- It's To The Best Of Our Knowledge, I'm Anne Strainchamps. Would you donate a kidney to a stranger?
- Last year in March, on Facebook, there was a little girl in our town that needed a kidney. My daughter looked at me, she goes, "You know, Mom, you would match up with her blood type." So, I called the hospital where she was working through, and that's how the process started.
- This is Missy McKenna.
- I had to go through all these blood tests and all these tests and everything, and then they tell me the little girl, she had gotten a kidney and that her transplant was going forward. And I felt I'd gone so far through the process. I said, "Okay, that's fine. I've come this far, I'm not gonna stop."
- And that's how Missy McKenna decided to give away a kidney to a stranger.
- You know what, it was like something that once I decided to do it, it wasn't, I never thought about it again. It was, I always+ felt my kids, it was a no-brainer. My said, +son said, "Are you're giving your brain too.?" You know, it was something that once I thought about it, once I decided to do it, there was no looking back.
- This is such an incredible story and incredible case.
- This is Missy's surgeon, Josh Mezrich.
- I have so many donors tell me, "This is the best thing they've ever done." And, of course, that's my goal.
- To lose a kidney?
- That part but really-+
- Why do you think it's the best thing they've ever done?
- Because they're saving these lives, it really is. It is like the kind of person who would run into a burning building to save someone. Now, the donors do really well. When you look at the numbers, the risks are low, but it's still surgery, it's still this leap of faith. There's gonna be a recovery, there's gonna be pain. Who has a month out of their life that they can go through this? But I do wanna be clear, our donors do very, very well, and I hope your listeners will get to hear it.
- When you think about it, this is astonishing, right? I mean, Missy chose to give away one of her kidneys just because she knows that someone somewhere needs it more than she does, that's a kind of donation that's actually on the rise. But there's another story here too about the extraordinary field of organ transplantation, and surgeons like Josh Mezrich who perform Medical Miracles every day. His new memoir, "When Death Becomes Life", takes readers inside the operating room. And so, Shannon Henry Kleiber decided to take us there in person.
- This was such a great opportunity. Josh's operating room is just a few blocks from our studio. The UW Hospital in Madison is one of the busiest transplant centers in the country. They do about 350 kidney transplants a year, and Josh does a lot of them.
- All right, so this is the operating room.
- Great.
- This is a kind of surgery that was unthinkable a few decades ago and now it seems like it happens almost every day.
- All our sutures are always on the side.
- I was just thinking about how our bodies can do incredible things every day.
- The part above the head is sort of anesthesia's domain.
- And it's one of the most miraculous things to think about. That part of our body can help save another person's body.
- The overhead lights on the table.
- These two human beings connected in this really visceral, amazing way.
- There's our patient, actually. Missy, how are you?
- Josh introduced me to Missy and I asked how's she feeling?
- I'm doing fine.
- She's got some sedation already.
- The anesthesiologist is about to totally put her under.
- I'm gonna put right on your face and let you just fill those lungs up with that good stuff.
- She's starting to get a little sleepy here.
- When I started Medical School, I really didn't know what I wanted to go into. On the first day of our surgery rotation, we had a really busy day. I was scrubbed in on a bowel obstruction and I realized I hadn't eaten or drank anything all day because I was so nervous. And I distinctly remember just watching the bowels sloshing around and feeling like I was gonna pass out and hanging onto the patient. I got through that around midnight and at that point, my resident said to me, "Hey, go scrub on this other case." I really wanted to go home, I was exhausted. I didn't feel that great. It turned out it was a kidney transplant. It was with this older surgeon in the middle of the night. He had classical music playing, everything went smoothly. It was almost bloodless. When they released the clamps, and I just watched this kidney pink up, and literally in front of my face, the urine was pouring out onto our hands. I just sat there thinking, this is so incredible. I can't believe this works. I knew that someone had just died to give this gift and I also knew that this patient's life had just changed so much. I felt like I wanna be a part of this.
- One, two, three. +Wanted, okay, so all right. Why don't you go rest.
- The mood in the room totally changes once the patient's asleep. they turn up the music.
- So, we'll drape up the patient.
- He has this whole playlist he likes to play.
- He can't ever do surgery without music, that's not-
- I'm embarrassed to say it, but for whatever reason, I like to listen to 2Pac on Pandora.
- Okay.
- Some Eminem and some 2Pac, he's pretty into it.
- I always wondered what, like if Slim Shady knew we were playing his music in the OR what he would say about that.
- I think he would like that. I do a lot of lung surgeries and a lot of them overnight, and you need something with energy that is gonna keep you awake. For me, classical music, as much as I love it, it's probably not gonna give me the energy I need.
