“So should we not call it a ‘seizure’ when the infant has a seizure? What should we say?” In this talk for some of Yerevan’s neonatologists, I am doing my best to shatter the notion of a neonatal seizure as something you can diagnose by eye. These are fine, conscientious physicians who believe in science, who voyage to the Marzes (outlying regions) to improve neonatal resuscitation; and who, like many US neonatologists, mistakenly treat all seizure-like newborn behaviors as epileptic.
I loved Harold and the Purple Crayon, the way he divided up space so freely.
Now, here in this Soviet-era lecture hall, I am dividing up seizures with little more than a purple crayon. “You can call it a seizure, as long as everybody knows that behind that word are 2 possibilities–epileptic and non-epileptic.” I feel the neuro-epistemology of seizures rounding a hairpin turn in the room.
A great many of us begin life with a paroxysm that you might call a seizure: we extend, we twitch, we contort, we ride imaginary bicycles, we roll our eyes. The ink runneth over in the world’s neonatal units, as we prescribe medicines for these events, even though a seizure is not always a seizure. To neglect would be a sin, seems to be the thinking; better be safe than sorry. The answer: do an EEG, and see whether the brain’s electromagnetic halo is pulsing along with those movements. But there’s no EEG at this hospital; I can’t just draw one.
Academics sub-divide as avidly as real estate developers; see, over here, I have split apart what you thought was whole! Sometimes, the academic’s intellectual avarice takes us on a frenzy of sub-division. You can imagine the sophisti-confusion. But today, I’m solid with my fission; until they get an EEG, I advise them which movements can more reliably be diagnosed as seizures, and which are the common masqueraders.
Clinic Maria, a 15 month old, former premature infant with motor delay, retinopathy. “Inke zhbtume?” Does she smile? The parents smile. It’s nice to know that, in all cultures of this planet, a smile is a smile is a smile, an indissoluble unit of behavior. And Maria has an ethereal smile. We trade waves as the discussion closes.
Matenadaran Museum; a lamb appears to be suspended amidst the branches. Look lower, there must be some misunderstanding: Abraham, his cutlass poised at his son Isaac’s throat, is looking upwards. I think he is about to change his mind. God drew a terrible line, and now is erasing it, ending this trial of faith, with the toss of a lamb.
Recently I found myself configured in an on-line spat. O purple crayon! Symbols, and a sense of fairness–these must be the most dangerous tools God ever put in our hands. “Put it on my list of sins” was the last, despairing rejoinder. But would I call it a sin?
Song: “Put it on My List of Sins”