Mercury, the closest planet to the Sun, possesses a lot of ice...
— New York Times, November 29, 2012
Erasmus says you must arrange your face each morning before leaving your door— wear one mask for friends, the least contentious, another for the rich or the poor. Even planets mutate their faces— immensities dwell in the smallest places: close to the Sun Mercury seethes at 800 degrees on its equator but deep in its polar caves the planet remains as cold as space, and ice of purest water crazes its youngest craters. Could there be more temperate burrows where Mercury’s ice has vaporized so that organic molecules and life itself may arise from a chance encounter of comet and crust? Who knows? The universe of souls like the skies seems a concatenation of quandaries & lies. Beneath the warmest smile a countenance may disguise deep hostility or a lack of surprise. If Hot no longer means Hot nor Cold Cold why not let the celestial waiter cloak with his frozen lip the unlikely trembling of life.
One day they move far off into another part of your head— it’s as if they’d died. Your eyes don’t meet, their trains don’t run on your tracks, their streetcars take different streets. They think they’re Arcturians from a blue planet. Beliefs become reality. Next thing you know they move to San Francisco and paint their faces blue at Burning Man in the desert. You may find there’s nothing left for art to save, no drug or suture capable of laving their heart. Worse sitting in the next room, miles apart you don’t even know how it happens but they insist they tell you.
As doomed love is better than lovelessness,
all the sensible world loves this stinking rose
better than no rose at all.
In the old places and the old times
the women slept with garlic hung
between their breasts like a lantern of desire
and the men breathed its aroma like a stone
laced up with vines.
Wanting slapped at their sides
as a wave does on the chine of a sloop
or a horse flicking its tail in the rain.
Even a few cloves popped on the tongue
would keep inconstant lovers away
or drive the vampires of New York and San Francisco
back into the darkness.
After eating some garlic last night,
its bulbs pressed to romance Italian scallops and pasta,
conjure aioli, or dress the slaughtered cattle of Kansas,
I slept uneasy dreaming of sleep
and when I awoke the old nickel sky felt like rain.
I’ve rubbed garlic raw on matzos, a trick my father taught me,
and felt memory bend to its power: a sweet bitterness
shared with its close relations,
alkali and belladonna—
O garlic, leaf and flower, we dream and die.
Sleep that knits up the raveled sleeve of care...
— Macbeth
i Locus coeruleus, the blue spot in the brain where a bright dot of pigment controls our mortal waking, where all that raveled coil’s unraveled by day and we greet the sunshine as fate, kismet burning. The legends say no tears for the dying lest you impede them on their way to heaven, my eyes so dry at your bedside they cancel my yearning that you stay. For this boy father’s the prime subject, his approval joy and all else dross. The only history the boy knows is in this body, its loss definitively loss. ii Kidneys still working, a silenced monitor and soft sweet breaths make almost no sound in the universe. Days go by with only moments of agitation that slump into rest and the rare round of grunts in a language of mystery and allusion, half Hungarian, half Venusian, as if lungs so far underwater could manage only deeply aquatic words like a whale feeling its way to a distant shore. Restfully he lies beyond distress, never sick for more than three days at a time. How could this happen, he asks, not yet oblivious to his rapid decline nor fooled by our hopes for his recovery. That’s how you made ninety-nine, I reply, but the past six weeks still startle as if Death were yet a grim German soldier who’d come in to his hiding place and noted the mark of the Jew on his face. We try shaking him awake but forego the pain I once gave my patients—the thumbnail pinch, the sternal rub— and stiffly watch others stick him with probes as if there’s finally an answer to life’s indignity. No dear friend, mentor in all things, there’s no alternative. Let go your stiff arm, the bent leg release. iii
The locus coeruleus: a small rod-shaped nucleus located within the dorsal wall of the rostral pons and lateral floor of the fourth ventricle, a part of the brain stem; sixteen mm long and 5 mm wide, the LC contains about 20,000 cells. The nucleus is the principal site for synthesis of norepinephrine in the brain. Melanin granules inside the medium-sized neurons of the LC contribute to its blue color; it is thereby also known as the nucleus pigmentosus pontis, meaning “heavily pigmented nucleus of the pons.” The projections of the locus coeruleus go far and wide, including the spinal cord, the brain stem, cerebellum, hypothalamus, thalamic relay nuclei, the amygdala, the basal telencephalon, and the cerebral cortex.