- You know, they +know they play it like in football games and stuff, but this is good.
- Josh talks pretty much nonstop. Their+ jokes, there's chatter.
- I do, I should say there was a stretch of time where I did all my cases with an English accent. It was quite clever, really.
- +
- Mm-hmm, all the nurses were dying to work with me because everyone wanted to try their English accent.+
- He owns the room.
- Right, can we, can everyone do a little moment of how great I am with... Talk about how great, no, just kidding. I hand-selected this team of people that all like me. You know, we feel like a family in there.
- Hello, mates. How's it going?
- It is almost like a performance in a lot of ways.
- I do think to be a surgeon, you have to kind of want to be the person who wants the ball. You wanna take the ball and be the one that's responsible for it. I always think about those golfers who will talk about their round and they remember like every shot what the win was, why they used a club. And I feel that way about operations. It's like a sport in so many ways. You have to develop muscle memory, you have to practice to perfect it. You have to work in a team. And you actually, can replay the case in your mind. I actually, once was sitting in my office replaying and I suddenly remembered I didn't tie a one end of a duct on this complicated case. I was sitting in my office just replaying. I was like, "Oh, my God," and I actually had to run down and take the guy back to the operating.
- Is it messy?
- I mean, gosh, we're... Different operations are more or less messy. I think a liver for me is the messiest thing, I do. There are some cases I've done where we lose more than a hundred liters of blood and that is a tremendous amount. We probably have five or six liters in our body. So, you can imagine-
- +It must just be blood all over the floor just sloshing around everywhere.
- A kidney's not like that.
- +Turn it +overhead like...
- It's remarkably bloodless, it's laparoscopic. So, the doctors are basically, putting these large probes into ports in Missy's abdomen.
- All right, so Clark has a harmonic scalpel which vibrates like, what is it, like 2000, 50,000 beats per second? +
- What's that sound?
- That sound is twisting the port with the camera in it to drill through layers, actually, of muscle and fascia to enter Missy's abdomen.
- Beautiful entry.
- Whoa, that's the sound of them twisting something into Missy's abdomen.
- Yes.
- Now, we look in.
- So, you can see the arteries and the fat and the other organs.
- It's the diaphragm the liver. It's a beautiful liver she's got, I always found to see, or I always look at the liver because I'm a liver surgeon too, so I always wanna see. I feel like I want someone to tell me my liver looks great.
- +Thank you, appreciated. Oh, for sure.
- It's probably different than what how people picture it. I've gotten to the point where I see people walking around, I can almost picture what the inside of their belly looks like, but I try not to.
- Oh, my God,+ that was a question I was going to ask you. I wanted to know whether, because most of us have never seen, probably never will the inside of an abdominal cavity.
- Yeah.
- Do you like if you're standing in line or on the bus glance at people and think, "Hmm, I bet you look like this inside."
- I have those moments, really, really small, thin people you think, how can they fit that all inside them. My wife's a surgeon and sometimes certain people walk by with certain body habitus and we'll comment "Tough kidney," or something like that. I probably shouldn't admit that. Once a surgery starts, it really is this puzzle. You're really focused on doing the case. You're not thinking at all about, "My gosh, this is a person with kids or with parents or something like that," I think, when things go disastrously wrong, then you start to get these moments of thinking about their family. But during an operation, you're really focused on the task at hand. You almost don't feel like you're operating on a human. You're just trying to put the puzzle together. Ah, but we're still looking for +ureter.
- Maybe down there or is that-
- Yeah, there it is. You see +the ureter is moving? It looks like some sort of sea creature, doesn't it?
- Yeah.
- That's it, man. +Josh, +look at that guy, what a beautiful ureter.
- +Isn't shape. Yeah. If.
- Was there a point where you thought, "I'm not sure they're taking this surgery thing seriously enough."
- I'm the master, bud.
- At one point I thought, "Wow, they're really talking a lot of-
- +Doing good.
- You know, as a reporter, I usually ask a lot of questions, but I kind of felt like I shouldn't ask too many questions because what if I ask a question, they look up and they are answering me and-
- Careful.
- This is surgery, this is, you know-
- +Slice open an artery.
- You could see another artery.
- Right, and they're saying, you know, "Is that the artery?"
- That's an artery there, that's where we're gonna divide.
- Hmm, let's look at, I mean, you know, there's if things could go very wrong.
