Organ of the Week

October 22, 2017 Medicine Comments (0) 532

The Lung

I may have been a little overwrought. By lauding the kidneys over the lungs in the last post, it’s possible I’ve done the body-bellows a disservice. So I resolve to address this. Today we shall examine reasons why the lungs, if not winning first place in the organ stakes, at least get a solid participation certificate.

There’s the obvious reason we like lungs. The whole oxygenation thing. Goes without saying, that’s cool. Plus the reverse removal of carbon dioxide. Sure. Great. We get it.

And yep, they do that half-assed, kind of flashy job with acid-base equilibrium (not to harp on, but nothing on the kidneys). Compensation, buffering, yada yada.

But, if we’re going to applaud the air-bags, then we should appreciate their more eclectic functions. After all, who wants to be known as a work-horse when you can be avant-garde?

Following are several of the lung’s more glamorous responsibilities:

  • Clot filter. When any muck, clot, or alien sort of material starts a-rambling through the vasculature, the immense pulmonary capillary network acts as a mostly impenetrable mesh, a fine sieve, a Gandalfian passage prevention kind of scenario. Which has raised the fairly recent question, in the light of our drunkenly lavish use of imaging, whether small pulmonary emboli are, in fact, a normal phenomenon. Lung lint, as they are amusingly alliteratively named. And, you may recall, lungs are a rich exuder of tPA and heparin like substances – helping melt away the coagulated clumps.
  • Lung as pawn. First line of immunological defence. Unlike the pawn though, the lungs have a staggering arsenal of protective mechanisms: a mucous blanket, a muco-ciliary escalator escorting inhaled foreign bodies back out the way they came, ravenous macrophages swallowing everything even slightly alien in a liquid eighties pac-man style,  and hundreds of other immunomodulatory functions.
  • A dizzying array of metabolic functions – molecules passing through the lungs have a high chance of being modified, activated, broken down, gender-switched and so on. I suspect we have hardly a clue as to the depths of activity going on in the dead of the thorax when we are not watching.
  • And, for the most surprising piece of new lung knowledge in 2017, some intrepid researchers from San Francisco discovered that the lungs produce up to 10 million platelets per hour, dwarfing the sluggish production line of the bone marrow. (Ed. note. One of the principle researchers was Mark Looney. I submit this without comment) (and who am I kidding. I am the editor. I was just trying to deflect such an infantile addition).

But let us move on from such dry physiological periphrastic discourse.

I have a story about lungs. It is not very pleasant. I have previously written about the German student exchange I endured when I was 16. My host family were not overly keen on having an exchange student, and they were quite fond of laughing at my expense. We were out to lunch one day just south of Nürnberg, and I was given a menu off which to order. My linguistic skills were lamentable. I recalled ordering an item like pinning a tail, blindfolded, to a donkey. It was lüngerl (or something similar). The family sniggered. I was wary. The dish came out, gravy brown and chewy, like a tyre stewed for 3 days in a steaming bog. I persevered. They laughed. Friends, lung is not a gourmet food.

Allegedly respiration was first described by an Arab physician, Ibn al-Nafis, in 1243. In the first half of the 16th century, the role of the lungs was thought to be to cool the heat and rage of the heart. In the next century, William Harvey, that most sensible of chaps, finally started to work out what the dickens was going on with them. The real Dickens speaks of our organ in Oliver Twist: “It opens the lungs, washes the countenance, exercises the eyes, and softens down the temper, said Mr. Bumble. So cry away.”

The lungs of vertebrates are evolutionary relations of the gas bladders of fish; in their most rudimentary form a simple outpouching of the oesophagus, allowing storage of a gulp of air in oxygen poor situations. Spiders have what is known as book lungs, and if I had to choose a type of lung, that is definitely what I would go for. Lungfish are ugly. There, I’ve said it.

A surprising number of songs have ‘lungs’ in the title. This includes Florence and the Machine’s Between Two Lungs and Megadeth’s Into the Lungs of Hell (if you were looking for a night lullaby for your children).

Now this is not a post about pathology and disease. We’d never get out of here if it were (and I can hear you straining to do so already). But as a last word, let us take a look at the lungs of some of the great writers. They were a pack of wheezing, dyspneic artists if ever there were, coughing their bloody expectorations delicately into their lace handkerchiefs. Proust died of asthma complicated by pneumonia, Keats, Katherine Mansfield, the Brontes, Chekhov and legions more succumbed to TB, Updike was carried off by lung cancer, and Evel Knievel’s life was (surprisingly, and really inappropriately placed here) terminated by idiopathic pulmonary fibrosis.

Thus, I end with an apology to the lungs, demonstrated this by this week’s award.

 

 

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Organ of the Week.

October 16, 2017 Medicine Comments (2) 594

The Kidney.

