Salamander
Fire Walking

Months ago I spoke in this forum about the NPR series “This I Believe”. I’ve listened to it on my local NPR radio station since it first reappeared a few years ago. I’d wanted to write a “This I Believe” essay myself, but when I tried to come up with a topic I mostly proved to myself that I really didn’t believe in anything except empirical data. That makes for a rather dry and uninspiring essay.

Thursday, December 6 changed that. I now know what I believe. I believe I’m invincible. I believe that every brick that life throws at me is just more building material for a nice, strong wall to shore up the boundaries of my life. I believe that what happens to you doesn’t matter; what you do when it happens to you is the crux of everything. I believe that yesterday and tomorrow don’t exist. I believe Now is the center of the universe, and that I stand invincible in the center of Now. I believe my life is more than the etiology of a disease.

Here’s an etiology for you:
- Unknown virus sneaks into the body of a 41-year-old veterinary student, attacks her heart and puts her in the cardiac critical care unit.
- Because her heart is beating irregularly, the doctors put said student on heparin, a drug that prevents blood clots from forming because of the irregular beat.
- The 41-year-old college student’s immune system has a little trouble telling the good guys from the bad, and makes antibodies against the heparin, taking out almost all of the thrombocytes in her body at the same time.
- Thrombocytes help the blood to clot, so at first aforementioned college student gets huge bruises and spikes high fevers. Then a weird thing happens.
- Paradoxical thromboembolisms (blood clots) develop because of the antibodies the immune system made against the heparin. The great veins of both legs and the right arm become blocked, and the appendages swell up from all the blood that can’t get out. Clots also travel to the lungs, and large areas of lung no longer work. [side note: Note that we have jumped from the frying pan into the fire here. The drug used to treat one life-threatening disease has caused another life threatening disease. This is a theme we will return to later.]
- Streptokinase, a drug that busts up clots, is administered. It is only given for three days because after that there is a large chance that it will start causing an allergic reaction. Urokinase is administered after that. The urokinase causes an anaphylactic reaction five minutes after it is delivered. [side note: Out of the frying pan into the fire into another fire. The theme continues.]
- TPA (another clot buster) is administered. Clots in limbs and lungs gradually fade away. Heart, against all odds, gets mostly better. Student loses three months, goes back to school, graduates. She is invincible.
- Unknown to doctors and ex-student/now veterinarian, other clots didn’t go away. Over the next five years, our now-veterinarian goes on with her life. During those same five years, clots in the liver slowly shut down all exiting veins in the liver. The liver is dying a slow, mostly asymptomatic death.
- Our now 46-year-old veterinarian begins to experience bloating, bruises easily, and is always exhausted. She puts on weight, especially around her belly. When she finally realizes that this is more than just a passing bug, she visits her doctor, who immediately admits her to the hospital, runs tests, and informs her that she is in end-stage liver failure and must have a transplant or will die.
- Weeks before her 47th birthday, the new liver arrives. With the new liver come new drugs. These drugs prevent the immune system from recognizing the invasion of a foreign liver. Veterinarian goes home, gets her strength back, returns to work, returns to her life. She is invincible.
- The veterinarian’s immune system, which has never been the brightest bulb in the lamp when it comes to recognizing friend from foe (see the above mentioned heparin incident) is further befuddled by the drugs intended to subdue it. While letting the foreign liver set up shop, it also permits other newly changing cells to establish a foothold elsewhere in the body.
- Our now 51-year-old veterinarian goes for a routine dermatological appointment and gets a routine biopsy done of what looks like a routine patch of eczema. The biopsy results, she was told, would be ready in a week. After two weeks she calls, and is told the doctor will call her back. Four days later, he finally does.
- The results are consistent with “mycosis fungoides”, a form of cutaneous T-cell lymphoma. It’s rare. The dermatologist won’t discuss these results with the veterinarian. He will refer to her a specialist who has dealt with this before. He will see that she gets an appointment with this dermatologist next week.

Don’t tell me that you googled this and found that this was a relatively benign condition that you can live with for decades. If you insist on googling it, as I did, make sure you google with the term “post-transplant” as part of the search. You can cut straight to the chase and check out Post-transplant cutaneous T-cell lymphomas .

But you know, it doesn’t matter. I’m invincible. Right up until I die, every brick that life throws at me just helps me build my house just a little stronger. Yesterday and tomorrow don't exist. I'm in the Now. The professional bullet-dodger is at it again.