by Mark Leyner
Our bodies have a nonvoluntary reflex mechanism to prevent our bladder from getting too distended, called the micturition reflex. When our bladder gets distended, there are stretch receptors in the bladder wall that let us know that it is time to go. As we all know, this is not the most comfortable sensation (if you wait too long). These sensory neurons cause contractions that can become strong enough to overcome the muscle tone holding the urethra shut and release all that urine.
WHAT CAUSES THE RUMBLING IN YOUR STOMACH WHEN YOU HAVE TO GO?
Borborygmi: bor•bo•ryg•mi; noun, plural : rumbling sounds caused by gas moving through the intestines.
Certainly not a word learned in medical school, or that can be easily used in a sentence.
These rumbling sounds are a normal part of digestion. They are generated from muscular activity in the stomach and small intestine as the food, gas, and fluids are mixed together and pushed through the intestine. This squeezing of the muscular walls is called peristalsis. Many people associate these sounds with hunger because they are louder and echo more when the intestine is empty. Yum!
9:07 A.M.
Gberg: Good morning.
Leyner: All the best to you and yours . . . give me one moment, just finishing an e-mail . . .
Gberg: I’m just making a coffee.
9:10 A.M.
Leyner: OK . . .
Gberg: Coffee and pizza for breakfast.
9:15 A.M.
Leyner: I had a Slim Jim and a fermented mare’s milk.
Gberg: It’s hard to find good fermented mare’s milk these days.
Leyner: People should drink the milk of as varied a miscellany of mammals as possible.
Gberg: Did you ever sample human breast milk back in the day?
Leyner: All those diverse antibodies are good for getting an immune system ready for the coming apocalyptic flu pandemic.
Gberg: I live in fear of the avian flu.
Leyner: No . . . never sample that mamma milk . . . I’ve tried to keep the birthing process and my sex life as far apart as possible.
Leyner: The whole avian flu thing seems like some Hollywood pitch . . . like Hitchcock’s The Birds and . . .
Gberg: So, my brother, we need to finish this bitch and move on to bigger and better things.
Leyner: What was that epidemic movie?
Gberg: Outbreak with Dustin Hoffman.
Leyner: What are doing right now . . . are we IMing about something we need to be IMing about?
Gberg: Not yet, really just getting loose.
Leyner: Otay.
Leyner: Tomorrow seems not so good to work . . . is Thursday any good?
Gberg: I am doing stretches at the same time.
Leyner: Tell me about Thursday.
Gberg: Can’t do Thursday. Working.
9:30 A.M.
Leyner: One of those six-pack ab cover mags . . . that men should do the recumbent bike in the gym and not the regular one that puts pressure on the cajones and the tender perineum.
Gberg: There is something about bike riding that can damage the pudendal nerve and affect your front end lifter.
Gberg: The tender perineum—who wrote that? Fitzgerald?
Leyner: I love when you conflate urology and heavy machinery.
Leyner: “The Tender Perineum” . . . yes, yes . . . the unfinished F. Scott masterpiece . . .
Gberg: I never knew I could conflate.
Leyner: Poor slob never had the chance to work out the denouement . . .
Leyner: I heard some woman talking about morning erections the other day . . .
Gberg: Did you just spontaneously spell denouement correctly?
Leyner: At a supermarket in L.A.
Gberg: I was wondering where you heard that?
Leyner: Yes, I spontaneously spelled it correctly . . . it’s the coffee.
Gberg: I didn’t know that people actually spoke in L.A.
Leyner: This woman . . . enormous plastic L.A. tits and the face of a wizened gargoyle . . . said she won’t touch a morning erection . . . because it’s not “for me” (she said) . . . it’s just a “reflex.”
9:35 A.M.
Leyner: I guess people want to feel they’ve “earned” a change in some other human’s physiognomy.
Gberg: L.A. is such a bizarre place. New Yorkers would take advantage of any erection. Why waste a good thing?
Leyner: You know those commercials for that new Viagra . . . whatever it’s called?
Gberg: Cialis. Damn, those people seem relaxed and happy.
