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| <p>In the hours before dawn, when the rest of the city dreams, I sit with my books cracked open like the skulls they describe. Tables of nerves. Rivers of pathology. The tender machinery of the body laid bare. I am studying for the STEP exams, those trials that guard the gates of medical legitimacy. They demand mastery of disease as taxonomy, the knowledge of what can go wrong in a human life, reduced to lists and patterns.</p><p>Yet the farther I travel into this world of clinical certainties, the more I am struck not by what I know, but by what I remember.</p><p>Today I came to the section on Cerebral Palsy, a condition granted less than a page. Perinatal hypoxia. Spastic diplegia. Intravenous magnesium for fetal neuroprotection. And the peculiar, high-yield pearl: “hand dominance before age one is concerning.” Important information, yes. But to me, it felt like hearing the name of someone I know called out impersonally in a crowded room.</p><p>For the past year, I have worked closely with a young man who lives with cerebral palsy. He is not a bullet point or a vignette. His life cannot be summarized in a mnemonic. He laughs. He labors to speak. He fights, daily, with a quiet strength that no textbook could anticipate. He has become, to me, a teacher.</p><p>When I see him reach across the table or steady himself on uncertain legs, that neurologist’s fact of infant hand preference returns. But now it is alive. Not a detail to be memorized, but a truth I’ve witnessed. This is not knowledge I acquired. It is knowledge that was grafted into me through presence, through story, through love.</p><p>This grafting is the difference between learning and understanding. We speak often of medical knowledge, but too rarely of medical wisdom. Information gathered in sterile rooms without patients can become cold, even arrogant. It risks becoming what the ancients would call <em>gnosis</em>: a knowing that puffs up, not builds up.</p><p>Detached from the person, medicine shrinks.</p><p>When we speak of cerebral palsy, or any diagnosis, without having lived beside it, we may know the shape of the thing but not its weight. We know the neural pathway, but not the toll it takes to re-learn a motion we take for granted. In the absence of the person, our knowledge is hollow. It rings with the tinny resonance of abstraction.</p><p>And so I’ve come to believe that medical education, if it is to be worthy of the name, must always pair study with witness. It must place the textbook beside the bedside. For every correct answer on an exam—displayed, answered, and then forgotten in no more than 90 seconds—there must be a face that lingers in the mind, a story that will not be tidied away.</p><p>The Greeks had a word for the wisdom that grows through experience: <em>phronesis</em>. It is not data. It is not theory. It is moral perception, sharpened by action and humility. We do not test for it, but we know when it is missing.</p><p>I study for STEP because I must. But I study my patients because I need to. They each remind me why any of this matters. And my friend with cerebral palsy reminds me that the body is not a puzzle to be solved but a soul to be tended. That healing is not merely an intervention but a form of presence.</p><p>Let our learning never outpace our reverence.</p><p>Let us not master the body and forget the person.</p><div class="captioned-image-container"><figure><a class="image-link image2 is-viewable-img" target="_blank" href="https://substackcdn.com/image/fetch/$s_!dB_L!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F5589e214-f3ce-47d4-b640-42dd47a73ff4_4032x3024.jpeg" data-component-name="Image2ToDOM"><div class="image2-inset"><picture><source type="image/webp" srcset="https://substackcdn.com/image/fetch/$s_!dB_L!,w_424,c_limit,f_webp,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F5589e214-f3ce-47d4-b640-42dd47a73ff4_4032x3024.jpeg 424w, https://substackcdn.com/image/fetch/$s_!dB_L!,w_848,c_limit,f_webp,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F5589e214-f3ce-47d4-b640-42dd47a73ff4_4032x3024.jpeg 848w, https://substackcdn.com/image/fetch/$s_!dB_L!,w_1272,c_limit,f_webp,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F5589e214-f3ce-47d4-b640-42dd47a73ff4_4032x3024.jpeg 1272w, https://substackcdn.com/image/fetch/$s_!dB_L!,w_1456,c_limit,f_webp,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F5589e214-f3ce-47d4-b640-42dd47a73ff4_4032x3024.jpeg 1456w" sizes="100vw"><img src="https://substack-post-media.s3.amazonaws.com/public/images/5589e214-f3ce-47d4-b640-42dd47a73ff4_4032x3024.jpeg" width="1456" height="1941" data-attrs="{"src":"https://substack-post-media.s3.amazonaws.com/public/images/5589e214-f3ce-47d4-b640-42dd47a73ff4_4032x3024.jpeg","srcNoWatermark":null,"fullscreen":null,"imageSize":null,"height":1941,"width":1456,"resizeWidth":null,"bytes":3206615,"alt":null,"title":null,"type":"image/jpeg","href":null,"belowTheFold":true,"topImage":false,"internalRedirect":"https://dominictanzillo.substack.com/i/162423754?img=https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F5589e214-f3ce-47d4-b640-42dd47a73ff4_4032x3024.jpeg","isProcessing":false,"align":null,"offset":false}" class="sizing-normal" alt="" srcset="https://substackcdn.com/image/fetch/$s_!dB_L!,w_424,c_limit,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F5589e214-f3ce-47d4-b640-42dd47a73ff4_4032x3024.jpeg 424w, https://substackcdn.com/image/fetch/$s_!dB_L!,w_848,c_limit,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F5589e214-f3ce-47d4-b640-42dd47a73ff4_4032x3024.jpeg 848w, https://substackcdn.com/image/fetch/$s_!dB_L!,w_1272,c_limit,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F5589e214-f3ce-47d4-b640-42dd47a73ff4_4032x3024.jpeg 1272w, https://substackcdn.com/image/fetch/$s_!dB_L!,w_1456,c_limit,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F5589e214-f3ce-47d4-b640-42dd47a73ff4_4032x3024.jpeg 1456w" sizes="100vw" loading="lazy"></picture><div class="image-link-expand"><div class="pencraft pc-display-flex pc-gap-8 pc-reset"><button tabindex="0" type="button" class="pencraft pc-reset pencraft icon-container restack-image"><svg xmlns="http://www.w3.org/2000/svg" width="20" height="20" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="2" stroke-linecap="round" stroke-linejoin="round" class="lucide lucide-refresh-cw"><path d="M3 12a9 9 0 0 1 9-9 9.75 9.75 0 0 1 6.74 2.74L21 8"></path><path d="M21 3v5h-5"></path><path d="M21 12a9 9 0 0 1-9 9 9.75 9.75 0 0 1-6.74-2.74L3 16"></path><path d="M8 16H3v5"></path></svg></button><button tabindex="0" type="button" class="pencraft pc-reset pencraft icon-container view-image"><svg xmlns="http://www.w3.org/2000/svg" width="20" height="20" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="2" stroke-linecap="round" stroke-linejoin="round" class="lucide lucide-maximize2 lucide-maximize-2"><polyline points="15 3 21 3 21 9"></polyline><polyline points="9 21 3 21 3 15"></polyline><line x1="21" x2="14" y1="3" y2="10"></line><line x1="3" x2="10" y1="21" y2="14"></line></svg></button></div></div></div></a></figure></div><p></p> |