- We seem we're relaxed and we're having fun, but like we are able to very quickly kind of turn it on if something goes wrong and, thankfully, that doesn't usually happen, but this is where my heart rate goes up. I think it'd be fun to have a monitor, like a heart monitor on me during these operations. Wouldn't that be good?
- The thing that seems so distinctive about transplant surgery, it's literally at the intersection of life and death, most of the time for the transplant to work, somebody died.
- Transplant really starts with death. It's a different field in a way we take from death. I really believe the donors, the deceased donors are my patients too.
- Sometimes, the call comes in at three in the morning that there's been a terrible accident and somebody's dead and there are some organs. You and your team are the ones who will then go sometimes fly to actually, you call it procurement.
- Mm-hmm.
- And the first thing you must do is meet with the donors family.
- What are those conversations like?
- When I first went on my first procurement, I was really nervous to meet the family because I thought, "Gosh, were these vultures coming in to take their loved ones organs away and it'll be the last memory they have and maybe this'll be too hard for them. You walk into the room and often it's a big group of people, they're in tears, there's an unexpected death of maybe a young person, but they absolutely hang onto every word, they wanna know about the transplants. They wanna know who the recipients are, which we can't tell them at that point. It's this one positive memory in this otherwise, terrible time.
- Wow.
- They often will wanna tell us something about the person that just died.
- You know, in a sense, when you're with a donor and you're gonna be taking organs, the organs are still alive.
- Right.
- So, there is still life there.
- I know, I agree, and probably, every transplant center has a picture like this. But our center, there was this woman who lost her young daughter in a car accident some years back and she finally met the recipient of the heart at a picnic that we sponsored. There's a picture of her listening 10 years after her daughter died, to her daughter's heart with a stethoscope +in this recipient. And, it really is a piece of her daughter that's still alive. And although she can't talk to her daughter or hug her, I just think it's so special and it is at that center of what's alive and what's not. Are they still alive in some way?
- Now, hold that thought because Missy's kidney is about to begin its life-saving journey.
- Okay, we got a plane to catch. The kidney has a plane to catch.
- We'll be right back. I'm Anne Strainchamps, it's To The Best Of Our Knowledge from Wisconsin Public Radio... And PRX. This hour, we're bringing you the extraordinary story of a humanitarian kidney donor and her transplant surgeon. Now, this is an amazing surgery when you think about it, but not without risks. Here's our transplant surgeon, Josh Mezrich.
- So, as to the right diaphragm in front of us, kidney to our right, spleen to the left, we're past the adrenal now. He just +doesn't wanna stick his blade into the diaphragm. It takes one millisecond to put a hole in the diaphragm with the harmonic, we're almost ready to start flipping the kidney. We're in really good shape.
- You remember the failures more than the successes, how come?
- I think managing the problems, managing the complications is absolutely the hardest thing for a surgeon. +We spend all our time thinking about that. I think every surgeon has to have this proverbial box and in this box you can kind of put your complications and you can keep them there. You need to be able to close that box so you can go home and be with your family, be with your kids, be in the moment, and not just be constantly agonizing, but you also need to be able to open that box and own that complication, be with the patient, see them every day and say, "We're gonna get through this." It was my fault or maybe it wasn't my fault, but I'm sorry this happened. I know surgeons who can't open the box and become these cowboys and never think it's their fault. I know surgeons who can't close the box and they're almost paralyzed.
- Sometimes, if a surgery is going badly, the thing that matters the most is the willpower of the surgeon.
- Yeah.
- You know, not necessarily the technical skill, just the guts.
- I write about this one case, Tito, which is this incredible story because I really almost lost my will during this surgery. It went on for hours. Things had gone wrong, we had lost a ton of blood.
- What was so hard about this one?
- When we started to reperfuse the liver, releasing the clamps, the spot where we had sewn the liver onto the vena cava where it drains out, the blood fell apart.
- Mm.
- And the more we tried to get control of it, the more it tore to the point that it was just exsanguinating and we could barely control it by, you know, holding it with our hands and kind of hit the point where I was like, "This is, we should just stop." And I went down to talk to his daughter, Orinda. She was there alone, it was like four in the morning. And I said to Orinda, "I don't think we can do this. I think he's gonna die on the table." And she kind of looked at me and she was very respectful and very kind person, but she said, "You know, I know you will do everything you can to save my dad." And I did have this moment where I'm like, "All right, I'm not gonna give up, let's go back after this." I went back up there and we started throwing stitches, called some partners in, spent multiple more hours and we actually were able to get through it. But I remember like there was this moment where I kind of lost faith, lost heart in this operation, and it's kind of resounding to me to think about that.
- Yeah, put that down.
- So, we'll take out this surgicel, +Watch that.
