Fins ’82 Delivers Phi Beta Kappa Address

Joseph J. Fins ’82, M.D., chair of the Alumni Association, spoke to members of the Wesleyan Gamma Chapter of Phi Beta Kappa during Reunion & Commencement Weekend. His speech was titled “Minding Time.” Membership for Phi Beta Kappa is conferred for high scholastic achievement.

It is a delight to be here with you today to celebrate your induction into Phi Beta Kappa. Let me add my congratulations to those of The Faculty, President Roth and your friends and family. This is a memorable day in your life and it is good that you savour this accomplishment. A former professor of mine once told me we should, “Cultivate resting points of satisfaction.”

And this is one of those resting points. A moment that seems to encapsulate all that has happened to you at this marvelous university. It is an occasion when time seems to stand still. Memory is flooded with images of your first academic success, the hard work, and the epiphanies when you figured something out and, as importantly, the failures, which really led to intellectual growth.

As I think about how you must feel, I am reminded of a distant College of Letters class with Professor Howard Needler. We were reading St. Augustine’s Confessions and I remember stumbling upon Augustine’s notion of the “eternal present.” Referring to God, Augustine wrote the following:

In your “today” you will make all that is to exist tomorrow and thereafter, and in “your today” you have made all that existed yesterday and for ever before.

When I was a student here, I sometimes felt there was a coalescence of past, present and future — certainly not on the Celestial scale envisioned by Augustine — but on a personal one. These were formative moments.

And in many ways, that is how it must seem to you now, as you sit back and reflect in this moment about the distance you have come and the paths you are yet to take.

But the cultivation of resting points of satisfaction is not so simple. It is not about the eternal present, about this moment. Instead, what is implicit in the message is that sense of evolution, of progress of moving on. We are not talking about early retirement here. Rest should be temporary.

This is but a resting point. The line of a life is made up of such points, but it remains a line facing forward. Soon it will be time to leave here, move on, and make continued progress.

Your lives will continue, you will refine your passions, settle into careers and make the contributions to society that we expect of you. I was reminded of this forward march when I found my copy of Augustine’s Confessions in my library, circa 1980 margin notes and all.

Not only did my “Penguin Classic” edition cost $2.95, I also realized that while that volume had not changed, as I read it, I certainly had. When I first read it 30 years ago, it was an older man’s reminiscences and making sense and even atoning for an errant youth. To put it bluntly, Augustine wasn’t always a saint.

When I was twenty, I was interested in his tales of youth, wondering how did this start of a life end up as accomplished and saintly as it did. Perhaps naively, I wrote in the margins that Augustine, “did not appreciate when young the gift of life that God gave him. He did not realize that his study of rhetoric was shallow and useless because it was the use of words without substance. He tries here to atone and retrospectively judge afresh his old deeds.”

If I were to judge my notations three decades later, I am struck by the sense that my marginalia precisely did what I accused young Augustine of doing. My words were true, but as yet I did not understand them. My rhetoric was shallow and I wrote of things I did not yet understand, and could not know. It remained the stuff of platitude.

My margin notes were written absent the lived experiences that tests ideas, challenge theories and temper stances. Over the decades, I have gained a deeper insight into what I wrote through life experience, or as the American Pragmatist, John Dewey succinctly put it, “learning by doing.”

As a physician and a parent, I have since come to understand that when I wrote of young Augustine’s inability to appreciate the “gift of life” given to him, I too had yet to fully appreciate life and loss and how precious each life is.

Sadly, this is a lesson that each of you learned prematurely when this community was touched by unspeakable tragedy weeks ago. This too is now part of this moment, this shared present, as you reflect upon your past and contemplate your future. A future that is made all the more precious because of the pain that comes when it is irretrievably lost.

We prize the future for the potential that each of you embody and for the ways it will manifest the unfolding of the education you have received here. At this point your knowledge and skills remain mostly latent, still unapplied to the great works and good deeds that you will undertake. And in realizing those accomplishments, none of us knows which aspects of your education will be relevant decades later, when the future becomes present.

Perhaps an illustration will make my point clearer. When I was an undergraduate and read about Augustine’s “eternal present,” I never thought I would have an occasion to invoke this conceptualization decades later this afternoon or in connection to medical research considering how the brain recovers from injuries severe enough to cause a disorders of consciousness, like coma or the vegetative state.

Most would see that as a purely scientific quest and reasonably ask, what could a 4th century theologian, much less a Saint, add to scientific studies exploring the natural history of brain injury and mechanisms of brain repair? And truth be told, if the question were narrowly cast, the answer would be, “not much.”

But if the broader dimensions of the injured self are invoked, Augustine and the humanities would have a lot to add. His Confessions became relevant again when my colleagues and I found a brain-injured patient who was physiologically — and I dare say — metaphorically stuck in the eternal present.

You may of heard of the case, the remarkable tale of a patient named Terry Wallis who sustained a severe brain injury in 1984 when he was in a car accident. For nearly two decades he lay in a nursing home bed diagnosed as being in the vegetative state. He came to international media attention six years ago, when he began to speak spontaneously.

