At five feet seven he walked amongst the sea of average. Slight of structure, fair of skin and possessing of a warm smile that would melt inches of snow off the rooftops in the winter. His eyes were set wide apart with a flattened bridge in between. He was a modest man but could distill the sweet drop of understanding from the nebulous cloud of information. “Always dig deep. Deeper than you can dig.” Was his mantra. In his own self-effacing way he would light the desire of learning. He was a chemist by trade, a émigré from Thailand, spoke impeccable English and his interests lay in a field where he possessed very little expertise - medicine. He could not practice the craft but there lay within him a deep understanding of the causality of disease. This passion had been kindled after the premature death of his father from a sudden heart attack. He had left his lucrative job to work in a restaurant. He loved to cook and creating “something out of raw material,” gave him ultimate satisfaction. Even though his salary was meager in relative terms, he was content. There were no financial pressures on him, no demands. He was single.
“So what do you think?” he would ask.
“About what?”
“About heart disease.”
“It has hereditary roots, it is amplified by diet and cigarette smoking and is the number one killer.”
“No, I mean how does it start?” He would probe.
“I guess, high cholesterol, stress, high blood pressure and bad genes.”
“See you came up with all this information just by asking the same question twice.” He would rub his hands as if getting ready to handle the prize he had sought.
“Okay, lets look a this cholesterol myth for starters. Do you think that just by raising the cholesterol the arteries would start clogging. If that were true then every artery would be evenly clogged?”
“I suppose.”
“No really, think. There must be a mechanism that must precede the event.” He said his voice getting softer in tone but the force behind his conviction flowing stronger.
“Well if you throw a lot of sludge through PVC pipes they ultimately get crud in them. Once the first layer settles then sedimentation follows due to uneven surface created by the initial sediment, and voila the clogged pipe!”
“Right, but certain kind of crud has to line the inner part of the pipes, right?” His voice raised a touch with an impassioned concern of sorts.
“So lets look at where the crud can get deposited first probably where the pipe hinges are and at where it bends and where it forks, Right?” His eyes now wild with passion, seeking comfort in his knowledge and a confirmation from the “medicine man.”
“Yup.”
“And if the inside of the pipe is smooth then that crud would not be able to stick to the inner surface either, unless the flow rate slows down. Right?”
“True.”
“So then there must be a trigger mechanism that causes the inner surface to allow for the crud to accumulate and slow the flow rate down. So far you’re with me?”
“Yes but…the pumping heart is a violent organ that dispenses a tsunami of blood through the vessels. Wouldn’t this force create the necessary damage to the innards of the blood vessel and create the soil for deposition?”
“True, good observation, that is why the blood vessels branch in such fractals. This branching (arborization) and the muscular walls dampen the forceful trauma into a docile continuous flow. He paused a moment for the image to sink in, “Agreed?”
“Pretty much.”
“Now lets find the trigger mechanism for the cholesterol to stick to the walls. Which brings me to the next question. Is this cholesterol stuff inside the lining of the wall or just lies on top of the inner side of the artery?”
“It lies under the inner lining.”
“Okay so now this crud or cholesterol has to somehow, pressured by the flow of blood separate from the rest of the blood (loss of linearity) and seep into the inner lining of the blood vessel?” There was silence for a minute as the question sank through the pores of understanding. “Now we are assuming multiple occurrences without a cause.”
‘Okay,” after the minute he allowed for contemplation, “So what would be the trigger?”
“Slow rate?”
“No, assuming the rate of flow remains constant until the trigger mechanism is turned on.” A little edge of dissatisfaction lingered at the edge of his tone.
“How about, Inflammation?”
“Bingo. And what causes inflammation?”
“Infection?”
“So 90% of all arterial plaques have Chlamydia antigens present according to one study.” He states with unadulterated but quiet repose. He had just slammed the royal flush on the table. To the victor belonged the spoils. Hooray. A brilliant cook had toppled the mountain of illogic.
“Serious?”
“Yes, I read it in one of your journals. A very comprehensive article but little mentioned by the rest of the medical crowd.”
“What about the genes?”
“Oh they make the cholesterol go up and all but without the trigger mechanism nothing can happen. The Macrophages or Foam Cells without the inflammatory irritation will not be desirous to pick up the Very Low Density Lipoprotein or VLDL. Hence the argument.” He rubs his hands together in his mental victory lap, all the while the smile never leaving the corners of his mouth.
“Remember the cholesterol is a very intricate part of what makes the brain function, the hormones that guide cellular networks in the body and what gives us the gender bias after the XY and the XX chromosome party is over.”
“Brilliant, so the body itself manufactures the product for its own function and need.” He slapped his hand on the glass table, rattling the half full glass of water. The agitated liquid laid testimony to his claim. “If this was bad for humanity, then evolutionary powers would have changed the game for the species perpetuation.” Taking a breath to collect his thoughts he continued, “Heart disease causes early deaths and that would prevent humanity to continue to prosper.” He nodded in assertion. That also made sense.
It was a Sunday afternoon after a heavy lunch when he was admitted to the hospital with abdominal pains. His diagnosis was acute bacterial diverticulitis. After his bout with antibiotics and the change of diet he was back home and again playing thought experiments. Sitting in the armchair he seemed subdued a bit. The visit was shorter then usual and there was a nagging sensation of “chance,” lingering in the room. Chance at what had happened to him, chance that he was where he was at this time, chance as the counter-intuitive physics of today would have you believe that life was mere a perception and reality restored only upon observation. But he did not. In a low whisper as if in deep thought he said he would take time off from the restaurant and visit the States of his adopted country. “See the real world, “ as he put it.
He seemed to disappear from the scene for a few months, which he was wont to from time to time. Never one to make long term plans nor spend time on the phone, his disappearance was a mark of his free spirit. But this time when he reappeared he had lost more weight and his appearance had a haggard look to it. The clothes seem to hang from him, not refining him but defining him. His demeanor was the same but there was the curse of knowledge that caressed his brow now.
“It was that darn colonic infection that was the trigger to my heart attack.” He said quietly. “You know, my genes were a little off from the beginning. But this infectious diverticulitis was not in the plans.” He shudders just a little, reflecting a bit and then continues his thought, “I survived this because of being forewarned and taking care of my nutrition and exercising this temple,” pointing to his belly. “Things would have gone along fine, absent the infection.”
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