Gberg: We should start our own pharmaceutical company.
Leyner: Why do they say—at the end of that ad—that you should report erections that last over four hours to your doctor?
Leyner: Maybe you should report them to the police?
Leyner: What’s the danger of a four-hour erection anyway?
Gberg: Priapism, my friend, priapism.
Gberg: Very painful and can cause permanent damage to the penis.
Leyner: Can you get a permanent erection?
Gberg: Me, personally?
9:40 A.M.
Leyner: That’s funny.
Leyner: Porn stars are said to be able to get their erections back quickly . . . it’s a vocational skill in high demand in the industry . . .
Leyner: What accounts for the difference in the refractory time for various men?
Leyner: Is that what that’s called?
Gberg: It sounds so scientific.
Leyner: That’s the right term! I just looked it up. I’m so smart . . . Don’t you think?
Gberg: You could write a scientific
article, “The Refractory Erectile Period in the Porn Industry.”
Gberg: Just as important as making it go up is making it go down. For those embarrassing public moments.
Leyner: Speaking of porn.
Leyner: Did we ask this in the book: Can women ejaculate?
Gberg: All we are doing is speaking of poop, porn, and penises.
Gberg: So sophomoric.
Gberg: Yes, and they can.
9:45 A.M.
Leyner: . . . that we’re hard-wired to launch our genes into the future before we decay in a puddle of excrement and putrescence???
Leyner: You think THAT’s sophomoric?
Leyner: That’s the whole comic tragedy of life!
Leyner: And the central thesis of our book, yo.
Gberg: What is the thesis of our book?
Leyner: The intertwining cosmic threads of poop and porn.
Leyner: That’s string theory, ever hear of it?
Gberg: I am very slow on the keyboard this a.m.
Gberg: I think my head is going to explode.
Leyner: That we valiantly attempt to create poetry and architecture and pass along culture and bequeath our genetic heritage, ALL in the face of certain decrepitude and the abject indignities of old age and DEATH.
Leyner: It’s a grim struggle each and every day to maintain my dinginity in the face of “reading glasses.”
Leyner: Dignity.
Leyner: I misspelled in my passion.
Gberg: Hold on 1 sec.
9:55 A.M.
You left the chat by logging out or being disconnected.
CHAPTER 7
MEDICINE FROM THE MOVIES AND TV
The flurry of bathroom talk was cathartic, leaving everyone feeling purged and invigorated. Joel, with a newly found confidence, is leading a small group in a game of charades. Leyner, with the nearly empty tequila bottle in one hand and a fat Cohiba in the other, is gesturing madly and attempting to act out a scene from Gone With the Wind. I mistake Leyner’s gesticulations for a focal seizure and I run across the room to administer first aid. The group assumes that this is all part of the clue giving and continues to shout out movie titles. Leyner’s face is contorted in a bizarre grimace as I assist him to the ground and protect his airway with a head tilt and jaw thrust. Leyner is now scowling and I realize this is not a seizure as Cinderella inc
orrectly guesses Spartacus.
Joel shouts out, “Vision Quest!”
And Jeremy quickly replies, “Dude, they’re not wrestling, I think they are in love.”
Joel quickly responds, “The Birdcage!”
And Cinderella guesses, “Willy Wonka and the Chocolate Factory.”
Jeremy turns to me and blurts out, “Are Oompa Loompas orange from eating too many carrots or are those little bastards just using too much self-tanner?”
Before I can respond, Eloise saunters over and—astonishingly—says in a slow, wistful drawl, “It’s got to be Gone With the Wind. I’d have a fit too if my ten-million-dollar Charleston bungalow burned to a crisp. Oh poor beautiful Tara.”
People often leave the movie theater filled with questions about what they’ve seen on the screen. After a thrilling episode of ER, I can always expect to get a call.
IS THE SHOW ER ACCURATE?
Accurate: ac•cu•rate; adjective.
1.Correct in all details.
2.Free of mistakes or errors.
Of course it’s not completely accurate! It’s TV.