- Yeah, sorry?+
- I'm just fixing my cord here.+
- What's it like when it's finally time for the kidney to come out?
- Everything becomes more serious then.
- Yeah, this is critical, so once we get the kidney out, we'll move it to the back, flush it, that's critical.+ And once it's flushed and on ice, then we can relax.
- The timing is really key because there's somebody waiting with a chest of ice to take it on a plane.
- Do we have our flush cannulas hooked up. All right, are we good? Is everyone good?
- Yeah.
- We got everyone we need.
- So then, they basically get the kidney free.
- Everybody's calm. I'm freaking out! Okay, we're calm again, all right. Push down all the way across. I think you're great there, dude, perfect. Fire in the hole. Dude, love that. All right, so now the kidney's fully, now keep, have your harmonic in case, we look like we're fully. Right, you keep your instruments in, I'm gonna take mine out.
- Josh pulls out the kidney.
- I got the bag here.
- And there it is.
- There it is.
- What does it look like?
- Flip the kidney in the bag like a fish.
- Oh, it looks like a... A big pink ball.
- How big?
- A big handful.
- Can we get the ureter in there?
- I have to say, the mood changes after the kidney came out.
- Good, lights on, please.
- +Rotate.
- They start analyzing it and that seems so much more serious right then.
- Okay, can I have a Westfall?
- They start working on the kidney and then it spurts out.
- Scissors.
- Urine.
- Pee.
- Yes.
- It pee.
- It does, like I actually saw that happen, you know, they're looking at it and it just shoots out this big amount of pee.
- Okay, there it is, left kidney, two arteries. I'm happy with it, plug+ it,+ I think it looks great.
- And then, they pack it all up.
- I mean it'll go, it'll fly across the country and then you know, it'll get plugged in and it'll start working right away. It's just awesome.
- There must be a moment of wonder, does that ever hit you in the operating room or is that like later at four in the morning when you're lying awake, thinking back over your day?
- No, it hits me every time I think. The wonder that we can even do this. The wonder that you sow an organ in and it just starts working right in front of your face. The liver starts making bile, the kidney starts peeing, the heart starts beating, the lung starts breathing. Those things are all amazing. But part of what's so great about this story, when we get a donor, like this young lady who is donating just into the pool, we can actually do something called a chain. She will donate her kidney, it will fly somewhere else in the country. Then that patient's donor will have a kidney go on a plane to somewhere else. These chains can crisscross the country over a period of months. I think the biggest chain was more than 30 pairs. 60 people involved +multiple transplant centers. I was at a talk through the NKR and this young woman who had started a chain was up there and she said, "You know, you doctors in the audience, you guys save lives all the time." Which I don't think that's necessarily true, but that's what she said. And she said, "Someone like me, I don't really have the opportunity to do that." And I went through this operation and I saved all these people and it will be the best thing I've ever done for the rest of my life.
- Wow.
- It's this beautiful thing that people do.
- So, what about the woman at the center of this story? Missy McKenna. She's the reason everybody was there in that operating room. What is it gonna be like to wake up without a kidney? Well, it's been six days and...
- Missy?
- Yeah.
- Hi, it's Shannon.
- How are you?
- Hi. Thanks so much for doing this today. It's amazing to me, the last time we met you were in the operating room and you were getting ready for surgery.
- Yeah.
- How do you feel?
- I feel awesome, I'm just kind of really, really tired and I'm not up to myself, but I'm actually, I'm tired out. But other than that, I would never know I had surgery.
- What's different about what you expected?
- Well, everybody talked about all the pain. I'm not in any pain. And somebody told me that when after you donate, you kind of feel like at a loss because it's done and over with. I did ask how the kidney was doing and they said it was doing really good and I'm just like in awe and how easy things were and how it went and how I feel now. I feel great and at peace.
- You saved someone's life.
- Well, you know, I guess until I hear that said like that, I didn't even think about it, you know? That's amazing. I always wanna help people, so I'm glad that I could save somebody's life.
- Wow. What is it like to think about part of your body being part of someone else's body right now?
- have to laugh because my daughter came to me as I was getting ready to go down to Madison for my surgery, and she said, "Mom, I came to say goodbye, you know, I'll see you," and I'm like, "Oh, thank you." And she goes, "No, I was saying goodbye to your kidney." You know, I guess being a part of somebody else, I don't even think about it. I just hope that their life is more enjoyable.
- Would you want to meet the person?
- Yes, I would, and I don't know why. I mean, I do if they wanna meet me. If they wanna meet me, if I don't want them to feel that they were have to meet me, you know, my kids want to. They want to meet the person that has a part of me is what they told me.
