ndab Ah Yes, Medical School: Feeling Blue

Tuesday, November 16, 2004

Feeling Blue

Now that the elections have (finally) passed, there appears to be a rise in stress and anxiety for many people, especially for us blue-staters, over what the next four years will bring. Such stressors may inadvertently lead to a rise in heart attacks throughout our nation. Given this information, I felt it was my duty as a writer of useless medical stories filled with questionable medical expertise to provide a public service and explain to you, the lay people, the pathophysiology behind what may end up happening to you in a few weeks (as well as provide me with the opportunity to see how far I can stretch a metaphor/allusion). Why in a few weeks, you ask? Well, just consider the heart attack you will have when you learn that we are invading El Salvador because the images of starving children Suzanne Summers keeps showing us on TV are deemed indecent by the religious right.

An acute heart attack, or myocardial infarction (MI) for those of you who want to sound smart to your friends, often occurs when a sudden and catastrophic blockage of cardiac arteries by things called thrombi (a collection of platelets, fat particles, and bits of that quarterpounder with cheese you had for lunch at McDonalds yesterday) leads to a cutting off of blood supply to parts of the heart. This can sometimes occur a result of sudden changes in blood pressure seen in stress. Imagine two big branches off a main cardiac artery, once the towering source of pride shared by an entire community of heart cells, being suddenly bombarded with two huge thrombi that cause a complete blockage. These two arteries then can quickly and catastrophically collapse, suddenly blocking off all the blood supply to part of the heart that these arteries served. The heart cells that depend on these arteries will soon go through a process called necrosis (for you porn freaks, it is from the same root as necrophilia), which is a fancy way of saying they are as done as Roe v. Wade once a couple of current supreme court justices kick the bucket.

From here, things start getting really bad. The part of the heart that is not getting blood will stop working, and this will have dramatic consequences for the rest of the body. Since the heart stops pumping blood as well as it used to as a result of faulty heart cells, the whole cardiovascular system gets backed up because the blood that was supposed to be pumped to the body is now just sitting there (and if you think cardiology could essentially be done by a plumber, you are correct). The first areas to notice this ironically enough represent other targets that are commonly targeted by the thrombi and are consistently under threat of a thrombotic “attack” (if you will): the two lobes of the lung. Due to a long process of evolution (or say about 6,000 years ago if you are currently a high school student in Alabama), the heart and lungs have been directly connected by arteries and veins to ensure efficient oxygen exchange for use by the rest of the body. The two lung lobes are especially interesting to consider, because upon dissection they tend to have a bluish tinge and have almost a coastal shape to them (excuse me while I stretch this metaphor a little too far).

So lets recap what is going on so far: the heart goes kaput, blood is getting backed up, oxygen is not getting to the blood like it is supposed to because the lungs are failing and being filled with fluid, and the brain is getting a little woozy because it isn’t getting any oxygen.

However, we are forgetting one important player in this game of love (and by love, I mean massive heart attack). Yes, the kidneys. That bastion of piss-producing, nutrient-saving fresh tissue is, just like the rest of the body, currently suffering from reduced blood flow as a result of the MI. However, the kidney has a peculiar response to what is occurring. Rather than recognize that the heart and lungs, whose main purposes are, interestingly enough, to obtain and distribute ("subsidize" comes to mind) the necessary blood and oxygen the rest of the body needs, are in trouble and need some help, the kidneys are a bit selfish. Very small and specific parts of the kidneys begin sending out this compound called renin, which, after a process of conversion to various other compounds, acts to maintain normal blood flow to the kidneys and constrict blood flow to other places.

You may be thinking to yourself, “wow, that’s a bit strange”. (Alternatively, you could be thinking to yourself, “why am I still reading this?”, in which case I suggest you consider whether I am trying to make a bigger point and failing miserably at it. And if you are thinking, “Beer goes in here” and pointing to your mouth, please apply to medical school now. We'd love to have you.)

