breaking at the time), which has since then grown to become, dare I say, a household term. Captivating as it may sound, I hadn't fully understood its nuances until I read Dr Hensch's articulate deep dive. So I took to Gemini to create an impromptu cover image, channeling some of my inspiration from him, and sat down to write this post ! 

Let my start by explaining the image so you can get some context (all the AI prompt engineering tips have led me to seriously consider this at every point of communication). When you think of how a child learns a new skill, it is amazing how quickly and easily they get adept and begin to master it. Let's take language for example. Children living in multilingual households master 2, maybe even 3 languages, each one quicker than the next. I have a very vivid memory of a young girl, in her father's arms on a train journey, saying a vehement "nahi" (meaning "no" in Hindi) to something he whispered in her ear. I assumed that he was probably reasoning with her to go to bed early, but the fiery little one seemed determined to watch the trees go by from the train's door. Maybe the ease with which she weilded those foreign-sounding words, was what astonished me. Everyone takes learning one's mother tongue while growing up for granted. It is in fact one of the finest examples of development, or neurological functional maturation. The scaffold exists in every human by way of your genetic code, but the richness and diversity of what it's populated by is in the hands of the individual herself/himself, or if you're a kid, then by the external inputs that you get. I remember thinking for the first time that day about how easily your parents' language becomes yours. If I was born in another part of the world, I'd just as easily be speaking an entirely different language. I don't need to prove to any of you how children are better at learning something they've set their minds to, when compared to their fully grown counterparts. Another instance I recall now was watching several tiny tots in my swimming class, race past me in the very first week, while here was I, a fully grown adult, having a hard time getting my recalcitrant body to get accustomed to floating in the water. The outperformance was not merely due to their advantageous size but by learning and perfecting the skillset needed to do so.  

Children can learn at super-speed, and the plasticity of connections in their brains is what facilitates them in doing so. This is the first part of the cover image, that I've tried to portray. The older neuron, looks on longingly at the younger one, who is in his "critical period" where connections rapidly form, moulded by environmental inputs and get strengthened, ultimately staying lifelong. The stronger those connections are, the longer they last. Now it's not as easy for a 30 year old, because his/her "critical window" is closed and the brain just isn't in a mood to learn as efficiently. When Dr Hensch spoke about reclaiming this period using chemical changes to the brain, specifically one involving injecting an enzyme deep into the brain, it sounded like the stuff of fiction (particularly invoking an image of Frankenstein's monster in my mind's eye, for some reason). Later, he went on to reason that because the latter might turn some heads (pun intended), they focused their attention towards using already existing drugs which could theoretically do the trick, and restart those critical periods, and turns out they're testing their hypothesis on mice. This could potentially mean that we middle-aged, life-worn folks could become as good at learning as we once were during childhood. While most people in the world are trying to achieve this very same thing in principle : a higher functioning version of themselves ; they seem to also be forgetting that we've already passed through that phase, i.e. childhood. Notwithstanding this, all of us naturally assumed that it wasn't possible to tap into that goldmine once more. What was gone, was gone forever. The power of the infant brain, however, is now back in the tabloids, thanks to neuroscientists. Cut to the second part of the image : where the forlorn neuron, who is faced with the Holy Grail of his existence, ponders being able to  transform to his younger self, kind of like Matthew Perry in 17 again, for want of a better reference. 

Now, younger or not, it doesn't automatically follow that using drugs to enhance neuroplasticity will make you the next Stephen Hawking. What it might do is probably catapult you to where you want to be getting in life (if you're determined to work for it) because you would be learning at a faster rate than what your present self can manage. Which brings me to end this rant with my current state of mind. Resilience, vendetta and wanting to prove myself. Just like everything has ups and downs, the bursts of energy and focus come and go, and I try to ride the wave for the longest time possible, hoping that the next crash isn't too steep. Consistency is key. These pivotal moments really do come with a price : the price of having time to yourself is being unable to enjoy it without guilt. The past days have helped me gain new insights into the process of learning and at the same time made me cringe at how ignorant I was just a few years ago, stubborn enough to think I didn't have to put in effort to try and learn as much as I can. So as a person struggling to learn, I can vouch for the fact that anything even remotely close to regaining the powers of my once-neuroplastic brain will be considered a veritable Holy Grail, and will be welcomed with open arms. 

The Itch you can't scratch

 A career in medicine isn't something everyone aspires for. A few (maybe more), like me, happened to find ourselves in it, primarily by being guided along through a singular path from a very young age. It is only later that I realised I was probably unintentionally blindfolded to all other paths. Be that as it may, now that I have been shaped into a clinician, for all intents and purposes, the profession has finally caught up to me. I can say I'm comfortable in my white coat, dealing with OPD patients, emergencies, critically ill patients, newborns, inter-departmental consults, juggling academic and administrative responsibilities all while trying to eat and stay healthy, which is no mean feat when you stay alone and hardly find time for a proper meal or exercise. On the downside, hobbies went down the drain and I wasn't developing my extra-curricular skills or personal identity but I could feel my clinical prowess and confidence in handling patients improving. I even realised that I could assign people tasks, and come up with on-the-spot adjustments which was a newly-learned skill. Despite all this, I felt like I was in auto mode, there wasn't a lot of curiosity stemming when it should have, I felt myself slipping down a steep slope, and gaining unwanted momentum at that. 