- Oh, that's so cool.
- Mm-hmm.
- Yeah, you've gotta feel some kind of closeness there.
- Yeah.
- Do you, you know, you're resting a little more and is there some kind of activity you'll get back to?
- I bowl, and I have lots of kids in my house. I do foster care, so I just look to getting back to doing some of the things that I do with them, you know, like going outside and jumping on the trampoline and stuff like that.
- Oh, that sounds like fun. So, you, do you have a bowling night?
- Yeah, I bowl on Wednesday nights.
- I bet your bowling team is excited to have you back.
- Yeah, they will be.
- That's great, it's an incredible story. Thank you so much, Missy.
- Mm-hmm.
- What you've done is amazing and incredible.
- Thank you.
- Bye-bye.
- Bye-bye.
- Missy McKenna donated her kidney in February 2019. Shannon Henry Kleiber was there for all three hours of her surgery, which was performed by Josh Mezrich and Clark Kensinger. Josh is a transplant surgeon at the University of Wisconsin and author of the medical memoir, "When Death Becomes Life". You've probably figured out by now that our theme this hour is "The Wonder Of The Human Body". Something it's all too easy to forget in the hustle of daily life. Until something goes wrong.
- Let's see, one of the first times I knew I was sick. Probably just when I was in my early teens and I fainted after a shower. That bathroom that we had in the+ house was extremely moldy, visible black mold everywhere. And so, every time I showered it was like a mold sauna. So, when that happened and I fully passed out, that was at that point... I had a sense of my own fragility.
- Porochista Khakpour has been fighting a mystery disease for a long time. Through years of chronic illness, remissions, and relapses. And what she eventually learned was Lyme disease has taken over a lot of her life. Porochista is a widely admired writer. And last year, she came out with a memoir called "Sick", which breaks a lot of unspoken rules about how we discuss illness. For one thing, she doesn't pretend there's any silver lining. Shannon Henry Kleiber caught up with her in Santa Fe where she's been staying with her mother and getting more treatment.
- How are you feeling?
- I'm not feeling very well, today. Pretty sick.
- What's going on?
- I just had a long day of IVs and I've had an endoscopy the other day, and I'm just having really bad abdominal pain and short of breath.
- I'm sorry to hear that.
- It's just frustrating because there's just so much to deal with and every part of my body seems to be affected. So, yeah, I mean, on the one end we know what's wrong with me, I have late stage Lyme disease. It causes systemic damage. But on the other end, you don't know which parts of the body are being eaten away by this sort of corkscrew bacteria, this spirochete illness that is so insidious.
- Can you tell me about how that feels? What does that feel like?
- It just feels horrible to feel unsafe in your own body. I mean, you know, I don't know what's happening, but it just feels like I'm being eaten by my own body. I feel like I am just, I think the feeling of illness is you just feel like a stranger to yourself. But oftentimes, you know, I remember remission just last year.
- What was that like?
- I was very active, I lived a normal life. I had minor aches and pains that come with Lyme that I +didn't even register for me. I have a very high-pain threshold, so I didn't make a big fuss about it. I wasn't certainly taking a ton of pills or gonna+ doctor every other day as I am now.
- You have your mom with you now, right? She's helping you.
- Yeah, uh-huh.
- What is it like when you kind of have to explain it to people and you say, "You know, these are my ups and downs and this is what I need." How do you ask for the help and how do you know what to ask for?
- Well, I mean I'm turning 41 next week and it's just on some level, humiliating to have to ask my mom to like make me every food meal, whereas last year, I could cook for myself. And also, it's humiliating and strange to feel like I can't be alone a lot.
- Are there parts of your body that you're happy with right now that you think that part is working well?
- I, +this is the problem with our culture. There's parts of my body, if you look at me right now, you'd think, "Oh, she's this like thin probably, in shape person," I'm rewarded constantly for being extremely thin. I fit into clothes I wore in middle school right now. That's not normal, but in our really disturbing, disgusting culture that is rewarded. So, everywhere I go, people think I look great and that really, really burns me because I was about 40 pounds heavier just a few years ago. And no one thought I looked healthy then, but I felt great. At night when I'm trying to sleep, all I feel are my bones.
- I'm sorry, that's a, it's hard. That's really hard, I'm sorry, and we're catching you on, you probably have a lot of days like this.
- Yeah, that's why when people ask me to do interviews, it's not like, I don't really say no because I don't really wait to feel better.
