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Joseph Cramer, M.D.: There are insufficient neurons to make sense of madness

People link hands to form a human chain from a makeshift memorial for fallen MIT police officer Sean Collier to a campus police station at the Massachusetts Institute of Technology in Cambridge, Mass., Monday, April 22, 2013. A moment of silence for victi
People link hands to form a human chain from a makeshift memorial for fallen MIT police officer Sean Collier to a campus police station at the Massachusetts Institute of Technology in Cambridge, Mass., Monday, April 22, 2013. A moment of silence for victims of the marathon bombings was also observed during the event. Collier was fatally shot on the MIT campus Thursday, April 18, 2013. Authorities allege that Boston Marathon bombing suspects Tamerlan and Dzhokhar Tsarnaev were responsible.

When one approaches a scene of an explosion with human victims, it is total chaos.

Our brains struggle to comprehend what should not be. It cannot be.

There is no understanding. There are no answers. Our minds must create from the unthinkable as if we had just landed on an alien planet. It makes no sense.

After the literal mental and physical shock, instinctive behaviors kick in. Many appropriately run away. Some can’t move. They are frozen. They do not want the anciently wired-in predator to see their movement and attack again. Still others run toward ground zero.

Just to glance momentarily at the killing zone even without a body count reveals the unfathomable. There is debris of all forms, types and sizes. Red is the prime color. It is everywhere. It overwhelms, frightens and disgusts all at the same time.

Trauma surgeons and trauma centers have been trained and created for this mayhem. It just is not supposed to be all at once.

These specially trained teams are part healers, heroes, repairmen, magicians, priests and puzzle masters. They may have personally fine-tuned their skills on the battlefield. Further, the science of rebuilding broken and torn human beings is advanced in the laboratory of war.

It is when hostilities are brought to our shores that we bless these front-line physicians, nurses and their teams and curse their necessity.

Combat breeds courage. However, there is nothing heroic, brave, gallant or justified in blowing up innocent people and killing children. Cowards plant a bomb, then run and hide.

Indiscriminate explosions hurt and maim the random soul. They accomplish two tasks: cause harm and, more importantly, they are constructed, planted and detonated to generate fear.

Terrorists randomly target the innocent. They do it so that all the other innocents, even the most remote who see or hear, will be damaged. The harm comes to the vicarious observer not by metal fragments but by the panic of our own mental invention. With communication satellites stationed symmetrically overhead, all the inhabitants on earth are simultaneously wounded and scared.

Predictability permits animals in experiments to withstand frequent and powerful shocks. It is when the electricity comes without warning or with no pattern that the rodent will mentally stop functioning. They are jolted into a stupor.

Terrorists are not psychologists or ethologists, but they know their wicked art and science.

Tragically, these plotted acts of evil are too common in the world. It is just that after Boston we are again personally reminded how vile they are. We feel it down into our guts. Too often there are reports about bombs in marketplaces elsewhere, explosions in crowds or pilgrimages, not here. It is worldwide.

Now we need to look among ourselves.

Now the horror is once more on our shore. Good morning, America.

We are awakened again to our own vulnerability in this time of growing insanity. Be it foreign or domestic, there is too much killing.

Is there no end?

Justice is our first objective after treating the wounded, comforting the bereft and mourning the dead. Nevertheless, our righteous anger is ignited against the assailant, regardless of whether we know his identity.

In contrast, it is raging hatred that motivates the killing through these acts of terrorism.

However, we cannot destroy hatred with more hate.

They do not cancel each other out.

If someone or their secret band is “past feeling,” then they will sleep on their weapons and wait to kill or be killed.

There is no reasoning. We must protect ourselves.

There are not enough trauma surgeons in the whole world to care for all the casualties of conflicts. There are not sufficient pints of blood, operating rooms, surgical instruments, prostheses or crutches to care for all of the innocent victims.

There are also not enough neurons in all of our collective brains to make sense of madness.

Joseph Cramer, M.D., is a fellow of the American Academy of Pediatrics, practicing pediatrician for 30 years, and an associate professor of pediatrics at the University of Utah. He can be reached at