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Thesis Time #3- Vestiges

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Hello, lovely readers. I’ll be posting pieces I wrote for my senior thesis for the next couple of weeks. If you’d like a PDF of the whole mess, shoot me an email. 

I’m not crazy about this one, but it was my advisor’s favorite and he’s smarter than I am anyway. In the printed formatting I used horizontal lines between sections, and here I clearly do not, but I think you’ll be able to read it. 

Pain. Dull, achey, inescapable pain. For twelve hours my world has been a fever haze broken only by coke syrup doused over ice. Cloyingly sweet and blessedly cold, a momentary relief at best.

A week ago I got a cold or flu, something unpleasant but typical, but the seventh day of toast and tea turned into a night of violent heaving. I’m twelve. I get sick often, but except for regular bouts of strep throat I’ve avoided anything serious until now. I figure I’m over-reacting.

On the right side of the abdomen, nestled near the ileocecal valve (where the large and small intestines meet), the appendix sits in vestigial limbo. Its full name includes the description vermiform, from the Latin for wormlike. It does look remarkably like a worm, trailing as it does from the wide, rounded base of the colon.

For the first time I can remember, my temperature is above 100: 102. Not dangerously high for most, but my healthy body temperature rarely crawls above 97 degrees Fahrenheit. I feel profoundly unwell, almost too sick to sit up. Worse, the pain in my stomach, a pulling I’d chalked up to muscle damage from a night of vomiting, has focused itself on one throbbing point.

A vestigial structure is one that’s been rendered useless by time and evolution. Wings on a penguin are one example. Humans have the coccyx, reminiscent of a lost tail, and wisdom teeth from the days of massive herbivorious jaws. We also grow useless muscles under our ears, once used to move them beyond a party-trick wiggle, and stunted third eyelids in the form of plica semilunaris, a fold of tissue in the inner corner of the eye.

Surely the peskiest of human vestigial organs, the appendix saw its heyday come and go some two to three million years ago. Before then, our evolutionary ancestors relied solely on foraging, eating only plants and seeds. Special bacteria were needed to digest enough cellulose (plant cell wall) material for proper caloric intake. These bacteria lived in the appendix.

With time, humanoid diets transitioned to omnivorous. Eventually people began to cook, making whatever plant material they did eat much easier to digest. Soon the appendix wasn’t necessary for survival. Without death by starvation to weed out them out, wimpy, worm-like appendices became the human norm.

My mother, a physician, diagnoses me on sight and drives me straight to my doctor. He feels my belly, probing for pain in the expected areas, but a coincidence in timing has him unconvinced: I happen to have my period. He says I must be experiencing normal cramping.

If this is normal, I mutter, take me in for a hysterectomy instead.

I’m very cynical for my age.

My mother insists that it isn’t normal, and we’re sent to another doctor for a second opinion. By now I clutch my belly, whimpering with every movement. It feels as if something is trying to kill me from the inside out.

Wormlike structures, being long and skinny and not-so-regularly shaped, have a habit of getting things wedged inside of them. Being attached to the colon, which handles fecal matter, doesn’t help much. In fact, it’s a wonder more people don’t get killed by wayward appendices. After something has been wedged inside, blocking the attachment to the rest of the digestive system for awhile, mucus will build up and swell the organ. As blood vessels become strained, necrosis begins to occur. The organ dies slowly, attracting bacteria and white blood cells in turn. The white blood cells usually can’t persist against the bacteria and their toxins, so they die and produce pus. The dead appendix, full of pus and mucus, has no way to avoid bursting.

In appendicitis, the bursting of the organ produces a sharp spike in pain levels before, surprisingly enough, a period of relief. This eye of the storm can occur for a few hours before the released bacteria make their way to the stomach lining, causing a dangerous infection called peritonitis.

Another office, another man telling me I just have bad cramps. Still, he agrees that it’s better to be safe than sorry. My surgery is confirmed and I’m brought in through the recovery room so I can be slipped in between scheduled procedures. The doctor who’ll be performing my appendectomy isn’t even on call, but that doesn’t faze me. I’m a doctor’s kid. I know the entry codes for the back door of the ER.