- There were so many moments in your book that were happy, but the book at the end is not a happy healing ending. As a writer, I can imagine that it was kind of hard to not have an ending. Did you feel that way as you're writing the book?
- Yeah, I mean I originally sold it as a book that would have one because I was feeling fairly good. But I think it's probably a better book for that reason. And I think its reached more people. It doesn't have a neat ending. The book is not neat but illness is not neat. And so, I feel like it's more of an honest book that way.
- A lot of writers talk about illness as metaphor and can you talk about your illness as a metaphor in your life?
- You know, I've been moving away from thinking about illness as metaphor. I mean, I've loved the Sontag, of course, and+ it's something I write about in the book. But more and more I've been walking away from the idea of illnesses metaphor as I get sicker because it romanticizes the issue a little bit. And I really like the literal and the pragmatic here. When we talk about illnesses metaphor, it creates a distance between us and science and the doctors. I can appreciate it aesthetically, but when you're trying to get well, you really wanna be nuts and bolts and facts and figures. I'm not very interested in the mystical aspects of illness. Nothing speaks to me more than when I look at a bloodwork and I see numbers there. More and more I step away from the metaphoric and the figurative and the aesthetic and I go in this other direction that has nothing to do with my art. And I almost think it's a disadvantage when doctors hear, I'm a writer, you know, I don't want them to really think about that.
- You want it to be real and scientific and-
- Yeah.
- See the numbers.
- I think that art can save in a certain way, can enliven and bring joy to people, sure. But at the end of the day, if someone is starving on the street or they're losing half the blood in their body, art can't save them. And I do think science and technology actually can, and you know, the artist in me surprised to hear myself even say that. But I'm at a point where I can't afford the other side of it. I need my doctors to be excellent scientists, excellent detectives of the body and to really know what's going on.
- Well, there's gotta be something that you're trusting in your body as much as your body has has not worked for you in some ways, you're trusting part of it in some way too.
- Trusting, yeah, I mean, I don't know. I don't know if I'm trusting my body. I'm trying to.
- Your hoping.
- I don't have a choice though. I don't think hope is something people can choose. I think everybody who's waking up every morning and putting on some clothes and eating has some degree of hope.
- Porochista, thank you so much for being with us today. We know you're tired and we want you to go rest.
- Thank you.
- Porochista Khakpour is a novelist and author of the best-selling memoir, "Sick". Shannon Henry Kleiber talked with her. Is it possible, do you think, to find any sense of wonder in illness? Probably not when it's your body that's falling apart but there are doctors who can find wonder in something as simple as a temperature.
- One of the many reasons we get a fever is that when you're unwell, there's some, if you like alien invaders into your body, that your immune system is engaged with fighting off. Your body picks up on the fact that you're fighting off an infection. Your white blood cells become alerted and they start to secrete certain hormones. Which affect your brain's central thermostat. For good reason, because when you're a little bit hotter, all the chemical reactions in your body happen a little bit faster. And the hope of our physiology, if you like, is that is gonna help us clear the infection out quicker. And that's why taking drugs, like I think in the US you call it Tylenol, don't you?
- Mm, yep. Yep.
- That disturbs the connection between that chemical production and the brain. And that's why it brings down the temperature.
- Scottish physician Gavin Francis on the art and science of medicine next. It's To The Best Of Our Knowledge from Wisconsin Public Radio. And PRX. We're talking about finding wonder in the human body this hour. Gavin Francis is a general practice physician in Edinburgh, Scotland. And when he is not taking care of patients, he's often writing. His books include adventures in human being and most recently "Shapeshifters" in which he explores one of the most common characteristics of life as an embodied human... Change. He told Steve Paulson about how medicine is both an art and a science.
- So, I'm guessing that as a doctor you see the common everyday cases and probably also some extraordinary cases as well. And I guess I'm wondering if there is anything in particular that surprises you or maybe even still amazes you about the human body?
- Mm-hmm, well, there's something surprising or even amazing happens every week or two. It's one of the great pleasures of medical practice. It's endlessly varied from week to week. I'm always stunned by the kinds of things that walk through the door. And I guess my books are an attempt to kind of communicate the sense of wonder. I still feel not just about the complexity, the intricacy, the beauty, the elegance, even of the human body, but also how there's tremendous capacities in the body to heal.
- Mm-hmm.
- And as a physician, we're often trying to take advantages of those changes and try and help the body along.
- Hmm, do you find this amazing that the body just has these natural powers of regeneration, of healing?
- Yeah.
- It just sort of does it by itself, it knows how to do that.
