By Surafel K Gebreselassie
He walked in the pathology sign out room, flushed with excitement. I have never seen him so excited since I joined his lab to appreciate some renal pathology.
‘There are many dense deposits on electron microscopy along the tubular basement membrane,’ he mumbled as we all focused on the microscopy in front of us.
The whole tubules were taken up by inflammatory cells.
There were many eosinophils (that I could easily identify), lymphocytes and plasma cells.
The tubular architecture was almost destroyed with relatively intact glomerulus.
I have never seen anything like this!
The sign out room had one microscope but six people can look at the specimen magnified however many times with one person, often Papa, driving the show.
We moved on to the next case.
The glomerulus looked all right until we stumbled on the edge of the specimen with a focal segmental sclerosis. I picked that one and felt good about it but Papa was not excited.
‘Wait a minute, do you see the protein resorption droplets?’ he paused and continued, ‘there are more of those,’ and then we stumbled on a glomerulus with atrophic tubules all around it.
‘That glomerulus looked ok but would die out eventually,’ he said with authority. The tiny blood vessels or capillaries didn’t look normal. They had, ‘double contours’, as Papa would call them. They have formed membranes all around them.
‘Look at this vessel, how old is the patient?’
‘Thirty seven, he is black,’ the fellow replied instantly. That was my age. That was me, I thought.
‘The vessels look eighty; there is a lot of scaring,’ he continued, ‘probably untreated hypertension.’
‘On and off the emergency room, this time admitted with severe headache and blood pressure of 230 by 120 millimeter of mercury. His creatinine was 8 and he is now on dialysis. ’ The fellow filled the gap.
The kidney was done.
I could tell by the look at Papa, a sad look, a resigned feeling.
They all called him Papa. He was a father figure in the pathology department. He has written several research papers, book chapters and books. He travelled all over the world to give magnificent lectures about the structure of the kidney as seen under a microscopy. He knew his stuff. He lived inside these small clusters of tiny blood vessels called glomerulus and its complex structure that filters the blood, and perhaps napped in the draining tubes or tubules as they are called in Latin.
Across the hall from the pathology department, in the basement of the old hospital building,
I emptied my bladder.
I paused at the dark yellow urine,
It never occurred to me how hard the many glomeruli, their tubules, vessels and nerve endings had to work along with the many hormones and signaling molecules to make that urine,
That we rush to flush off!
We bounced back and forth every five minutes. Before I knew it time was up and I found myself taking exit from the free way. There was no time to introduce each other. Every one of us shouted our names as we approached the narrow alleys. Something must have happened in a split second. Why some of us had to leave the free way was a mystery. The alley was large enough for me, my partner Chloride, friends such Magnesium, Potassium and Calcium. I envied their names.
Why didn’t they name me Magnesium?
Several others have made it too. I remember seeing Phosphorous from distance. We were on the same plate at one point. A lot more friends were left behind. Albumin was crying but couldn’t fit the tiny alley. Losing some of the weight may have helped. Those left behind, I was told, made it to the rest of the crowd by boat.
There were many train stations. I had to carry Phosphorous, Glucose, Amino acid and some other friends who begged me on to the train. My beautiful Chloride is always with me. Potassium didn’t need help. He is always gentle, dressed up and no one touches him. They say he could stop the heart or drive it crazy if he wants. Just before the train left I saw Bicarbonate having a date with Hydrogen, and then they disappeared. Their children carbon dioxide and water are on a private jet. Chloride noticed that Magnesium was nowhere to be seen so we left the station and moved on, down the hill and up the mountain. Potassium was there waiting with a kite. There was no extra seat for a guy other than me. Magnesium was on his feet any way along with his friend Calcium, chatting and praising vitamin D. Calcium was frustrated about the news of his clone and how Parathyroid is being confused these days. They could have waited or moved to the next station and have their own kite as people of their tribe had done for generations.
I don’t trust Magnesium, I don’t know much about him.
We wanted to check it out any way and moved to the next station,
But there was no room for Potassium.
Before we knew it we are at the last stop where there was a lot of chaos. It was wet. Word came that there was no hope beyond that.
I had just enough for me to rent a bike. With tears in her cheeks, I left Chloride behind and crossed the bridge. She would try to walk across however slowly. Potassium was resigned to his fate thinking of missed opportunities all along.
A full bladder woke me up. I rushed to dump it again.
It was foggy outside, a rainy day in Boston.
I headed to the lab, to learn from the master.