My sister is away at camp, and my mother calls her so she can speak to me. She’s sobbing. I shouldn’t be surprised, because this is the girl who cried when I crushed my finger in a car door in third grade. Still, her hysteria reminds me for a moment that this is my first time going under for surgery. Anything could happen. My mother asks me if I’m scared, but I tell her I just want it to stop hurting.

Everyone else in the room has already been treated. Their families are hugging them in relief and joy. We’re the only ones that have to pretend we’re not saying goodbye.

Two to four hours after an appendix bursts, the peritoneum—the membrane surrounding the abdominal cavity—turns from the slick greyish color of health to a dull surface. It weeps a fluid that grows thicker over time. As the body becomes full of more dead and infected tissue, the immune system reacts to excess.

I am amazed that being wheeled back to the operating room is exactly like it always looks in movies. One door opens onto a sterile white hallway, then another, then another. They lift me onto the table and do the final surgical prep. The last five minutes before I go under will be lost to the effects of the Propofol being injected into my arm. Doctors call it “The milk of amnesia” for good reason.

Laporoscopic surgery, considered minimally invasive, usually requires three incisions of about a centimeter in length. The abdomen is inflated with carbon dioxide, creating a dome under which the surgery can take place without touching abdominal wall.

A camera is inserted through the largest incision, projecting the surgical site onto a screen placed in the operating room. The remaining incisions are used as entry points for a multi-pronged tool. Using the image on the screen for guidance, a surgical team will sever the appendix from the large intestine and remove it. It isn’t uncommon for the appendix to burst on the operating table, but at this stage massive doses of antibiotics will prevent a spread of the infection.

I wake up to my surgeon telling me that my appendix was really infected, as if there can be degrees of such a thing. I guess he means that it was totally necrotic and close to bursting, which is a scary thought. How is it that I’ve survived the death of one of my organs? It seems so strange.

That night, my mother braids my hair and I beg for food. A nurse brings me a ham sandwich and a waste pan, telling me I shouldn’t expect to keep anything down two hours post-op.

I eat, the first step in bringing my body back to a healthy equilibrium. I fall asleep. In the morning, all will be well.

Thesis Time #1: The Golden River (Personal Essay)

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Hello, lovely readers. I’ll be posting pieces I wrote for my senior thesis for the next couple of weeks. If you’d like a PDF of the whole mess, shoot me an email. 

The Golden River

For this valley, the river must be the center. Certainly it is the physical center; perhaps, in a sense, the spiritual center. Perhaps from that very freeing of spirit will come other freedoms and inspirations and aspirations which may be steps toward the diffusion and diversification and enriching of culture throughout this land.-W.E.B. Du Bois, 1930

Watching the waters of the Housatonic rush by after a few days of rain is an unparalleled visual experience. The rapids peak and foam climbing up the banks in a picture so perfect it’s practically a caricature of itself. Even the color of the water, opaque cafe au lait, seems like a detail added deliberately to make the river seem more wild and rugged. I imagine Nature’s paintbrush, thick with green and brown and red pigment after styling the forests and mountains, being dipped into the water and washed clean.

This stretch of river on the outskirts of Great Barrington isn’t one that invites swimming, even on more peaceful days, but a few miles further down the water turns crystal clear and the current slows to a calm, winding pace. By the Du Bois river garden, one can stop and stare into the swirling, glimmering river and remember a time when W.E.B. was around to admonish the town for polluting his golden waterway. Du Bois and his compatriots would be thrilled to see it now, free of debris and refuse. On the surface, at least, the Housatonic is as clean as it was in the days before man. To see it on a hot day is to long for the water, to submerge yourself and drink. It’s funny that my knowledge of the river’s toxicity hasn’t done anything to displace that instinct.

The Housatonic, center of the Berkshires and home to thousands upon thousands of organisms, is full of deadly chemical compounds. We put them there, or at least let them be dumped in, and the damage to generations was done before the start of the 21st century. If we do nothing, humans and river-dwellers alike could lose their lives, but to get rid of the toxins as completely as technology allows we would have to sacrifice the stability of the river. I’ve heard personal, agonizingly passionate arguments on both side of the spectrum everywhere from Town Hall meetings in Lenox to dinner tables in Lee. One thing that most citizens of the area have in common is where they lay the blame: We are a people betrayed.

