Saturday, April 21, 2007

Myristolated, palmitoylated and prenylated

Discourteously long time no post, my apologies. And this isn't going to be some magnum opus, some big work, it's going to be a selection of trivial insights posted in between pharmacology questions.

First off, today I have been studying, and results so far have been goodish. It's a weird feeling - If I hadn't basically dropped out of the programme for a year or so I would, obviously, be a year or so ahead of where I am now. Others who were behind me are now ahead, which feels odd.

One of those, who last year sat the exam I am studying for now, assures me that "the secret" is memorising the entire textbook and doing hundreds (at least) of practice multiple choice questions. Memorising (the smaller and simpler bits of) the textbook is actually coming along relatively well - although every so often I come up against sentences such as the following:

Proteins may be myristolated, palmitoylated or prenylated (i.e.: attached to geranylgeranyl or farnesyl groups).

This sentence is found on page ten and is accompanied on page eleven by what purports to be an explicatory diagram. The text underneath assures me that what is depicted is myristolation, palmitoylation, and both forms of prenylation (geranylgeranyl and farnesyl). There is also some kind of squiggle with the word - one word - glycosylphosphatidylinositol underneath it.

When I was doing theology, years ago, we were introduced to the term hapax legomenon. A hapax legomenon is a word only used once by an author - James Joyce has a couple. You can use them to argue whether a particular text is by a particular person, for example. The next best thing to a hapax legomenon is a dis legomenon, a word only used twice. As far as I can tell, myristolated is one of Ganong's dis legomenons. He brings it in, mystifies us with it and lets it go.

Anyway. In the interim I have been working at the ICU and at the Drug and Alcohol place. The drug and alcohol side of things goes well, but to be honest, I think I am reaching some kind of limit with it, some kind of plateau. I still believe it's useful and worthwhile work - although perhaps if I believed I wouldn't have just asserted that I did, rebutting an arguement no-one has put forward - but it does wear you down.

And lately there has been more of the coercive stuff - taking driving licences off people, forcing them to go to the chemist to pick up their medications every day "like a junkie" rather than getting them all in one lot, cutting them back on medications - frequently medications that other doctors have prescribed.

This is partly because we have had a few deaths around here lately. As a result, government controls on what we are allowed to do have tightened up. This has taken some of the independence out of the job, I find myself making fewer and fewer decisions and more and more often just referring to the handbook.

Possibly as a consequence I have found fewer and fewer reasons not to be honest about some stuff now. I am up-front brutally honest about methadone, for example. "This is a horrible drug" I say to people. "It can screw up every hormone in your body. It can make you fat and tired and miserable. Your bones might get brittle and your muscles might get weak and your teeth will all fall out unless you take incredibly good care of them. Plus, the laws and regulations and controls mean a lot of the liberties you have now are going to be compromised."

And it is bad. But the way things are for my clients, heroin's worse.

The ICU progresses. The boss is back from his holiday, taller, more cheery, with his mop of red heair looking even more photoshopped onto his head, and we have been very busy - almost at full capacity. To get an Intensive Care Unit bed (as opposed to the Slightly Less Intensive Care Unit bed, often known as HDU or high dependency unit beds) you have to be either intubated (a machine doing the breathing for you) or have failure of two body systems. This means your heart and lungs, or heart and kidneys, or liver and kidneys are needing serious support.

Because of this you get one on one nursing. ICU nurses, by the way, are a remarkable lot. They know vast amounts. Having said that, at Florey being an ICU nurse is a much easier job than being an ED nurse. Almost anything is.

Anyway, we have our full quota of patients and they are horribly unwell. In bed eight the curtains are drawn around Mrs Reynolds, a woman who was hospitalised with an adverse reaction to her herbal medication - dropped dead of a heart attack at fifty one, smoked fifty cigarettes a day for thirty years. She died while getting dressed to go to a school play, she has never been without visitors. Immediate CPR, ambulance only ten minutes away.

Throughout her stay our notes had said "no neurological activity" - she did not speak, she did not move, when you shone a light in her eyes nothing happened. Her heart beat, her lungs moved. Her extended family were gathering - Queensland, Tasmania, Alice Springs. This morning I came in and she had died again in the night.

I don't know. I don't know how I want to be remembered, or even if. I gave this a good deal of thought a few months ago, how to minimise the impact on those I was going to leave behind, making arrangements for being found, that kind of stuff.

But one thing I didn't take into account was this whole partial thing - the way some elements of your life stop, while others pass on.

I don't have the words here for what I am trying to say.

Your heart stops for a number of minutes, maybe ten. The brain darkens, is damaged, parts of it die. The heart, being only a muscle, stupid and tough, is rescuable in a way the brain, and thus the psyche, is not.

You died, back on the floor of your kitchen, getting ready to go out. We are preserving the appearances of life, the beating heart, the sighing lungs, the face in repose, but you are not there. Substance versus accident.

I don't know. Part of it is the preservation of the old idea of death as a state, as a separate kingdom, as something whole and fixed. It is none of those things anymore, it's something that to a certain extent parts of us can be moved in and out of.

Anyway. These are not helpful thoughts to anyone. I have to get on with studying, or I'm going to be completely myristolated come Friday.

Will try to write soon. Thanks anyway,


Blogger SEAMONKEY said...

Seeing a new post on your page is almost as good as finding twenty bucks on the sidewalk.

12:33 PM  
Blogger Bardiac said...

Oh, cool!

Exsufflicate. I didn't know there was a term for words that appear only once, but that's my favorite one. (Othello, 3.3.182)

2:47 PM  
Blogger Camilla said...

Seamonkey, I'll see your $20 and raise you €20 :D

Great to see you again, BJ! As usual, I've learnt something new from you (well, several new things, not least of which is the word myristolated).

8:17 PM  
Blogger Benedict 16th said...

I remember in my PhD thesis having words up to 70 letters long, they were a class of chemicals called diazapolyoxamacrobicyclic ligands. One of my favourites was 4,7,13,16,21-pentaoxa-1,10-diazabicyclo[8.8.5]tricosane or C221 for short and 4,7,13,16-tetraoxa-1,10-diazabicyclo[8.8.5]tricosane or C22c5 for short.

1:18 PM  

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