Thus begins a new series; blogposts to celebrate features of ourselves that are scandalously overlooked. Our internal organs. This will be a collection of pieces drawing attention to our hard-working innards, a compilation that will be barely educational, seldom beneficial, and not even remotely weekly. But I do so love the complex machinations of the bits that make up our bodies, and I thought I would like to write about them.

So first, the kidney. But why does this liver-coloured bean get first place? The gold medal? Let me count the ways.

The kidney is the modest and loyal guardian of the internal milieu. Unlike the flashy lungs, who, at the first hint of acid-base disturbance get all huffy puffy, the kidneys are slow, considered, and in the case of respiratory alkalosis, almost completely capable of returning the pH to normal, a feat the lungs can only dream of. Yes, the lungs may be quick to blow off CO2 in metabolic acidosis, but they bore easily, never quite finishing the job. The kidneys, on the other hand, quietly get on with their lumbering business of bicarbonate and proton shuffling, restoring neutrality without fanfare.

The derivation of the word kidney is joyfully obscure. It comes, possibly, from the root words for belly, womb, and teste. The proto-Germanic (and once again, bless that amusement park of a language) has kidney and testicle freely interchangeable. Allegedly it is also an obsolete, slang term for waiter.

Talking linguistically, when learning of the peripatetic ways of the internal workings of the kidneys and their tubules I first heard the term, and you may well be the same, countercurrent mechanism. What a joy! One could picture the molecules marching in and out of the newly sprouted urine, up and down the nephron, following the concentration gradient the way a retiree with a caravan chases the sun. Marvellous! Evolution is a crazy wonderful thing.

Humans can live perfectly well with a single kidney. Subsequently they have been the source of some fabulous urban myth stories about hand-written notes, telephones, and ice baths. On the sobering side, it means that organ trafficking is a dire global problem. Iran remains the only country where it is legal to sell one’s kidney – a legally traded kidney fetches several thousand dollars, but on the black market prices balloon to hundreds of thousands of dollars.

Your kidney can smell (allegedly). Or perhaps, more accurately, it sniffs at the urine as it gushes by. This marvellous fact was discovered by Jennifer Pluznick, a professor of physiology at Johns Hopkins.

Speaking of receptors, there are, almost definitely, hundreds, possibly thousands of different receptors on each nephron. And there are at least a million of these itty serpiginous pythonesque things per kidney. One can only read this, slack-jawed, and realise that we have barely begun to understand all the functions of this beany beauty. We are but toddlers in our knowledge.

The primary function of the kidney is, of course, to jealously guard the creation of the golden waters – to perfect the concentration of them, compared to plasma. The kidney is the gatekeeper, the demilitarised zone, the border patrol, policing the movement of all manner of molecules, in order to produce a perfectly balanced cocktail of liquid waste.

Allegedly it is edible, with steak, in a good pie, although I think that the human variety may not be the ideal ingredient.

For all its good and wonder though, it is a rather savage stonemason, and concretes small rocks into existence, made from various concentrations of calcium, oxalate, phosphate, uric acid, and cystine. It’s also been known to carve brick red stones out of xanthine, and struvite, which resembles glass crystals and can occasionally be found, disconcertingly, in canned seafood.

The above features are but a tiny fraction of the wonders of the kidney, its function and dysfunction, but it has given me great pleasure to award the kidney the title of top contender for organ of the week. I hope you’ll join me in a round of applause for this sensational viscus, however I’d be surprised if any of you have got this far. Please do add any nephrologically fascinating facts if you’d like.

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We, sisters.

October 13, 2017 Musings Comments (2) 2729

This is a post that has had many years to brew. There is much I want to say – there are vast reams of words and shouts and polemics with which I’d love to spray paint the page. But I shall test my embryonic writerly skills, and see if I can keep it short. Succinct. Meaningful.

I’m off twitter for a day. In the swirling wake of rage following the outing of Harvey Weinstein, there has been a twitter response: #WomenBoycottTwitter. While I am under no illusion that this will change a thing (in fact the choice of silence as a protest when silence has been the age-old problem feels incongruent), and it may seem like somewhat of a pointless exercise, I choose to join with women who believe it to be important. I am part of the sisterhood.

 

I am an Emergency Physician. I have worked for decades in a sweaty, high-stress, muscly environment, requiring skills that may be considered kind of masculine. Control, a firm voice, a steely resolve, and an ability to suck up the bad stuff and just carry on. For most of my career I have considered myself oddly genderless. It is not infrequently I am asked what it is like to be a woman in this world. For years though, I have made a conscious decision that this is an issue I do not want to talk, or write, or speak on stage about. I have wanted, for my entire career, to make my beliefs and ideology known by doing. The ultimate ‘show don’t tell.’ I have tried to be the best role model I can, in my own messy, fallible way, so that every woman (and man) behind me will be supported and valued in their lives of critical care, and to see that it’s OK to achieve quietly. I hope, after this tiny, inconsequential post, I shall go back to doing the same.

