Those Late Nights

NEESHA NAMA

Ever since classes started, Marvin has felt emotionally truncated. His emotional register used to be as large and diverse as the Brooklyn botanical garden, but now it’s the size of the single potted plant he barely remembers to water on his desk. The darkened, spotted leaves remind him of his neglect. He thinks the plant is diseased. How fitting. He applied to medical school because he wanted to hear people’s stories, become their confidant, and then give them knowledge they can use to empower themselves. He still craves a life of communication, of the buttery, sugary, rich cake of human-to-human interaction, but all he does hour after hour, minute after minute, second after second is stare at words. Endless words on endless pages in an endless number of books. He never leaves the word vortex–he eats with his books, he sleeps with his books, he pees with his books. They provide him consistent, reliable company. And despite how much they have to say, they don’t tell him anything at all. There’s no exchange. It’s just a one-way relationship. Books are definitely attention hogs.

He spends so much time with his books because time spent without his books is time spent worrying. How can he compete with the scientists, the born doctors, the photographic memories, unless he spends every moment studying? His peers have published papers in the most prestigious medical journals, even the ones with one-word names–Lancet, Blood, Brain—they started NGOs in far-off countries, created clubs, phone apps, and websites. How do you appreciate the work of your peers when every additional thing they have done seems like one less thing you have done? How do you remember that we’re all working for the same goal – to improve health? Marvin just thinks, All I’ve done is get into medical school. Over the course of a year and a half, Marvin slid down the existential slope of his glass-half-full parabola and hit the desperate, sordid, milky bottom. It is here that he has decided to sell his body parts and organs for a half-million dollars on the black market, leave his family with some comfort, and leave himself with some peace from words.

After searching craigslist, subreddits, and misplaced threads on Marilyn Manson blogs, Marvin found what he believes to be the address of a warehouse where black market exchanges happen. It isn’t too far from where he lives. Go figure. I guess it was meant to happen. The next day, he writes a letter to his parents, puts it in a stamped envelope, and lets USPS handle the rest. He begins his walk to the warehouse. On the way, he thinks about how many lives he’ll be saving. Maybe one for each organ? So maybe around 10? Lungs, heart, stomach, intestines, pancreas, liver, spleen, and two kidneys. Maybe they do brain transplants now.

Step by step, Marvin thinks his last thoughts. He thinks about how he’s thinking about thinking. And the whole mindfuck that is. And how he has an idea of what’s going on up there, and how amazing that is. He thinks about picking up his right foot, and how his frontal cortex makes a decision that gets sent to his motor cortex, goes down the corticospinal pathway which crosses over the medulla, synapses in the anterior horn of the spinal cord on lower motor neurons. And then how these neurons make their way out to each of the muscles working to pull his left leg up off the ground, the hamstrings, quadriceps, and gluteus maximus to name a few, and synapse on the myofibrils of each of these muscles at neuromuscular junctions. And then at these junctions, neurotransmitters bind receptors and create action potentials. Calcium is released and does a bunch of things, and then a sarcomere just got a little shorter. And that’s happening a million times in all his itty, bitty muscle cells, causing him to take one more step. Ironically, this whole sequence of events actually stopped Marvin in his tracks as he processed the whole thing.

One more block to go. I got to keep moving though. I definitely picked the right stuff to study, but that’s not enough. I’m just tired of the words. It is amazing though how my heart is pumping blood to my muscles, so that my muscles’ mitochondria can make ATP using the oxygen that my hemoglobin is delivering as the final electron acceptor in the electron transport chain. There’s the door to the warehouse. Just a few more steps. It’s equally amazing that my heart is pumping blood to my legs which are taking me to a place that’s going to remove my heart from my body. If my heart had a brain, then I wouldn’t be doing this. My heart would say, “Hell no! I like it in here.” And then I guess people wouldn’t smoke or eat foods high in cholesterol because the heart would have a say. I should be in charge of creating a new species. There’s the door.

As he approaches the gateway to his death, thoughts of how his heart pumps harder if it’s filled with more blood begin to flush into his head. That’s the Frank-Starling mechanism. Stroke volume increases in response to an increased preload. More volume in the ventricle causes more stretch on the ventricle, and this causes the cardiac muscle to contract more forcefully.

Maybe I don’t want to open the door. Maybe I don’t want to send the action potential to my fingers to clutch the knob. I don’t. Just thinking about how much I’ve learned, and how far I’ve come, I can’t wait to share the knowledge with future patients. Oh shit, the door’s opening. A hand is reaching out for me. Noooooo—!

“Marvin, wake up, wake up. Class is almost over,” whispered Lara.

The professor intones, “In summary, class, the Frank-Starling curve is the heart’s intrinsic way of synchronizing the cardiac output with an increased venous return.”

“Dude, you gotta lay off the late nights. What time’d you stay up till again, 4am? Wanna get some lunch?”

“Yeah, that’d be great. Can we go somewhere veggie though? I don’t wanna eat any animal muscle right now.”

“Why can’t you just call it meat like everyone else?”