Friday, April 3, 2015

Making Order Out Of Disorder

The Human Body

Lack Of Homeostasis: Sacks writes:It is especially when things are going wrong, internally — when homeostasis is not being maintained; when the autonomic balance starts listing heavily to one side or the other—that this core consciousness, the feeling of how one is, takes on an intrusive, unpleasant quality, and now one will say, “I feel ill—something is amiss.” At such times one no longer looks well either.”
Photo Credit: Trent Parke;
Magnum Photos Newcastle Beach, New South Wales, Australia, 2000; Source: NYRB

The preferred state for all organisms including humans is homeostasis, where the body is in a state of balance, where all parts work as they ought to in accordance with their design and function. In an article in The New York Review of Books, Oliver Sacks gives a first-person account (“A General Feeling of Disorder; April 23, 2015) of the means medical science has at its disposal when our bodies fail to work the way they ought to; it is equally about our desires for recovery and balance, however and by whatever means this can be achieved.

Sacks, 81, a well-known author and a professor of neurology at the New York University School of Medicine, has publicly shared that he has a form of metastatic cancer that has no real possibility of being stopped (“The cancer occupies a third of my liver, and though its advance may be slowed, this particular sort of cancer cannot be halted”); he describes a procedure to both increase his life and give him more energy, a temporary but needed restoration of balance in what is called palliative treatment:
If new thoughts about illness and recovery—or old thoughts in new form—have been stimulated by thinking back to my first patients, they have been given an unexpected salience by a very different personal experience in recent weeks.
On Monday, February 16, I could say I felt well, in my usual state of health—at least such health and energy as a fairly active eighty-one-year-old can hope to enjoy—and this despite learning, a month earlier, that much of my liver was occupied by metastatic cancer. Various palliative treatments had been suggested—treatments that might reduce the load of metastases in my liver and permit a few extra months of life. The one I opted for, decided to try first, involved my surgeon, an interventional radiologist, threading a catheter up to the bifurcation of the hepatic artery, and then injecting a mass of tiny beads into the right hepatic artery, where they would be carried to the smallest arterioles, blocking these, cutting off the blood supply and oxygen needed by the metastases—in effect, starving and asphyxiating them to death. (My surgeon, who has a gift for vivid metaphor, compared this to killing rats in the basement; or, in a pleasanter image, mowing down the dandelions on the back lawn.) If such an embolization proved to be effective, and tolerated, it could be done on the other side of the liver (the dandelions on the front lawn) a month or so later.
The procedure, though relatively benign, would lead to the death of a huge mass of melanoma cells (almost 50 percent of my liver had been occupied by metastases). These, in dying, would give off a variety of unpleasant and pain-producing substances, and would then have to be removed, as all dead material must be removed from the body. This immense task of garbage disposal would be undertaken by cells of the immune system—macrophages—that are specialized to engulf alien or dead matter in the body. I might think of them, my surgeon suggested, as tiny spiders, millions or perhaps billions in number, scurrying inside me, engulfing the melanoma debris. This enormous cellular task would sap all my energy, and I would feel, in consequence, a tiredness beyond anything I had ever felt before, to say nothing of pain and other problems.
I am glad I was forewarned, for the following day (Tuesday, the seventeenth), soon after waking from the embolization—it was performed under general anesthesia—I was to be assailed by feelings of excruciating tiredness and paroxysms of sleep so abrupt they could poleaxe me in the middle of a sentence or a mouthful, or when visiting friends were talking or laughing loudly a yard away from me. Sometimes, too, delirium would seize me within seconds, even in the middle of handwriting. I felt extremely weak and inert—I would sometimes sit motionless until hoisted to my feet and walked by two helpers. While pain seemed tolerable at rest, an involuntary movement such as a sneeze or hiccup would produce an explosion, a sort of negative orgasm of pain, despite my being maintained, like all post-embolization patients, on a continuous intravenous infusion of narcotics. This massive infusion of narcotics halted all bowel activity for nearly a week, so that everything I ate—I had no appetite, but had to “take nourishment,” as the nursing staff put it—was retained inside me.
The procedure, although resulting in post-surgical tiredness, pain and unwelcome physiological changes,  eventually had the intended effect; it worked, Sacks writes:
On day ten, I turned a corner—I felt awful, as usual, in the morning, but a completely different person in the afternoon. This was delightful, and wholly unexpected: there was no intimation, beforehand, that such a transformation was about to happen. I regained some appetite, my bowels started working again, and on February 28 and March 1, I had a huge and delicious diuresis, losing fifteen pounds over the course of two days. I suddenly found myself full of physical and creative energy and a euphoria almost akin to hypomania. I strode up and down the corridor in my apartment building while exuberant thoughts rushed through my mind.
For anybody who has been in a state of disorder, when there is knowledge that something is not right with your body, when there is knowledge about being in a state of despair, having a felling of severe malaise, the desire for recovery is the primary object. Does anything else matter? I, like many others, have experienced a portion of what Dr. Sacks so eloquently and articulately describes. It is human poetry; I wish him many good days to enjoy his life. His voice is rich and strong. Thank you, Dr. Sacks, for sharing your knowledge and your humanity with us.

For more, go to [NYRB]

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