The Kidney Dialysis Puzzle

by Godfrey Onime

Arm hooked up to dialysis tubing
Arm hooked up to dialysis tubing – from Wikipedia

“Dr. Onime, your patient in room 607 is throwing a fit,” read the nurse’s message on my iPhone. “He wants to leave. What should I do?”

I was half-way through lunch. I placed a call to the nurse and asked her to try and convince the patient to stay until I got there. “I have called security,” she said, “but we can’t continue to hold him if he doesn’t want to wait.” Gobbling down the rest of my meal, I clutched my drink and dashed to the elevator.

I’ll call the patient Mr. Freeman. He had irreversible kidney failure, or End Stage Renal Disease (ESRD). He often missed outpatient dialysis. He would end up in the emergency room huffing and puffing from volume-overload, his lungs bathed in fluids, and his potassium level dangerously elevated.

This time, Mr. Freeman had also suffered a heart attack and had been admitted to the ICU. He had received urgent hemodialysis, the on-call kidney specialist physician, or nephrologist, and nurse dashing to the hospital in the middle of the night for the task. Mr. Freeman had only been transferred out of the ICU to a monitored bed earlier today, the plan being for him to be observed for one more day and to receive another dialysis session tomorrow. Read more »

Brain, liquefaction of

by Liam Heneghan

The following is an excerpt from my unpublished manuscript “A Shorter History of Bodily Fluids”


Brain, liquefaction of: also known as encephalomalacia (from the Greek, μαλακία softening), necrencephalus (from Greek, νεκρο + κεϕαλή deadhead), ramollissement cérébral (from the French ramollissement cérébral), cerebromalacia (from the Greek, μαλακία a colloquial onanist, esp a vehicular onanist; cf blood, semen), cerebral softening (from the Old English soft meaning soft), or more commonly, softening of the brain (pronounced US /breɪn/). When the tissue affected is white matter it is called leukoencephalomalacia; polioencephalomalacia refers to necrosis of the gray matter. This condition may manifest as multiple Brainnecrotic fluid-filled cavities replacing healthy brain tissue. It is preferable to inspect this necrosis post-mortem especially if attempting to administer home remedies. If you are a sheep the following suite of symptoms will be diagnostically useful in identifying brain liquefaction: somnolence, short sightedness, ataxia (poor coordination), head pressing, tumblesaulting, walking in circles, walking bipedally, excessive bleating or bleating in prime numbers, and terminal coma. I treated a mouse once that after a fall complained to me that she could only walk in circles. It greatly affected her travel plans and she died penniless, vastly undereducated, and living very close to where she was born.

If after munching on yellow star thistle (Centaurea solstitialis) you become excessively sleepy or find yourself given to aimless wandering and go off your feed, you might be a horse. Unfortunately you also have a condition called nigropallidal encephalomalacia. Avoid prehending Russian Knapweed. If you are a chicken and have ataxia, paralysis, severe softening of the brain, and are brooding excessively on death you have “crazy chick disease”. Take vitamin E capsules with your feed and avoid gassy foodstuffs. Rhinoceroses should also remember to regularly get their vitamin E levels assessed; consider doing so even between regular checkups. If you are a Rhinoceros be vigilant for signs of depression; if you are feeling down, just pop in to your vet. If your condition has progressed to coma, its best to have him visit you.

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