The great American naturalist, John Muir, once said, “When we try to pick out anything by itself, we find it hitched to everything else in the Universe.” This is a striking expression of metaphysical holism, the idea that individual things and their properties are not isolated objects, but parts of a larger interconnected whole, a complex system, in which apparently isolated objects are connected to one another by their roles in the system. Whether that’s true of reality in general, I’m not going to hazard an opinion. But complex systems certainly exist, and they are especially interesting to some mathematicians, philosophers, biologists, and medical scientists.
This calls to mind a song that I learned as a school child that went like this:
The leg bone’s connected to the knee bone,
The knee bone’s connected to the thigh bone,
The thigh bone's connected to the hip bone,
Now shake dem skeleton bones!
The idea that parts of an organism are interconnected members of a complex system is something that patients also need to keep in mind. This was driven home to me last week when I went in for one of my now bi-weekly check-ups.
For quite some time now—I can’t really remember for how long—I’ve noticed that my fingernails had an odd wave in them. Every one of my ten nails has it; it runs nearly the width of the nail. At about the mid-point the nail dips down and then back up again. And a couple of my nails have superficial cracks in them that run the better part of their length.
These nail deformities appeared at some point in the past six months since I’ve been out of the hospital. I haven’t given them much thought, but I have found myself rubbing my fingertips over my thumbnail to catch a wave. And I improvised an arm chair oncological theory that went like this. Chemotherapy kills cancer cells because it kills quickly reproducing cells. It kills hair cells for the same reason. Fingernails are fairly quickly growing. So, the fingernail deformities are probably the legacy of chemotherapy that I received in March. The fact that my toenails are not similarly affected is explained by their comparatively slow growth.
An elegant and a priori plausible theory that served the purpose of satisfying me and encouraging me not to think too much about my odd finger nails. But, it turns out that I will not win any Nobel prizes in medicine for the theory because it is probably just flat out wrong. The connection is more likely to be to the immune system!
This past week I could not see my regular post-transplant doctor because he was on vacation. Instead I saw the doctor who oversaw my transplant. And for some reason, although I never mentioned my nails to the post-transplant doc, I felt moved to mention them to her. I have no arm chair psychological theory about why I did that, but I did. To my great surprise she wasn’t impressed with my oncology. She examined my nails pretty closely, showing definite interest. And finally she declared that the deformities were consistent with Graft versus Host Disease!
You might recall from some of my earlier posts that this disease in its manifold forms is one of the main things that doctors watch for after a stem cell transplant. It amounts to the immune system (the graft) telling some organ of my body (the host) to piss off! I’ve compared the immune system before to a guard dog. In The Republic Plato compares the best guardians of the city to good guard dogs, friendly to their own and hostile to foreign threats. With Graft versus Host Disease it is as if the guard dogs have confused who the foreigners are. The danger is that any organ could be targeted. Obviously it would be dangerous if it were my brain, or my heart, or my lungs. My fingernails, not so much…I think. I suppose that this will pass without event. The dogs will go back inside in due course. But, of course my oncological credibility is already in doubt.
The doctor and I also discussed the diarrhea that I still suffer from periodically, and she mentioned the possibility that I’ve developed a case of lactose intolerance, which apparently can occur after a transplant. She told me to cut back on milk and that if I still have occasional bouts of the runs, they’ll need to scope me again to see if my digestive track might also be traumatized by snarling dogs. Having gone along for that ride once, I may choose to sleep through it a second time. But with any luck, there will be no need for that and I’ll have no further details to share.
Today is the six month anniversary of my transplant. I’m pleased to report that I’ve been feeling good and have just traveled to a conference for the first time since the transplant. We had some excellent discussions on the ethics and politics of climate change. Assuming more and more of the duties of work feels good.