“I am fearfully and wonderfully made.” -Psalm 139:14
A VERY LONG TWO MINUTES
Roscoe Worth, a twenty-five year-old man who lives with his parents, had been unusually sleepy for a day or two. This afternoon his mother found him standing in the living room, staring into space. Suddenly he collapsed, went rigid, and began convulsing.
She held his heaving body as he grunted and frothed at the mouth and lost control of his bowels and bladder. She saw his beautiful blue eyes go horribly blank. Then she felt her son’s body go limp. Though the ordeal lasted less than two minutes, it seemed like an eternity to her.
In the emergency department, I note that Roscoe is skinny and pale, with filthy clothes, unkempt red hair, and rotting teeth. I see blue eyes as I flash my light at his pupils, but Roscoe is not looking back at me. Nearly an hour after his seizure, he still has not recovered consciousness.
A careful examination and even a CT scan of the brain do not reveal the cause of the event. The initial lab work is unremarkable too, with one notable exception: the sodium level in his blood is perilously low. That certainly explains the seizure and unconsciousness, but why the drop in sodium in the first place?
FAILSAFES FAILED
Normally, the level of sodium in the blood is tightly regulated by a delicate interplay of hormones from the brain, kidneys, heart, and adrenal glands, acting in concert with conscious drives, such as thirst.
When you come in from exercising, dripping with sweat, your thirst mechanism will prod you to drink exactly the amount of water needed to replace the lost volume and electrolytes.
In Roscoe’s case, something is seriously amiss with these corrective mechanisms, or his sodium would never plummet to such a life-threatening low.
Dehydration causes most cases of low sodium. Yet the membranes of Roscoe’s eyes and mouth are moist, and his skin turgor is normal. When I pinch and release the skin over his breastbone, it snaps back sharply into place, rather than slowly resuming shape. These findings suggest that Roscoe is well-hydrated. Something besides dehydration is to blame.
POIGNANT – AND CRITICAL – DETAILS
I learn from his father that the young man had been previously healthy until age twenty, when he began hearing voices and having paranoid delusions. Roscoe was diagnosed with schizophrenia and started on medications, which were partially effective in controlling his psychotic symptoms, but not enough for him to live independently or appear anything but disheveled and insane to others.
With a wistful expression Mr. Worth recounts that Roscoe had been a great baseball pitcher in high school. Details like that tend to haunt me for a long time. They give a glimpse of the lonely story behind a case.
In order to help this family, however, I must solve this case. I ask a lot of questions to close in on the culprit, but I know that the most likely diagnosis hinges on the answer to one particular question:
“Does your son drink a lot of water?”
WATER, WATER EVERYWHERE
At my query, Mr. Worth gives me a curious look, cocks his head toward me and whispers: “Sun up to sun down.” Apparently the young man keeps several large bottles of water in the refrigerator and guzzles continuously.
That seals the diagnosis. Roscoe has psychogenic polydipsia. In this disorder the patient’s thirst mechanism is deranged, and he begins drinking water with the same avid obsession of a mental delusion. The sodium level falls in the blood because of dilution. Out of unbearable thirst Roscoe has drunk water to the point of death.
You and I would be hard-pressed to force down this amount of fluid; our bodies would simply say, “Enough is enough!” and we would be repulsed by the idea of swallowing another drop. But that normal inhibition is lost in these patients, who will do anything to imbibe water, sometimes even sneak it out of a toilet!
DOWN TO EARTH
In our quick trip through the cosmos over the last few posts, we saw the works of a super-power, who inscribed unalterable laws into reality and fashioned a universe of staggering size and dynamism. I hope this rebuked our tendency to believe in a God who is small.
And shouldn’t it make sense that God’s grander works would give us the fullest picture of who he is? After all, which is more impressive, a child’s Lego creation that fits in a shoebox, or a Legoland model of New York City with buildings taller than a man? Isn’t bigger better?
And yet…suppose that a hobbyist could somehow assemble an accurate, fully functioning model of New York City on the head of a pin. Such is the marvel of life!
CLOSE TO HOME
Biological systems are more complex than physical systems. And rather than power and size, they reveal different, but amazing, properties. I am convinced that it is as instructive for our souls to look into inner space – into the veritable universe of the human body – as into the wonders of the heavens.
When we trade in our telescope for a microscope, the human body’s complexity and balance demonstrate the wisdom of God. Looking at life forms we see complexity, detail, and…fragility.
The smallest alterations in almost any bodily system or behavior can have dire consequences for our health. You and I and every living thing are perched on a razor’s edge, an edge so fine, that it makes life seem impossible.
And yet we enjoy that improbably narrow ledge of health with apparently little effort on our part. Let me demonstrate how vulnerable and complex you are. And, by extension, let me emphasize how loving our creator is.
And what will become of Roscoe Worth? Still unconscious, he has fallen off of that narrow ledge. And if I misstep and cannot restore his sodium at a precise rate and amount, he may be paralyzed or die as his brain dissolves.
Dr. Bill Maynard