The desire to be doing something else, to be free of the weight of handling a human life in your hands, does pop into existence on a random Sunday afternoon, but it gets quelled within seconds, and my brain returns to its baseline state, almost like waking up from an impossible dream. It's interesting how the brain is programmed to forget dreams within a few minutes of waking up, lest we confuse dream-space for reality (the repercussions of which have been vividly depicted in the movie "Inception"). Maybe our subconscious desire to stay in our respective lanes, profession wise, however unpleasant it may be, stems from some similar epigenetic influence. Think about it, is it maybe the "Sunk cost" fallacy, where you find the idea of seemingly throwing away years of time and money spent in pursuit of this very outcome, utterly stupid? Is it the guilt at taking for granted the rigorous training you went through before finally ending up a doctor, a programme that lakhs of students are probably turned away from each year? The fear of losing the respect that people gave you for being a productive member of society? You were lucky enough to get through the door, yet the room isn't quite the way you imagined it. Every ounce of thrill is countered with a pound of deadweight. One that you have to deal with all on your own, most of the time. 

It might seem to defy all logic, to a rational observer, how a practising clinician who finds herself burdened and distraught with her work, comes back to the same work, time and time again. Maybe it's a bit too narrow-minded of paint medicine as the only occupation that can ellicit such feelings of exasperation, but I'm pretty sure its up there on the list. The first episode of "The Pitt" comes to mind, a series as close to being inside a real hospital as ever shown before on television, at least from what I've seen. "We're the worker bees protecting the hive" says the consultant Emergency physician who kept pondering over the same question in his head while off-duty, "and we can't stay away from it". Its as though an anthropomorphic sea, in a constant state of tempestuous unrest, gets so used to the unrest that if it ever catches itself seeming gentle or calm, feels ridiculous and immediately switches back to thundering sounds of waves crashing. Maybe the doctor world is a world of opposites, where you're so conditioned to working under pressure, working on an adrenaline rush, working to survive and stay ahead of the rat race, that you don't know how to not do what you do. 

Let me try and give you my perspective. I've been unemployed for nearly 4 months now, after having resigned from my previous job, a high stakes one - where rush is the norm. It was not just managing patients and making life-saving decisions that I needed to worry about, it was constant judgement, academic pressure, dealing with colleagues and superiors and finding my way in a system set in stone. It all seemed a bit too much at a point. I quit. I wanted to study and get into a DM programme or at least I thought I did, but here I was, hardly able to get through the task of being a mere Senior resident. Hanging over me like Damocles' sword was the idea that I wasn't good enough without a DM suffix to my name, pervading into every thought, action and interaction. Mostly because that is exactly what the place made me think. It was almost like the institution morphed into a living, breathing entity, with one resonating voice - be better or get lost. I did wonder how people managed to breeze through their three (sometimes even ten) year tenure, accepting the fact that "this is the way things are", that "pressure makes you better at your job". They were stronger than me, smarter than me, more deserving, I reasoned; relegating my queasiness to unprofessionalism and indiscipline. Six unsuccessful attempts (three of which I put in some effort) later, my "hesitant-to-arrive-at-decisions" brain decided that its time is up. Let the ego go and help yourself. I can lean on my parents for a while, until I get into a DM programme and can stand on my own two feet again. Its okay being unemployed. These persistent thoughts led me to finally throw up my hands  in defeat and head home. 

Fast forward four months, and I think I made the right decision. It was a break that I desperately needed : time with my parents, some well needed time spent outside the bubble that I thought was life. It didn't have to be that way, and now I know. I can look at things from a bigger perspective, my stress hormones are not skyrocketing 90% of the day. I can sense myself breathe, actually see and feel nature, play with my cats. Its liberating to say the least. However, an itch has begun to surface, one that I cant quite put a finger on. There have been many days in the past few months where I've regretted my decision to quit. Foregoing a stable income and a secure job, financial independence and the privilege of not having to watch where every cent of my money goes. Bigger than that though is the feeling of missing out. The feeling of not being in a high risk-high reward environment where you're driven to perform, where you try your best to assess and act at the same time, where you reach out for help - sometimes you get it, sometimes you don't and that pushes you even farther. The thrill of being part of something bigger, being in the presence of the "greats", whether or not I get to learn from them. I get that itch a lot more frequently now, probably a result of being sessile for far too long. I keep going back to the days I didn't have time to think ! Now I think perhaps, that was in some way necessary for surviving the place. Maybe it helped to get out of your own head, to immerse yourself in your work, because the risk of making a mistake was just too high. I know there are two sides to it, but unfortunately, you only feel the emotion of one thought at a time. 

In some measure of time, this so called itch that I'm feeling now will probably be replaced by feelings of relief. The roller coaster ride of emotions is infamous for being bad at asking for directions. I can however rest assured that the feeling will not lie in a corner and gather dust. It's dynamic, just like life is. So I intend to enjoy the current chapter and move forward, or better, let the arrow of time move forward and let myself be moved along by it, like much of the things in my life. I consider the ability to pause and write down this whole train of thought as one of the highlights of this "treasured" time of my life, something to look back at when I'm older, and chuckle as I relive all aspects of this moment, including the sight of my fiancè on video-call, in the inset next to this draft. I just thought of another advantage of this "work-break" (sounds better than "unemployment") - getting to see him, talk to him and day dream about our future together- and my spirits have been lifted right away !!!