The Anatomist - Bill Hayes [77]
The urge-to-go that gets me out of bed now comes with its own series of illustrations. In my mind, I can see the bladder, a small, delicate organ, stretched to capacity, like a balloon that won’t survive one more blow. I can picture it right above the chestnut-sized prostate gland and pressing against the thin muscles of the lower abdomen, making the surface of my belly feel as taut as a snare drum. In the moment before splashdown, I know that the visceral afferent nerves in my bladder are flaring, sending distress signals to my brain via the spinal cord: Empty me now! Once the keg is tapped, so to speak, and the pressure reduced some, a larger picture starts coming into focus. From the bladder, I can mentally trace the twin tubes of the ureters crossing the pelvic brim and ascending in graceful lines up to the kidneys. Within each kidney, I see inside the complex filtration system that has strained this thin pale yellow stream from my blood. And by the time I flush, I have glimpsed the greater complex of blood vessels leading back to, and out of, the heart.
Having a vision of how the body works also comes, naturally, with a finer understanding of how it can fail, of how the body can betray you. When my friend Richard told me over the phone recently that he had been diagnosed with kidney cancer, it was as if, before the news sank in, a slide carousel had dropped into the projector in my head: views of a kidney—anterior, posterior, hemisected—began flashing behind my eyes. As Richard talked about the symptoms that signaled something was not right with his body—drenching night sweats, fatigue—I zoomed in on the area of his lower back where the kidneys sit. I pushed deeper, peppering him with specific anatomical questions, all the while building a detailed picture in my head of his diseased organ: Which kidney—right or left? (Left.) Where was the tumor? (Right on the surface; two inches in diameter.) Had it penetrated the bedding of fat? (Yes.) What about the renal hilum? (No.)
“Well, that’s good news,” I said, visualizing how, when caught at this early stage, such a cancer probably could not spread.
“Yeah, it is,” Richard answered. “On the list of cancers to have, they say this is not a bad one. I didn’t have to have chemo or radiation. They simply removed it—” At this, I could imagine the procedure—the renal artery and vein being transected, the kidney and surrounding fat lifted out—yet I also found myself thinking, What happens to the ureter? It must be removed, too, tied off at the bladder.
The conversation gave me a small sense of the diagnostic skill doctors in training must develop, the ability to play out possible treatment scenarios in their mind. A doctor’s vision is not always an enviable one, though, as Meri, a fellow student in the anatomy lab, helped me appreciate. One afternoon she told me about a friend of hers, a recent med school graduate, whose mother had developed a life-threatening autoimmune disease. “She knows how bad it is, what’s happening inside her mom,” Meri said. “But she really can’t tell her mom everything—it’s all too awful. And when her mom asks her questions about her condition, sometimes she just doesn’t answer. She doesn’t want to tell her mom what she knows.”
June 20, 1856
33 Ebury Street
London
Dearest ‘Ma,’
I beg of you to send for me, if you feel the least inclined, or if you think me capable of doing any good, however little. This brings me at once to a little request of yours: can I propose any remedy (marvelous! it must be) to restore you at once to health and strength? Oh! ho, dear Ma, you don’t ask this, do you? It is but a little thing….
If Carter