Party Trick

The patient perched on the corner of the exam table. He stood up gingerly, a snap and crackle underlying his every move. An younger man, his delicacy was premature, the cautious movements of a man twice his age. His eyes could have used a good cleaning, the whites anything but. Grey orbs with a brown center, he looked at us nonchalantly, a cup of fresh urine in his hand.

The doctor takes the cup, places it on the table, and tells me to keep an eye on it. Nonplussed, I examine the urine, looking for the typical marks of illness. It wasn't cloudy, or discolored. It didn't smell sweet, or musty. I saw no crystals, no blood. So I looked away, taking in the interview, wondering what the doctor thought was going to happen.

After the final reflex hammer falls, the doctor looks up at me, asking for a diagnosis. The only thing I noticed was arthritis, the reason for his care in movement. Gambling, I toss out rheumatoid arthritis, and receive for my trouble a slow shake of the head, and an extended arm pointed at the cup of urine, now sitting there rather dark shade of black.

The patient had alkaptonuria, a fairly benign metabolic disease, a failure of tyrosine metabolism. His buildup of homogentisic acid has stained his connective tissue, darkening his eyes and causing pain in his joints. He eliminates it in the urine, and on exposure to air, it turns itself black.

As diseases go, its a fairly innocuous one to be stuck with. Unless you are the guy at the urinal next to him.

French Pox

Kurt Vonnegut used to discuss the lurching old men of his youth, ambulating irregularly about downtown Indianapolis. His wandering examination of the terrifyingly possessed men, mumbling and bumbling in their confusion and discordance, paints a fairly terrifying picture of the disease once known by names varying from the French Pox to the scourge of royalty: Syphilis.

Treponema Palladium, a gram negative spirochete, has brought down rulers and vagabonds, and remains today one of the most prevalent (if slow moving) sexually transmitted disease around. It's readily treatable (simple penicillin does the trick), but if you let it go, it begins to run amok in your cerebellum, corkscrewing its way through the all important cognitive matter. Over years, you slowly go crazy, lose your ability to sense your arms and legs (except for pain and temperature), and develop a series of unsavory skin conditions.

The trick with syphilis is that it spends so much time with no clinically apparent symptoms. (although also decreased chance of catching it). The diagnosis can be tricky because the little spirals are adept at avoiding tests, and the symptoms are erratic and transitory. Perhaps the best (not most effective, just most hilariously named) diagnostic technique for the final stages of syphilis is the the eye exam. A person with late stage syphilis will have normal eye constriction with general eye use (known as accommodation), but not respond to light. This is known as the "prostitute's pupil," although in deference to modern terminology, it has recently been rebranded the Argyll Roberston pupil. Which honestly just makes me associate syphilis with sweaters for some reason (perhaps its because the human race most likely got syphilis in the first place by having inappropriate relations with sheep?)

Recruitment

At some point, something threw a wrench in your machinery. Cosmic rays, bad food, invading microbes, or piss poor protoplasm, but somewhere along the way, something in you got knocked out of place. Your roadmap, your building blocks, got altered. DNA alkylation, cross-linking, deletion.

It had happened before, but this one, this one was different. That single mistake happened to be in just the right place. It amplified, expanding in flawed protein designs, processes erroneously instantiated or failed. The mistake prospered, through luck and tenacity. It defeated or ignored your internal defenders, hiding behind a protective mask of your own flesh. It made a place for itself, even as it made more of itself, reinforcements in its desperate effort to expand.

You have a tumor. Reproductive drive incarnate, an invasive expanding riot of your constituent cells, demanding that the rest of you be more like them. These renegade cells, in their zeal to expand, have lost what defined them. Increasingly ill-shaped and deformed, the multiplying cells have lost their function, their irreplaceable role in the community that is your body. They swarm, they hustle, and dedicate resources in one vast effort to outcompete everything around with sheer numbers.

I’m here to stop them. I have an arsenal of methods, from futuristic rays to simple reinforcements for your beleaguered immune system. But this mistake, it is crafty. It hides itself behind the hostages of your healthy cells, component human shields staying my hand. Its hustle is it’s weakness, its sheer drive to reproduce differentiating it from your more sedate and helpful cellular citizens. Its growth makes it a target for my toxins, my rays. Some cells hide, biding their time, hoping I will accept the elimination of their more eager brethren as total.

I pump you full of poison, indiscriminate and wild. But I have been careful. My agent won’t kill you or your unruly cellular mob, but it will hurt. The tumor shrinks under the onslaught, even as your hair wilts and your immune system surrenders, casualties of friendly fire. When I withdraw my horsemen of alkylation, my carmustine, my mechlorethamine, the tumor will spring forth, hustling to reproduce and replenish, secure in the belief that it has resisted modern medicine. It doesn’t see me, waiting in the wings, an army of specific anti-neoplastics chomping at the bit. It was a trick you see, a con, a bamboozlement.

Your tumor got hustled.