But the writing staff does capture the general controlled chaos of an ER. They deal with real medical cases but their medical depictions are always embellished to add a little extra Hollywood flair.
I did my residency in emergency medicine in Los Angeles, when ER was just starting and the writers often came by our hospital looking for new ideas. One patient I saw there was portrayed in an early episode, and highlights the writers’ taste for the dramatic. One day, a baby was playing with a coat hanger and the tip of the hanger got stuck in the back of his throat. The paramedics carefully brought the baby in to our ER with the hanger dangling from his mouth. This was, of course, very dramatic looking, and we all rushed over immediately. The child was scared but was breathing fine and my fellow doctors and I did our best to just leave him alone and keep him calm. (Rule #1 of medicine: do no harm.) An X ray showed that the tip of the hanger was superficially caught up on the back of the child’s throat. Now . . . for the big dramatic ending: we simply reached inside and removed it. Case over!
On ER, however, when the glamorous doctors tried to remove the hanger from the child’s throat, the baby started to bleed profusely. After an emergency tracheotomy, some miraculous bedside surgery, and a little on-screen romance, this child was just barely saved.
DOES THE KIND OF AMNESIA YOU SEE IN THE MOVIES REALLY EXIST?
Amnesia seems to be one of the favored topics of screenwriters for an easy plot twist. The list of “amnesia movies”; can go on and on: The Bourne Identity, 50 First Dates, Desperately Seeking Susan, Eternal Sunshine of the Spotless Mind, Overboard, Spellbound, Total Recall, to name just a few.
The amnesia that doctors see is very different than the big-screen version.
Amnesia is best defined as a failure to retrieve information or to place information in an appropriate context. Amnesia rarely erases memory of all past events. No one suffering from amnesia actually goes through the rest of his or her life without an identity or any knowledge of the past. Memory loss is usually temporary and only involves a short time span of the person’s life.
Types of Amnesia
•anterograde amnesia: Inability to remember ongoing events after the incidence of trauma or the onset of the disease that caused the amnesia. Anterograde amnesia often occurs following an acute event such as a trauma, a heart attack, oxygen deprivation, or an epileptic attack.
•retrograde amnesia: Inability to remember events that occurred before the incidence of trauma or the onset of the disease that caused the amnesia. Retrograde amnesia is often associated with neurodegenerative pathologies such as senile dementia and Alzheimer’s disease.
•emotional/hysterical amnesia (fugue amnesia): Memory loss caused by psychological trauma such as a car crash or sexual abuse. Usually it’s a temporary condition.
•lacunar amnesia: Inability to remember a specific event.
•Korsakoff syndrome: Memory loss caused by chronic alcoholism.
•posthypnotic amnesia: Memory loss sustained from hypnosis. Can include inability to recall events that occurred during hypnosis or information stored in long-term memory.
•transient global amnesia: Spontaneous memory loss that can last from minutes to several hours and is usually seen in middle-aged to elderly people.
Here are some movies that Hollywood executives would like to forget: Gigli, Ishtar, Howard the Duck, The Postman, and The Adventures of Pluto Nash.
WHAT WOULD HAPPEN IF YOU STUCK SOMEONE IN THE HEART WITH A NEEDLE AS IN PULP FICTION?
“No, you don’t gotta fucking stab her three times! You gotta stab her once, but it’s gotta be hard enough to break through her breastbone into her heart, and then once you do that, you press down on the plunger.”;
—Lance (Eric Stoltz), Pulp Fiction
No, intracardiac injection is not recommended for routine use during CPR. Translation: ER docs don’t ever inject anything directly into people’s hearts. There is an uncommon procedure called a pericardiocentesis when a needle is inserted under the breastbone and into the sac around the heart to remove excess fluid. This is done when fluid or blood surrounding the heart is restricting its function. This is only done in serious emergencies.
In Pulp Fiction, John Travolta and Samuel L. Jackson are trying to save Uma Thurman from a drug overdose by injecting her with adrenaline. Instead, they should have given her an injection of a medication called Narcan to reverse the effect of the heroin. Adrenaline (epinephrine) is often given during cardiac arrest but only through a vein. Sorry, not as dramatic but definitely less painful.
