乌鸦传媒

Every week I write my next essay on a Saturday, send it to friends for comments, revise it on a Sunday, and submit it on a Monday. The post comes online on Wednesday.

This week, the pattern was the same. Over the weekend, I wrote a nice essay on the loss of democracy at medical meetings. And today, being Monday as I write this, I was ready to send it to the 乌鸦传媒 editors.

But today is Valentine's Day. And I am in tears.

I have been listening to Dos Oruguitas, again and again. And again.

What is Dos Oruguitas?

Many of you have heard about the new animated Disney movie Encanto. It is about a family whose members have special powers. But the family recognizes -- much to its dismay -- that the world changes; the status quo cannot be maintained; and the family needs to reinvent itself.

The songs for the movie were written by Lin-Manuel Miranda, who has already won an array of prestigious awards. He has an enormous gift of writing songs that people remember and sing (at least to themselves) long after hearing them. His most famous work, the Broadway show "Hamilton," dominated the internet for a long time (my late wife Beth and I saw the show on Broadway during its initial run, and it was wonderful).

The most famous song from Encanto is "We Don't Talk About Bruno." It is an exceptionally catchy song. But when Disney decided to nominate a song from the movie for the Oscars, it submitted "Dos Oruguitas." It is the first Oscar-nominated song written entirely in Spanish. Dos Oruguitas translates into "Two (Little) Caterpillars." The song is performed beautifully by the Colombian singer Sebastian Yatra.

The song describes two caterpillars in love. They rejoice in their togetherness, holding each other, staying together constantly through good and bad weather. But somehow they know that, very soon, they will need to let go. It will be time to turn into larvae and re-emerge some time later, each as a butterfly. There is nothing the caterpillars can do to stop the inevitable. The song is gorgeous, and the images it evokes are emotional beyond words.

Scientists have long been astonished by the transformation of caterpillars into butterflies. The caterpillar eats voraciously during its entire lifespan, presumably to accumulate sufficient nutrients for the coming transition. When the time is right, the caterpillar spins itself into a silk coverlet (a cocoon) and digests itself. During the larval phase, the release of enzymes kills the caterpillar and destroys all its organs, turning it into a mushy soup, with nothing left of its former self. If one opens a larva, there is no sign of the original caterpillar; it is gone -- except for a few cells (known poetically as "imaginal cells") that survive.

Then, by some miraculous sequence of events, a new set of instructions takes hold, and the amino acids in the larval soup are rearranged, carefully and meticulously, into an entirely new organism. The imaginal cells emerge, armed with the genetic instructions for the transformation. Initially, the caterpillar's immune system rejects the imaginal cells, but they continue to multiply with abundance. Finally, the begin to clump together, forming the organs of an entirely new organism with completely different anatomical features, with long legs and wings.

The fact that the caterpillar's immune system attacks the new cells of the butterfly demonstrates that -- biologically -- the two insect forms are entirely distinct life forms.

So essentially, the caterpillar dies and is resurrected.

Religions have debated the concept of death and resurrection for tens of thousands of years. And during the millennia, scientists have generally been silent about the likelihood of rebirth. After all, from an empirical point of view, there is nothing to say. There is no experiment that one can perform to prove or disprove the existence of life after death.

As a physician and scientist, I often needed to inform families that a loved one had died. The emotional pain in the room was so palpable that I often wanted to take back what I had just said. I sought to provide comfort by saying they had died peacefully and we did everything we could possibly have done.

But such a "medical approach" provided only superficial comfort. The loss was incalculable, and I could say nothing to diminish it. Yet, for some families, the grief yielded hope, almost immediately. Perhaps grounded by religion or some personal philosophical perspective, some relatives or friends would say, "We will see her/him again soon." They proposed there would be some future meeting between those who loved each other deeply during this lifetime, perhaps in a spiritual sense or even in some alternate physical world.

When these predictions were made, I always agreed with them. But I did not believe them. I was trained to believe that death had absolute finality. There was no scientific basis for resurrection. There was no way a living form could die, dissolve away, and be reassembled into another creature.

Yet, it happens every day. Caterpillars die and are resurrected as butterflies, using the same juices as the original life form.

It is clear that the genetic instructions for the formation of the caterpillar and the butterfly coexist in the same animal. The DNA for the caterpillar is activated first (with the genes for the butterfly being inactivated). But then the caterpillar DNA is suppressed, and the DNA for the butterfly takes control. None of this is controversial.

Ten years ago, Bernd Heinrich, an eminent biologist, proposed the that the conversion of a caterpillar to a butterfly results from the ancient intermating of two species -- one resembling a worm-like creature and one with wings. He suggests the DNA for each one was sandwiched together in the same genome, allowing each to become activated sequentially.

The concept of two organisms being sandwiched into one genome has been rejected by mainstream science. But to be sure, the caterpillar and the butterfly organs and physiology are entirely distinct. Immunologically, the two organisms are entirely different; each consider the other to be antigenically foreign.

If science were to seek for evidence of death followed by resurrection, we have it.

Suppose two people were to fall in love, only to be separated by death. They know death will come eventually, and they want to spend as much time as possible holding each other through both good and bad weather. Like two little caterpillars.

But two caterpillars in love are lucky. Assuming a similar age, they both undergo larval transformation at about the same time. Neither caterpillar misses the other for very long.

It has been 21 months since Beth died. I think about her all the time. Every year, we would celebrate Valentine's Day as if we had met for the first time.

So today, I set my planned essay for this week aside. And after wiping the tears from my computer laptop, I decided to write a new post. I wrote it in just a few hours, and I have not spent any time refining it. I did not send it to my friends and family for review. So, if readers think it is a mushy soup of digested and degraded ideas, they are right. But maybe something magical will be reborn from it.

Today I am consumed by a story of two caterpillars in love. They both hold each other dearly, each fearing death and neither is aware they will be resurrected.

I have only one question: When the two butterflies are reborn, will they remember they loved each other when they were caterpillars?

Milton Packer, MD, is currently distinguished scholar in cardiovascular science at Baylor University Medical Center at Dallas and visiting professor at Imperial College in London. Packer is an internationally recognized clinical investigator who has made many seminal contributions to the field of heart failure, both in understanding its mechanisms and defining its rational management. His work has spanned more than 40 years and has established the cornerstone of the current modern treatments for heart failure, including ACE inhibitors, beta-blockers, angiotensin neprilysin inhibitors, and SGLT2 inhibitors. He has authored nearly 600 peer-reviewed publications and has been the overall principal investigator for 20 large-scale international trials of novel interventions in heart failure.

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