- Yeah, absolutely, it's phenomenal. And the scale of it is truly extraordinary too, you know, when you think of just the simplicity of you reacting to a viral infection, so somebody sneezes some viral infection on you, and the way your immune system can respond to that by very, very quickly recognizing if you've ever been exposed to it before, if you have been exposed to it before, very quickly managing to engage and bring online all the white blood cells that can produce the antibodies to get rid of that infection. They quickly start multiplying. They start pumping out the right antibodies, and lo and behold, you don't catch the infection and that whole thing your body has done for you without you having any conscious awareness of it at all. I think immunology, the way we fight infections and also neurology, the way our nervous system works are two of the most extraordinary aspects of our humanity and they're actually still very little understood.
- Give me an example of one of these more ambiguous cases where you know, you're using your intuition, you and the patient are trying to come up with a story about what's happening.
- Mm-hmm.
- Give me an example of that and why that's so important to develop a good narrative.
- Well, there's so many conditions which fall under the category of many medically unexplained symptoms. And they can be recurrent headaches, they could be recurrent abdominal cramps, they could be even odd rashes or episodes of fatigue. And when the doctor carries out a full history to try and find if there's any of the particularly well-known culprits for these symptoms can be found, they had to run a whole set of blood tests, and imaging scans, and so on. And they perhaps still can't find any cause for this fatigue or the recurrent headaches or for the recurrent abdominal cramps, then we're into the realm of trying to understand what these symptoms really mean. When do they come on, what are the symptoms exacerbated by? How is the patient affected by these kind of symptoms? What do they hope for from treatment? Because when medical science and water, when Modern Western medicine has drawn a blank at trying to understand where they're coming from, then we're in another realm of trying to approach them from a different perspective. And I think those kinds of symptoms are really, really very common.
- And then, there's some other examples of sort of this interesting connection between brain and mind, for instance, there's a phenomenon that I've heard various people describe that they're experiencing a heart attack and they have this sense of dread that they're going to die.
- Mm.
- And in fact, it seems to be one of the diagnostic signals of cardiac arrest, even if the chest pain is not so bad, they have this sense that, "Oh, my God, the end isn't here." How do you explain this?
- That phenomenon that you're describing is still called in the Medical Textbooks, we call it in Latin It means anguish of the soul. And it's still used regularly on hospital wards and in emergency rooms to describe that experience that somebody has that they're imminently about to die. And we take it very, very seriously as physicians. And I think it shows that the old idea that from the chin down, our bodies are just kind of plumbing and almost going ahead like a robot. That's not true. Actually, the connection between our mind and our mental state and the rest of our body is very, very intimate.
- But I still don't understand how that happens.
- Mm.
- Somehow, people just know that something really dire is going to happen. What do you think is going on there?
- I think our perspective that the mind and the body have been so separated that position is just wrong, so we don't fully understand all the different ways in which the body and brain are communicating. You know, it's often described that we have five senses, but actually we have a lot more senses than that because there's all sorts of senses that are going on in terms of your balance, in terms of your proprioception, your understanding of where your limbs are in space. You have senses that are to do with whether your bladder is full or empty. You have senses that are to do with whether you're feeling short of breath or thirsty. There are all kinds of different senses that are going on that are far, far more than the classical five senses. And when you have a disturbance in some of those, this+ is the way in which I think we're coming to appreciate a fundamental shift like that if you're going into a heart attack, there's changes in your blood pressure, there's changes in the feel of your pulse all over your body and all these things we can actually sense at subconscious level.
- Yeah, it makes you wonder that as we use more technology in medicine, for instance, an artificial heart, would people have those same sensations? You could have an artificial heart without a pulse, right?
- Yeah, absolutely, and there's been a fair bit of research done into this. You know, some of the artificial hearts, they pump in a continuous ceaseless fashion. So, the blood just moves ceaselessly through the body instead of having a pulsatile flow, which is how our body is used to be. And there is a theory that in some sense, our brain needs that pulse, that there's a kind of connection between that pulsatile flow of blood through our brains and our sense of wellbeing. So, people who go on a heart lung bypass machine for very long surgical operations and they come round from that surgery often describe a really profound shift in their mood, often feel very low, feeling very depressed, sometimes disinhibited, almost like they've been drinking. And we don't understand why that has happened. And there is a theory that is to do with the loss of this pulsating flow through the brain.
- Hmm, fascinating, it almost sounds like you're saying that our understanding of the body and what doctors do, I mean the practice of medicine is to some degree still as much art as it is science.