WHY DOES EVERYONE IN THE MOVIES GO INTO SHOCK?
In the movies and in the dictionary, “shock”; can mean to strike with great surprise and emotional disturbance. In medicine, “shock”; is a major medical emergency. When doctors talk about shock we are referring to the failure of the circulatory system to maintain adequate blood flow. This requires rapid treatment, otherwise it can lead to death.
There are a number of different causes of medical shock, including bleeding (hypovolemic shock), inability of the heart to pump enough blood (cardiogenic shock), severe infection (septic shock), and life-threatening allergic reactions (anaphylactic shock). People suffering from shock have low blood pressure, difficulty breathing, a weak rapid pulse, cold and clammy skin, decreased urination, and confusion.
So, the shock that we so often see on-screen should be more appropriately called freaked out.
CAN PEOPLE REALLY WAKE UP AFTER BEING IN A COMA FOR YEARS?
If real life were a soap opera, then the answer to this question would always be yes. Unfortunately, coma is a very serious problem and although people do wake up, the longer they remain in this state, the less likely they are to return to consciousness. This is a very delicate question because doctors can’t really predict which patients will wake up and which will not.
If you look carefully in the original movie Coma, you will see Tom Selleck, that’s right, Magnum, P.I., in a state of suspended animation. Recent movies like While You Were Sleeping, Kill Bill, and Talk to Her also used coma in their stories. The medical story of coma isn’t as glamorous as Hollywood portrays.
To begin, there are several different categories of coma, or disorder of consciousness. Consciousness can generally be divided into two main components, arousal and awareness. Coma is defined as a state of unresponsiveness from which an individual has not yet been aroused. Patients in a coma are neither awake nor aware of their surroundings. On average, coma doesn’t usually last very long. After several weeks, most patients either regain some level of consciousness and if not are classified as being in a persistent vegetative state. Persistent vegetative state is characterized by complete lack of awareness of self or one’s environment. These patients can appear awake and even have their eyes open but are totally unaware of their surroundings.
Another category of consciousness is the minimally
conscious state, an intermediate stage of consciousness, which indicates that a patient is somewhere in between a persistent vegetative state and normal consciousness. These patients can show intermittent signs of awareness.
The “locked-in”; syndrome is a rare condition that must be distinguished from disorders of consciousness. It is characterized by complete paralysis of the voluntary muscles in all parts of the body except for those that control eye movement. These patients can think and reason but are unable to speak or move.
DO YOU REALLY NEED TO REMOVE A BULLET RIGHT AWAY LIKE THEY DO IN OLD WESTERNS?
It certainly would be dramatic if we had our gunshot trauma patients take a swig of whiskey and bite on their belt as we removed the bullet with a knife that had been sterilized by heating over a fire. I also would love to ride a white horse to work every day but that doesn’t happen either.
In old Westerns, there is an urgency involved with removing a bullet, as if this is the life-saving maneuver. In reality, doctors are not concerned with the presence of the bullet but rather the damage that it does on its way in or out. We often see patients who get an X ray for another reason only to find a bullet from a previous injury.
There are some special situations when we worry about leaving a bullet in a person’s body. When bullets or fragments are near large blood vessels, nerves (especially the spinal cord), or in a joint, then they can migrate and cause damage. In these cases, bullets are usually removed.
People have also asked whether or not you can get lead poisoning from bullets that are left in the body. In general, lead fragments in soft tissue become surrounded by fibrous tissue and are therefore essentially inert. If a bullet is in a joint, there can be a problem with lead poisoning. A study in Los Angeles in 2002 looked at more than four hundred patients who had bullets retained in their bodies. They found increased levels of lead in a small percentage of patients. Bullets or shotgun pellets are 50 to 100 percent lead and people are more likely to have problems with lead poisoning if there are multiple bullets or multiple fragments in the body. Sorry to disappoint you spaghetti Western aficionados, but the old whiskey-and-leather routine is just for show.
