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Bone Tired

By Dr. Jim Ferguson

A patient recently asked me how long I had been writing for The Focus.  I couldn’t remember.  However, I quickly divided two hundred and seventy essays by fifty-two weeks in a year and came up with five years of stories.  I’ve wondered if my muse will someday leave me, but it hasn’t yet.

My new patient told me that he had recently begun to have what doctors describe as petechiae – small purplish splotches of blood just beneath the surface of the skin.  He’d mentioned this to the nurse practioner in a walk-in clinic where he’d gone several times over the previous two months for a lingering cold and fatigue.  I called the clinic and had them fax me the patient’s lab work and his CBC (complete blood count).  I was shocked to see that a platelet count of 4000/microL had been initialed by the practioner and the doctor who was supervising her work.  Furthermore, this serious problem was again ignored on a repeat CBC.  To give you some perspective, a normal platelet count is 150,000-450,000/microL, and there is increasing danger of hemorrhage as the platelet count drops below 100,000/microL.  Spontaneous hemorrhage into the brain can occur with counts below 20,000/microL.

Platelets are produced in the bone marrow and circulate in the blood stream along with red and white blood cells.  A CBC measures all of these cells and is a reflection of proper bone marrow function.  Most of us are familiar with a soup bone and have observed its core where cell-forming marrow resides.  Platelets are responsible for plugging holes in damaged blood vessels.  Many of you may recall the story of the little boy in Holland who saved the day by putting his finger in the hole of a leaking dyke.  For illustrative purposes you can envision that platelets do the same in our body and a deficiency of these cells is associated with bleeding.

The CBC also measures white blood cells (WBCs) likewise produced in the marrow and then released into the circulation.  The principle subtypes of white cells are polymorphonuclear cells which combat bacteria and lymphocytes which fight viruses and modulate the immune system.  Sometimes a minor subpopulation of WBCs known as eosinophils increase as a reflection of allergic diseases and parasites!

Red blood cells (RBCs) from the bone marrow are tasked with carrying oxygen to the cells of our body.  Imagine a dump truck that picks up a load of oxygen in the lungs and carries it to your big toe and there dumps the oxygen, exchanging it for a load of carbon dioxide (CO2) waste.  On completion of their circulatory trip the RBCs dump their load of CO2 in the lungs and pick up another critical load of oxygen necessary for our metabolism of carbohydrates, fats and proteins.

One of my top ten books is “Pilgrim at Tinker Creek” by Annie Dillard.  One story by this modern day Thoreau at Walden Pond is about hemoglobin, the molecule in RBCs that carries oxygen.  Dillard describes the hemoglobin molecule as a ring-like structure with an iron atom at its center.  A virtually identical ring-like molecule is found in plant chlorophyll.  The only difference is a magnesium atom at the center of this ring.  How amazing that plants use the carbon in CO2 which we expire as waste, and we in turn use the “expired” oxygen of plant metabolism that is carried around by the hemoglobin in our RBCs!

The phrase bone tired seems to resonate with me these days.  I used to be able to take a hot shower, drink a cup of coffee, and feel energized for the day.  It takes a lot more effort and devotional time to get me going these days.   I’m not anemic nor am I physically sick like my patient with the life threatening low platelet count who was misdiagnosed.  Our English language has adopted the word ennui from the French lexicon.  It means weariness, and this often describes me these days.  In fact, I find myself identifying with Psalmist who once asked, “How can I sing the Lord’s song in a foreign land?”

Some friends advise me to play it safe and ignore the destruction of our country and our liberty.  But, how can you advise this on the 69th anniversary of the D-Day invasion of Europe, the 64th anniversary of the publication of George Orwell’s “1984,” and the latest revelation that our government is accessing all our phone records?  It’s not courageous to oppose tyranny or injustice if there is no personal risk.  The Army Rangers who scaled the cliffs of Normandy understood courage.  Sixty percent of the 2nd battalion died in the successful assault.  How can we play it safe with liberty won at such a price?  I can’t sit back and play it safe as Big Brother listens and reassures us that we have nothing to worry about.

So, daily I leave the peace of my home and reenter the world of cares where I try to “do my best, to do my duty, to God and country,” and those I serve; a country where even the Boy Scouts are under assault by the liberal-progressive juggernaut aided and abetted by media acolytes and the uninformed masses.

These are trying times and “How Should We Then Live?” is both a question and the title of a book by Francis Schaeffer.  This book tops Dillard’s on my list of influential works.

Yes, it will all work out, but probably not for us in our lifetime; and how we live matters.

 

 

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