- Well, yeah, I think very much. I mean, the doctors have to know what to do, but they also have to know how to do it, when to do it, why to do it. And all those things are still very much an art. And you know, I think very much I find in my work as a physician, it's helped by the fact that I also work as a writer and that I write books and think a lot about language. But the two, they go hand in hand. So, being a writer, thinking a lot about language is helped by medicine, but medicine also helps the writing because there's so much art in medicine and in its practice.
- Are you saying that because you are a writer that makes you a better doctor?
- Yeah, because as a writer I'm very interested in people's stories. I'm very interested in seeing how they position themselves in their own life story and those around them. I'm trained constantly as a writer in how to say things concisely and elegantly and quickly. And being able to communicate elegantly and concisely is of huge advantage to doctors, so, yeah, definitely being a writer helps my medical practice.
- Oh. Just sort of getting back to this notion of the wonder of the body.
- Mm.
- You say that there are some parts of our body, there are really kind of miracles of engineering.
- Mm-hmm.
- The foot, for instance.
- Oh, yeah.
- What's so remarkable about the foot, the way it's engineered?
- Well, most biology students of our generation were told, of course, that the human hand was a miracle of engineering. And that we have these opposable thumbs that make us so much more special than the apes. But actually the human hand isn't that different from an ape's hand but what is really unique about us is our feet, because all the other mammals have feet that are adapted for going around on all fours. And our feet are beautifully engineered for supporting our weight on two legs for a few different reasons. So, the shape of the IESs of the foot, there are three different +IESs, two down its length, and one across the width of the foot that sustain the weight just like a stone-built bridge has +IESs, the bones are actually shaped the same way. And then, there are ligaments on the underside of the +IESs of the foot that are almost like the staples underneath stone bridge that hold it together. And we also have special tendons that come down from the calf. They support and lift the center of the arch, just the way that a suspension bridge is supported. So, yeah, there's a great deal about the human foot that I find truly miraculous. And it's such a pity that, you know, medical students, they always leave it to last and... They come into their anatomy exams and they've never studied the foot. But, yeah, as a physician I'm always dealing with people with problems with their feet, so.
- So, you're saying kind of in the deep evolutionary sense, the foot is maybe what made us human?
- Yeah, it's probable that the changes in the foot are what enabled us to stand up right, and then that freed our hands to be able to becomemakers. And it's that process which allowed the great evolutionary leap for our brains to start developing.
- Hmm, are there particular cases you've seen that are just so out of the ordinary, so extraordinary that you sort of think, "Wow, how does the body do that?"
- I wonder behind your questions, I'm sometimes wondering if you're thinking of particular parts of this book that you've just read. There's one chapter in there talks about a patient I met who had a horn growing out of the center of her forehead.
- That's exactly what I was wondering about.
- No, the body is endlessly surprising, yeah, and that is an example, human beings can even grow horns sometimes, and +then no two days are ever the same in clinical practice. You never know what the next patient is gonna say to you.
- Okay, you have to explain this. How can a horn grow out of someone's forehead?
- Well, there's lots of different reasons a horn can grow, believe it or not.
- Okay.
- Sometimes a horn is derived from the kind of tissue that makes sweat glands. Sometimes it's derived from the skin that just does the surface, you know, the waterproof part of the skin.
- Mm-hmm.
- It just undergoes a process whereby instead of flaking off as it should do, it just gets more adherent and grows and grows and grows and grows. And if you have one patch of skin that keeps growing a thickened layer and it just grows and grows and grows, then you end up with a horn. You know, there's this wonderful iconography of Moses from the Bible, he is always shown with horns. Horns are supposed to give you this idea of dignity and authority, and I'm not convinced that in our modern world, people that grow horns have that sense.
- Right, what did you do with the woman with a horn growing on her forehead?
- Well, she was actually very good-natured about it. That particular case, I was in a dermatology clinic and the senior consultant in the dermatology clinic, made arrangements to have the horn removed and a small skin graft put over and the patient turned around and said, "Well, don't do it too soon because I've got a fancy dress party next week." "I was thinking of going as a unicorn." So, yeah, sometimes people's sense of humor about their own predicament can be helpful.
- That was Steve Paulson talking with Scottish physician and writer Gavin Francis. His most recent book is called "Shapeshifters". ♪ Ah ♪
- And that's it for this hour of, "To The Best Of Our Knowledge", but there's always more online. Check out our articles and digital extras ttbook.org. Shannon Henry Kleiber produced this hour with help from Charles Monroe-Kane, Mark Riechers, and Angelo Bautista. Our sound designer and technical director is Joe Hardtke. Steve Paulson is our executive producer, and I'm Ann Strainchamps. See you next time.
- Shew.
- PRX.