Norepinephrine from the LC has an excitatory effect on most of the brain, mediating arousal and priming the brain’s neurons to be activated by stimuli. The locus coeruleus receives inputs from the hypothalamus, cingulate gyrus and amygdala, allowing emotional pain and stressors to trigger chemical responses. It also gets inputs from the medial prefrontal cortex, whose connection is excitatory and increases in strength with raised activity levels in the subject, the nucleus paragigantocellularis, which integrates autonomic and environmental stimuli and the lateral hypothalamus, which releases orexin, a substance excitatory to the LC. The locus coeruleus may be involved in clinical depression, panic disorder, and anxiety. Some antidepressant medications act on neurons in the LC. The locus coeruleus is intimately involved in REM sleep and dreaming: the dream in prose.
iv When the dreamer’s in his dream, like the dancer in his dance, he can’t tell what’s real outside from the reality within. He knows he’s dreaming but it doesn’t matter; the LC’s firing and his arms are moving without volition, his eyelids twitch, his penis rises and his heart races with a thrill. When my father’s sleeping perhaps he’s dreaming of me like I am of him. Then we are both as real as a sunrise in the mind of the other. Perhaps I’m the dream he’s been having all this last century and he will be the dream I am having next year. Danto thought Warhol as much a philosopher as artist because his Brillo Box seemed as real as the box on a supermarket shelf; no visual evidence could disprove what the artist claimed, hence an end to retinal art as Duchamp proclaimed. If I’m not the son he wished for, how would my father know? He dreamed me up so I appear at his bedside, like a genie watching the sheets blow with each breath. Dying is slow. v
Enhanced responsiveness in the neuronal pathway (brain circuit) that originates in the locus coeruleus and ends in the basolateral nucleus of the amygdala is a major factor in the pathophysiology of most stress-induced disorders and especially in posttraumatic stress disorder (PTSD). A study of deceased World War II army veterans shows that combat-related PTSD is associated with a postmortem loss of neurons in the locus coeruleus (LC) on the right side of the brain. The locus coeruleus is responsible for mediating many sympathetic effects during stress. The LC responds by increasing norepinephrine secretion, which alters cognitive function (through the prefrontal cortex), increases motivation (through the nucleus accumbens), activates the hypothalamic-pituitary-adrenal axis, and increases sympathetic discharge while inhibiting parasympathetic tone through the brainstem. By activating the hypothalamo-pituitary adrenal axis, norepinephrine stimulates the secretion of corticotropin-releasing factor (CRF) from the hypothalamus, which induces adrenocorticotropic hormone (ACTH) release from the anterior pituitary and subsequent cortisol synthesis in the adrenal glands. Is that clear?
vi When I was a young doctor, we called it sundowning, watching grief and disorientation descend with darkness, the formerly meek and gentle getting loud and violent, the old afraid of their lostness as if PTSD came out at night. My father at night is not the same man I know by day, his inner Kurtz comes out in a shadow land of foreign shores and prisons. Up every hour to pee, he shouts for help, fearing he’ll fall to the ground or into the hole of his other self. Agitated by fear, not knowing where he is or why, he curses his wife and nurses as Nazi jailers. What life he has by day disappears as the sun goes down. I call him too late and he refuses to talk to his son, the first break between our souls in sixty years, the first brick laid in the permanent wall to come. vii. In non-Western cultures people sleep on floor-bound mats, not beds, sleep in groups around fires and never extinguish the light. My father feels better if his wife joins him or a friend spends the night cornering in a chair. He’s a Polynesian now, afraid of what Pinsky calls the lie down and die model, Shakespeare’s little death. Father drifts in and out of slumber gets up to dance or sing or stays on guard as if hung up between the Orient and the Occidental. What’s it good for? A way to keep an animal safe when it doesn’t need to eat or have sex, a means to enhance memory or learning? A way to re-charge whatever consciousness is or salve our emotional well-being? Is he busy solving problems in a stupor like Poincaré or in a tunnel seeing the future or departed souls? Is sleep a type of entertainment? If any of this is true, my father is missing all of it. viii
The role of the locus coeruleus in cognitive function in relation to stress is complex and multi-modal. Norepinephrine released from the LC in the right amount acts to increase working memory through some receptors; in excess, NE may decrease working memory by binding to other lower-affinity sites. Opioids inhibit the firing of neurons in the locus coeruleus. When opioid consumption is stopped, the increased activity of the locus coeruleus contributes to the symptoms of opiate withdrawal. Since the locus coeruleus is the major source of noradrenergic innervation in the brain and sends widespread connections to brain areas above (cerebral cortex, hippocampus, hypothalamus) and below it (cerebellum, brainstem nuclei), restoration of normal LC function may be of potential therapeutic value for cognition and respiratory dysfunction. Up to 70% of locus coeruleus neurons are lost in Alzheimer’s Disease.
There it is, death or its simulacrum: the LC, blue eye of the brain— my father’s hurricane.
Michael Salcman is a physician and teacher of art history. He was chairman of neurosurgery at the University of Maryland and president of the Contemporary Museum in Baltimore. Recent poems of his appear in Alaska Quarterly Review, Hopkins Review, New Letters, Notre Dame Review, Ontario Review, New York Quarterly, and are forthcoming in The Hudson Review. He is the author of two collections: The Clock Made of Confetti (Orchises, 2007), nominated for The Poet’s Prize, and The Enemy of Good Is Better (Orchises, 2011). A suite of Salcman's poems has been set to music and performed in recital by composer Lorraine Whittlesey at An Die Musik in Baltimore. His anthology of classic and contemporary poems on doctors and diseases is forthcoming from Persea Books. You can learn more about Michael Salcman by visiting his website, Necessary Speech.