After all, it’s not like the kidneys were directly hurt by the heart attack. The heart was. The kidneys also aren’t the organs most immediately threatened with future attacks. The lungs are. You could argue that the kidneys are just completely misinformed about what is going on in the rest of the body, as if a small part of the kidneys is responsible for sending out misinformation in the form of renin to the rest of the body in order to manipulate blood flow for its own greed and power. That the sea of red blood, which is too ignorant to do anything other than follow the orders of the compounds that control it, is simply blinded by the sheer horror of the situation. Or perhaps the kidneys think they know what is best for the rest of the body, as if they were moralizing the parts of the body that work to provide them with what they need in the first place.

While you chew on that, let’s return to what is now happening in the rest of the body. When we last left our clogged up plumbing system, the blood had backed up into the lungs, causing excess fluid to spread into the lungs and some shortness of breath. What is next up in the backward blood flow bonanza? The liver! Yes, that lifesaver for college binge drinkers worldwide is now overflowing with deoxygenated (blue) blood, incapacitating it and leading to fluids spilling into the area around the gut ("ascites" for you medically curious folk). It doesn’t take a degree in rocket science to know that this is probably not a good thing. While I’m at it, it also doesn’t take a degree in rocket science to know that, unfortunately, Jesus probably does not have a subscription to Science, Nature, or The New England Journal of Medicine, so he is probably not going to be very helpful in making policy decisions about little things like global warming or stem cells. But I digress.

Returning to the action, the kidneys have not stopped their actions. They are pretty stubborn when it comes to getting their blood, and this is just compounding the blood flow problem for every other organ. If you really think about it (or have way too much time on your hands), you could argue that the kidneys, which come in identically shaped pairs in most people, are concerned that somehow their inability to get their normal blood supply could result in something like the lungs getting too close together so that their surfaces kiss (hows THAT for a stretch to try to make a point?). Could something as inane, primitive-minded, and unimportant (considering there is some serious heart attack and organ failure going on here) be the primary driving force for the kidneys selfish actions? Please don’t answer that question.

Well, as you can imagine, this just keeps on getting worse and worse. Even the kidneys, who thought they were helping the entire body by maintaining their own blood supply, begin to fail. Pretty soon, the heart will stop pumping. The lungs will stop expanding and shrinking. The kidneys will stop filtering and being ignorant. And, most importantly, the brain will no longer be able to think…

You can imagine what comes next.



While many friends of mine described the voting results of November 2, 2004 as emblematic of a huge brain fart on the part of millions of people, a more thoughtful friend of mine said that it is as if our country, clutching at its heart and soul, just suffered a massive heart attack last week, and that we will all be gasping for air for the foreseeable future.

Is there a doctor in the house?


Please note: All medical information presented in this post is factual. Or as factual as you might expect from some putz medical student who doesn’t pay attention to lecture half the time. As far as the other stuff goes, well, rather than accept the company line (whether that is Fox News, moveon.org, Jesus, or whatever), do your own reading and research and draw your own conclusions. I would suggest 1984, by George Orwell, as a good place to start.

6 Comments:

Anonymous Anonymous said...

I like this post. I like how you told a narrative of what happens in the body. Let's have more of this kind of posts.

9:21 AM  
Blogger wyn said...

(on "Feeling Blue")

ever consider medical writing....? well, with a fact-checking step, of course. =) it was colourful enough to make this girl with the 10-second memory remember the detail 20 seconds later.

3:30 PM  
Anonymous SDNer said...

i loved it!

5:06 PM  
Anonymous Anonymous said...

all very nice, except GFR (kidney's blood flow hoarding activity) is ultimately decreased with high enough a stimulation by sympathetic nervous sys.

But really fucking brilliant for a recent MS2. I end up sounding like a robot when I try to put together a "story" to help me remember stuff

9:42 AM  
Blogger Teeny Jo said...

For a putz medical student, you seem to know your stuff. :) Your post is much easier to follow than my Pathophys textbook. Ditto to wyn's comment about medical writing.

I have your residency blog bookmarked as well, but alas, no posts yet. Are they working you too hard?

11:29 PM  
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8:31 PM  

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