The reason, however, that I am breaking this personal reticence, is that occasionally silence equals complicity. The silence of those in Hollywood, and on the other side the silence of the generations of women who knew they’d be pilloried, disbelieved, or worse, if they spoke out. Silence, truly, in this day and age, is not a valid option. I also choose not to be silent about Australia’s inhuman treatment of refugees, or the world’s entrenched racism, or that appalling man on his gaudy golden throne across the ocean, legitimising all that is bad on this planet.

I am also deeply fortunate that I work, and am surrounded by, good men. I see and interact with them everywhere, and admire their moral fibre, their considered intelligence, their respectfulness, and I am grateful for being among them. I am also aware that there are other voiceless people oppressed by those more powerful – many of the former being men, people of colour, and our LGBTQI community, and as such singling a group out, above the others, has always felt wrong.

Almost as an aside, I have also suffered sexual harassment, as well as sexual assault. These are certainly things that mark you forever, change how you feel about yourself, crush a part of you, damage you, strip you of confidence. Now I am (trying to be) a grown-up, I have no more need to delve into those times. Now is my time to extend the hand of love to those behind me.

I stand up for every person who is crushed by someone of power above them. I stand alongside all women, and I believe you. I intend to live my life in a way that honours and supports anybody who does not have the means to do that for themselves. I am a feminist, and this is my version.

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The Road South

October 6, 2017 Musings Comments (1) 402

I’ve just been driving on the little artery connecting Perth with ‘down South’ (the only holiday destination a drivable distance for we people in this sorrowfully isolated city, a refuge to which the townies escape in order to furiously recreate).  The road is in jolly good nick, hugging the coast as it does, and it bypasses the bristling little towns on the way. It’s very different from driving the mean-looking Albany highway, which is straight as a Cormac McCarthy sentence, and bisects off the juicy little south-west triangle, dividing southern Western Australia into the haves and the have-nots – a partition between green and brown, grapes and wheat, money and not, leisure and work.

Anyway, heading southwards, I saw a man riding a motorbike. He was dressed from top to toe in the richest of browns, copper coloured corduroy pants, a brownish khaki shirt, nut-coloured shoes and an open faced helmet, and he was riding a Royal Enfield – a majestic thing on two wheels, all elegance and history. He rode it slung back in his seat, and, with the entire horizon steeped in smoke from some distant bushfire, as he passed I could taste adventure. Smell the exploits ahead of him. In the lane next to him was a brown volvo – actually more beige, the colour of slacks that men of a certain age wear to their Rotary meetings. And in that car, was me. And a song played over in my head. How did I get here? This is not my beautiful life.

Back in university days, when ‘down South’ was the only vacation option for the cash-strapped and unimaginative among us, when our thighs were hard-muscled and our cars were borrowed, we would stay in makeshift campsites, or the friend of a friend’s beach shack, and play drinking games nobody really knew the rules of, our only bath the icy washing machine of the Indian Ocean.

But now, in the mesmerising drive down to the ‘resort’ where we are booked for a few days, I had plenty of time to reminisce, compare the then and the now. The road, of course, was full of visual distractions, little snippets that make this drive so unique. I saw a fully assembled drum kit being played next to a rubbish bin in one of the truck lay offs, genderless youths in black hoodies hurling rocks at birds, boxes of squashed end of season fruit advertised for sale for the price of a gold coin, and the repeated lonely little crosses by the roadside, covered in their colourful synthetic flowers, paying stoic homage to our national pastime of slaughtering our young on our roads.

Before I knew it though, before I could descend into too much maudlin memory and regret, I arrived at the main hub of this holiday destination, this odd place of perhaps the undeservedly rich. It’s got itself a bit of a bad rap, this town, as though it were the Hamptons misplaced, Gatsby’s West Egg without the glitz, the cafes with their queues of people as impatient here as they are in high street Claremont, their annoyances simply transplanted along with their neighbours, every bank holiday weekend. Not unaware of my own hypocrisy, we trooped into our own bungalow with its gleaming marble basins and hand lotions arranged just so.

I haven’t done this place justice though. The southern coast of Western Australia has far more exquisite beauty than it does plastic pop-ups. It is mostly ancient and wild and has air full of fresh, screaming wind, and more biodiversity than we paltry humans have any idea about.

And as we pulled into our home for the next few days, I saw, for a brief moment, simultaneously, the setting sun – a burnished bronzed orb, alchemically distorted by the smoke – and on the other horizon a warm, full moon, so clear you could see the valleys and rifts and seas upon it, and for a few minutes they were balanced exactly, as though they were a Calderian sculpture, and I felt such a sense of perfection, such wonder, I was overwhelmed with gratitude that I was right here in this moment, able to see such things, knowing I would never have done so in my unseeing university days. And that I am deeply happy to be the age that I am, and with the words to say so.

 

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