It’s easy to hate General Electric for what they did. Easy, but maybe rational as well. In the early 90’s, the giant company abandoned a Pittsfield, MA, factory and left it teeming with polychlorinated biphenyls. Usually referred to as PCBs, these compounds are carcinogenic, fat soluble, and almost impossible to get rid of. Standard clean up requires dumping contaminated materials into a ditch and covering the whole thing with asphalt. If that sounds crude, it’s because it is. Throughout Pittsfield one can find stretches of land surrounded by chain-link fences, useless lots dedicated to the “safe” disposal of PCBs. Some bio-engineering companies are working on processes that would decontaminate the soil, allowing it to be returned to the river, but even today those methods are experimental at best, and expensive to even attempt. When the worst areas of contamination, those surrounding the condemned factory in Pittsfield, were cleaned in 1999, the sediment was simply disposed of. Throw a tarp over it, forbid trespassing, and you’ve taken care of the problem. Sort of.

The rest of the river is harder to deal with. PCBs cling to the dirt on the river bed and banks, getting stirred up and carried along the river in bits of sediment. They accumulate in plants and small fish that in turn pass the contamination along to those higher in the food chain. The worst accumulation occurs in fatty organisms at the top of the food chain. Ducks, for example, carry shockingly high percentages of PCBs in their breast meat. Humans aren’t much better, and PCBs can do a lot of damage.

PCBs have been linked to Attention Deficit Disorder and other mental development problems in children, all sorts of cancers in adults, and a wide range of health problems across the board. For every person who dies from overexposure to PCBs, hundreds or even thousands of individuals are experiencing a decline in quality of health and life. This slow, quiet poisoning is harder to track, but perhaps more detrimental overall.

The process of cleaning up PCBs from the river is one that will take years in even the most optimistic scenario. In Pittsfield, where the levels were highest, the river has been dredged, a process in which sediment is scooped from the banks and beds and either cleaned or replaced. As dredging destroys the natural banks, the river has been rebuilt with rocks. These also keep any remaining PCBs from seeping into groundwater. Meanwhile, the contaminated sediment was packed up and buried in lots around the city, then covered with asphalt and tucked away behind chain-link fences. The clean-up is, by its nature, destructive of the contaminated area.

From south of Pittsfield, running all the way down to the Connecticut border, the river and ponds are still contaminated. No option seems ideal. If residents want the area to be virtually free of PCBs, they must consent to the destruction of the wildlife along the banks of the Housatonic. The ecological stability could be restored in time, but it would take a century or more to regrow anything that resembled the picturesque surroundings of today’s river. For every measure taken to preserve the landscape, the effectiveness of the clean-up goes down a bit, and the cost tends to go up. Many argue that there is no ideal balance, and that Monitored Natural Recovery (called MNR) is the only viable option. With an MNR plan, the EPA and General Electric would simply measure and monitor the natural degradation of PCBs. It would take almost a hundred years, but eventually the river would clean itself. In the mean time, residents would simply have to steer clear of dangerous activities.

Others consider MNR to be General Electric’s idea of an easy way out. It’s certainly the cheapest option, and the corporation wouldn’t have to deal with placating residents once the river banks had been torn up. As surely as GE is biased against expensive solutions, the residents of the Berkshires are tainted by a desire to make GE hurt. One with a more balanced approach to the situation might conclude that the best solution is neither the most nor the least expensive, but one of the moderate plans, one that preserves as much river bank as possible while dredging the areas that truly need to be remediated.

It may well take another five years or more for a legal decision to be reached. Depending on which solution is chosen, the clean-up of the river might not be implemented for decades. While we argue, the river waits with an ancient patience. Du Bois called his river golden, the “life stream of the town,” and it is indeed the golden life stream of the Berkshires as a whole. It remains scenic and inviting, a place for residents of The Berkshires to enjoy the natural beauty of their world. We must accept, however, that preserving its golden serenity comes with a price.