Chemical Eric by Eric Ribbens

Part IV—At Forty-Five…

Dr. Lee sat down at her desk with a weary sigh and rubbed her stiff neck. Sometimes she wondered whether it was worth it all. She worked such long hours, and it was so hard to watch helplessly as a patient died. She’d just lost an old dear friend, and there wasn’t a thing she could do to stop the relentless spread of her disease.

She picked up a fat folder, full of lab tests, notes from office visits, and other documents. Ah yes, this was one of her challenging patients. The guy’s hormones were seriously whacked, and trying to keep all of them in balance plus dealing with his high blood pressure was a bit like juggling china plates while riding a unicycle. As if that wasn’t enough, he kept coming up with odd things. One morning his right eye stopped working, which led to the diagnosis of an aneurysm in an artery immediately beneath the pituitary. The aneurysm was probably due to radiation damage to the blood vessel walls in the area of the tumor. They had gone in and surgically wrapped it to hold it together, but his recovery had taken months. Fourteen months later his right eye began to work again, although he lost most of his peripheral vision. A stroke he had two years later may have been due to radiation or due to high blood pressure, but meant frustratingly long months of physical rehab. And of course, just to make things interesting, he had to have the stroke while he was in a jungle somewhere in Costa Rica. He came home from China testing positive for tuberculosis, from the Marshall Islands with beaver fever, and from Costa Rica with parasitic botflies burrowing under his skin. Botflies! Here in Illinois they only infected sheep. Maybe she was becoming a veterinarian.

Well, back to work. Let’s see…her patient was 45 years old, 6'6", 310 lbs. At 5'2" she was small to begin with, but he always made her feel tiny. He had two cute adopted daughters. She smiled, thinking of his youngest, Mara, who had given her a rather enthusiastic hug the other day when Dr. Lee had been picking up her daughter Beth from the preschool both girls attended. One of the nice things about small town life was getting to know your patients, and Mara just loved Beth and tried to take care of her at their preschool.

Now Eric’s wife was complaining he wasn’t sleeping enough. Eventually they had figured out that his sleep was getting seriously disrupted by frequent nighttime trips to the bathroom. It’s quite normal for a 45-year-old male to make one nighttime visit and dump 350 cc of urine, but Dr. Lee had asked him to record the frequency of his visits and the quantity of urine produced. Her nurse had attached the chart he had just sent. She looked it over.

Yes! She mentally gave herself a high five. Finally she had a problem she could solve; this was what she spent all of those years of training to do. The diabetes insipidus was so obvious when you looked at this data. All she had to do was to write one prescription!

Questions

1. Why are his kidneys so active at night? Note: diabetes insipidus is NOT diabetes mellitus, so the answer is not high blood sugar levels or an insulin deficiency. Diabetes merely means high urine production. Look for a specific hormonal problem involving the pituitary.
2. It also turns out that he has unpredictable shock responses, so that a small cut needing three stitches left him pale and in shock while breaking his left wrist in at least 15 places did not. What hormone could be involved?
3. If the pituitary is so important, and if Eric is not getting replacements of hormones the pituitary makes (except for ADH), why isn’t he dead? To answer this question, think through the cascade of events from hypothalamus to effect.

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