Like Karen Ann Quinlan or Terri Schiavo, Terry Wallis carried the diagnosis of being in the permanent vegetative state. As the years rolled by and he ceased to improve, he and his family were ignored by the medical community. He was marooned in a nursing home bed. His parents who visited him regularly asked that he be seen by a neurologist or have another scan of his brain. They were told that he was immutably injured, that he would never recover from his vegetative state and that further assessment was futile and too expensive.

The medical system had written him off as forever gone in a vegetative state of “wakeful unresponsiveness” in which his eyes were sometimes open but there was no awareness of himself, others or his environment. He had been relegated to what is euphemistically called “custodial care.” And there he lay, day after day, minding time.

But his parents thought they saw glimmers of awareness, only to be told that they were in denial or overly hopeful. Sometimes he would follow them with his eyes when they came into the room. At other times he seemed to follow an isolated command or nod his head. But these signs of awareness, of minimal consciousness, were not reproducible when the occasional doctor visited.

All of this changed in the summer of 2003 when Terry began to speak spontaneously. His first words were “Mom” and “Pepsi” and over time he gained greater fluency. But what was really interesting was that for Terry, it was still 1984. Ronald Reagan was still president. Like Rip Van Winkle he was locked in time.
Terry has continued to live in an eternal present since then, although his speech has become more fluent and he is laying down new memory. For example, he now knows the song “Bad Boys, Bad Boys, what you gonna do?” — which may or may not be an improvement. But it is important because his brain is learning and it seems, also changing structurally.

Neuroimaging studies using advanced MRI techniques at Weill Cornell showed what was described as new axonal sprouting or new connections between existing neurons in his brain. Over an 18-month interval two scans revealed dynamic changes in his brain with both axonal sprouting and pruning.

We don’t know if these neuroimaging changes were responsible for his ability to speak but they are suggestive. In tandem with his improved functional status, the neuroimaging findings show that while Terry was temporally locked in an eternal present, his brain injury was not immutable. Some degree of recovery was possible, even decades after injury.

But despite this forward progress it remained 1984. A couple years ago, Terry and his family watched President George W. Bush deliver the State of the Union Address at their home. Terry turned to his mother and asked, “Mama, who’s that?”

Mrs. Wallis said, “That’s President Bush.”

Terry responded, “What happened to Reagan?”

In preparation for this talk, I called the Walllis family last week to check in with them and to secure their on-going permission to share their story. They graciously have allowed me to continue to talk about Terry and his progress.

In our conversation, Terry’s mother, Mrs. Wallis told me that Terry’s daughter, Amber had graduated from college the night before. Since 2003, Terry has had difficulty reconciling that Amber was his daughter and not his ex-wife. Amber had been born after his accident and resembled her mother. Terry confused her with his former wife because in 1984, he was still married and had no children.

So it was all the more remarkable when Mrs. Wallis told Terry about his daughter’s graduation and he responded, “Amber’s graduating college? She’s not a kid anymore. She’s a young lady.”

Although Mrs. Wallis tells me that it’s “still 1984, most of the time”, Terry’s appreciation that Amber is getting older suggests the return of a temporal sense, at least on an inconsistent basis, now 25 years after he was injured.

Terry is not alone in his temporal dislocation and the slow march of recovery. The brain injury literature recounts other cases. In one case, a psychologist described his own disorientation after regaining consciousness:

During this period, I had no awareness of time. I existed in a world of the here and now. I was not even aware that such a concept of “time” existed. I knew who “I” was but did not think of myself as being a child, a boy, or a man…One day, however, my “mental clock” began ticking again and the concept of time began to become significant. (Cited by W. Winslade, Confronting Traumatic Brain Injury. New Haven: Yale U, Press, 1998. pp 78-79.)

Cases like these raise perplexing questions about time and personhood. Can you fully be you stuck in an eternal present, not knowing whether you are “a child, a boy or a man”? Imagine the thought experiment of self-awareness devoid of temporal reference points.

Although neuroscience may be on the way to answering this age-old question, the humanities have already weighed in on the issue over the course of millennia. Augustine saw the eternal present as that which divided us from the deity.

Deities aside, humans are not meant to reside in an eternal present — or as the psychologist put it, “a world of the here and now.” We are destined, instead, for a temporal grid with a past, present and future.
And in more modern times, Martin Heidegger would write in his aptly titled masterwork, “Being and Time” that we achieve our potentiality as Beings only after fully assuming a temporality and appreciating their broader place in History. Fundamentally, we need to be aware of the march of time for an authentic understanding of our Being.

Milestones like the one we mark this afternoon — and on Sunday — are reminders that the passage of time is inextricably linked to the realization of one’s potentiality and to the cultivation of a perspective on personal growth.

As the Wisdom of the Ages and newer insights from the Neurosciences show us, though we might savor these resting points of satisfaction, they do not define what we are but rather who we are in the process of becoming. It is the stringing together of these moments that make for a reflective life. So as we celebrate your accomplishments, let us also mark the passage of time, which allows us to appreciate such moments, knowing that they are singular and fleeting, and indispensable to the trajectories of each of our lives.