A few days ago, possibly compounded by a longer-than-usual working week, my PhD fears finally transcended their usual realm of waking hours and pushed their grabby tentacles into my dreams. This, perhaps, is to be expected at some point, but I venture that poorly-understood diseases might just top the anxiety-inducing list of things to study. In addition to the general feeling of inadequacy (well-documented by PhD Comics), there is a growing feeling that, the more you learn about a disease, the more possible it is that you have, or could have it. Throw in some vague facts from the odd news piece, and the old “my PhD will not save any lives” feeling, and you have the perfect mix for a nightmare. Being an engineer (where it’s ALL about APPLICATION(!)) and studying cerebral aneurysms, a multi-factor-dependent disease with a significant impact (5-6% of the population) and a somewhat higher prevalence in women -well, it was bound to happen.
And it did, a few days ago, and I document it here for anyone whose work sometimes sends them loopy: you are not alone! Here goes:
Sometime between the hours of 11pm and 3am, my dream self went to the doctor with a headache. But it was no headache. It was an aneurysm. A cerebral aneurysm, in fact –a weak part of the wall of an artery supplying my brain, which, under the pressure of blood-flow, had distended to form an ominous looking bubble. It hadn’t ruptured, but MRI scans showed that it was large, and situated at a vulnerable meeting point of four arteries. Coincidentally, it also looked exactly like the aneurysm of a 37-year-old man, that appeared in a clinical study I read that day, by Doenitz et al:
Doenitz et al, 2010
‘I’m afraid it’s serious’, said the doctor, his expression adjusting a millisecond slower than his tone, to what I assumed must be his attempt at “solemn”. He shifted awkwardly, but then, as if remembering one more trick left in his sleeve, he conjured up a set of images of my aneurysm, showing blood velocity, pressure and wall shear stress profiles.
Wow, I thought, recalling how long it takes to set up and run a hemodynamics simulation, I wonder what software they’re using!
He guessed my thoughts, because his face lit up and, excitedly, he said:
‘Impressive, right? It’s this amazing new software we found. And you know the best thing?’
I didn’t.
‘It’s free. And it does everything at the touch of a button: the meshing, the boundary conditions, the-’
‘What is it called?’ I demanded, hands reaching for the lapels of his white coat.
‘Oh,’ he said, stepping back cautiously, ‘just Google it, it’s called-’, but before he finished, the door was violently flung open, revealing a panting radiologist. Too breathless for words –or, perhaps, just to be cool –she threw a new set of MRI images like frisbees, which transcended the room in slow motion and landed with impressive accuracy onto a viewing screen.
‘It has grown…’ she spluttered between gulps of air, ‘…by 50%!’, and sure enough, the bubble was now clearly visible from the other side of the room.
Wait. When did they-
‘You see,’ the doctor said loudly, with the sudden focus of someone who has limited time, his finger tapping the dome of the bubble, ‘the combination of low wall shear stress and chronic high blood pressure is creating a vicious cycle of aneurysm growth!’
Damn!
‘The elastin in this part of the artery has fully degraded,’ he continued, a little faster now, ‘and there is not enough time for the collagen to grow, remodel and stabilise the aneurysm!’
Double damn!
‘But doc, wait, high blood pressure…? I’m 25!’
‘But you drink coffee, don’t you?’ said the radiologist accusingly, her face a menacing mask of malevolence.
I do -a skinny latte most mornings.
‘And you enjoy vigorous exercise.’ added the doctor, raising a matter-of-factly index finger.
Guilty.
‘And you suffer from constipation!’ shouted the radiologist, triumphantly.
Doesn’t everyone, at times?
‘And you have a boyfriend?’ said the doctor, suggestively, hips gyrating for effect.
Oh, come on!
‘Oh, come on!’ I shouted, exasperatedly.
‘Young lady,’ he started, gravely, ‘if you read BBC news, you would know that coffee, exercise, constipation and sex can, each in their own right, pop a blood vessel! In combination –well, I dread to contemplate!’
‘So, what does this mean?!’ I demanded, growing impatient.
‘Well, imminent rupture, of course’ he answered promptly. I said nothing.
‘You know, blood spilling into the subarachnoid space,’ he said and moved his hands upwards into a funnel shape, presumably mimicking blood pouring out of the artery. I said nothing.
‘Vaso-spasm’ he added, his hands switching into a squeezing motion. I stared blankly.
‘Oh for heaven’s sake, you are going to have a stroke, and probably die!’
Shit!
‘What are we going to do doc?!’
He shook his head sadly. The radiologist did not manage to hide a smirk.
‘There is nothing I can do.’
‘Wait –what about coiling? What about clipping?!?’
His head turned sharply, and he stared at me.
‘My dear,’ he said softly, ‘I am not a doctor doctor.’
The radiologist snorted.
‘I can’t put you on a surgical table, -’
‘Why not?’
‘-insert a catheter into a vessel in your groin,-’
‘Why not?!’
‘-feed it into the arteries of your brain, -’
‘Why not?!?’
‘- and deposit platinum coils into the aneurismal space to encourage the formation of a blood-clot!’
‘WHY NOT?!!’ I shouted, shaking him angrily by his coat.
‘BECAUSE I’M AN ENGINEER!’ he shouted back.
Oh shit.
‘With a PhD’ he added, with a dignified tug of the coat.
Oh shit, shit, shit.
‘In computational modelling of cerebral aneurysms!’
by alisa
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